"Mental health care is a necessary part of comprehensive health care systems, not because of its potential to save costs but, rather, because mental disorders are real and have adverse, sometimes life-threatening, consequences and because treatments are available that effectively reduce common mental symptoms and associated disabilities." (Olfson 1999, p.80)
People with a mental illness struggle with public misperceptions and misunderstanding. To many, the mentally ill have a character flaw or lack the fortitude to simply "get hold of themselves." Such a lack of understanding of the causes of mental illness, and assumptions that these causes are not organic, has helped to create separate and unequal systems for the treatment of physical and mental illnesses.
During the last half of the twentieth century, research demonstrated that many symptoms and behaviors of the mentally ill are due to organic or physiological changes in the body. Drugs capable of treating the biological origins of mental illness (psychotherapeutic or psychotropic medications) began to appear in the late 1950s (NIH 1995 No. 95:3929). They represented the first breakthroughs in treating mental illness with medications that were safe and effective. In the 1980s and 1990s, however, a wider array of even more powerful, safe and effective medications became available for use. Not surprisingly, this dramatic advancement in the availability of medications to treat serious mental illness was accompanied by an equally dramatic increase in their cost.
Psychotherapeutic medications control symptoms, correct and compensate for some malfunction in the body. They do not yet cure the mental illness. They do allow people to get on with their lives even if there is continuing mental pain and problems. Just as taking daily insulin injections does not cure a diabetic, patients (particularly those with schizophrenia or manic-depressive illness) may take medications indefinitely to control their disease. Psychotherapeutic drugs and drugs for medical illnesses are equally effective in treating the illnesses for which they were developed.
SMI patients in Arizona are adults diagnosed with discrete psychiatric disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). The following disorders are categorized as a serious mental illness in Arizona: Schizophrenic Disorders; Delusional Disorders; Psychotic Disorders; Bipolar Disorders (such as manic depressive); Depressive Disorders; Anxiety Disorders; Disassociative Identity Disorder; and Personality Disorders (ADHS/DBHS). Approximately 1-2 percent of the adult population experience the most serious mental disorders (schizophrenia, major depression, bipolar illness, or manic depression) annually (IOM 1997).
Need and functional status of the SMI patient rather than a specific diagnosis dictate the treatments and care provided in Arizona (Interviews). What follows is an overview of research on the impact and cost of using antipsychotic and antidepressant medications to treat SMI patients.