November 08, 2007

Just How Badly Is America's War On Mental Illness Going?

I took a look last night at the Social Security Administration 2006 statistical report of the SSI program (aka disability), which a reader passed along thinking I'd find it interesting. I found that it rendered me speechless. That's because many of these raw numbers, which come without interpretation, tell me that the psychopharmacological revolution--or the war on abnormal behavior, if you prefer--that's been raging in earnest in this country since the late-1980s sure doesn't seem to be producing positive results.

The particular parts of the report I'll get into cover data for SSI recipients under 65 years of age who are listed in the report as "mental disorders-other," which is to say the mentally ill, particularly ones who meet the criteria for being so disabled by whatever disorder they have that they cannot support themselves.

I am too tired to go through this in detail, so let me offer some statistics from the report and ask some questions along the way.

In 1998, 4,533,060 Americans were less than 65 and on SSI for any reason. In 2006, 5,231,107 were, a 15 percent increase. Almost all of the 698,047 person increase in people on SSI was accounted for people with on SSI with a mental illness.

In 1998, 1,232,642 Americans under 65 were on SSI for mental disorder-other--meaning they had a mental illness of some kind. In 2006, 2,042,751 were on SSI for a mental illness, a 66 percent increase or 810,109 people. Keep in mind that some other SSI categories went down, but mental health conditions were clearly the big uptick. You can go through the table on that report and see what categories of disability went up and down.

So if the psychopharmacological revolution were working well, wouldn't you expect a much more modest increase? I would. And if our paradigm of aggressive diagnosis and getting people on meds early in order to prevent future episodes were a slam dunk success wouldn't we be seeing better results?

What also jumped out at me from these stats is just how many youngsters are on SSI for a mental illness. Under the age of 18, 524,347 Americans were, 73.4 percent of them male and 26.6 percent female. That disproportionality is amazing to me. Are these the bipolar and ADHD boys? Why are boys ending up so much sicker than girls and on SSI? You have to be pretty darn ill to wind up on SSI. What the hell is at work here?

Among adults aged 18 to 64, 1,518,404 people were on SSI in 2006, 42.8 percent men and 57.2 percent women. While that's close to gender prevalence in the general population, it's just out of whack enough to make me wonder why more women than men are on SSI. Would that be because of depression and just how well the medications are working? Schizophrenia alone could account for those numbers, but I bet not. The data is not broken down any further than just mental disorder-other, but from what I know of people on SSI in Washington State there is a pretty even distribution of people on SSI for schizophrenia, bipolar disorder and depression.

To put some dollar figures on all of this, the average SSI recipient gets about $450 a month in SSI benefits (they also get some food benefits and Medicaid health insurance separately). Using that figure, in 1998 the total SSI outlay for the mentally ill would have been about $6,656,266,800. In 2006 that figure rose to about $11,030,855,400, an increase of $4,374,588,600. Those figures aren't absolutes, but they give you an idea of the dimensions of the problem and our failure as a culture in grappling with mental illnesses in American culture. Also keep in mind that this is not money for meds or therapy, it's straight up living expense money.

Because if you are going to tell someone they have a problem and that getting diagnosed and taking meds is the answer for them, then things are supposed to get better if your model is to have much validity and justify all the taxpayer expense going on here.

(Thanks Joe. I think you are right.)

Posted by Philip Dawdy at November 8, 2007 01:10 AM
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Comments

You know I didn't go out on disability until I was in the psych system for 15 -20 years and I do attribute my decline to psych meds...not underlying pathology!

In hindsight it's pretty damn clear and I'm more and more suspecting the doctor never even had a right to call me mentally ill....it was all drug induced. Starting with my own hallucinogenic drug use---but it should have been identified as such and not a permanent pathology that I needed treatment for for the rest of my life. Just as when antidepressants cause mania---drug induction---clear and simple much of the time.

Posted by: Gianna at November 8, 2007 04:45 AM

Sorry, I don't think SSI figures are relevant for charting upswings in the diagnosis of mental disorders. I think they are relevant to people learning more about SSI benefits for mental illnesses, as well as people's realization that it will almost always take more than one application to receive any benefits. Perhaps parents of boys are more diligent in applying for and receiving benefits due to the larger threat of violence and fear of incarceration if their children cannot gain a little control of their illness. Without money to pay for meds and docs, I'm quite sure my 17 yo son would be in the corrections system by now.

Perhaps the upswing in attorneys specializing in SSI applications (and advertising that fact) has more impact on these figures than anything else.

Posted by: anonymous mom at November 8, 2007 05:08 AM

"You have to be pretty darn ill to wind up on SSI. What the hell is at work here?".

Here's some perspective on SSI in the adult system:

It's very hard to get SSI as an adult let alone a child. You have to prove you cannot work. My daughter's SSI process started when she was inpatient in hospitals when she turned 18[legal adult].It took records from doctors,psychiatrists, history and severity of illness,[psychosis NOS]and hospital records, with all dates needed.[and the files] It's a long process and hard to get.[process took 6 months and typically is denied].What then happens with that SSI $ fluctuates-depending on living situation[such as residential care]she also attained medicaid coupon, which pays for dental, medical and her medications in her case.[BUT not her out patient psychiatrist, and not most dentists take it either] Her residential care facility runs off of SSI/medicaid. Residents get $15.00 a week of that.[and their meds] The rest is considered room and board. She is considered gravely disabled and unable to work. I agree with that right now. But $15.00 a week doesn't buy many clothes, shoes, winter coats, personal care, or other things.Unless a client has family/friends to help with bedding, books, clothes, all those things you might want in your room--etc., it's 15.00 a week, that doesn't go far.She also never would have gotten into her residential care facility if she didn't have SSI.[it's mandatory] She uses her 15.00[when feeling well enough to shop]like a 19 yr.old with allowance. Books, candy, a blanket for her bed. Mostly, she saves it.
~
One year ago, I had an inside source tell me that it is common for residential care facilities to keep everyone medicated, change meds around, and "keep 'em sick, cause they want the SSI money, it's a racket." Gives you something to think about eh?

Posted by: Stephany at November 8, 2007 06:23 AM

IMS Health Reports Global Pharmaceutical Market Grew 7 Percent in 2005, to $602 Billion Link

I am sure it is more now. If income exceeds expenditure's all is well. Who cares if it is a medical science or not?

Posted by: mark p.s. at November 8, 2007 08:32 AM

I reluctantly type that you may not be viewing these statistics with the appropriate level of cynicism. The way the system is set up, with a despotic establishment of "though leaders" at generally fairly corrupted top tier schools, the metrics that count are pharmaceutical sales, pharma co profits, campaign contributions, hospital beds filled, and social workers hours billed.

The very worst thing that could happen to the present "system," to be generous with my nomenclature, is that a cure be found for severe mental illnesses; there would go all the "consulting" (aka pimping) fees, the corporate profits and bonuses, the campaign contributions, the hospital beds filled, salaries for generally intellectually mediocre "rent a friends" known as social workers and therapists - it beats a real job. With a heavy heart, I post that I think that as long as the system is at is, the very last consideration will be the wellbeing of the patients.

This is why I am so inordinately encouraged by Congressman Paul's running for president; he wants to get the federal government, and to a not insignificant degree big pharma out of the their corrosive roles in maintaining the status quo. I urge every reader who suspects that the "healthcare" they've received may have had more to do with satisfying a predatory and corrupt system to go over to Dr. Paul's website, www.ronpaul2008.com, and form their own opinion.

Posted by: Julian at November 8, 2007 08:44 AM

Robert Whitaker's article "Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America" deals with exactly this issue.

Basically, Whitaker says that once you're on a couple of psych meds (and who ever gets prescribed just one?), you're well down the road to chronic disability.

This would certainly seem to be the case with most of the psych patients I've talked to. The "cure" is worse than the "disease."

Posted by: Francesca Allan at November 8, 2007 09:16 AM

Here's the Whitaker article:

http://psychrights.org/Articles/EHPPPsychDrugEpidemic(Whitaker).pdf

Posted by: Francesca Allan at November 8, 2007 09:31 AM

In the County in California I live in, there is probably 90% of people living hand to mouth on SSI/SSP at $856 and now a COLA raise as of today Dacember 31st, 2007 of aproximately another $32 per month on top of that for a individual.
It is pitifully easy to get on SSI/SSP in California. It is a way of life.
You have many that live together in a household each getting the over eight hundred each a month and that multiplies into quite a bit of tax payers money. Most in my small town of just over 200 are all on SSI/SSP. They own their property free and clear thru inheritance and have several cars. Many have at a minimum 5 plus acres. They get homeowners assistance as well each year and pay absolutely no taxes except for around the average of $200 a year on their properties. They all talk each 1st of duh month about stratigies for getting other family and friends on 'checks'. Look around sometime at all the handicaped placards hanging or on the plates of people driving around. Look around on the 1st of duh month. They are all on 'checks'. Free Medical, free Cash Assistance. Why? Oh Why do they do it? Because a SSI/SSP never has ever had to work a Single Day in their Life, nor' ever will. They are proud and happy to sit and either become morbidly obese and toothless or strung out on meth, meds for pain, and alcoholism. Many cash their checks at liquor stores or bars to 'pay their tab' and begin again their month long process of SSI/SSP waste. There are more of them than tax paying workers probably. Or there will soon be more of the SSI's than workers, then what will happen to Social Security for those that worked all their lives and paid the SSI's? Why all the mental disorders increasing BECAUSE IT IS FREE MONEY, what else. It's going to get bigger and bigger too, free money is free money and the more people figure it out they will apply and get SSI/SSP money.

Posted by: SSI Phd at December 31, 2007 12:41 PM

Many on SSi need that money, sure there are those that scam and get free money, but a lot of us have serious mental illness and need help....our only other alternative is suicide or homelessness

Posted by: will at January 13, 2008 02:11 PM

Its a shame!!That they say i wont get ssi in my generation.And the goverment lets people on ssi now get away with drug dealing,using without testing them.They are making so much money and i cant even get food stamps.what can be done??

Posted by: chad at April 23, 2009 07:23 PM

I FEEL THE SAME WAY YOU DO, AND I AM GLAD TO HEAR IT FROM SOMEONE OTHER THAN ME. I HAVE C.O.P.D.
AND PROGRESIVE SPOTS GROWING ON MY LUNGS. AND ARTHARITIS IN AL JOINTS. I HAVE BEEN DENIED 7 TIMES AND STILL FIGHTING FOR SOME TYPE OF ASSISTANCE..... LETS KEEP TALKING, MAYBE SOMEONE WILL LISTEN. THANK'S

Posted by: rick at July 30, 2009 05:29 PM
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