Indiana loses $4.2 billion due to untreated mental illness. How did we get here?

If you or someone you know is in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.

Doctors diagnosed Willie Frazier with depression when he was about 13 years old and borderline personality disorder roughly six years later.

“As I got older, all the colors in the world would just become so dull. Like, the things you love you will no longer really care for. And it's just like, why? Like, why what's going on?”

Frazier is one of around 400,000 people in Indiana whose mental illness is untreated.

Mental illnesses, such as depression, can be a precursor to physical ailments that can lead to an increased risk of chronic conditions. That includes diabetes, heart disease and stroke, according to the U.S. Centers for Disease Control and Prevention. Untreated mental illness can also consign individuals and families to unstable lives. It’s a factor for many people who experience homelessness or interact with the criminal justice system.

But research shows that it also leads to a significant financial burden. Nationwide, untreated mental illness costs the United States nearly $193 billion in lost earnings every year, according to a 2008 study.

Newly published research in Indiana shows the state lost $4.2 billion in 2019 due to untreated mental illness, according to the JAMA Network study. For context, corn, Indiana’s leading commodity, generated $3.8 billion in sales the year before. Indiana lawmakers recently adopted a new law to improve access to mental health care. Still, those efforts are not nearly enough to help hundreds of thousands of people navigate a complex system and find treatment.

Measuring untreated mental illness and putting a price tag on it is difficult because individuals who are untreated have little to no interaction with the healthcare system, said Heather Taylor, the study’s lead author. Taylor, who is a researcher at Indiana University Purdue University Indianapolis, used Indiana-specific data from the 2018-2019 National Survey on Drug Use and the National Survey of Children’s Health to estimate the prevalence of mental illness and combined that with Indiana’s 2019 population data.

The financial loss due to untreated mental illness equates to more than $600 per Indiana resident. That number was derived by looking at how many people died prematurely and didn’t contribute to the economy, lost wages and productivity if someone misses a day of work due to their mental health and the overworked criminal justice system and homelessness resources that have to spend additional funds on mental health services.

“If you take those costs that we're incurring, $4.2 billion a year, that equates to about 100,000 jobs,” Taylor said. “So we are taking money out of our economy, because we're not treating these conditions. Well, frankly, individuals don't have appropriate access to the treatments that they need.”

Barriers to care

Some people choose not to seek mental health treatment, but more often, people are unable to access the care they want and need due to barriers on an individual or system-level or a combination of both.

Marion Greene, a researcher who studies behavioral health sciences at IUPUI, said she thinks the community has made progress in reducing stigmas around substance use and mental illness over the years. But the interviews and focus groups she did as part of her research confirmed that stigmas around mental health are still stronger in communities of color.

Of those who felt comfortable talking about their or a loved one’s mental health, 40% were White, 12.5% were Black, 12.5% were East Asian, 8.33% were Latino, 4.17% were Southeast Asian and 4.17% were Middle Eastern, according to a 2018-2019 survey in California.

For 24-year-old Frazier, nearly 100 scars running across his body from times he’s self-harmed bear witness to what stigma and untreated mental illnesses can do.

“I just want to feel something besides the thoughts in my head telling me I'm not good enough. And so my thing was, I wanted to feel as ugly on the outside as I do on the inside,” Frazier said.

Frazier said mental illness runs in his family, but they don’t really talk about it. He said he’s even lost friendships over his mental health struggles. Some friends couldn’t look at him the same way when they knew he self-harmed. This lack of social support is one reason it may be difficult for people to open up to others and seek treatment.

Nationwide, more than half of the 50 million people who have a mental illness go without treatment. Similar patterns play out in the Midwest and the region around it, where as much as 69% of people with mild mental illness in Indiana and 45% of people with severe mental illness in Oklahoma have gone untreated in 2018, according to federal data.

Within Indiana, people in certain counties may face more barriers to seeking help than others. Nearly two-thirds of serious mental health needs are unmet in Marion County, an area that includes the state’s capital, Indianapolis. That includes clinical depression, schizophrenia and bipolar disorder.

There are many reasons treatment can be out of reach. Greene said unreliable transportation and lack of access to technology like stable internet for telehealth appointments add to the barriers.

Another piece of the puzzle is insurance coverage. According to a recent survey, cost is one the biggest hurdles for people with mood disorders. Even if people are actively trying to seek treatment, they may be unable to get it because their insurance doesn’t cover it or they are uninsured and can’t pay the hefty bills out-of-pocket.

“Therapists cost so much, mental medicine costs so much,” Frazier said. “I’m not going to pay for this when I can't afford it.”

Greene said the state’s over 20 Community Mental Health Centers serve people with serious mental illnesses, chronic addictions and people who are at or below the 200% federal poverty level. Many of these centers continue to stare at high appointment requests, without enough providers to fill them. In the U.S., there is an average of 350 individuals for one mental health provider. The numbers are even worse in Indiana, where there are 560 individuals to one provider – the eighth worst ranking in the country.

Some centers barely break even because government insurance pays so little. Medical providers leave their jobs due to burnout and a lack of a competitive salary. That, coupled with an aging workforce and not enough medical residency spots, can lead to long waitlists.

“For example, if you want to see a psychiatrist, that may take quite some time,” Greene said. “And if we're talking about people with serious mental illness, they generally have to have some type of medication and medication management. So they need to see a psychiatrist before they can get the right prescriptions.”

Potential solutions 

Indiana lawmakers unanimously approved Senate Bill 1 earlier this year. It was the first time in Indiana’s history that behavioral health was made the number one priority during the legislative session. The law aims to expand community mental health services, address some of the insurance reimbursement issues and establish and sustain a crisis hotline. But the law received a fraction of what the state commision on behavioral health said is desperately needed. Greene said it’s a step in the right direction, but not nearly enough to significantly move the needle.

“SB1 was approved, and unanimously, and that to me is a great start,” Greene said. “[But] it’s the beginning and we cannot stop there. ”

Mental illness is a growing and complex problem, especially since the COVID-19 pandemic. None of the solutions are simple, cheap or fast but, sufficiently funded, they have the potential to make a big dent in people’s lives and the country’s economic health.

Mental health experts said individuals also have agency and can look for support in social networks. For example, having intentional, open discussions about mental health can help destigmatize and normalize seeking mental health care. Therapists also suggest that speaking to mentors could be valuable if people are struggling to access a mental health provider.

“I would encourage anyone who feels that way to try to talk to at least one person that they trust," said Denise Senter, the director of mental health education and innovation at Reach for Youth. "It may or may not be a family member, it may be a teacher, it may be a friend. But just starting that conversation about how they might be feeling, what their struggles are, can make a big difference in getting a little bit of relief. And then being open to continuing that conversation with a trusted person who can offer the right kind of help."

That’s what Willie Frazier is trying to do. He’s now on a journey to break through the stigma and improve his life. His last suicide attempt was two years ago, and he hasn’t harmed himself since July. He’s also trying to get his own insurance so he can get closer to accessing the health care he needs.

“There's nothing wrong with black people and their scars,” Frazier said. “If you're going through it, and it's hard to stop, don't feel bad. You're not alone here. Nobody is ever alone.”

Contact health reporter Elizabeth Gabriel at egabriel@wfyi.org.

If you or someone you know is in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.

Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.