The Cost of Not Treating Serious Mental Illness

To the Editor: Dr. Daniel Callahan's cost-benefit analysis (1) in the May 1999 issue betrays a woeful lack of information about the consequences of not treating serious mental illness. Dr. Callahan claims that "it is difficult to make a persuasive case for spending much money on the care of persons with serious mental illness" because it would not "satisfy the principle of the greatest good for the greatest number."

According to the National Advisory Mental Health Council, there are approximately 5.6 million seriously mentally ill adolescents and adults in the United States. Of these, 40 percent, or 2.2 million, are not receiving treatment in any given year. The group not being treated includes most of the 180,000 seriously mentally ill individuals in jails and prisons and at least 150,000 more who are homeless (2). It also includes approximately 1,000 seriously mentally ill individuals who commit homicides each year (3) and at least 10,000 more who commit suicide.

In calculating "the greatest good for the greatest number," Dr. Callahan should also include in his calculations the number of people who no longer use public parks, public libraries, playgrounds, bus stations, or subways because these facilities have been taken over by individuals with untreated serious mental illness. And he should calculate the time spent and costs incurred when law enforcement officials must deal with problems caused by mental illness, thereby taking them away from other duties.

Dr. Callahan also says that, on a cost-benefit basis, money spent on less serious conditions like "mild neuroses" would "help more people per dollar spent and achieve good therapeutic results." I would certainly like to see citations to the economic and therapeutic studies that Dr. Callahan used to arrive at this conclusion.