As an actor, comic and humanitarian, Robin Williams touched millions of lives. His untimely death by suicide linked to serious depression has deprived all of us of years more of his extraordinary gifts. More importantly, his family lost a husband and father. The media has been abuzz about the profound pain wrought by depression on its victims and their families. But before we move on to the next important news story, let's first tally up what Robin Williams' death tells us about the stigmatization of mental illness and the cost of investing in its early detection and treatment vs. the cost of not doing so.
Throughout history, as a society we've treated mental illness in short bursts, separated by large periods of benign or active neglect. From the purges and bloodletting in the Middle Ages, to later "madhouses" that housed inhabitants in cages, to reforms creating more humane state hospitals in the late 1800s, public policy has come full circle. In the 1960s we learned that state institutions were no better than incarceration of previous centuries. That recognition led to deinstitutionalization in the mid-1960s, codified by President Kennedy's funding for treatment facilities through the Community Mental Health Act of 1963. (President Kennedy's sister Rosemary had famously undergone a lobotomy, which left her inert and unable to speak more than a few words).
But while the number of institutionalized mentally ill people in the United States dropped from a peak of 560,000 to just over 130,000 in 1980, only half of the proposed community mental health centers intended to support individuals who transitioned back to communities were ever built, and many of those that remained were dismantled in the 1970s and '80s due to lack of funding. Sadly, the promise of deinstitutionalization -- helping vast numbers of people with mental health disabilities lead normal and productive lives through treatment in their communities -- was never fulfilled.
From Deinstitutionalization to Transinstitutionalization
Today, inadequate treatment options in communities have forced people with serious mental health problems into homelessness and, once again, to prison. Across the country, individuals with severe mental illness are three times more likely to be in a prison than in a mental health facility, and 40 percent will spend some time in their lives in jail. In fact, the three largest mental health providers in the nation are jails: Cook County in Illinois, Los Angeles County and Rikers Island in New York. Collectively, jails and prisons now house an estimated 400,000 people with serious mental illness.
The consistent theme in the cycle has been a lack of a political will to fund appropriate mental health facilities and treatments. But with suicide rates among Baby Boomers, e.g., those in Williams' generation, increasing by nearly 30 percent since 1999 and depression rates, closely correlated with suicides, likewise skyrocketing for people in this age group, it's a public health crisis of tsunami proportion.
We pay dearly for our failure to invest in adequate early detection and treatment in communities. The cost of housing an inmate in prison is around $25,000 annually, not including the cost of social and medical services and education. (Ironically, getting these services upfront could keep many out of prison in the first place.)
In the workforce, stigmatization and inadequate treatment imposes similarly high costs to workers and employers alike. According to the National Alliance on Mental Illness, mental illness accounts for $193.2 billion in lost earnings and 217 million lost workdays annually, as well as dramatic reductions in on-the-job productivity.
Call to Action
We can figure this out. Advances in neuroscience and psychiatry have led to new therapeutic approaches that allow people with mental illness to live and work productively in their communities, at fractions of the cost of incarceration and homelessness. Failure to fund these treatments upfront is penny wise and pound-foolish.
Can we use Robin Williams' death as a catalyst to resume an important national conversation about the stigmatization of mental illness, the inadequate treatment for those experiencing it, and the huge and unnecessary cost society bears as a result?
It's time to bring the issue back full circle. We need a national commitment to community supports, both for early diagnosis and treatment. And humane inpatient psychiatric care is necessary for some individuals in need of a more structured care environment. We need better training for mental health care providers. And we need to educate families and employers about the prospects for a productive life, together with the cost-effective supports needed to get there. In short, we need a national commitment to alleviating the devastating costs of inadequately treating mental illness.
As a first step, we need to show all of America's nearly 43 million people with mental illness the same compassion and empathy we've shown Robin Williams. They all deserve to live a full life, all of us need to benefit from what they have to give, and it can be done at a fraction of the cost of the alternatives.
Have a story about depression that you'd like to share? Email firstname.lastname@example.org, or give us a call at (860) 348-3376, and you can record your story in your own words. Please be sure to include your name and phone number.
Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.