HARI SREENIVASAN: Next: a pair of health care stories that focus on disturbing gaps in the U.S. system.
First, a major problem with mental health care that’s drawing little attention day to day, yet is having a profound impact on costs, treatment and the way Americans live.
Judy Woodruff recorded this conversation earlier this week.
JUDY WOODRUFF: From 1995 to 2012, the number of Americans diagnosed with a severe mental illness rose by 8 percent from 7.2 million up to 9.6 million. At the same time, the number of psychiatric hospital beds available decreased by 32 percent.
This has left hundreds of thousands of the mentally ill on the streets, in emergency rooms or behind bars. Mental illness accounts for 6 percent of total health care costs and yet the cost of treatment, disability benefits and lost productivity add up to a loss of almost $450 billion for the U.S. economy.
These numbers frame a year-long investigation by USA Today into the toll this crisis is taking on families, on the economy and on the health care system. They’re calling it “The Cost of Not Caring.”
Liz Szabo is a health reporter for USA Today and she is the main author of the series.
And, Liz Szabo, welcome to the program.
LIZ SZABO, USA Today: Thank you.
JUDY WOODRUFF: The sheer magnitude of this problem is staggering, isn’t it?
LIZ SZABO: Yes, it’s really something that touches everyone, and we wanted to call the series “The Cost of Not Caring” to show how we all pay the cost both in dollars and in human suffering.
JUDY WOODRUFF: What drew your attention to it in particular? You cover health regularly, but what about mental health in particular?
LIZ SZABO: I think this story grew out of some of the mass tragedies that we have suffered in the past few years, but we also wanted to go beyond those shootings.
I learned a lot about the health care system and what’s going wrong, but we really wanted to look at the tragedies that happen every day, privately in people’s homes and the losses that people are suffering from mental illness that don’t make headlines.
JUDY WOODRUFF: How did you find out how widespread this is?
LIZ SZABO: We made a lot of phone calls and we talked to a lot of people around the country. We have heard from many families with heartbreaking stories that are just sadly familiar, people trying to get help and just not managing.
JUDY WOODRUFF: In fact, Liz, we have right now — as you were saying, you talked to a lot of people around the country.
I want to show our viewers just a short excerpt of one of the people you spent time with. Her name is Karen Kelly. She lives in Vermont. And here’s part of what she had to say.
KAREN KELLY: The year I turned 40, I noticed that was really sad. I couldn’t get happy or excited about anything.
My husband gave me a wonderful weekend in Montreal, and I had an absolutely miserable time. I came back and told him that I thought that I was depressed. I went through a screening. And the psychologist said, you absolutely have depression.
Most of the time, it’s not something you can explain. For a lot of people, they can look really good on the outside, and on the inside be a total mess, yet they have to still live with it, and it’s a struggle.
JUDY WOODRUFF: What happened to her? She got into a pretty dire set of circumstances, didn’t she?
LIZ SZABO: It was an extraordinary situation. She’s a wife and mom, like many of your viewers. And she recognized that she needed help. She was thinking about death and her psychiatrist couldn’t find her a hospital bed.
She couldn’t get help. She knew she would have to be on the verge of death to get help, so she swallowed an entire bottle of pills, went to the emergency room. The closest bed they could find three days later was in the next state.
JUDY WOODRUFF: She had to go across state lines.
LIZ SZABO: She had to go 200 miles.
JUDY WOODRUFF: To get into a place where she could be treated.
LIZ SZABO: That’s right. And an ambulance took her to Massachusetts, at a cost of $3,600, which was paid for largely by Medicare.
JUDY WOODRUFF: How typical is her situation?
LIZ SZABO: It’s pretty typical.
We hear horror stories from every emergency room in the country that we talk to. There is something going on called boarding. When someone goes to the emergency room and they can’t get a psychiatric bed, they just live in the E.R. We talked to someone who said he has had psychotic patients for two weeks waiting in the E.R. just waiting a bed.
JUDY WOODRUFF: Why, Liz Szabo, do you believe in your reporting it’s gotten to this sort of epidemic state that it is?
LIZ SZABO: There are a lot of complicated reasons, but the recession really hit the mental health field hard. States cut nearly $5 billion from mental health care services just from 2009 to 2012.
So they cut 10 percent of all the health care psychiatric beds in the country. So, it’s really just gotten to be a crisis state.
JUDY WOODRUFF: But, before that, was the country doing pretty well by people who were mentally ill?
LIZ SZABO: I don’t think there has ever been a sense that the mental health system has done particularly well.
There was a move in the ’60s to get people out of hospital beds and to get people out of institutions into the community. Unfortunately, the community resources never materialized. People really were left with nowhere to go.
JUDY WOODRUFF: And I remember — you and I were talking just before the year here. I covered the Jimmy Carter presidency.
Rosalynn Carter, the first lady, made this a central focus for herself, that the mentally ill, not enough attention, not enough resources. And yet I have guess you have seen since then it just takes a constant effort.
LIZ SZABO: Yes. It really does get pushed to the back-burner.
People say that when there are budget cuts, mental health is one of the first things to be cut. Maybe it’s because people who are profoundly disabled can’t always advocate for themselves. And I think there seems to be a false idea that — that we don’t have to pay for mental health, we can somehow get by on skimping.
But what we find is, when mental health care gets cut, states do pay. They pay by paying for the emergency room. They pay to build homeless shelters. They pay to build prisons. I think something like 16 percent of people in prison and jails are psychotic, acutely psychotic.
JUDY WOODRUFF: So if these people, if these folks are not able to get some kind of treatment early on, then they end up in a much worse place?
LIZ SZABO: Often, yes.
When did the tally, I think we tallied up 590,000. Over half-a-million Americans are in these new institutions, in prisons, in homeless shelters or the morgue. There are 38,000 suicides a year. That’s more than deaths from homicide, more than deaths from prostate cancer, more than deaths from car accidents.
JUDY WOODRUFF: And you were also telling me — we mentioned USA Today is making this a year-long series.
You’re focusing on the costs. There’s also the stigma associated with being mentally ill or having an emotional illness.
LIZ SZABO: Yes. And we’re going to be looking into the issue of stigma, because stigma can prevent people from getting help if they’re afraid of being labeled.
It also — it also keeps people from just supporting their neighbors. People tell me that if you have, God forbid, a child with cancer, your neighbors will come over and offer their support. When you have a child with schizophrenia, your neighbors turn away.
So, what we’re hoping is — we can’t put $5 billion back into state coffers by ourselves, but we’re hoping that we can help inspire a little compassion and understanding, if only for these families and people going through the suffering.
JUDY WOODRUFF: Liz Szabo, reporter with USA Today.
And the series you’re doing this year is “The Cost of Not Caring,” about the mentally ill. We thank you very much.
LIZ SZABO: Thank you.