“It is estimated that mental illness costs the economy more than $50 billion a year.” This is the kind of sentence you might encounter in any old issue of a newspaper, though it’s actually from the Oct. 13 Globe and Mail. When I say you would encounter it, I am not suggesting you would read it. It’s the kind of claim we are so used to encountering in the press that the eye slides right past it. We don’t usually sit down and think about what $50 billion literally means, contrasted with $1 billion or $500 billion. In the context of a news story mongering war against some social ill or disease category, all such numbers are simply read as “a huge amount.”
The annual gross domestic product of the country is about $1.8 trillion, with human labour’s share being about half. So the figure of $50 billion, which comes from a study issued earlier this year by the Mental Health Commission of Canada, represents a loss of about 5.5 per cent in the potential annual output of Canadian workers. Is this a realistic number? Is it in the nature, let us stop to ask for once, of a true assertion?
It is realistic in the sense of resulting from a conservative calculation. When one probes social-cost claims made by do-gooders, they often turn out to incorporate laughable or downright dumb assumptions. When a politician screams about the costs of smoking, you can be sure he is always including every dime of hospital costs for lung-cancer treatment, and never subtracting the years of senior care and pension payments saved by the public-spirited unhealthy.
But mental illness doesn’t have apparent benefits that need to be weighed in the balance, and 5.5 per cent is pretty reasonable on its face. You know plenty of people whose incomes are 20 per cent, or 100 per cent, less than they might be because of mental or emotional disorders. The commission’s actual report calculates that we spend $29 billion a year directly on care for the mentally ill, so that is the bulk of the $50 billion right there. Another $21 billion in lost productivity does not seem like a lot to ask of our credulity.
The real problem is what we mean by “lost productivity.” What is being postulated here is a sad, spiritually afflicted populace whose “economy” could be bigger if absolutely everyone were well enough to work to their full capacity. We all sacrifice some part of “the economy” to personal happiness or to the well-being of our families and loved ones. Probably we all sacrifice some to personal pathologies, whether or not they could be characterized as mental illnesses. Is being somewhat lazy a mental illness? How about having an IQ of 88? “Costs to the economy” are, in this sense, hard to take seriously: human imperfections defy accounting.
When it comes to mental illness, the incremental loss “to the economy” of diminished human productivity is only relevant to policy to the degree that it could be corrected at no compensating expense. Otherwise, cost claims amount to the difference in earnings between ourselves and hypothetical, perfectly rational gods. The irony of mental health advocates waving the $50 billion figure around is that they explicitly want to increase it by pouring more money into public mental-health programs. Give them $100 billion more and they would quickly be using that in their argument for the next $100 billion.
If the economy, rather than humanity, is the relevant guiding principle here, it might make more sense to ask what, if anything, the $29 billion a year we already spend gets us. Schizophrenia, to take perhaps the most horrendous single form of mental illness, is still a “disease” with constantly shifting diagnostic criteria, a hundred etiological theories, no biological test and an array of drug therapies that work well for the exceedingly few people who will stick to them reliably. The Globe story advocates a “social movement that will . . . do for mental health” what other foundations have done for cancer and heart disease. Is it gauche to observe that doctors can actually cure some cancers, and that there are strong validated treatments for heart disease?
We treat the mentally ill in the name of hope, not GDP. The Mental Health Commission’s $50-billion figure is really nothing but attention-getting ad copy. It does not seem to have been torqued upward by use of sleazy mathematical assumptions—but it could have been, if the original number were not impressive enough, and it is not as though anybody would check. So what’s it doing in a newspaper anyway?
On the web: For more Colby Cosh, visit his blog at macleans.ca/colbycosh