addressing Depression

By Karmen Hanson | Vol . 23, No. 48 / December 2015

NCSL NewsDid you know?

  • Depression incurs costs of $210 billion per year.
  • At least 13 states support Mental Health First Aid for first responders, teachers and others.
  • Depression is the leading cause of disability worldwide.

Depression and other depressive disorders, which are common mental illnesses, affect about 6.7 percent of American adults each year, and approximately 10 percent of adolescents age 12 to 17 had a major depressive episode in 2013. Depression can cause problems not only for the person suffering from it, but also for family members and the larger community. Factors that contribute to clinical depression and depressive disorders include genetics and biological conditions; gender and hormone-related influences; co-occurrence with other illnesses, medication side effects; and difficult or stressful situations.

While depression is a concerning condition for anyone, depression that lasts two or more weeks within a one-year period may negatively affect personal and work lives. A recent study by experts from the Harvard Medical School and the Analysis Group Inc. calculated that depression in America costs society approximately $210 billion per year, about 40 percent of which is attributed to direct costs of treating depression. They also calculated that, for every $1 spent treating depression, another $4.70 is spent on direct and indirect costs of related illnesses and other co-occurring conditions. Costs to businesses from lower worker productivity and absenteeism due to depression accounts for nearly half of the total, or more than $105 billion in 2010.

In addition, 64 percent of jail inmates have a mental health problem, including depression, according to the Bureau of Justice Statistics in the U.S. Department of Justice. People with mental illnesses are also two to four times more likely to be on probation than the general population, according to the American Psychological Association.

Depression also causes stresses on families and has been a leading cause of medical disability for people age 14 to 44. Isolation from family, impaired functioning, potential loss of income, less interaction and enjoyment of activities weigh heavily on both the person with depression and family members.

Effective treatment options exist for depression. Medications, talk therapy, exercise, cognitive and dialectical behavioral therapy, and other therapies all have proven to be successful treatments for the majority of people with depression. Seeking and receiving treatment early increases the chances for a more positive outcome.

Only about 35 percent of people who experience a depressive episode seek and receive treatment from a mental health professional. People may not seek treatment for various reasons, such as believing the condition will go away quickly on its own, or that it’s a personal problem or weakness rather than something more serious. Many people do not have access to a mental health professional, some because they are uninsured or don’t live near a provider.

State Action

States have taken specific actions to address depression and major depressive disorders, from supporting awareness campaigns and establishing crisis diagnosis and treatment centers, to creating education and awareness campaigns.

At least 21 states recently introduced or considered legislation to encourage or require mental health crisis intervention training, mental health first aid, and other types of evidence-based programs for people most likely to encounter a person in crisis. These include first responders, teachers, clergy and similar professionals.

Other efforts include increasing access to mental health screenings, integrating mental health and primary care, providing incentives for providers to practice in underserved areas or populations, and offering additional training. Idaho and Wisconsin, for example, established student loan repayment and grant programs, respectively, to facilitate services in underserved areas. Wisconsin also provides grants to train law enforcement in crisis intervention involving people with depressive disorders. Ohio defines “telepsychology” (providing mental health services remotely via technology) and requires the state psychology board to regulate the practice in order to expand services and protect patients. Nebraska is among the 13 states that support Mental Health First Aid training. The state also instituted a program to place interns in underserved areas to provide behavioral health services.

Some lawmakers are also working to ensure that people have access to the drugs they need to treat their depression. Their efforts include reviewing programs such as Medicaid, so that the most effective, evidence-based treatments are covered. Several states are reviewing their “Essential Health Benefit” benchmark plans to make sure insurers provide access to appropriate and affordable treatments. Illinois passed legislation this year to help increase or maintain patients’ access to prescription drugs under certain conditions.

Federal Action

The Affordable Care Act (ACA) requires parity for depression and other mental health conditions so they are treated and covered at the same level as physical health conditions. The ACA also requires coverage of prescriptions to treat depression, as well as talk therapy and other treatment options.

The National Mental Health Awareness Campaign was started in 1999 by the White House Conference on Mental Health to encourage people to identify, discuss and seek help for mental health problems. Numerous federal awareness and education efforts are designed to assist specific populations experiencing depression, including children, young adults, adults and veterans.

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