EARLY DIAGNOSIS OF MENTAL ILLNESS KEY TO SAVING COSTS
Despite the increasingly costly financial implications of mental illness for both sufferers and health-care networks, the necessity for depression, anxiety and other mood disorders to be given urgent diagnosis and treatment as chronic illnesses has long been ignored. It has been estimated that in 1990 alone, the cost of anxiety and depression to both the public and private sector in the United States amounted to in excess of $90 billion.
An international study, in which South Africa’s Depression and Anxiety Support Group participated, was recently conducted by the Global Alliance of Mental Illness Advocacy Networks (GAMIAN). The results of the study reveal areas in the South African health care system where substantial savings can be made by way of early diagnosis and treatment.
The vast majority of people affected by mood disorders delay seeking initial treatment for at least two years, and often for as long as five years, due often to previous misdiagnoses and lack of information regarding the severity of their symptoms. During this time, funds are usually drawn from medical aids to seek relief for the physical symptoms associated with the illness, rather than the underlying disorder. As this is a short-term symptomatic response to a deeper pathology, treatment is usually ineffective and unnecessarily erodes away at medical funds. Compared to a global average of 35%, 43% of South African sufferers only received a correct diagnosis after multiple undiagnosed visits to four or more doctors, each visit incurring noticeable expenditure on the part of the sufferer and medical aid. Misdiagnoses often result in referrals to specialist physicians practising in fields unrelated to the core mental problem - including endocrinology and gastro-enterology - with each referral requiring funds for specialised tests and clinical investigations It is estimated that in excess of R22 000 is spent in attempts to obtain a suitable diagnosis and subsequent treatment. This startling figure can be reduced substantially by making speedy diagnoses and effecting a suitable treatment programme immediately. In referring sufferers to professionals experienced in the field of mood disorders, appropriate diagnoses are possible early on, facilitating an effective long-term treatment process and eliminating any further unnecessary expenditure. Such early (and effective) treatment represents a huge saving to both patient and medical aid.
Statistics for South African treatment programmes show medication to be effective in over 62% of cases, yet dropout rates remain a cause for great concern. Of those who are correctly diagnosed and receive treatment, a startling 45% drop out of the treatment at some time due to the medication’s side effects. As a result, many patients will experience relapses of their disorder - which will undermine any attempts to regain previous levels of performance and productivity - and will require further treatment for an extended period of time, at a greater cost to individual and medical aid. Many of those who discontinue treatment prematurely complain that they were uninformed as to the side-effect profiles and possible ways to minimise these problems. The side effect profiles most commonly selected as reasons for stopping treatment include sleep disturbances, agitation and sexual dysfunction. Treatment compliance can be increased through education and active involvement in a support group, where patients are encouraged and motivated to continue treatment, making recovery an attainable and affordable reality.
Education about medication and associated side effects is thus a primary concern in addressing the problem of treatment dropout. This is an area in which the Depression and Anxiety Support Group works tirelessly. To help combat the lack of education and information available to the public, the group has embarked on both patient and doctor education programmes countrywide. In the past four months over 45 such programmes have been completed. The group already has a membership of over 7000 and offers a toll-free telephonic help-line service 6 days a week, from 8 am to 8 p.m. Backed by brochures, pamphlets, videos and books as well as 75 regional support groups countrywide, the support group offers a non-judgemental and supportive atmosphere in which sufferers can share feelings. Referrals to GPs, psychiatrists and psychologists experienced in dealing with mood disorders such as anxiety and depression, are also available to facilitate early diagnosis and treatment.
In order to address problems of loss of productivity, absenteeism and excessive public and private spending, people need to become aware of the debilitating effects of mental illness and the importance of prompt, correct and cost-effective diagnoses and treatment. This can only be achieved through continued education and interaction between all involved in the South African mental health system.