The ACE study was a landmark study involving 17,000 participants surveyed between 1995 and 1997 enrolled at Kaiser Permanente. The aim of the study was to assess associations between childhood maltreatment and later-life health and well being.
The results and associations are extremely revealing, but also makes incredible sense when you apply this to the idea of controlling health care costs. For example, the total lifetime estimated financial costs associated with just one year of confirmed cases of child maltreatment (physical abuse, sexual abuse, psychological abuse and neglect) is approximately $124 billion. The impact of child maltreatment, specifically increases the risk for these conditions (this is not the exhaustive list, here’s more): ischemic heart disease, alcohol abuse, drug abuse, obesity, headaches, smoking (and all the medical conditions associated with it like lung cancer, COPD), teen pregnancy, unintended pregnancy, mental health conditions (depression, anxiety, and much more).
So why isn’t this a major headline and why isn’t more being done to address this?
My answer is that part of this is related to the stigma of abuse in our society. Although the recent Jerry Sandusky coverage has highlighted that abuse can happen anywhere and doesn’t just happen in lower socioeconomic groups, we as a society have mostly focused on sensationalizing the abuser and the bringing them to justice, but we don’t talk much about treating the victims. Although there are breakthroughs in the neuropsychological fields regarding recognition and management of childhood trauma, there is much work to be done to really focus on helping the victims on the ground.
The second part of this answer is receiving mental health care also carries a social stigma as well as a significant cost barrier. Compounding the problem is that individuals who have mental health issues, in general, do not have the means to pay for health care, and thus are either uninsured or under-insured.
Do you see the same pattern in the previous post? Cost is the largest barrier here, yet again.
The lack of prioritization on prevention and early treatment as demonstrated by the inequality of reimbursement rates produces outcomes that are woefully inadequate. It’s further reflected by our prioritization (or the lack thereof) of mental health interventions compared to other interventions, such as drug intervention. Not too long ago, the standard belief was that mental health was separate from physical health and their treatments were paid differently (less, of course). In fact, remnants of this belief still exist, especially for treatment, even though the Mental Health Parity Act in 2008 was an attempt to improve this disparity.
Although mental health providers are bearing the brunt of this unfair system, primary care providers also experience a significant share of the burden. In my own practice, 60% of my time was spent managing mental health issues, including depression, anxiety, bipolar disorder, chronic pain, addiction, and a large majority of that was related to a past history of childhood maltreatment. I can also attest that managing adults is much more challenging than children because positive change happens much more slowly. The neurological plasticity of children is the main reason why early intervention is so crucial and so cost efficient in the future if we actually paid attention (more time for providers to interface with the family and patient), and we directed health care costs towards early intervention that has been shown to work.
If money is indeed the measure of worth to society, society is saying right now that mental health treatment is not valuable to society. Is that really what we believe?