NRPM: Standards for Privacy of Individually Identifiable Health Information. Substance Abuse and Mental Health Treatment

11/03/1999

When individuals have a better understanding of the privacy practices that we are requiring in this proposed rule, some will be less reluctant to seek substance abuse and mental health treatment. One way that individuals will receive this information is through the notice requirement. Increased use of mental health services would be expected to be beneficial to the persons receiving the care, to their families, and to society at large. The individual direct benefit from treatment would include an improved quality of life, reduced disability associated with the mental conditions, and a reduced mortality rate. The benefit to families would include quality of life improvements and reduced medical costs for other family members associated with abusive behavior by the treated individual. The benefit to society would include reduced costs of crime and reduced future public program treatment costs.

The 1998 Substance Abuse and Mental Health Statistics Source Book from SAMHSA reports cost-of-disease estimates from a range of studies, suggesting several hundred billion dollars of non-treatment costs associated with alcohol, drug, and mental (ADM) disorders. As an example of the magnitude of costs associated with mental health treatment, a 1997 National Institutes of Health report suggests that the total economic cost of mental health disorders such as anxiety, depressive (mood) disorders, eating disorders, and schizophrenia is approximately $115.5 billion annually 34. Evidence suggests that appropriate treatment of mental health disorders can result in 50-80 percent of individuals experiencing improvements in these types of conditions. Improvements in patient functioning and reduced hospital stays could result in hundreds of million of dollars in cost savings annually.

The potential additional economic benefits associated with improving patient confidentiality and thus encouraging some unknown portion of individuals to either seek initial mental health treatment or increase service use are difficult to quantify well. Nevertheless, one can lay out a range of possible benefit levels to illustrate the possibility of cost savings associated with an expansion of mental health treatment to individuals who, due to protections offered by the privacy regulation, might seek mental health treatment that they otherwise would not have absent this regulation. This can be illustrated by drawing upon existing data on both the economic costs of mental illness and the treatment effectiveness of mental health interventions.

Although figures on the number of individuals who avoid mental health treatment due to privacy concerns do not exist, some indirect evidence is available. A 1993 Harris- Equifax Health Information Privacy Survey (noted earlier) found that 7 percent of respondents reported that they or a member of their immediate family had chosen not to seek services for a physical or mental health condition due to fear of harm to job prospects or other life opportunities. It should be noted that this survey is somewhat dated and represents only one estimate. Moreover, given the wording of the question, there are other reasons aside from privacy concerns that led these individuals to respond positively.

For the purpose of an illustration, however, assumptions can been made about what proportion of the 7 percent responding affirmatively to this question may have avoided seeking mental health services due to privacy concerns. Given the proportion of mental health services that compromise total health care services in this country, a reasonable upper limit of the number of individuals avoiding mental health treatment due to privacy concerns might be 1.8 percent (i.e., 25 % of 7 %), while a reasonable lower limit might be 0.36 percent (i.e., 5% of 7%). Taking these figures as upper and lower limits, it is possible to estimate potential benefits by multiplying these figures by the annual economic cost reductions associated with treatment effectiveness rates. For example, using the upper limit of 1.8 percent, multiplying this by the annual economic costs of mental illness ($115.5 billion) and a treatment effectiveness rate of 80 percent, yields an estimate of potential annual benefits of $1,663,200,000. Similarly, using the upper limit of 1.8 percent coupled with a treatment effectiveness rate of 50 percent yields an estimate of potential annual benefits of $1,039,500,000. Assuming a lower limit of 0.36 percent more individuals seeking mental health treatment due to enhance privacy protections, coupled with a treatment effectiveness rate of 80% yields an estimate of potential annual benefits of $332,640,000. Similarly, using the lower limit of 0.36 percent coupled with a treatment effectiveness rate of 50 percent yields an estimate of potential annual benefits of $207,900,000. Therefore, given the existing data on the annual economic costs of mental illness and the rates of treatment effectiveness for these disorders, coupled with assumptions regarding the percentage of individuals who might seek mental health treatment under conditions of greater privacy protections, the potential additional economic benefit in this one treatment area could range from approximately $208 million to $1.67 billion annually.

Illness Total Annual Economic Cost of Illness (in billions) Percent Net Cost Reduction if Additional Care is Received
Table 3. Potential Benefits of the Proposed Privacy Regulation from Cost Savings Due to Early Treatment of Mental Health Disorders
Mental Health – Anxiety Disorders $46.6 70-90%
Mental Health – Depressive (Mood) Disorders $30.4 60-80%
Mental Health – Eating Disorders $6.0 40-60%
Mental Health – Schizophrenia $32.5 60-85%
Total $115.5 N/A