Contributor: Ronke Komolafe, DBH, MBA
To learn more about Ronke, click here.
Mental health trauma can have far-reaching consequences for individuals and the entire healthcare system. Understanding how mental health trauma can impact healthcare outcomes is important to improving the clinical treatment approach. This article will discuss five key points on how mental health trauma affects healthcare outcomes:
1. Increased Risk of Medical Disorders
Mental health trauma can leave an individual more susceptible to physical illnesses, chronic health conditions, and permanent disability. Especially during persistent traumatic events (such as neglect, abuse, and abandonment) or in living with post-traumatic stress disorder (PTSD), stress hormones can become chronically released. In turn, this can heighten the risk for developing a wide variety of potentially preventable chronic disorders (e.g., heart disease, digestive problems, Type 2 diabetes, and even cancer). Furthermore, individuals experiencing mental health issues such as PTSD have been found to have a higher likelihood of delaying needed medical care (also due to a lack of healthcare access and/or affordability). Then, a consequence of this delayed (or neglected) medical care can worsen overall health status.
2. Increased Hospitalizations
Studies have shown that those suffering from mental illness are more likely to be repeatedly hospitalized than those without mental illness (and often due to health complications resulting from a preventable chronic disorder).1 Indeed, patients afflicted with mental health disorders have the highest readmission rates of all hospitalized patients.2 Not only does this increase the burden on hospitals and other healthcare facilities, it also puts added strain on both healthcare provider resources and clinical staff across the healthcare system.
Through delaying treatment of the mental health disorder and/or co-occurring chronic health disorder, the adverse health outcome can be the need for inpatient care and/or far more intensive treatment than would otherwise be necessary. Some early-stage cancers are highly treatable, but – if caught at a later stage – require ongoing treatment over the lifespan, increase the risk of multiple hospitalizations, and result in increased financial and emotional strain experienced by the affected individual.
3. Higher Rates of Substance Abuse
Experiencing mental health trauma often results in anxiety and/or depression,3 and – in an effort to relieve their distress – the affected individuals may self-medicate with alcohol and/or drugs. This can lead to dependence on the substance for relief of the distressing symptoms. The unfortunate consequence can be prolonged self-medication with alcohol and/or drugs, leading to biochemical changes in the brain that make it harder to control symptoms of anxiety and/or depression, and result in psychological and physical addiction to the substance. Meanwhile, substance abuse has been linked to a higher likelihood of developing chronic health conditions. Depending upon the substance(s) abused by the individual, these can include liver cirrhosis, hepatitis C, kidney disease, various cancers, HIV/AIDS, and many others. Besides adversely affecting the overall health of the individual, the consequence is an increased financial strain on the healthcare system related to providing needed medical interventions for these co-disordered individuals now afflicted with both a mental health condition and substance abuse.
4. Impact on Activities of Daily Living
Mental health trauma can significantly interfere with an individual’s ability to perform normal activities of daily living (ADLs) at home or in the workplace. In the work realm, this can result in poorer performance and decreased productivity levels, which in turn can lead to an increased risk for unemployment. Consequently, people living with mental health trauma can experience an increased financial burden resulting from lost wages or the need to rely solely on disability payments for economic survival.
There is also a negative impact on the national economy when individuals with mental health disorders (such as PTSD) and chronic health disorders are unable to contribute to the workforce due to their disability and are therefore reliant on federal Social Security Disability (SSD) benefits. One major national consequence is fewer federal monies for allotment to states to aid in covering their public health-related and healthcare system-related costs. In turn, this economic strain has resulted in not enough public health and social support programs to help vulnerable populations nationwide who are in desperate need of these necessary support services.
The current dysfunction in the U.S. healthcare system as a whole creates the following vicious cycle: people with mental health disorders and substance abuse often do not receive care in a timely manner to prevent chronic disorders, which further economically burdens the U.S. healthcare system. If appropriate care were easily available to people living with PTSD as a result of experiencing trauma, the higher level of chronic disease and disability in this population might be prevented. Thus, increased federal funds allotted to preventive care for this population might lessen the overall financial impact on the entire system.
5. Impact on Health Insurance Premiums
The costs associated with treating any type of mental health disorder are significant and contribute to the calculation of health insurance premiums.
Healthcare costs have increased significantly over the past five decades. In constant 2021 dollars, the per person cost has increased from $1,951 in 1970 to $12,914 in 2021.4 In turn, monthly premiums (and/or required co-pays and/or deductibles) typically increase every year. This situation has made purchasing high-quality health insurance unaffordable for many people. Since some individuals with mental health disorders and disabling conditions may have incomes too high to qualify for Medicaid, they can often find themselves underinsured or uninsured altogether. Additionally, 49% of the U.S. population has insurance coverage through their employer. For those whose employment status is tenuous, there is one more obstacle to access to insurance coverage. In turn, this combination of factors leads to delayed care or no treatment at all.
Consequently, people co-disordered with a mental health/substance use disorder are far more likely to need (and seek) emergency medical interventions in the emergency rooms (ERs) of hospitals. Given this situation, hospitals that primarily serve the poor and/or uninsured are being forced into crisis mode and sometimes closing altogether, especially in states that did not expand Medicaid. The overcrowding of ERs is endangering the lives of patients, placing tremendous stress on ER physicians/nurses, and draining hospitals’ financial resources. Furthermore – as hospitals’ financial resources are drained – more of them are simply closing their ERs (and other services lines) to save money. And that impact can be felt by other hospitals in the area.
Conclusion
It is incumbent upon healthcare advocates and policymakers to focus more attention and financial resources on mental health trauma and PTSD to decrease the cost burden linked to potentially preventable (and manageable) chronic disorders – including mental health disorders resulting from experiencing trauma.
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References
- US Agency for Healthcare Research and Quality (AHRQ). Healthcare Cost and Utilization Project (HCUP). (October 2008). Statistical Brief # 62. Hospital Stays Related to Mental Health, 2006. Webpage: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb62.pdf
- Gentil L, Grenier G, and Fleury MJ. (2021). Factors Related to 30-day Readmission following Hospitalization for Any Medical Reason among Patients with Mental Disorders: Facteurs liés à la réhospitalisation à 30 jours suivant une hospitalisation pour une raison médicale chez des patients souffrant de troubles mentaux. Canadian Journal of Psychiatry 66(1):43-55. Webpage: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7890589/
- Center for Substance Abuse Treatment (US). (2014). Trauma-Informed Care in Behavioral Health Services. Chapter 3, Understanding the Impact of Trauma. (Treatment Improvement Protocol [TIP] Series, No. 57). US Substance Abuse and Mental Health Services Administration (SAMHSA): Rockville, MD. Webpage: https://www.ncbi.nlm.nih.gov/books/NBK207191/
- CMS.gov. National Health Expenditure Accounts. December 15, 2022. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical