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Vital Directions from the National Academy of Medicine
October 25, 2016

Improving Access to Effective Care for People With Mental Health and Substance Use Disorders

Author Affiliations
  • 1New York University, New York, New York
  • 2Rush University, Chicago, Illinois
  • 3Columbia University, New York, New York
JAMA. 2016;316(16):1647-1648. doi:10.1001/jama.2016.13639

The United States needs to do more to help improve the outcomes of people with mental health disorders, substance use disorders, or both. In 2014, approximately 18% of US adults experienced some form of mental health disorder and 8% had a substance use disorder.1 Mental health disorders are among the most expensive conditions; in 2013, annual health spending on mental health disorders in the United States was approximately $201 billion.2 Importantly, behavioral health and overall health are fundamentally linked. Mental health and substance use disorders are often accompanied by comorbidities, such as cardiovascular disease and diabetes, and the additional costs associated with behavioral comorbidities are $293 billion.3 Patients seen in primary care settings with chronic medical conditions, such as diabetes, asthma, and cardiovascular disorders, have a higher probability of having a substance use disorder or more common mental health conditions, such as depression and anxiety disorders. Coexistence of mental health or substance use disorders with general medical conditions complicates the management of both and is associated with reduced life expectancy. For example, a 35-year-old man with schizophrenia, diabetes, and tobacco dependence can expect an up to 25-year shortened life span.4