Untreated Mental Illness Cost a Single State $4.2 Billion

Pauline Anderson

October 24, 2023


The cost of untreated mental illness, including direct healthcare, non-healthcare, and indirect costs, cost the state of Indiana more than $4 billion in 2019, which represents 1.2% of the state’s gross domestic product that year, new research shows.


  • Researchers estimated the individual, family, workplace, and community costs associated with untreated mental illness in Indiana using a comprehensive approach and framework that could be replicated in other states.

  • The approach involved determining prevalence of mental illness from the National Survey on Drug Use and Health for adults and the National Survey of Children’s Health for kids and estimating the number of individuals with untreated mental illness based on the Indiana population in 2019.

  • It also involved using multiple data sources to tabulate direct non-healthcare costs of untreated mental illness, indirect costs (including costs related to reduced labor supply and premature mortality), and direct healthcare costs, while considering varying levels of illness prevalence and risks.


  • Of 6,179,105 individuals included in the analysis (median age, 38.0 years; 82.8% White), 429,407 had mental illness in 2019.

  • The 2019 prevalence of mental illness was 22.6% among adults and 25.9% among children, and 22.6% of adults had serious mental illness (SMI).

  • 26.8% of adults and 4.1% of children with any mental illness and 52.5% of adults with SMI did not receive mental health treatment in the previous 12 months.

  • The authors estimated that the total economic burden of untreated mental illness in Indiana was $4.2 billion (range of uncertainty, $2.1 billion-$7.1 billion) in 2019 ($3.3 billion in indirect costs, $708.5 million in direct healthcare costs, and $185.4 million in non-healthcare costs), equivalent to 1.2% of the state’s gross domestic product that year.


Clinicians, policymakers, and employers "need to understand the social context and needs associated with mental illness," the investigators write. "Given the findings of our study, eliminating barriers to seeking and accessing treatment should be prioritized, including offering culturally responsive care and recognizing populations stigmatized or discriminated against for seeking treatment," they add.


The study was led by Heather L. Taylor, PhD, MPH, Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, and colleagues. It was published online October 13, 2023, in JAMA Health Forum.


As there's insufficient evidence to show that mental health treatments are fully restorative, it's unlikely that treatment would reduce or avert all associated costs described in the study. The framework used by the authors can't account for varying levels of mental illness severity; it may be that those diagnosed with mental illness and not receiving treatment are less ill than those diagnosed and receiving treatment. The study could not include all potential negative societal outcomes that incur costs; for example, judicial and legal service fees associated with incarceration. The analysis did not include disorders or outcomes associated with substance use in the absence of SMI or other mental illnesses.


The study received support from Wellbeing Informed by Science and Evidence in Indiana, a partnership between the Indiana Clinical and Translational Sciences Institute’s Monon Collaborative and the Indiana Family and Social Services Administration. The authors have no relevant financial relationships.

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