Munko & paint bubbling up: Staggering costs of mental health, spectacular rate of return opportunity

I used to approach things swiftly, speedy and try to cram as much as I could in each day, each minute. Walking quickly from here to there, trying to accomplish a weeks worth of work in a few hours, taking quantum leaps in all I was involved in. But speed kills. Now I am finding a slower pace, more deliberate plodding allows me to slow down and in the end go faster, achieve more than I ever could when it comes to my mental health and almost every other angle of my life at the same time. They say take a minute to smell the roses and for me that thought is about allowing yourself to truly process what is around you, inside you and what you can learn to be better and feed true growth, make your day better and add something positive to others and the world around you. More and more I find that being attentive, taking a minute to step back and examining things for once, is really, really valuable. At work, which is a quality role at a manufacturing plant, we just repainted a common concrete walkway outside, big deal right – how could that be even remotely informative or significant. Of course I would have said that until now. Figure out why it got screwed up, don’t let it happen again, make sure that same weakness doesn’t apply anywhere else on our site, paint it and move on period. So here we are, talking about just a standard walkway or sidewalk, 400 people walk over it every day on their way in and out of the factory. The manufacturing plant is located in Puerto Rico in the Caribbean, the tropics, and it rains a lot here, the temp is warm year-round, so no biggie - the elements are brutal and things deteriorate quickly without the right care, to be expected from the water, the sun and the salt air, so what. Of course the paint gets worn down and it needs to be repainted periodically. And here we were at that periodically point in time, the paint was chipping in such an unremarkable and expected manner, and that walkway quickly revealed a slippery, slick and dangerous quality with just a bit of rain - so it needed to be remediated, updated, refreshed.

I can’t help but relate everything to mental health these days, so here I go again, an addict, an obsessive compulsive. The walkway - Chipped, beaten up surface with more pain and danger underneath, now exposed and visible. Until that exposure of what is inside, no action, no repair, no preventive call-out to stay on top of it. I had seen the cracks forming, seen the paint starting to break away but hey I have to run to my next meeting, I have to run home, I have places to be and so does everyone else. And before you know it, we have a worn-out surface which needs intensive care. And then in a snap of the fingers, a day, because we know how to respond to issues and get things back on track, there’s a new coat of paint and everything looked so good and shiny, problem solved. The issue was finally so visible that action was taken and the situation easily corrected, time to move on, or so we thought. Well, corrected initially, but then evidence that the job wasn’t performed robustly soon surfaced (no pun intended), the process of making a bigger mess and doing more damage to fully resolve the issue was ignored. It was a quick-fix job, because I’m sure there was much more critical work to attend to, somewhere else to get to, on to the next one. Or maybe it was just Friday afternoon and the bar was calling. And so just a few days later and after a day of rain, afternoon sun and the steamy conditions you would expect in the Caribbean, the paint started to bubble up. Just as expected we had a new problem and had done negative work because certainly the job cut a couple corners, ignored a few critical elements - we didn’t fully clean the exposed concrete surface with soap and bleach, sand and smooth, prime, prepare the surface for the application, and furthermore, moisture was within the concrete from recent rains. The target was not ready for the treatment. These are all known parts of the process in the island where everyone’s home is concrete, this is not some unique situation. More likely we knew that and still rushed the job, so that moisture wasn’t eradicated before the makeover, the path was not ready to receive the treatment, and now we are back to square one. Actually, we are back further back than we started, at square negative one with more damage to clean up just to get back to square one from which we need to put in work to repair and heal after a larger catastrophe and wasted time, money and effort – it’s interesting the parallels I take away. My mental health journey feels like it was on the same path for so many lost years and coats of paint on my face. But now I am finally taking all the steps necessary to remediate myself, yielding a truly improved product.

In my addiction and mental health struggles, all prior efforts to overcome, correct myself had failed because I didn’t go beneath the surface, reach inside fully to pull all the nasty history out of myself and evaluate it, I left additional moisture that would need to get to the surface one way or another. I also avoided or missed many preparatory steps, critical parts of the holistic approach needed. You can’t haphazardly lay on a thick coat of paint or a solution to complex mental health issues without going in deep and connecting all the dots, addressing all the loose ends, without all the pre-work done and expect a lasting, or even marginal change. So, with my issues and with the painted walkway at work, we didn’t fully treat both the inside and the surface properly, both have to be cared for to ensure the fix is one that is sustained, that things stick - or you just end up right back where you started from and actually worse off, doing negative work and increasing disorder. That negative work and increasing disorder in the thermodynamics world is entropy, and in my life entropy has been my guiding darkness and inescapable monster in my head, which comes out just to beat me into oblivion over and over. So on the bubbled up walkway I can see that little entropy monster eating up all the rushed and now wasted time and energy like a mid-day snack after a bender, laughing at you with a full belly yet again. Then that nasty little fucker hits you with a stinky fart and scuddles off to his dark cave of disorder, until we meet again, until he feeds on you again.

My mental health issues and story aren’t a money thing, what I have is an addiction thing, an internalization thing, a depression thing, a stubbornness thing and a delusional false hope, comeback, chaser mentality thing. A destructive devil chip on my shoulder and the thought that I can keep that entropy monster inside myself, manage it alone. I have a sickness inside, rotting from the inside out with an ability to maintain normalcy and a false sense of not just being in control, but also thriving and achieving and being so wonderful in so many ways externally. But in reality, things are spinning out of control inside, a completely different story, daily collisions between destruction and despair. And the deception, lies and harm that result, are present to the extent that they leave you in awe, maybe enough shear disbelief that the story resonates. But then there’s the money factor, we all know the power and importance of money in society and all of our lives. And money has the power to control attention, deliver false assumptions of good and bad, right and wrong. With money, the magnitude is the bright light, the bell-ringer that amplifies every aspect of perception. Nobody cares when someone wins a $2 scratch-off lottery ticket, but when the Powerball goes up to $300 million, yeah there’s a buzz. Same thing when we talk of other windfalls and tragedies. If I told you this was about a $300 loss, a few bad decisions - big deal, next. Yet a $3 million hole from a run-of-the-mill average joe that raises the first eyebrow. $3 million that vanishes, poof, stolen by the owner, from the owner and has disappeared in the longest, darkest carnival mirrors magic trick ever, that would catch your eye, your ear and attention. Stolen by the owner, from himself, what does that even mean? Well we love magic tricks, shipwrecks and buried treasure, money heists - maybe this is something of that nature. Can the golden dabloons ever be recovered from the bottom of the dark, silty ocean floor? What was behind the magic trick? How many died along the way, how did they elude the authorities and escape, vanish into the salt air?

So the hook on my story is just getting set, and if I went on to tell you that $3 million was just the setup, and the real story is not about the heist, the trick or shipwreck, as those are in the past; this is more about the future and what happens next in a beautiful twist, about saving $10 million from similar loss in a tragic four-alarm fire, we have a story of interest, persons of interest to profile, more than enough of a story to move the needle. The character development is so complex, the hero and the villain, do we root for this underdog or are we duped by the two-faced devil and he needs to burn? If I told you this story isn’t about the money at all, those stacks of cash and jewels were just to get your attention, even the deeply tangled and coincidental tangents and parallels were all just bringing you in for the main event, you would be at the edge of your seat, addicted to the story and counting the days until the next season drops. And then you find out about the real plot, the smokescreen in the fog, this is much more than what we saw on the surface – this is not about money at all, something much more valuable. This is a real-life escape tragedy, about escaping death and saving lives, while just 1 precious life at the current count from past to present, the subsequent scenes set the stage for saving many other lives in the future. And then you find yourself in the story and a main character in the rescue mission. This feels so convoluted, levels and twists and flashbacks and diversions, it must be a mental health patient who wrote the script, but your attention is peaked now, you are invested in the story and where it goes next. Saturday rolls into Sunday and you are binging the entire series. A thriller, a drama, horrific tragedy which births an amazing inflection with a comeback and feel-good story, just throw in a little dark humor and we have every box ticked. And this is real, a biopic, how is this possibly a true story, no its not possible. Yet that reality is what drives the screaming call to action crescendo.

My story is all of those things and so much more. And yes you are part of the story, we collectively need to take the next step as a society to truly engage one another, painfully highlighting a true global pandemic that has been causing destruction in every country and at every level for eternity. Mental health will never be controlled or managed if we don’t change our attention level, focus and resource level, courage to bring the topic to the table early and often. Across so many different forums, when you think about your home and the physical dinner table, there’s a start. Look to schooling and the skills and knowledge you want your kids to have, lets sprinkle that in too. Why do we teach sex ed and not mental ed, why do we have counselors but no discussion on how to utilize them, utilize each other as counselors and listen to one another. We teach foreign languages but don’t teach our children how to communicate their feelings or thoughts in any language. We can take anatomy class but are never taught how to open up and dissect the most important organ – our minds. Pull out the intestines of a frog no problem, but keep your emotions inside you, never to be extracted. We go through chemistry class with reactions and measurements of heat and energy, but never learn how to take our own mental temperature or watch for pressure building up in ourselves or those around us. When we send our kids off to soccer camp or they start participating in hobbies, another important place – your art and passion is an expression of you – lets add some meaning to that or when we say we play as a team, what does that truly mean and how does it transcend from the field and a scoreboard to how we live our lives?

I will beat the drum here, well the second drum because I already beat one into oblivion getting to this point, but we need to all beat the drum and come together – our collective energy is needed to take more aggressive steps to help others deal with just that, the internal aggressions, doubt, fear, hate that they have inside. For their own benefit and to tamp down the collateral damage to our families and social and work-environments that result from mental health issues, you know from a selfish standpoint – you and many around you are likely saying “I am mentally stable, why do I care if we help a bunch of cuckoos anyways.” Well, society is a singular collective, its all of ours, our society, money and disorder – a parallel to the mindset shift needed.

And if we want to close the loop on this where we started, financially speaking, the return on investment is perhaps the biggest spark in all of this. A $200 million blowout budget big-screen thriller is cheap when you consider the $2 billion revenue return. In this story we have a better return than 10X opportunity and surely the downside risk is more daunting, an endless pit and all-consuming, entropic.

I am a geek, I love to learn and do research, so here is some research to make the point about mental health, the depths of the issue and opportunity to avoid future impact – its not just about telling a story, the data speaks volumes and has so much more power than any eloquent and sneaky complex plot. Check out this article: The economic costs of mental disorders. Do our societies react appropriately to the burden of mental disorders?

Sebastian Trautmann, Jürgen Rehm, and Hans‐Ulrich Wittchen

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007565/

Interesting starting statistic in this article, far higher than the 20% statistic I have commonly seen: up to 50% of the general population in middle- and high-income countries will suffer from at least one mental disorder at some point in their lives. Flip a coin with your wife, husband, best friend and see who is the winner there. I call heads!

Mental health and substance abuse disorders constituted 10.4% of the global burden of disease and were the leading cause of years lived with disability among all disease groups.

A lot of very smart people have completed very complex analyses on this topic of mental health and societal, economic burden. The conclusion which we don’t want to discuss or face is that mental disorders account for more economic costs than diseases such as cancer or diabetes. Here we can talk about direct and indirect costs (the scarier and more significant invisible costs, think about the iceberg visual and that you can only see 20% of the total mass that lies below the surface of the water). Reminds me also of countless horrific work-related discussions where we talk about our staffing levels, direct and indirect labor – they are all heads and they are all dollars regardless of how you bucket them.

When I say many complex analyses have been completed to evaluate mental health impact, there’s even different approaches to come to that all-important bottom-line number: the human capital approach – direct and indirect costs in the form of medication, hospital visits, productivity and income lost. Then there is the economic growth model – where depletion of capital and depletion of labor lead to lost GDP, an aggregate significant impact on our society’s output. And finally, perhaps the most challenging and morbid one, the value of statistical life approach or VSL approach. [You know its nasty when they have to hide the true words and definition behind an acronym to dehumanize and soften it up.] Well, VSL is all about risk, so talk to your local insurance agent about this, will we see mental health insurance come into play in the future, you bet it will because there is an enormous market here, one that is rocketing higher too – how much am I willing to pay to combat all the losses because my head is screwed on backwards, the lost income, medical costs and what is my life truly intrinsically worth? Aflac duck enters from stage left. Or play it even more below the belt, how much will I pay to insure against the mental health collapse of my loved ones – ouch, that is like pet health insurance commercial where they show you the irresistibly cuddly and playful labradoodle, now in a cast. Forget planning for a rainy day, we are talking about lifting the fog. A book in itself, funded by the National Association of Insurance Providers of America Coalition. There is no simple way to calculate the tradeoffs between money and the damage that mental health disorders can do. The death risk, the severe disability and tangential impacts they are large and avoiding them infinitely valuable. Even more than we allow ourselves to not ignore, and we ignore most of the issue and impact. The direct and indirect impacts are staggering.

The world revolves around money and numbers, so from the human capital cost standpoint (direct impacts like medication and hospital, doctor visits; indirect impacts like disability, care seeking, lost productivity due to work absence or disappearance from the workforce) the global number in 2010 was a staggering $2.5 trillion dollars total bill for mental health disorders. And with inflation and all that, we are likely looking at over $6 trillion annually by 2030. And unlike many other diseases, cancer, cardiovascular disease, the indirect costs of mental health ($1.7 trillion) far outweigh the direct costs ($0.8 trillion, 2010 comparison here). So that’s model 1 of 3, the human capital cost perspective. And the breakdown shows that the impact is much more significant on society vs. the sufferer.

In the economic growth model, we hit $16.3 trillion for annual worldwide mental health impact – a much bigger number, where mental health impacts both labor and capital, burning the candle wick from both ends. The burning hot wax is screaming, the candle has no chance of survival, flame soon to be extinguished. Then there is the third and final model, the VSL model which also hangs a staggering number on the scoreboard for mental health at $16.1 trillion annual worldwide. In relative terms, when you apply the VSL model, mental disorders are responsible for more total cost than any other disease group (almost 4 times the cost of cancer, diabetes or chronic respiratory diseases which each are about $2-2.5 trillion each, and mental health comes in just larger than cardiovascular diseases, both around $8.5 trillion in 2010 dollars (again that number doubles or triples when we get to 2030, a time and a place not far off).

Regardless of which of the three models you believe or gravitate to, they all show the same thing here: mental health is a bigger health concern than any other disease class. And because of the monetary size, we have a lot of money to play with to fix this and still know we are saving – they say you gotta spend to save baby. The only way to save $5k a year on delicious wine is to spend $30k!

Here’s an example from the VSL approach:

suppose that the average lifetime risk of dying from a depressive disorder is 15 in 1,000. Suppose further that there are measures that could reduce that risk to 5 in 1,000. If people of a certain population are willing to spend on average US$50,000 for these measures, VSL in that population would be US$5 million ($50,000/[(15–5)/1,000]). The same logic can also be applied when evaluating the willingness to monetarily pay in order to avoid living with a certain disease.

I would argue that is still cheap, you just saved 10 lives when we are talking about depressive disorders and mental health along with all you saved along the way for all 15 people that represents cost avoidance for the rest of the 1,000 people. Because we are all part of one society and whether you are sick or not in terms of mental health, you are paying for it in numerous ways, five ways or seven others.

To go further, look for evidence that confirms or denies my theory that we are ignoring mental health, we don’t want to face this beast, perhaps we don’t realize the significance and impact. No, we realize it, we just don’t want to face it, enter the ring against such a strong and prevalent beast. The undefeated entropy monster. Well if you follow the money you can usually find the truth, regardless of what is being said or how we like to slant things – my thought and theory to prove or disprove is this: that we do not place the appropriate resources necessary to combat this disease and sickness, an exhibit A in the case for our guilt and shame in the ongoing crime of ignoring mental health. And it’s a logical theory given how many of us look into a crystal clear mirror every morning and ignore what we truly see, how many of us mute the words and message in our heads, projecting outwardly something drastically different than our true internal realities.

So from the above analysis, we see that the top 2 disease classes, roughly equal in magnitude worldwide by three different methods of evaluation, are cardiovascular and mental health. Then we see a rough tie between diabetes and cancer at 1/4th the magnitude. These are the big four categories, of course there are many others but they are pennies on the dollar. So lets focus our analysis on the big four: cardiovascular, mental health, cancer and diabetes. So for every $10 of investment we have at our disposal to devote to treatment, research and advancing our charge against these devastating classes of illness, you would think that $4 should go to cardiovascular, $4 should go to mental health, and $1 should go to each diabetes and cancer. Pretty simple, we invest proportionally to the significance of the issue and the magnitude of the reward (or magnitude of the risk we can alleviate). That is pretty simple logic to me.

How much is invested in each of these disease classes relative to mental health? And I will go with US dollars and statistics as there is an expected wide noise in the data when you try to globalize spend.

Each year in the US we spend the following to manage, advance against the largest impact disease states:

Cardiovascular: $320 billion annually (15% of healthcare spend in 2016). Source: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.053216

Diabetes: $237 billion direct plus $90 billion in reduced productivity (those indirect costs surfacing again, 2017 numbers). The articles says 25% of healthcare spend in the US, coming from the ADA in a 2017 analysis published in Diabetes Care. Source: https://www.cdc.gov/chronicdisease/programs-impact/pop/diabetes.htm

The article also presents one of those grim concepts that has to be acronymized QALY (quality-adjusted life year or how much we are willing to spend to give someone another year of life, and that is recognized as $50,000; so your life if you live to the average expectancy of 75 in the US is worth $3.75 million.

Cancer: $209 billion in 2020 dollars (or $190 billion in 2015 dollars). Source: https://progressreport.cancer.gov/after/economic_burden

Mental health: $225 billion in 2019 dollars. Source: https://www.nami.org/Press-Media/In-The-News/2021/What-you-need-to-know-about-the-cost-and-accessibility-of-mental-health-care-in-America?feed=In-the-news

Ok so the numbers are not exactly from the same year and the same source, but good enough to make our point and if we want to get the last 2% of value out of this we can dive deeper into the numbers on healthcare spend. But I have all the information needed here to make the primary point with 98% accuracy, value and volume for you to listen up and think about it. Lets just say for arguments sake we normalize the data above to $330 billion spent on cardiovascular, $240 billion spent on diabetes, $200 billion spent on cancer and $230 billion spent on mental health. That adds up to a total annual spend of $1 trillion – awesome how that comes out to such a nice round number, its like magic and I didn’t back calculate it, truly I just took the data and normalized as best I could considering the years the data corresponded to. There is a magic working here, more on that as we go.

The ’cut the pieces of the pie’ breakdown of the $1trillion annual spend tells us we have a 33% spend on cardiovascular, followed by 24% on diabetes, 23% spend on mental health and 20% on cancer. Going back to our $10 in our pocket perspective we have $3.3 for cardiovascular, $2.4 on diabetes, $2.3 on mental health and $2 on cancer and lets compare that to what we theoretically should spend when looking at the opportunity for each ($4 or 40% each for cardiovascular and mental health, $1 or 10% each for cancer and diabetes). Who got a big piece of pie when they shouldn’t have and who got just a sliver for a taste?

For cardiovascular we are underspending by $0.70 and we are highly underspending by $1.7 on mental health. Conversely, we are overspending on cancer by $1 and diabetes by $1.4. In terms of percent over/under target spend we have the following and here comes the Ah Ha moment:

· Cardiovascular: underfunded by 21% (we should spend 1/5 more than we do)

· Diabetes: overfunded by 140% (we spend 1.4 times more than we should - wow)

· Cancer: overfunded by 100% (we spend twice as much as we should)

· Mental health: underfunded by 73% (we should spend ¾ more than we do)

Pretty clear picture here for me, we are drastically overfunding cancer and diabetes, mildly underfunding cardiovascular disease and drastically underfunding mental health. The analysis is simple, well-source and proved my thought and gut/intuition with data and facts pretty clearly. We need to devote at least another $150 billion a year to mental health targets in the US each year. So over the last 10 years we have missed $1.5 trillion of mental health impact. So what do we owe the 20% of our society in the US (conservative estimate, as it may be up to 50% of us) for looking the other way or only filling their cups half full for the last 10 years: we owe each of you $25,000 and oh when you go back to that nasty little acronym from the diabetes article, QALY – the quality-adjusted life year, we owe each mental health sufferer 6 months of life each decade. We have thrown away 30 million years of life, we have discarded that much life, lost due to mental health disease in just the last decade in the US because we are allocating our focus incorrectly. That makes the point pretty loud and clear for me.

And for diabetes, half of this is our sugar addiction – isn’t that a mental health thing, control, addiction? I won’t touch that candy here, but will surely come back to it.

That is where you end up on the map when navigating from putting your money where your mouth is, or what song you hear when you let your spend and money speak for your heart or mind (I guess figuratively and literally that is the case here). Our perceptions are skewed to the sugar-rush and cancers of reality but blind to our head predominantly and also not fully listening to our hearts. So I think we have learned something from putting our ear up to the microphone that our wallets speak into. But to be sure we are hearing the message loud and clear, we must go further and take a second look, approach this from a different perspective. I love triangulation – so I will work on other analyses in subsequent posts.

I have the thought already: another way to look at this, lets see what the public thinks as total spend in the above analysis is mainly government sourced and we all know (without bias or conflict of interest and can agree bi-partisanly on this) our government is very detached from reality and their make-up and mindset in no way represent the America they are designed to be representing. More on that later too - compare diversity and age and economic status in Congress vs average Jane’s and Joe’s. Now that will really give us all a mental health disorder.

Ok, so jumping back up from the depths of financial analysis, and closing out the article “The economic costs of mental disorders” I love this part at the end of the article:

(and we should close for now because this is approaching book chapterville when this was meant as a blogger)

Society, politicians, and stakeholders have to be consistently and persistently informed about the true burden of mental disorders, including the individual burden and the full range of potential economic costs, but also about the effectiveness, the feasibility, and affordability of measures to reduce that burden. If we continue to take these actions, society will hopefully be more willing to come to accept that spending money for preventing and treating mental disorders is a sustainable investment.

Go to:

Conflict of interest

The authors declare that they have no conflict of interest.

This is not partisan, biased or conflicted – this is a unanimous direction to go in. And lets just keep that $16 trillion dollar global annual cost for 2030 in our heads and move forward with that in our pocket – a weighty reminder of the magnitude of opportunity with increasing our focus on mental health.

What other topic can you find where there is no conflict of interest, a very rare thing today. And doesn’t that speak to how critical solving this issue really is, everyone is at risk, everyone will benefit tremendously. You can’t eat something, love something, or build anything, anywhere without stepping on toes or causing an argument, unless you are talking about eating up mental disorders, loving the process that saves your neighbor, wife or child, building bridges out of lonely heads and dark caves, taking a few bites out of the elephant. And again, that elephant is the nasty little entropy beast inside my head, the inability to get out of your own head and walk through a clear day, no blanket of fog engulfing you, that elephant is likely the weight you can help lift off of your best friend or lover, father or daughter, it surely is represented by the famous painter and mental health advocate David Choe’s Munko (munko.com). Munko, now that is a good name, but what does it mean - you have to look that up for yourself, I’ve already done my goggling and reflection but need time to process it all. Now I’ve eluded to David Choe already a few time and we will soon find ourselves in the belly of Munko painting with Choe on the beast’s intestinal walls before this story is finished, trust me on that.

This is a call to action and for change, we cannot allow, we must not allow our current disregard and ignorance, inability to face the beast of mental health to become our societal Munko move. [A Munko move is when a game player does something so elaborate, but also incredibly stupid that the game player either kills themself or gets themself killed in a pretty stupid way.]

"Munko has no arms or legs, but don't take pity and cry for her. He is here, she is there, he is everywhere all at once. She is him and he is her, she is chubby little baby and 2 billion year old wise wizard. She can transform and shape shift into your wildest wet dream or your worst nightmare. She is selfish and cares nothing about you. Fuck your stupid problems, fuck your feelings, but also loves you and cares about you and puts more importance on you, more than anyone In your life, I love you I love you I love you. The black hole in her head eats all the pain and darkness in the world. She believes all her strength knowledge and luck comes from his only tooth, but in reality it's the sole survivor of her over active sweet tooth. Munko is simple in form and mind and shape, yet so complex living on many levels and realities, not so simple that he can't feel multiple emotions and contradicting feelings and opinions all at once. She is telepathic and can read your deepest darkest thoughts, you cannot hide or lie to Munko, when you are with Munko you just be, and you will finally be at peace with your fucking self. " —David Choe