CLINICAL HANDBOOK OF SCHIZOPHRENIA

510 VII. POLICY, LEGAL, AND SOCIAL ISSUESwithout chronic conditions (Clark, 1994). Family expenditures for members with schizophreniawere more often for daily maintenance needs and less likely to involve investmentssuch as support for education or assistance in purchasing a home. Because informalfamily care appears to be linked with use of formal mental health care, reductions inpublic spending may shift costs to family members.Costs of Physical and Emotional SufferingEstimating the monetary value of physical suffering and emotional distress, also referred toas intangible costs, is a very new area of health economics research. One study has arguedthat people with schizophrenia can distinguish, assess, and place utility rankings or willingnessto pay amounts for improved health status (Voruganti et al., 2000). This study suggestedthat the cost of physical and emotional burden of schizophrenia is considerable: Willingnessto pay to maintain current health status was more than $2,000 (Canadian) per year.Criminal Justice CostsThe deinstitutionalization and transition to community-based care has led to a welldocumentedrise in encounters of people with severe mental illnesses with the criminal justicesystem. Individuals with schizophrenia are much more likely to be arrested andcharged with a crime, and prevalence of severe mental illness in prisons is two to threetimes higher than that in the general population. Criminal justice costs are incurred for lawenforcement, legal defense, and incarceration. Updated estimates of these costs are unavailable,but an older study reported a total cost of $464 million in 1990 (Rice & Miller,1996). Legal system encounters among people with severe mental illnesses are uneven, with asmall group of people incurring the majority of encounters and related law enforcementcosts.The costs of schizophrenia in the United States are summarized in Table 48.1.COST-EFFECTIVENESSThe value of specific pharmacological or psychosocial interventions is grounded in their evidence-basedability to improve symptoms, social functioning, or quality of life. Cost-effec-TABLE 48.1. The Cost of Schizophrenia in the United StatesCost $, billion Diagnostic group Study (year)Direct 85 in 2001 All mental disorders Mark et al. (2005)Drugs 18 in 2001Other outpatient 45 in 2001Inpatient 19 in 2001Residential 17 in 2001Indirect Schizophrenia Rice (1999)Morbidity 10.7 in 1990Mortality 1.3 in 1990Informal caregiving 2.5 in 1990Criminal justice 0.46 in 1990Intangible costs National estimatesnot available