pression roughly triples one’s risk of dying from a future attack or other heart condition (Bush et al., 2005).

Evidence is mounting that M/SU problems and illnesses result in a considerable burden on the workplace and cost to employers owing to absenteeism, “presenteeism” (attending work with symptoms that impair performance), days of disability, and “critical incidents,” such as on-the-job accidents (Burton et al., 2004; Goetzel et al., 2002; Kessler et al., 2001).

M/SU problems and illnesses lead to poor educational achievement by children (Green and Goldwyn, 2002; Weinfield et al., 1999; Zeanah et al., 2003), which itself breeds emotional and behavioral problems. Children with poor school achievement are at risk for delinquent and antisocial behavior (Yoshikawa, 1995) and for dropping out of school and rapid, repeated adolescent pregnancies (Linares et al., 1991).

M/SU problems and illnesses also shape the nation’s child welfare system. Almost 48 percent of a nationally representative sample of children aged 2–14 who were investigated by child welfare services in 1999–2000 had a clinically significant need for mental health care (Burns et al., 2004). Because of limitations of insurance for mental health care, some families resort to placing their severely mentally ill children in the child welfare system, even though the children are not neglected or abused, to secure mental health services otherwise unavailable (GAO, 2003); parents who take this step must sometimes give up custody of their children (Giliberti and Schulzinger, 2000).

Similarly, children who are not guilty of any offense are often placed in local juvenile justice systems or incarcerated for the same purpose. The U.S. Government Accountability Office counted about 9,000 children who entered state and local juvenile justice systems under those circumstances in 2001 but estimated that the number of such children was likely to be higher (GAO, 2003). The emotional toll on the children is high. Some 48 percent of facilities that hold youths awaiting community mental health services report suicide attempts among them (U.S. House of Representatives, 2004).

The proportion of adult U.S. residents incarcerated has been increasing annually—from a rate of 601 persons in custody per 100,000 U.S. residents in 1995 to 715 per 100,000 in 2003. In the middle of 2003, the nation’s prisons and jails held 2,078,570 persons—one in every 140 residents (Harrison and Karberg, 2004). The U.S. Bureau of Justice Statistics estimates that about 16 percent of all persons in jails and prisons report either having a mental disorder or staying overnight in a psychiatric facility (Mumola, 1999). Overall, the costs of providing no or ineffective treatment—as well as the costs of treatment—impose a sizable burden on the nation.



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