The concept of delivering nutrient-rich meals directly to people who most need them, in an effort to decrease overall healthcare spending, has gained considerable momentum over the past several years. Those who have benefited the most include adults aging at home, people with disabilities remaining independent at home, people recovering after discharge from the hospital, and people struggling to manage one or more chronic conditions—like diabetes, heart disease, cancer and obesity. However, there is another group who may benefit greatly from programs like these: individuals with behavioral or mental health issues.
Behavioral health issues (including substance abuse and addictions) and mental health issues (such as depression, bipolar disorder and schizophrenia) are among the costliest conditions to manage.
The Agency for Healthcare Research and Quality reported that mental health and substance abuse cases accounted for 1 in 8 emergency room (ER) visits in the U.S. in 2010. According to the Centers for Disease Control and Prevention (CDC), one in five American adults will experience a mental illness in a given year, and one in 25 American adults currently lives with a serious mental illness. The Substance Abuse and Mental Health Services Administration (SAMHSA) published that in 2014, nearly eight million American adults battled both a mental health disorder and a substance use disorder, or co-occurring disorders.
Here’s where nutrition comes in. A common symptom characterized by behavioral and mental illnesses is a major change in eating habits.
Someone with depression or anxiety may experience a decrease or an increase in appetite and may skip meals or over-eat for emotional comfort. Alternately, people suffering from these and other conditions may feel too distracted or fatigued to prepare and consume healthy meals and snacks. Whether under- and over-eating, both scenarios can lead to poor nutritional status—which, in turn, can affect one’s mental health. In addition, when someone has not eaten or is malnourished, his or her medications may not be optimally absorbed or may cause controllable side-effects—such as stomach upset, which can impact medication efficacy and adherence.
Further, nutritional imbalances have been linked to depression. For example, vitamin B-12 and other B vitamins play a role in producing brain chemicals that affect mood and other brain functions. Low levels of B-12 and other B vitamins, such as vitamin B-6 and folate, may be linked to depression.” As another example, persons with bipolar disorder are believed to have lower levels of the chemical messenger serotonin, which can spark a craving for carbs and sweets.
Research studies have provided evidence of a strong link between mental illness, mental health and physical health—especially as it relates to chronic disease occurrence, course and treatment. For example, depression has been shown to affect the occurrence, treatment and outcome of several chronic diseases and conditions, including heart disease, diabetes, hypertension, cancer and obesity. (Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. Prev Chronic Dis. 2005;2(1):A14) The likelihood of depression increases with an increasing number of chronic conditions. Emerging evidence shows that positive mental health is associated with improved health outcomes. Researchers found a link between an upbeat mental state and improved health—including lower blood pressure, reduced risk for heart disease, healthier weight, better blood sugar levels and longer life.
A critical factor associated with both mental health and diet is poverty. A person’s mental health, and many common mental disorders, are shaped by various social, economic and physical environments throughout different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality, the higher the inequality in risk (Jessica Allen, Reuben Balfour, Ruth Bell & Michael Marmot (2014) Social determinants of mental health, International Review of Psychiatry, 26:4, 392-407, DOI: 10.3109/09540261.2014.928270)
Medicaid plays a key role in covering and financing behavioral health care. In 2015, Medicaid covered 21% of adults with mental illness, 26% of adults with serious mental illness (SMI), and 17% of adults with a substance abuse disorder (SUD). In comparison, Medicaid covered 14% of the general adult population. On a per-enrollee basis, average Medicaid spending for people with behavioral health diagnoses was nearly four times what it was for enrollees without these diagnoses ($13,303 versus $3,564). Medicare Advantage plans are also strongly impacted: Medicare plans pay for approximately 14% of mental health costs.
It’s clear that individuals struggling with behavioral and mental health issues require holistic programs of care. Addressing nutrition, along with food access through a fully prepared meal-delivery program, can help optimize member engagement, clinical outcomes and overall cost of care.