A Painful Price

March 16, 2016

By Anthony Moore

image of Don Shepard and colleague in office

On the surface, suicide seems like an intensely private problem. The very word conjures images of isolation, shame and secrecy. Its impacts, though severe, appear confined to an individual, a single family. Their loss is highly personal and impossible to quantify.

Yet for Donald Shepard, a professor at the Heller School’s Schneider Institutes for Health Policy, the key to attacking this national health issue that claims more than 40,000 Americans annually is to place it in a public context—one that assesses suicide’s cost not in emotions but rather in dollars and cents.

“Putting a monetary value on a problem calls attention to it,” explains Shepard, a health economist who has probed the economic impact of malaria, HIV/AIDS, food insecurity, and drug addiction. “That allows you to make comparisons between the cost of the resources needed to mitigate the problem and the enormity of the problem itself.” And that, he knows, is the surest way to get key decision-makers to pay attention.

To put that monetary value on suicide, Shepard recently teamed up with four other researchers: Deborah Gurewich from the University of Massachusetts, Aung Lwin from Heller, and Gerald Reed and Morton Silverman from the Education Development Center.  They published “Suicide and Suicidal Attempts in the United States: Costs and Policy Implications,” a cost-estimation study, in Suicide and Life-Threatening Behavior, the official journal of the American Association of Suicidology. What they found is that the true public price of suicide and suicidal attempts in the U.S. is roughly $93.5 billion—more than twice the previously published estimate.

“The magnitude was much larger than we had previously thought,” says Shepard, noting that the Centers for Disease Control and Prevention recently updated its own estimate of the public costs of suicide. “The problem—and just how big it is in terms of economic costs—has been substantially underestimated.”

The most significant reason for this, the study found, is related to our cultural treatment of suicide as a private and often hidden health issue. “With every problem, getting accurate data is a challenge, and that was the case with suicide,” says Shepard. “Most counts understate the total numbers of suicides due to the stigma involved. I knew that this could be a challenge from my work with alcohol and drug abuse, which are also underreported for the same reason.”

To adjust for this challenge, Shepard and his team tapped research that quantified the misclassification of suicide in the United Kingdom. Applying this to the most recent U.S. suicide data (from 2013), they compensated for the significant number of deaths that coroners fail to identify as suicides, particularly among teens and minorities. Then they put a price tag on this new higher suicide number by calculating direct medical expenses as well as indirect costs such as lost wages resulting from premature death and injury (in the case of attempted suicide).

Shepard’s study went beyond the numbers to assess how hospitals and health care workers can better combat suicide. Through interviews with emergency department employees, the research team found that hospitals and community providers can do more to assist potential suicide victims find help, given that there are 9.6 intentional self-injuries for every death by suicide.

“There are 395,000 self-inflicted injuries—or suicide attempts—each year, compared to 41,000 reported suicides,” he explains. “In my view, the public health system fails to properly treat those attempts. A system that treats those events as warning signs and does a better job connecting those people to care could address the underlying problems and reduce the likelihood that they make a subsequent attempt.”

If this study has the impact Shepard wants, then that’s exactly the kind of system the U.S. healthcare system will someday have. But he’s not counting on goodwill alone to move the needle on this issue; he’s looking at the bottom line. By enhancing connections between psychotherapy and emergency care, the study estimates, we could cut suicides by 10 percent nationally, which would represent $9.4 billion in savings annually—more than twice the estimated cost of implementing the interventions. It would also save 4,100 lives each year.

So while the prospect of attaching dollars to an issue as personal and sensitive as suicide might first seem inappropriate, it’s the surest way to advocate for a change in policy that could reach far beyond finance.

“This study would help to say, regardless of your politics, that these recommendations would make good economic sense,” says Shepard. “More importantly, they might also save some lives.”