On March 24, 2015, the captain of Germanwings flight 9525 left the cockpit to use the restroom, while the flight was at cruising on the flight from Barcelona to Düsseldorf. In what was clearly a premeditated act, copilot Andreas Lubitz locked his captain out of the cockpit, and set the autopilot to 100 feet. The plane began descending from 38,000 feet at 10:31 am, at a rate of 3,500 feet per minute. While the pilot tried desperately to break into the cockpit on his return, the plane continued to descend until 10:41, when a wing clipped the mountain at 5,000 feet. Moments later the plane slammed into the mountainside at 403 miles per hour, killing Lubitz, the captain, four flight attendants, and 144 passengers [1].
Lubitz was later shown to have had a history of major depressive disorder, recurrent and severe. He was treated in 2010 and improved, but later deteriorated with intense suicidal thoughts. His employer knew about the history of depression, but accepted the doctor’s report of remission. Lubitz’s psychiatrist never told the employer about the relapse. Any number of circumstances could have changed and no one would have died that day.
When an act so heinous makes the news, the risks associated with behavioral disorders are thrown into stark relief. So, too, with Adam Lanza, the perpetrator of the Sandy Hook School massacre of 20 children and 6 adults, plus the murder of his mother. The problem is that these risks are hard, though not impossible, to intercept. And they are rare, which masks a much larger underlying problem.
One way to think about the real scope of the problem is by estimating costs, and they are staggering. In 2013 behavioral disorders topped the list of highest treatment costs for medical conditions in the US, for the first time, at an estimated $201 billion [2]. Most methodologies argue that the direct medical costs of a condition are about 30% of the total economic impact, with the remaining 70% ascribed to lost work productivity [3], bringing the total to $670 billion for those who are treated. That’s still not all, though, because we know that roughly 45-50% of behavioral illness is untreated [4], and even more is undertreated. So add another $500 billion, give or take, and the likely total economic impact of behavioral disorders is almost $1.4 trillion. With a “T.” In the US alone.
We haven’t even begun to consider the impacts of the more than over 1 million people worldwide who commit suicide each year (44,000 in the US alone), or any of the impacts to the families and coworkers around those with behavioral disorders. When I hear arguments that we can’t afford to manage behavioral health risks, my response is quite simple: we can’t afford not to.
[1] http://www.gq.com/story/germanwings-flight-9525-final-moments
[2] Roehrig C. Mental disorders top the list of the most costly conditions in the United States: $201 Billion. Health Aff, May 2016; 36(2):1659.
[3] Loeppke R, et al. Health and productivity as a business strategy: A multi-employer study. J Occ Envir Med, 2009; 51(4):411-428.
[4] http://mentalillnesspolicy.org/consequences/percentage-mentally-ill-untreated.html
About the Author: Dr. Les Kertay, Ph.D., ABPP, LP, a licensed and board certified clinical psychologist, provides clinical direction and perspective to all areas of R3 Continuum as chief medical officer. He brings extensive experience and expertise in the arena of mind-body health including disability medicine, chronic pain, health behaviors, and managing workplace absence. With over 15 years in executive leadership positions in the medical and vocational areas of the disability insurance industry, Dr. Kertay has presented at national and international conferences on topics related to the psychological aspects of work and disability, practical approaches to managing psychosocial issues in medical practice, pain management, somatoform and personality disorders, and professional ethics. Also, in addition to other publications, he is a contributor to three books on psychosocial aspects of complex disability claims and is lead editor for the AMA Guides to Navigating Disability Benefit Systems. Dr. Kertay is also a practic
