Highlights from the 2020 BMO Public Lecture: Child Mental Health as Human Capital
Graduate Student, SFU Department of Economics
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On October 23, Janet Currie, the Henry Putnam Professor of Economics and Public Affairs at Princeton University, spoke at the annual BMO Public Lecture, hosted online by SFU Public Square and the SFU Department of Economics.
As Currie succinctly phrased it, human capital is “wealth embodied in people.” Essentially, it is a mix of your skills, intelligence, health – and much more. Mental health is an often overlooked aspect of human capital, yet a large proportion of the population self-reports having mental health issues of some degree every month. Issues range from anxiety to depression and send thousands to the emergency room every year. These cases have wide-ranging implications for the world of economics, including days lost to work and poor labour market outcomes for those with mental health conditions – not to mention the emotional toll on them and their loved ones.
In her lecture, Currie described her novel research into mental health issues. She noted that these issues can often be traced to early in life, which can have long-lasting economic ramifications for individuals and society. To say that these issues can be traced to early in life is an understatement, as Currie’s previous work shows that mental health problems can even arise in utero. Her work measuring the mental health outcomes of siblings, which allowed her to reduce the bias that might stem from differences in upbringing, showed that children who had a maternal relative pass away while their parent was pregnant with them had a higher propensity to have attention deficit hyperactivity disorder (ADHD) when compared to those who had a maternal relative pass away shortly after they were born. This research strongly implies that there are prenatal links to mental health.
Currie also addressed why there have been more mental health diagnoses in recent years. This is easily explained, she said, by increased screening and knowledge about conditions, and is not limited to mental health but also applies to physical conditions, such as asthma.
Research on mental health treatment for adolescents
The cornerstone of Currie’s talk, however, dealt with whether mental health is being treated properly. In her new research, done in conjunction with Princeton graduate student Emily Cuddy, she used machine learning to evaluate the outcomes that different types of treatment have on the cost and outcomes of mental health.
Currie and Cuddy compared the treatment given to adolescents for mental health conditions based on their location within the United States. This allowed them to compare the density of different types of health care professionals between locations to determine whether this leads to differences in treatment.
As it stands, there are generally accepted standards of treatment for adolescents, usually beginning with therapy before moving on to drugs. Usually, a class of drugs that are considered dangerous or addictive are not meant to be prescribed for adolescents with mental health issues. Currie calls this class of drugs “red flag drugs,” which includes, as an example, benzodiazepines.
Currie and Cuddy found that treatment does indeed largely depend on the density of different health care professionals in the area where someone lives. Having a higher density of psychiatrists leads to more drugs being prescribed, often without first using therapy, whereas higher densities of psychologists usually lead to treatment starting with therapy. This is a fascinating discovery, especially since Currie and Cuddy were careful to use an accepted standard for treatment as the baseline. If the standard for treatment is not being followed based on the available health care professionals in a given location, then those adolescents with mental health conditions in that location are not receiving the same level of care. However, the most troubling aspect of Currie’s lecture was her revelation that red flag drugs are heavily prescribed to adolescents despite improvements in other therapeutics.
Q&A: Red flag drugs, COVID-19 and child mental health
In the Q&A period following the lecture, Currie answered a broad array of questions on the topic of mental health. There was significant interest in the effects that COVID-19 might have on mental health, specifically with regards to children in school. Currie believes that the effects will likely be mixed, with some children excelling and others struggling. These effects may even be mixed within families. She does, however, foresee that the current situation could exacerbate existing mental health conditions.
Addressing questions about the reasons for the overprescription of red flag drugs, she noted that despite her prior assumption that these drugs were being pushed by the pharmaceutical industry, there is little evidence of a marketing effort leading to such a conclusion. Many of these red flag drugs have been on the market for a long time and are no longer under patent. Rather, Currie noted that the high levels of prescriptions in certain areas more likely have to do with the comfort level of doctors who have been prescribing these drugs for a long time. As such, these doctors may suffer from imperfect information as they are not aware of advances in treatment that have occurred in recent decades.
Currie’s fascinating lecture raised serious concerns about whether mental health issues are being treated properly by the American health care system. Her research provides ample evidence that continual education is needed for mental health care providers to ensure that they do not provide inappropriate treatment due to a lack of information.
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