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Managing the Toll of Serious Illness on Mental Health

managing the toll of serious illness on mental health

People with severe physical health problems confront a range of challenges, which can include mental health issues. According to a recent survey led by researchers at the Harvard T.H. Chan School of Public Health, the New York Times, and the Commonwealth Fund, more than half (56%) of those who’ve had a serious medical condition, two or more hospitals stays, and visits with three or more doctors within the past three years report anxiety, depression, or emotional or psychological problems resulting from their illness.

We know from previous research that serious medical conditions and such mental health problems can exacerbate one another. A condition such as depression can make it harder to manage chronic conditions like diabetes, for example. The reverse is also true; grappling with an illness such as cancer can worsen anxiety and depression.

Here, we examine the challenges faced by people coping with serious physical health conditions compounded by emotional or psychological problems. We find that while many people who have a serious physical health condition experience these challenges, those who also have emotional or psychological problems fare worse.

What Challenges Do the Seriously Ill with Mental Health Issues Face?

Among people with serious illness, those reporting mental health issues were more likely to:

Feel socially isolated. They are more likely than others to lack companionship, left out, or are isolated (49% vs. 12%). As social isolation has been linked to health problems and an increased risk of mortality, those with serious physical illness and mental health issues may be at even greater risk.

Experience financial vulnerabilities. People with serious illness and mental health issues are financially vulnerable. First, they have lower incomes than people with serious illness without mental health issues: more than half (52%) make less than $25,000 dollars a year (versus 29% of those without mental health issues). Second, they are less likely to be able to work: among people with serious illness and mental health issues, 74 percent report having a long-term disability that keeps them from work, school, housework, or other activities, compared with 53 percent among those without mental health issues.

In addition, those with serious illness and mental health issues are more likely to report they lost or had to change jobs, were unable to do their job as well as before, or wanted to work but were unable to do so. Moreover, those with mental health issues report using all or most of their savings as a result of their medical condition at a rate nearly three times higher than seriously ill people without mental health issues. Lacking income and savings, people with serious illness and mental health issues could wind up with long-term financial problems.

Experience problems with their health care. The health care system may unintentionally add to the challenges faced by people with serious illness and mental health issues. They feel helpless, anxious, or confused when receiving care at a rate nearly twice as high as their counterparts do (79% vs. 41%) and are much more likely to experience a significant problem (72% vs. 41%), such as not understanding what was being done to them, receiving conflicting recommendations from providers, or feeling providers were not responsive to their needs. These poor experiences with health care could lead to distrust, avoidance, and missed opportunities to get the best treatment for their medical conditions.

What Can Health Care Systems Do?

People with serious illness have intense and repeated interactions with the health care system, but their mental health concerns and other problems, like social isolation and financial stress, too often go unseen and unaddressed. Nevertheless, some creative organizations are reimagining care to better support their needs and reduce the confusion of the health care system:

  • Commonwealth Care Alliance (CCA), a Medicare Advantage special needs plan, uses interprofessional care teams and a flexible benefit design to identify and address the mental and social needs of people with serious illness or disability. CCA connects patients to mental health treatment and provides social supports at no cost, such as transportation and air conditioning, to those that need them. They also engage patients and caregivers in their treatment planning and coordinate care for them to reduce the burden of navigating the health care system. The program has improved adherence and receipt of mental health care for complex patients, and reduced emergency department visits and hospitalizations.
  • CareMore, a California-based Medicare Advantage plan, established care centers with multidisciplinary teams that work closely together and integrate behavioral health services into physical health care. A key feature of the program is close care coordination, which helps people with serious illness navigate the health care system and reduces their confusion. In addition, CareMore tackles social isolation among their complex patients by providing them with “togetherness connectors” that regularly check in on them and encourage them to spend time with others in their community. The program so far has improved health outcomes and decreased spending by reducing costly hospitalizations.

More information and resources including promising care models and practical tools can be found on The Better Care Playbook, a repository of resources to guide those seeking to improve care for people with complex needs.

People with serious illness and mental health issues are unnecessarily burdened by the current health care system and their care may be unnecessarily costly. As health care providers and insurers seek to improve care while controlling costs, focusing on better and more coordinated care for those with serious medical conditions and mental health issues should be part of the solution.

Learn more about the “Health Care in America: The Experience of People with Serious Illness” survey, including methodology and additional findings.

Publication Details

Publication Date: January 10, 2019

Corinne Lewis, Mekdes Tsega, and Eric C. Schneider, "Managing the Toll of Serious Illness on Mental Health," To the Point (blog), Commonwealth Fund, January 10, 2019.


Corinne Lewis
Program Officer, Delivery System Reform, The Commonwealth Fund
Mekdes Tsega
Program Associate, Delivery System Reform, The Commonwealth Fund
Eric C. Schneider, M.D.
Senior Vice President for Policy and Research, The Commonwealth Fund