Average annual earned income for people with serious mental illness was $16,306 less per person than for others in 2001–2003. The analysis of data from the National Comorbidity Survey Replication by Kessler et al. (CME, p. 703) reveals that only one-fourth of the lost earnings was due to unemployment among respondents with serious mental illness. Most was accounted for by lower earnings among the employed. Serious mental illness was assessed for the 12 months preceding the survey interview and was defined as nonaffective psychosis, bipolar disorder, seriously impairing depression or panic disorder, serious suicide attempt, impulse control disorder with repeated serious violence, or other disorder causing 30 days or more of missed role performance. The total lost earnings for the entire U.S. population of seriously mentally ill are estimated as $193 billion, more than this year’s federal economic stimulus payments. Dr. Thomas Insel discusses the total economic cost of serious mental illness in an editorial on p. 663.