Justin Frewen & Anna Datta (Dr.) — When discussing mental health, it is common to focus on the distress and suffering mental health problems may cause together with the most appropriate manner by which society might respond. The human rights entitlements of mental health service users have also begun to receive far greater attention in the past couple of decades.
For many, these facts alone should serve as sufficient justification to ensure the deployment of the required resources to cater for the needs of every mental health service user. The harsh reality, however, is that such arguments frequently prove insufficient to mobilise the political and social will required to ensure the enactment of essential reforms.
One of the principal obstacles to mental health receiving sufficient public resources is the ever increasing and conflicting demands being placed on state resources. During a recession, like the one we are now experiencing, these demands become ever more intense.
In such an environment, economic arguments tend to come to the fore. While it may be argued that an effective and responsive mental health system should be a priority, others will counter by claiming that although this may be so, there are simply insufficient funds available to do so right now. It is therefore crucial that the case for improved mental health services should be supported by economic arguments.
As Brid O’Connor, CEO of the Irish Mental Health Commission, stated at the launching of Eamon O’Shea and Brendan Kennelly´s 2008 report on The Economics of Mental Health Care in Ireland:
“Resources are not infinite, so choices must be made between alternative uses of the same resource or service… As the report says, ’economic analysis is therefore a crucial aid to decision making on resource allocation and on priority setting’. While decisions on resource allocation are grounded in values, economics is a central tool in the making of these decisions.”
In short, calculating the economic cost of mental illness provides crucial information, which will help inform and improve comparison between different policy options and implementation plans.
Indeed, there is an ever increasing volume of research which demonstrates that the failure to effectively address mental health concerns can result in significant economic repercussions. International studies undertaken both inside and outside the European Union are virtually unanimous in this respect.
The past few decades have seen a constant rise in the overall global burden of mental health problems. At the turn of the third millennium, the World Health Organization (WHO) estimated that mental health problems were at an aggregate point prevalence of approximately 10% of all adults worldwide or 450 million people. In 2000 alone health issues emanating from mental and behavioural factors, resulted in some 12% of disability-adjusted life years (DALYs) lost through disease and injuries. Moreover, it was calculated that this figure would soar to 15% by 2020, a 25% increase in just 20 years. Worst of all, only a minute percentage of people experiencing mental health problems received any treatment.
To properly evaluate the costs of mental health, it is not enough to simply consider the costs involved in providing mental health services through the public health system. The broader economic impact of mental health problems on society must also be taken into account.
In terms of economic cost, a 2000 International Labour Organization (ILO) study – Mental Health in the Workplace – estimated that mental health could cost as much as 3 to 4% of the GNP of EU states.
A 2004 study by Sobocki et al – The Cost of Depression in Europe – calculated that depression alone had an economic cost for the EU25 and European Free Trade Agreement (EFTA) countries of up to €118 billion or €253 per person. Almost two thirds of these costs arose as a direct result of lost productivity through early retirement, premature mortality or sick leave. Therefore, healthcare costs only comprised a minority of these costs.
The European Commission (EC) strategy – Together for Health – stresses the importance of good health in terms of improving economic output and prosperity. These factors are shown to not only be critical with respect to life expectancy but also as one of the crucial factors in improving overall economic performance.
However, these studies fail to take into account the human and social costs of mental health issues. One such analysis which did provide an economic weighting for the social costs of mental health was the UK´s Sainsbury Centre for Mental Health´s policy paper – The Economic and Social Costs of Mental Health.
In addition to calculating the health, social care and lost economic output costs, this paper examined the human costs of mental health issues, which corresponded to the “adverse effects of mental illness on the health-related quality of life.” Taking 2002-3 as its base period, this report calculated the total cost of mental health problems to the English economy at £77 billion.
The expenditure on NHS mental health services comprised a mere 10% of this total at £7.9 billion. Even when the £3.9 million in estimated costs for providing informal care for people with mental health problems was added, to give a total of £11.8 billion, the economic costs far outweighed these costs at £23.1 billion.
However, the economic evaluation of the human cost of mental health is of greatest significance. According to this report, the human costs of mental illness in economic terms are £41.8 billion or 54% of the total estimated cost of mental health problems in England for 2002-3 of £77.4 billion.
While the report acknowledges that this calculation should be regarded as “experimental”, it can be justified on the grounds that it is clearly wrong to “ascribe a zero value to the human costs of mental illness.” Furthermore, this approach would enable the taking into consideration of the effect of mental health issues on individuals who are not part of the labour market, including older people and children.
The economic evaluation of the cost of mental health issues is therefore beneficial in a number of ways. Primarily, it serves as a reminder that failure to invest seriously in mental health, not only in provision of public mental health services but also in tackling the determinants of mental health, can have serious economic consequences for society.
In addition, it highlight the significance and relative priority of various mental health problems through providing an economic measure of their importance. This will facilitate an improved level of debate as to where mental health service resources might optimally be invested.
Economic analysis can also help gauge the actual costs of mental ill-health with respect to different social categories. This analysis would assist decision-making on how best to allocate the available mental health funding and resources. Finally, increased and well-targeted investment in mental health has the potential to pay for itself many times over.
References
1. WHO (2001) Mental Health: New Understanding, New Hope (The World Health Report 2001) WHO: Geneva
2. Gabriel, P. & Liimatainen, R-M. (2000) Mental health in the workplace. International Labour Office: Geneva
http://www.ilo.org/wcmsp5/groups/public/—ed_emp/—ifp_skills/documents/publication/wcms_108221.pdf
3. EC (2007) Together for Health: A Strategic Approach for the EU 2008-2013. European Commission: Brussels
4. Sobocki, P., Jonsson, B., Angst, J. & Rehnberg, C. (2006) ‘The Cost of Depression in Europe’. Journal of Mental Health Policy Economics. 9(2): 87-98
5. SCMH (2003) The economic and social costs of mental illness: Policy Paper 3. The Sainsbury Centre for Mental Health. http://www.scmh.org.uk/pdfs/costs_of_mental_illness_policy_paper_3.pdf
Related news articles:
1 Comment