The Economic Costs of Mental Health
In discussing mental health, we tend to focus on issues such as the distress and suffering of mental health service users as well as the most appropriate manner in which we might respond to their needs. The human rights of mental health service users are also a significant issue and have been assuming a more important role in this debate thanks to the efforts of bodies such as Amnesty International.
For most of us, these facts should in themselves provide sufficient justification to ensure the deployment of the required resources to cater for the needs of every mental health service user in Ireland. Indeed, there is surely a moral responsibility upon all of us to demand that a relatively wealthy nation such as ours, economic recession notwithstanding, allocates sufficient funding to guarantee the provision of an effective public mental health system.
However, the sad reality is that these arguments frequently prove inadequate to mobilise the political and social will to make sure the essential reforms are enacted. One of the principal obstacles in this respect is the ever increasing and conflicting demands as to the optimal allocation of the state’s resources with which the political community finds itself confronted. During a recession, such as we are now experiencing, these demands become ever more frantic.
In such an environment, arguments based upon economic factors are apt to come even more to the fore. While many will accept that an effective and responsive mental health system should be a priority of any society, others will counter by arguing that while this may be so, there are simply insufficient funds available to do so right now. It is imperative therefore that the case for improved mental health services should be supported by economic arguments.
As Brid O’Connor, CEO of the Mental Health Commission, stated at the launching of The Economics of Mental Health Care in Ireland report - prepared by Eamon O’Shea and Brendan Kennelly - in September 2008.
“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, figures for the total impact of mental illness provide a relevant and crucial context and background to improve the analysis of and comparison between policy options and implementation plans.
The World Health Organization (WHO) has been extremely clear in this respect also. In their 2005 report, The Economics of Mental Health in Europe, they emphasised the importance of taking into consideration the economic cost of mental health issues to society, given that they could amount to as much as 3 to 4% of the GNP of EU states.
According to the O´Shea and Kennelly report, mentioned above, mental health associated issues cost Ireland some €3 billion. Approximately one third of this figure was taken up with the provision of healthcare, social care and other forms of direct care while the remaining two thirds came from lost economic output. These are highly significant figures for an economy the size of Ireland´s and are surely worthy of serious consideration in the formulation of our public mental health policy and implementation plans.
Another study by Behan, Kennelly and O’Callaghan in 2008 calculated that schizophrenia alone in 2006 had an economic cost of €460.6 million. Again the cost of direct care (€117.5) was dwarfed by the indirect costs (€343 million). Lost productivity alone, due to unemployment, absence from work and premature mortality was calculated at €277 million.
It soon becomes clear on reviewing these studies that the major costs associated with mental health problems are not those allocated to providing mental health services through our public health system. Instead, the cost to society in lost economic output far outweighs those incurred through the provision of mental health services.
However, at the same time, these economic studies do not take into account the actual human and social costs that arise from mental health problems. One study which did try to provide some form of economic weighting for the social costs of mental health was the policy paper produced by the Sainsbury Centre for Mental Health in the UK - The Economic and Social Costs of Mental Health.
In addition to calculating the health and social care costs and output losses to the economy, this paper examined the human costs of mental illness which corresponded to the “adverse effects of mental illness on the health-related quality of life.” Taking as its base period, 2002-3, it was estimated that mental health illness had cost the English economy a total of £77 billion.
Once again the expenditure on the provision of NHS mental health services comprised only a small part of this total, some £7.9 billion or just over 10%. When one added the £3.9 million in estimated costs of informal care for people with mental health problems, this figure rose to £12.8 billion. Once again the lost output to the economy was significantly higher, being estimated at £23.1 billion, some 3 times the amount allocated to the NHS for mental health.
However, it is the economic evaluation of the human cost of mental health that is of the 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 such a calculation should be regarded as “experimental”, it can be justified on the grounds that it is clearly wrong to fail 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, such as older people and children.
While we most probably will have to wait for the development of an accurate and widely agreed calculation methodology for the human costs of mental illness, this does not mean that they should be disregarded. At the same time, the costs of mental illness in terms of lost economic output are clear enough. As Dr. Brendan Kelly argued in the Irish Medical Times last April there is “a compelling economic rationale for enhanced investment in mental healthcare.”
The economic evaluation of the cost of mental health issues can benefit us in several ways. Firstly, it helps highlight the significance and relative priority of various mental health problems by providing an economic measure of their importance, facilitating an improved level of debate as to where mental health service resources might most optimally be invested. Of course, specific interventions would still need to be justified on their own terms. It will also help us gauge the actual costs of mental health illness 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, and most importantly of all, increased and well-targeted investment in mental health has the potential to pay for itself many times over.
This article was co-authored by Justin Frewen and Dr. Anna Datta and originally published in the Irish Medical Times. The second part, The Social Determinants of Mental Health, will be published next week.
Discussion
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Comment by: An tSionainn
May 3rd 2010 at 06:05
The Mental Health Commission uses the economic crisis as an excuse for their inaction, which comes however primarily from a lack of transparency and accountability, and not from economic constraints.
MHC has been unwilling to wield the powers conferred on them Mental Health Act 2001 to close treatment centres that have been found to be non compliant with the Act. The Mental Health Commission has lost its independence and acts in the interests of the Health Services Excutive, which it is meant to regulate, rather than the service users whose human rights it is meant to protect.
One could imagine that the Mental Health Commission could easily accomplish the “Vision for Change” for Ireland’s mental health care simply by applying the law (MHA 2001) as it stands and revoking the registration of all of the approved centres that are found to be in violation of the Act. This would cause the closure of these centres and instantly liberate the funds necessary to establish community-based treatment in those catchment areas.
It is all very well to establish a framework for involving service users and the public in health care regulation, but what is the point if the regulations that already exist are not enforced by the very organisations that are charged with that oversight?
It’s no wonder there is institutional resistance to the ‘Vision for Change.’ So many prestigious careers and pinnacles of power depend on keeping things just as they are, with Ireland’s mental health system stuck in the Victorian era, if not the dark ages.
A sharp change in attitude by MHC is needed to align their actions with the proposed reforms.
I would not recommend that the Mental Health Commission receive any further funding until Minister Harney performs her due dilligence in oversight to assure the independence and transparency of the operations of the Mental Health Commission. This should inclue sacking of the current CEO Hugh Kane and Inspector Pat Devitt, as well as a re-staffing of Mental Health Tribunal panes where bias and conflict of interests are discovered.
A sham cure is worse than the disease in this case.
A link to a recent example follows:
http://www.indymedia.ie/article/96368