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The economic dimensions of mental health

The economic dimensions of mental health. Dr Anita Patel Senior Lecturer in Health Economics Institute of Psychiatry, King’s College London. Outline. 1. Adults of working age. 2. Children & young people. 3. Older people. Outline. 1. Adults of working age. 2. Children & young people.

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The economic dimensions of mental health

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  1. The economic dimensions of mental health Dr Anita Patel Senior Lecturer in Health Economics Institute of Psychiatry, King’s College London

  2. Outline 1. Adults of working age 2. Children & young people 3. Older people

  3. Outline 1. Adults of working age 2. Children & young people 3. Older people

  4. Where does economics come in? • Mental health problems place a clinical and social burden on individuals, families and communities • All of these burdens have economic dimensions, which impact on all levels of society

  5. Health care Products Human resources/services

  6. Family burden • Time • Average weekly hours caring for person with schizophrenia: • Amsterdam 0.9 • Leipzig 6.9 • London 10.6 • Verona 5.2 • Lost work, leisure & education opportunities • Lost income • Out of pocket expenses • Family strain Unpublished figures from the QUATRO Study (European Union QLG4-CT-2001-01734)

  7. Economic costs of mental illness in England = £32 billion (43 billion Euros) Patel & Knapp, Mental Health Research Review, 1998

  8. Costs of depression (adults), England, 2000 Thomas & Morris, British Journal of Psychiatry 2003; 183: 514

  9. Costs of depression (adults), England, 2000 Thomas & Morris, British Journal of Psychiatry 2003; 183: 514

  10. Absenteeism (UK) Average employee takes 7 ‘sick days’ per year...40% are for mental health problems Cost to business = £8.4 billion (11.3 billion Euros) The business costs of mental illness Presenteeism (UK) • Mental health problems can make people less productive in the workplace • Cost to business = £15.1 billion (20.4 billion Euros) Staff turnover (UK) • Replacing staff who leave because of mental ill-health • Cost to business = £2.4 billion (3.24 billion Euros) Sainsbury Centre for Mental Health. Mental health at work: the business case. 2007

  11. A caution about interpreting lost productivity costs • Many lost productivity estimates are calculated as: • Number of days absent x average daily wage • This (‘human capital’) approach could lead to over-estimates • Workers may compensate for short term absence (Jacob-Tacken et al, 2005) • Workers may be replaced. So only need to calculate costs of the intervening (‘friction’) period e.g. advertising, recruiting, training, low productivity in early phase • Lost productivity due to schizophrenia-related deaths (1996) • Human capital approach = Canadian $105 million • Friction cost approach = Canadian $1.53 (Goeree et al, 1999)

  12. Other large financial impacts • Early retirement – lost productivity • Disability pensions • Disability-related social security benefits (Approximately 40% of people receiving Incapacity Benefit in UK is due to mental illness) • Lost tax income for government • Insurance payouts Centre for Economic Performance, LSE, 2006

  13. Economic burden of mental illness We now know something about: • How large this burden is • How the burden is distributed across the economy • The potential savings from tackling some of the problems But what can we do about it?

  14. What can we do about it? • There are numerous examples of health care, social care, educational and vocational interventions that work • But we can’t pay for them all • Firstly, there are not enough professional, pharmaceutical and other resources to meet all assessed needs • Secondly, even if local, national & Europe-wide budgets were greatly increased, we still need to decide how to allocate these extra funds as effectively as possible • Thirdly, we need to consider equity, not only within mental health sphere but also outside of it…other health and welfare programmes may equally deserve more investment • Economic evaluation can help inform such decisions by considering costs as well as effectiveness • Example….

  15. EQOLISE: evaluation of a supported employment scheme • Sample of 312 people • Adults with diagnosis of psychotic illness • Minimum 2 years duration • Living in community • Not been in competitive employment in previous year • Expressing desire to enter competitive employment • Randomised controlled trial • Individual placement and support (IPS) versus existing rehabilitation and vocational services • 6 European cities: Zurich, London, Ulm, Sofia, Rimini, Groningen Burns et al., Lancet 2007; 370:1146

  16. EQOLISE: effectiveness IPS worked… • Employment rate 27% higher • Average of 100 more days of work • No significant differences between the two groups in other outcomes • But some association between working more and better social functioning, clinical and quality of life outcomes Burns et al., Lancet 2007; 370:1146

  17. EQOLISE: costs And it cost less…so IPS is cost-effective Mean difference in health & social care costs (£) over 18 months Burns et al., Report to EC 2006 (Project QLRT-2001-00683)

  18. A caution about interpreting international evidence • EQOLISE: effectiveness varied across the centres (socio-economic factors, such as GDP growth per capita and local unemployment rate, explained some of this variation) • Costs also varied across sites, with no cost savings in Groningen • This is not an unusual finding….

  19. QUATRO: Another example of variations across study centres Percentage of QUATRO study participants using each resource • Shape and size vary • % using secondary care: 28 – 76% • Average length of stay: 19 – 88 days Need to account for local/national contextual factors when applying evidence to alternative settings Patel. Unit costs of health & social care, University of Kent, 2006.

  20. Outline 1. Adults of working age 2. Children & young people 3. Older people

  21. Children & young people How many people are affected? • 10-20% of European children and adolescents suffer from mental health problems • Suicide is one of the 3 most common causes of death • Other family members are affected With what consequences? • Poor quality of life; damaged family relations • Disrupted education; failure to fulfil potential • Enduring problems into adulthood • High costs to individuals, families, State & economy See Jane-Llopis & Braddick, EC Consensus Paper, 2008

  22. Children with persistent antisocial behaviour: costs in childhood (2000/01) Total annual cost per child excluding state benefits = £5960 per child (8046 Euros) (benefits = £4307; 5814 Euros) Romeo, Knapp & Scott, Brit J Psychiatry 2006; 188: 547

  23. Children & young people How many people are affected? • 10-20% of European children and adolescents suffer from mental health problems • Suicide is one of the 3 most common causes of death • Other family members are affected With what consequences? • Poor quality of life; damaged family relations • Disrupted education; failure to fulfil potential • Enduring problems into adulthood • High costs to individuals, families, State & economy • individuals, families, State & economy What can we do about it? • Parenting support • Prevent bullying & violence • Support in schools • Work with communities • Tackle poverty • Better treatment access But we can’t do everything…so need cost-effectiveness evidence See Jane-Llopis & Braddick, EC Consensus Paper, 2008

  24. Outline 1. Adults of working age 2. Children & young people 3. Older people

  25. Older people How many people are affected? • 5 million or more older Europeans have dementia • 10-15% of people aged 65+ have depression • Suicide rate is highest for older people With what consequences? • Again – devastating impacts on quality of life • Heavy burdens falling to family carers • But often these consequences remain hidden • High costs to individuals, families, State & economy Knapp, Prince et al, Alzheimer’s Society, 2007

  26. Distribution of dementia costs (UK) Knapp, Prince et al, Alzheimer’s Society, 2007

  27. Costs of mental illness (UK) - now Total = £49 billion (66bn Euros) McCrone et al., King’s Fund, 2008

  28. Costs of mental illness (UK) - 2026 Total at 2007 prices = £ 61 billion (82bn Euros) Total at 2026 prices = £88 billion (119bn Euros) McCrone et al., King’s Fund, 2008

  29. Older people How many people are affected? • 5 million or more older Europeans have dementia • 10-15% of people aged 65+ have depression • Suicide rate is highest for older people With what consequences? • Again – devastating impacts on quality of life • Heavy burdens falling to family carers • But often these consequences remain hidden • High costs to individuals, families, State & economy What can we do about it? • Better treatment access • Better preventative efforts • Support for carers • Social integration • Choice and control But we can’t do everything…so need cost-effectiveness evidence See Jane-Llopis & Gabilondo, EC Consensus Paper, 2008

  30. Potential annual savings from selected interventions Range depends on how many more patients are treated and how quickly new services are introduced

  31. Conclusions Mental health problems… • devastating - for individuals of all ages • burdensome - for families • challenging - for communities • very expensive - for economies

  32. MentalHealth care Conclusions Mainstream Health care Criminal justice Social caresystem Mental health care • Sits among a complex array of support agents • Crosses multiple boundaries Familycaregivers Housing provision Educationsystem Community support Income support Employers Danger is that individual sectors may be reluctant to invest if benefits are felt elsewhere and/or much later, leading to low overall investment NEED FOR COORDINATED CROSS-AGENCY ACTION WITH A VIEW TO THE LONG TERM

  33. References • Burns, Catty, Becker, Drake, Fioritti, Knapp, Lauber, Rössler, Tomov, van Busschbach, White, Wiersma, EQOLISE Group. Lancet 2007; 370 (9593):1146-1152. • Burns, Becker, Catty, Fioritti, Knapp, Lauber, Rössler, Tomov, van Busschbach, White, Wiersma, EQOLISE Group. Final Report to European Commission, Project code QLRT-2001-00683, 2006. • Centre for Economic Performance, London School of Economics, 2006 • Goeree, O’Brien, Blackhouse, Agro, Goering. Canadian Journal of Psychiatry 1999; 44: 455-463 • Jacob-Tacken, Koopmanschap, Meerding, Severens. Health Eocnomics 2005; 14: 435-443 • Jane-Llopis & Braddick, EC Consensus Paper, 2008 • Jane-Llopis & Gabilondo, EC Consensus Paper, 2008 • Knapp, Prince et al. Dementia UK. Alzheimer’s Society, 2007 • McCrone, Dhanasiri, Patel, Knapp, Lawton-Smith. Paying the price. The King’s Fund, 2008. • Patel. Unit costs of health & social care. University of Kent, 2006. • Patel & Knapp. Mental Health Research Review 1998; 5: 4-10. • Romeo, Knapp & Scott. British Journal of Psychiatry 2006; 188: 547 • Sainsbury Centre for Mental Health. Mental health at work: the business case. 2007 • Thomas & Morris. British Journal of Psychiatry 2003; 183: 514

  34. Appendix A EQOLISE outcome measures • Positive and Negative Syndrome Scale (PANSS) • Global Assessment of Functioning (GAF) • Hospital Anxiety and Depression Scale (HADS) • Lancashire Quality of Life Profile - European Version (LQoLP-EU) • Rosenberg Self-Esteem Scale (RSE) • Camberwell Assessment of Need (CAN-EU) • Groningen Social Disability Schedule (GSDS) • Helping Alliance Scale (HAS)

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