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Martin Knapp & Paul McCrone PSSRU, London School of Economics

Best Practice in Mental Health GP Led Commissioning 25 March 2011. Investing in Mental Health: the Economic Case. Martin Knapp & Paul McCrone PSSRU, London School of Economics King’s College London, Institute of Psychiatry. Current & projected future prevalence.

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Martin Knapp & Paul McCrone PSSRU, London School of Economics

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  1. Best Practice in Mental Health GP Led Commissioning 25 March 2011 Investing in Mental Health: the Economic Case Martin Knapp & Paul McCrone PSSRU, London School of Economics King’s College London,Institute of Psychiatry

  2. Current & projected future prevalence N of people by disorder, England 2007 & 2026 McCrone, Dhanasiri, Patel, Knapp, Lawton-Smith, Paying the Price, King’s Fund, 2008

  3. Context: current & projected future costs Cost by disorder, England 2007 & 2026 McCrone, Dhanasiri, Patel, Knapp, Lawton-Smith, Paying the Price, King’s Fund, 2008

  4. Our approach Aim - model the costs and economic pay-offs of initiatives to prevent mental illness and promote mental well-being. • Look at evidence-based mental health interventions (incl. non-NHS) – must have well-established outcomes • Looked at 16 different areas and interventions • Use simple decision analytic modelling • Close liaison with DH officials; consultation with experts As far as the robust evidence base allows: • Include promotion, primary & secondary prevention • Look at widest range of economic impacts • Estimate impacts over long time periods • If in doubt, adopt conservative estimates

  5. Please note … • Examine interventions from 2 perspectives: - pay-offs to society as a whole and - cash savings to the public sector • The wider impacts are important, given the high ‘external’ costs of many MH problems … but are they considered? • Over and above the economic pay-offs estimated here there are health and QOL benefits to individuals (‘patients’ etc) Please be aware that … • The findings are not definitive – they provide platform for discussion • These are simple, partial and incomplete models • The interventions modelled are not necessarily the only ones that are economically attractive

  6. What economic case needs to be made?

  7. What economic case needs to be made?

  8. What economic case needs to be made?

  9. What economic case needs to be made?

  10. What economic case needs to be made?

  11. Many causes; widespread impacts Genes Health care NHS Social care Family LAs CLG Mental health Housing Income Emply’t Education DfE Crim justice MoJ Resilience Trauma Benefits DWP Phys env Employment Firms Events Vol sector CVOs Chance Income Indiv Mortality All Each of these links is evidence-based

  12. Parenting for conduct disorder

  13. Early intervention teams for psychosis

  14. Early detection of psychosis

  15. Workplace well-being programmes

  16. Other interventions examined • Post-natal depression – health visitors (universal or targeted) • School-based social and emotional learning programmes • School-based anti-bullying initiative • Workplace screening for depression risk, then CBT • Debt counselling • Alcohol misuse - GP screen and advice • Suicide – population awareness scheme + CBT for people at risk • Suicide – ‘hotspots’ - e.g. safety barriers on bridges • Co-morbid diabetes and depression – collab. care • Medically unexplained symptoms – CBT • Older people – befriending schemes (various) • Dementia - physical exercise programmes • [previously done] Anti-stigma campaigns

  17. Summary of findings

  18. Conclusions • Very conservative models even so, many interventions look good value for money. • Some are self-financing from NHS perspective • Some are very low cost: a small shift in expenditure from treatment to prevention/promotion could generate efficiency gains • Many have broad pay-offs - both within public sector, and more widely (educational performance, employment/earnings, crime). • Pay-offs may span many years; need to invest for the longer term • Process parameters - targeting, take-up rates, drop-out rates – are important. It may be most cost-effective to increase take-up among high-risk groups, or improve ‘completion’ rates. • Each modelled intervention is evidence-based – each has been shown to be effective (to achieve good outcomes) … • … which means that there are health and QOL gains to individuals over and above the economic pay-offs here

  19. Team; and further information Iris Molosankwe 2 Gerald Mullally 1 A-La Park 1 Michael Parsonage3 Margaret Perkins 1 Andres Roman 1 Marya Saidi 1 Azuso Sato 1 Madeleine Stevens 1 Jamie Vela 1 1 PSSRU, LSE 2 KCL, IOP 3 Centre for Mental Health 4 PSSRU, Univ of Kent 5 Royal Coll. Psychiatrists Further details of work to date: Report published by the DH, Jan 2011 More work likely to be undertaken in 2011 Contact: m.knapp@lse.ac.uk paul.mccrone@kcl.ac.uk Rebeea’h Aslam 1 Florence Baingana 1 Annette Bauer 1 Jennifer Beecham 1,4 Eva-Maria Bonin 1 Sarah Byford 2 Adelina Comas 1 Sara Evans-Lacko 2 Chris Fitch 5 Nika Fuchkan 1 Derek King1 Martin Knapp1,2 Canny Kwok 1 Paul McCrone 2 David McDaid1

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