New mental health policies could benefit wider economy

Mental health supporters need to engage with economic arguments to further their influence. By Justin Frewen and Dr. Anna Datta.

When 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.

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.

(Picture: Amnesty supporting the rights of mental health service users)

There is surely a moral responsibility in a relatively wealthy nation such as ours – economic recession notwithstanding – to allocate sufficient funding to guarantee the provision of an effective public mental health system.

However, the harsh 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 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 these demands become ever more frantic.

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 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”.

Figures for the total impact of mental illness provide a relevant and crucial context 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. 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, given that they could amount to as much as 3-4% of the GNP of EU states.

According to the O'Shea and Kennelly report, 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.

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.

While we 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 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.

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 be invested. Specific interventions would still need to be justified on their own terms.

It will also help us 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.

This article was originally published in the Irish Medical Times.

(This is Part 1 of a report by Justin Frewen and Dr. Anna Datta. Part 2, 'The social determinants of mental health' is available here)