[The Socio-Economic Realities of Mental Health in Europe] Part 2: Human and Social Costs

When discussing mental health, focus is frequently placed on the distress and suffering of those with a mental health problem and the most appropriate manner in which society might respond to their needs. The human rights of mental health service users has also begun to receive far greater consideration in such debates over the past couple of decades.

2. Human and Social Costs

However, these economic studies fail to take into account the human and social costs that arise from mental health problems. One study which attempted to provide some form of economic weighting for such costs was the policy paper produced by the Sainsbury Centre for Mental Health in the UK – The Economic and Social Costs of Mental Health.13

This report looked not only at the health care and lost productivity costs of mental health problems. It also took into account the human costs of mental illness which corresponded to the “adverse effects of mental illness on the health-related quality of life.” Taking 2002-3 as its base period, it estimated that mental health problems had cost the English economy a total of £77.4 billion.

As with the studies noted above, the provision of health care services through the NHS accounted for only a fraction of this total. Expenditure on direct health care support amounted to some £7.9 billion or just over 10% of this total. When the estimated costs of informal care of £3.9 billion were added together with some £0.7 billion in other public sector costs and private expenditure, the figure for healthcare rose to £12.5 billion or 16.1% of total costs. 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 and close to twice that of overall health care costs. These figures confirm those of the studies discussed above.

However, it is the effort to determine an economic evaluation of the human cost of mental health that is of most interest. According to the methodology applied in this report, the economic valuation of the human costs of mental illness is £41.8 billion or 54% of the estimated £77.4 billion total mental health costs in England.

In an Irish context, using O`Shea and Kennelly´s calculations, this would mean that the €3 billion they estimated would only be 46% of the total economic costs of mental health issues in Ireland. The human and social costs would be equivalent to over €3.52 billion making a total potential mental health cost of €6.52 billion.

Although these calculations are “experimental”, the Sainsbury report argues that they 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 enables an evaluation of the consequences of mental health problems of mental health problems on individuals who are not included in the labour market, such as older people and children.

It is clear that in the absence of an accurate and widely agreed calculation methodology for the human costs of mental health problems such figures will be disputed. Indeed, every effort should be made to develop a transparent and broadly accepted methodology in order to fully understand the impact of mental health problems in society. However, in the meantime, they serve as an economic indicator of the serious nature of the human and social costs of mental health problems.

Additional Benefits of Economic Cost Analysis
Furthermore, in addition to demonstrating the economic rationale for the allocation of adequate resources to mental health, research into the economic costs of mental health provide a number of other important benefits, including the following:

a) It helps highlight the significance and relative priority of various mental health issues by providing an economic measure of their importance, thus paving the way for a more effective allocation of resources. However, specific interventions would still need to be justified on their own terms.
b) It could assist decision-makers on how best to allocate the available mental health funding and resources. Increased and well-targeted investment in mental health has the potential to pay for itself many times over. Economic analysis would enable us improve our decisions in this respect.
c) Such economic assessments will also help us gauge the actual costs of mental health with respect to different social categories thus increasing our awareness of the relative impact on different sectors of the Irish population.

(continuation: Part 3: The Social Determinants )

Justin Frewen &  Dr Anna Datta
Galway, Ireland

References
12 Behan, C., et al, 2008
13 SCMH, 2003

Back to Part 1. The Economic Costs (23/07/2010)