Transcript Children & young people

The economic dimensions
of mental health
Dr Anita Patel
Senior Lecturer in Health Economics
Institute of Psychiatry, King’s College London
Psychosocial Health and Work Conference,
Ljubljana, 9 October 2008
Outline
1. Adults of working age
2. Children & young people
3. Older people
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
Outline
1. Adults of working age
2. Children & young people
3. Older people
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
Health care
Products
Human resources/services
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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Unpublished figures from the QUATRO Study (European Union QLG4-CT-2001-01734)
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
Economic costs of mental illness
in England = £32 billion (43 billion
Euros)
Health care
12%
Social care
6%
Suicide –
productivity
9%
Benefits
24%
Informal care
9%
Lost
Other costs
employment
3%
34%
Criminal justice
3%
Patel & Knapp, Mental Health Research Review, 1998
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
Costs of depression (adults),
England, 2000
GP
consultations
Medications
1%
33%
Inpatient care
Lost
3%
productivity
Day case
(suicide)
61%
0%
Outpatient
care
2%
Thomas & Morris, British Journal of Psychiatry 2003; 183: 514
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
Costs of depression (adults),
England, 2000
Lost
productivity
(morbidity)
90%
Treatment
costs
4%
Lost
productivity
(suicide)
6%
Thomas & Morris, British Journal of Psychiatry 2003; 183: 514
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
The business costs of mental
illness
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)
Presenteeism (UK)

Mental health
problems can make
people less
productive in the
workplace

Staff turnover (UK)

Replacing staff who
leave because of
mental ill-health

Cost to business =
£15.1 billion
(20.4 billion Euros)
Sainsbury Centre for Mental Health. Mental health at work: the business case. 2007
Cost to business =
£2.4 billion
(3.24 billion Euros)
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
A caution about interpreting lost
productivity costs

Many lost productivity estimates are calculated as:


This (‘human capital’) approach could lead to over-estimates



Number of days absent x average daily wage
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)
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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?
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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….
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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
Psychosocial Health and Work Conference
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EQOLISE: effectiveness
IPS worked…


140
120
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
IPS
Vocational services
100
80
60
40
20
0
% worked
Burns et al., Lancet 2007; 370:1146
Mean days
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
EQOLISE: costs
And it cost less…so IPS is cost-effective
Mean difference in health & social
care costs (£) over 18 months
5000
2500
0
-2500
-5000
-7500
h
Zu
r ic
lm
U
So
fi a
i
Ri
m
in
G
O
ve
r
ro all
ni
ng
en
Lo
nd
on
-10000
Burns et al., Report to EC 2006 (Project QLRT-2001-00683)
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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….
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
QUATRO: Another example of
variations across study centres
Percentage of QUATRO study participants using each resource
Amsterdam
Leipzig
Special accommodation
Inpatient services
Outpatient services
Community-based day services
Community-based professionals
Mental health medications
Criminal justice services
Informal care
London
Verona
• 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
Psychosocial Health and Work Conference
Patel. Unit costs of health & social care, University of Kent, 2006.
Ljubljana, 9 October 2008
Outline
1. Adults of working age
2. Children & young people
3. Older people
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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)
Benefits
43%
Health care
5%
Social care
0%
Family costs
45%
Education
5%
Voluntary
2%
Romeo, Knapp & Scott, Brit J Psychiatry 2006; 188: 547
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
Outline
1. Adults of working age
2. Children & young people
3. Older people
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
Distribution of dementia costs (UK)
Health services
8%
Social care
15%
Accommodation
41%
Informal care
36%
Knapp, Prince et al, Alzheimer’s Society, 2007
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
Costs of mental illness (UK) - now
Total = £49 billion (66bn Euros)
Cost (£ billions)
25
20
Lost earnings
Service cost
15
10
5
0
Depression
Anxiety
disorders
McCrone et al., King’s Fund, 2008
Schizophrenic
disorders
Bipolar
disorder/
related
Eating
disorders
Personality
disorder
Child/
adolescent
disorders
Dementia
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
Costs of mental illness (UK) - 2026
Total at 2007 prices = £ 61 billion (82bn Euros)
Cost (£ billions)
Total at 2026 prices = £88 billion (119bn Euros)
25
Additional cost in 2026 (2007 prices)
20
Lost earnings
Service cost
15
10
5
0
Depression
Anxiety
disorders
McCrone et al., King’s Fund, 2008
Schizophrenic
disorders
Bipolar
disorder/
related
Eating
disorders
Personality
disorder
Child/
adolescent
disorders
Dementia
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
Potential annual savings from
selected interventions
Condition and interventions
2007
2026
Medication for those currently untreated
£5 – 36 m
£8 – 61 m
Medication + psychological therapy for those currently untreated
£1 – 9 m
£2 – 16 m
Medication for those currently untreated
£8 – 66 m
£13 – 102 m
Medication + psychological therapy for those currently untreated
£1 – 7 m
£2 – 11 m
£4 – 22 m
£7 – 37 m
Expansion of early intervention services
£0 m
£13 – 65 m
Introduction of detection services
£0 m
Up to £19 m
£2 – 10 m
£3 – 16 m
Expansion of early intervention services
£0 m
£8 – 31 m
Introduction of detection services
£0 m
Up to £4 m
Reduction in prevalence among those aged 65-74
£0.2 – 0.6 bn
£0.4 – 1.2 bn
Reduction in prevalence among those aged 65-84
£0.8 – 2.4 bn
£1.7 – 5.2 bn
Depression
Anxiety disorders
Schizophrenia
Expansion of crisis intervention teams
Bipolar disorder
Expansion of crisis intervention teams
Dementia
Range depends on how many more patients are treated and
how quickly new services are introduced
Psychosocial Health and Work Conference
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Conclusions
Mental health problems…




devastating - for individuals of all ages
burdensome - for families
challenging - for communities
very expensive - for economies
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
Conclusions
Criminal
justice
Mental health care


Sits among a complex
array of support agents
Crosses multiple
boundaries
Housing
provision
Income
support
Mainstream
Health care
Mental
Health care
Social care
system
Family
caregivers
Education
Community
system
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
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
WITH A VIEW TO THE LONG TERM
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
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008
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)
Psychosocial Health and Work Conference
Ljubljana, 9 October 2008