The economics of mental health

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Dale Dalton
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1 The economics of mental health Professor Martin Knapp - Professor of Social Policy, London School of Economics and Political Science Michael Parsonage - Chief Economist, Centre for Mental Health

2 Mental Health Network NHS Confederation 16 March 2017 The economics of mental health Martin Knapp & Michael Parsonage Personal Social Services Research Unit, LSE & Centre for Mental Health

3 Structure A. Why economics? B. Evidence to support decisionmaking: examples C. Next steps Image from Flat Icon

4 Why economics?

5 Decision-makers need economic evidence Why? obecause resources are always scarce owe (society) cannot meet every need, or agree to every request, or accommodate every preference. oso we need to choose how to get the best out of our available resources. Consequently o any new intervention will be looked at very carefully: Is it effective? Is it affordable? And is it cost-effective?

6 What kind of economic evidence can help decision-makers make better decisions? o o o o o Overall costs of a need (e.g. anxiety), how those costs are distributed, and patterns of association Cost of an intervention (e.g. a psychological therapy) compared to its alternative(s) Cost of an intervention compared to savings it generates (and how any savings are distributed) Cost of an intervention relative to outcomes it achieves (& compared to alternative interventions) An understanding of how economic incentives might change patterns of behaviour. More useful but more complicated

7 What kind of economic evidence can help decision-makers make better decisions? o o o o o Overall Cost-of-illness costs of a or need cost (e.g. impact anxiety), studies how to those raise costs awareness are distributed, of the overall and impact patterns of association Cost Budget of an impact intervention studies or (e.g. (?) a cost-minimisation psychological therapy) studies compared to check current to its affordability alternative(s) /save money Cost-offset of an intervention studies to compared check current to savings or future it generates affordability (and of an how investment any savings are distributed) Cost-effectiveness, of an intervention cost-benefit relative to outcomes or similar it achieves studies (& to compared examine efficiency: to alternative Is it interventions) worth it? An Behaviour understanding / nudge of how studies economic to understand incentives how might incentives change might patterns change of behaviour. for the better

8 To clarify: what cost-effectiveness means If the policy/practice question is: Does this intervention work? Then the economic question is: Is it worth it? So an evaluation must define what is meant by work and worth : hence we must define outcomes and costs. Often the decision-maker faces difficult (perhaps controversial?) trade-offs

9 Evidence to support decision-making

10 Examples along the life-course 1. Maternal mental health 2. Child mental health 3. Early intervention psychosis 4. Psychiatric liaison 5. Individual Placement and Support 6. Dementia

11 Maternal mental health

12 Maternal mental health Economic consequences of maternal mental illness high, wide-ranging and long-lasting Especially high costs associated with child emotional, cognitive and behavioural consequences (2014 report funded by Comic Relief) Government decision to invest extra funds in maternal MH services What works in prevention, early intervention and treatment? Evidence review and modelling - strong economic evidence to support action (2016 report funded by NHSE).

13 Child mental health

14 Conduct disorder in young children 60% of all children with a diagnosable mental health problem have conduct disorder Long-term outcomes are much worse than for other childhood problems Cost to public services from ages = c. 5,000 a year per child; lifetime costs to society estimated at around 275,000 per case Cost of a NICE-recommended group parenting programme = c. 1,300 per child; over two-thirds of children improve and most recover, i.e. fall below a clinical threshold Economic modelling indicates benefits over 25 years of 14 for every 1 invested, including 5 of savings in the public sector

15 Early intervention in psychosis

16 EI teams Psychoses (esp. schizophrenia) generate high & enduring costs, across many areas Unemployment 39% Private exp 0% Informal care 9% Other health & social care 13% Absenteeism 0% Institutions 17% EI psychosis teams (or their equivalents) can help improve clinical outcomes Mortality 13% Carer productivity 0% CJS 0% Social security 9% Soc sec admin 0% avoiding substantial costs to the NHS & social care Benefits in terms of employment and/or engagement with education Possible links to reductions in suicide & homicide Over 10 years, every 1 invested saves > 15 in costs

17 Liaison psychiatry

18 Liaison psychiatry About 50% of all inpatients in acute hospitals have a comorbid mental health problem Comorbidity is associated with poorer health outcomes and increased costs of care (c. 25 million a year a typical 500-bed DGH) Recommended intervention is a dedicated liaison psychiatry team in every acute hospital at CORE-24 standard Good evidence that a pro-active liaison service improves clinical outcomes and significantly reduces bed use RAID evaluation found cost savings of 4 for every 1 invested; this has been replicated in US studies

19 Individual Placement and Support (IPS)

20 Individual Placement and Support Most people with severe mental illness want to work but only a small minority do so This carries significant costs to the economy, the exchequer and the NHS There is unequivocal evidence that IPS is the preferred intervention ( place then train, not train then place ) IPS is effective: (i) as an employment intervention; (ii) as a mental health intervention; and (iii) as an intervention that saves money in the NHS Cost of IPS = c. 2,700 per client; evidence suggests recurring savings in mental health service use of c. 3,000 a year

21 Dementia

22 Dementia 56% of social care is self-funded High costs ( 26 bn) that will rise; high (& growing) proportions are self-funded and unpaid care (est.) Rapid recent growth in evidence on what works (or doesn t work) & on cost-effectiveness There is no simple cure just around the corner Risk-reduction strategies are known but slow to act MODEM: projecting future needs & costs; and then modelling outcome & cost-effectiveness gains from wider use of evidence-based interventions.

23 MODEM Dementia Evidence Toolkit

24 Next steps

25 Challenges Economic evidence is accumulating quite rapidly now, but unevenly

26 Some of the main evidence gaps Mental and physical health comorbidities Medically unexplained symptoms Youth mental health Old age mental health (other than dementia) Eating disorders Self-harm PTSD

27 Challenges (continued) Economic evidence is accumulating quite rapidly now, but unevenly. Non-UK evidence may not always transfer across Implementation Impacts that span multiple systems Impacts that span multiple years

28 Funding, disclaimer, conflicts of interest Some of the material presented here was supported by: Alzheimer s Society CentreForum Department of Health (England) Economic and Social Research Council National Institute of Health Research NHS Confederation Mental Health Network NHS England Rethink Mental Illness All views expressed in this presentation are those of the presenters, and are not necessarily those of any of the funders. We have no conflicts of interest to report that are relevant to this presentation. Thank you

Developing an effective business case: the art of persuading engagement and investment in liaison psychiatry 18 OCTOBER 2013

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