The economic impact of psychological services. Sarah Byford Centre for the Economics of Mental Health

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1 The economic impact of psychological services Sarah Byford Centre for the Economics of Mental Health

Under Pressure: The finances of Mental Health Trusts in 2006 Warning of mental health crisis Pressure on the number of hospital beds is leading to a crisis in

2 Under Pressure: The finances of Mental Health Trusts in 2006 Warning of mental health crisis Pressure on the number of hospital beds is leading to a crisis in care for people who are mentally ill NHS ' 750m in the red' this year Mental health still 'Cinderella' of the NHS The NHS deficit problem has gone from bad to worse

3 Why economics? Scarce resources Demand > supply Economic evaluation Lost opportunities Value for money needed

4 The problem for psychological services

5 Existing economic evidence Systematic review of economic evaluations in depression (Barrett et al, 2004) 58 economic evaluations located 47% drug treatments 28% psychological treatments (n=16) 22% health system approaches 3% screening Systematic review of economic evaluations in child and adolescent mental health (Romeo et al, 2005) 21 economic evaluations located 5% drug treatments 19% psychological treatments (n=4) 19% health system approaches 33% specialist mental health service 14% parent training 10% social work intervention

6 Limitations of existing evidence I Systematic review of the quality of economic evaluations in mental health (Evers et al, 1997) 91 economic evaluations located 44% were full economic evaluations 30% experimental/quasi-experimental design Almost none justified their sample size Follow-up varied from 2 weeks to 4 years 17% included non-medical costs & 30% included productivity losses Few good full economic evaluations have been undertaken in the domain of mental health care Systematic review to explore improvements in quality (Byford et al, 2003) Economic evaluations in mental health are more commonly undertaken and the methods employed are improving with time. However, there are still inadequate numbers of such evaluations to inform resource allocation decisions and poor methods are still common

7 Limitations of existing evidence II For Mynors-Wallis et al, 1997; Guthrie et al, 1999; Browne et al, 2002; Leff et al, 2000 Against Scott & Freeman, 1992; Lave et al, 1998; Kamlet et al, 1995 Unclear Bower et al, 2000; Friedli et al, 2000; Harvey et al, 1998; Miller et al, 2003; Simpson et al, 2003; Scott et al, 2003; Patel et al, 2003; Richards et al, 2003 Suggested explanations Insufficiently powered Insufficient length of follow-up Therapists insufficiently trained/qualified Therapy too brief/too long Measuring the wrong outcomes Wrong patient group too mild/too severe Participants didn t attend enough sessions

8 And yet the rise of CBT Economic evidence has had important impacts on policy NICE guidelines recommend the provision of psychological interventions (particularly CBT) for Anxiety Depression in adults Depression in children and adolescents Eating disorders Obsessive compulsive disorder Post-traumatic stress disorder Shortage of therapists makes the implementation of these guidelines impossible (Layard, BMJ 2006)

9 Cost of therapy = 750 per patient Increased productivity = 1880 Savings to the Treasury = 850 Reductions in use of NHS services Therapy will pay for itself

10 800,000 patients per year would prefer a psychological therapy One therapist per 80 patients needed = 10,000 extra therapists 5000 extra clinical psychologists 5000 psychological therapists

11 A simplistic approach Concerns about the ability to increase number of clinical psychologists to that extent Concerns about effectiveness of psychological therapists Neglect of psychological therapies beyond CBT Concerns about the ability of therapists to treat 80 patients per year Neglect of multi-disciplinary needs Concerns about the accuracy of the data the calculations were based on But an effective one Oct 2007 Health Secretary announced an additional 170 million to expand psychological therapies for anxiety and depression

12 Research needs Trial design Complex interventions Quality of therapy Sample size & power Length of follow-up The future starts now Outcome measurement Depression, relapse, depression free days QoL/HRQoL Systematic cost measurement Methods Perspective (not necessarily NICE)

MENTAL HEALTH POLICY AND EMPLOYMENT

MENTAL HEALTH POLICY AND EMPLOYMENT OECD Mental Health Expert Meeting 26-28 April 2010, Paris RICHARD LAYARD CENTRE FOR ECONOMIC PERFORMANCE, LONDON SCHOOL OF ECONOMICS www.cep.ac.uk/layard WHY MENTAL