Making the Economic Case for Investing in Prevention and Promotion for Better Mental Health During Times of Austerity David McDaid PSSRU, LSE Health & Social Care and European Observatory on Health Systems and Policies, London School of Economics and Political Science E-mail: d.mcdaid@lse.ac.uk European Health Forum Gastein 2013
Potentially there are substantial economic benefits from improving mental health
The costs of poor mental health Bloom et al, World Economic Forum, 2011
Total economic costs of poor mental health Gustavsson et al 2011 European Neuropsychopharmacology
Social costs of alcohol in EU in 2010 Unemployment & Absenteeism 45 billion Total Cost : 156 billion Rehm & Shield 2012 Centre for Addiction and Mental Health, Toronto
Premature mortality Chang C-K et al, PLOS One, 2011
Disability Benefit Claims GB 2008-2012 7% 24% 15% 6% Other 5% 43% Mental and Behavioural Disorders Nervous System Musculoskeletal System Circulatory and Respiratory System Injury, Poisoning, External Causes Source: Department of Work and Pensions, 2012
Higher levels of absenteeism DAK Gesundheit 2013
Overlap between long term physical conditions and mental health problems 1 in every 8 for long term physical conditions due to mental health needs Long Term Conditions and Mental Health,Kings Fund - Naylor, Parsonage, McDaid et al 2012
Impacts on chronic disease management Welch et al 2009
Figure 2. Forest plot of suicide risk following unemployment, follow up over time, results of meta-analysis. Milner A, Page A, LaMontagne AD (2013) Long-Term Unemployment and Suicide: A Systematic Review and Meta-Analysis. PLoS ONE 8(1): e51333. doi:10.1371/journal.pone.0051333 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0051333
Economic shocks not just during times of downturn. More visible during downturn opportunities for action
Opportunity for actions within mental health care systems and also for health promotion/public health strategies in the world of work
Economic benefits of mental health promotion and disorder prevention Growing evidence base on mental health promotion / wellbeing interventions. Evidence Reviews e.g: Smit, Cuijpers, Petrea, McDaid 2013; McDaid & Park, 2011; Zechmeister, Kilian, McDaid 2008 BMC Public Health Modelling work synthesing evidence on effectiveness with costs Matrix Consulting 2012 Knapp, McDaid, Parsonage (eds). Department of Health, London, 2011 Mihalopoulos C, Vos T, Pirkis J, Carter R. Annual Review in Clinical Psychology 2011
Review of 15 potential actions for promotion and prevention Calculation of return on investment if implemented at England level Review of effectiveness literature Local cost data attached Decision analytical models constructed 1 year, 5 year and 10 year time frames where feasible
Net Return on Investment
Intervention Authors Economic findings Health-risk assessment, lifestyle management, nurse telephone advice line and telephone nurse led disease management Power to change stress management and health-risk reduction programme. Includes emotion refocusing and restructuring techniques A multi-component health promotion programme incorporating a health-risk appraisal, wellness literature, and seminars and workshops focused upon identified wellness issues Loeppke et al., 2008), USA McCraty et al., 2009), USA (Mills et al., 2007), England Net savings after taking account of costs of intervention, but level of net savings not reported 43% of the intervention group had a sufficient reduction in number of risk factors to reduce projected health-care costs compared with just 26% of control group Improved work performance and reduced absenteeism led to return of investment (ROI) of 6.19: 1 McDaid & Park, Health Promotion International 2011
Matrix for DG Health & Consumers 2012
Change in levels of non-employment 2007-2013 Source: the Economist July 16, 2013
Other actions beyond health systems Active labour market programmes have physical and mental health and labour impacts; key issue for young people What level of public purse support for occupational health services? What scope for ensuring that psychological support is a mandatory requirement for who lose their jobs? Simulate private sector opportunities not just restructuring public sector Scope for reduced working hours /salary cost cutting rather than downsizing? Maintaining social protection safety nets Pre-school education, & psychological wellbeing programmes can reduce risks of adverse circumstances in adulthood
Going forward Economic arguments can strengthen case for action Not just an issue during time of austerity Importance of promoting and protecting mental health at work a national and pan-national issue Making a business case as well as a health case for action Europe can help share knowledge and bring different stakeholders together e.g. the social partner to address issues of mutual benefit Using EU funds to help support evaluation and innovation in different types of workplace