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The Cost of Mental Health in Europe

Justin Frewen and Dr. Anna Datta, August 26, 2010

Students participate in a mental health awareness exercise in England.

The past few decades have seen a steady rise in the overall global burden of mental health illnesses. At the turn of the third millennium, the World Health Organization (WHO) estimated that mental illness was at an aggregate point prevalence of approximately 10 percent of all adults worldwide, or 450 million people.

In addition to the distress mental illnesses can cause individuals, they can also have serious economic consequences. This is borne out by a range of studies looking at the economic cost of mental health.

The 2000 International Labour Organization (ILO) report, "Mental Health in the Workplace," estimated that mental health cost as much as 3 to 4 percent of the GNP of E.U. states. A 2004 review by Sobocki et al, "The Cost of Depression in Europe," calculated that depression alone had an economic cost for the EU25 and European Free Trade Agreement (EFTA) countries of up to €118 billion, or €253 per person. Almost two thirds of these costs arose as a direct result of lost productivity through early retirement, premature mortality or sick leave. Therefore, healthcare costs comprised only a minority of these costs.

However, these studies fail to account for the human and social costs of mental illness. One analysis that did provide an economic weighting for such costs was the United Kingdom´s Sainsbury Centre for Mental Health´s policy paper, "The Economic and Social Costs of Mental Health." In this analysis, the human costs of mental health issues—the "adverse effects of mental illness on the health-related quality of life"—were estimated. Taking 2002-2003 as its base period, this report calculated the total cost of mental health problems to the English economy at £77 billion annually, of which £41.8 billion, or 54 percent, was comprised of the human cost of mental health.

The economic evaluation of mental health provides a number of benefits. Primarily, it serves as a reminder that failing to invest seriously in mental health can have serious economic consequences. It also helps clarify the relative priority of various mental health problems through providing an economic measure of their importance. Furthermore, economic analysis can gauge the actual costs of mental ill-health with respect to different social categories. This will enable an improved level of debate as to where mental health service resources might optimally be invested.

Social determinants and health inequity

While genetic factors help determine the dissimilar health prospects of individuals, they are unable to explain larger scale variations between social groups. Furthermore, they cannot account for rapid changes in health prospects and life expectancies over relatively short timescales.

As the WHO emphasized, "The new discoveries on the human genome are exciting in the promise they hold for advances in the understanding and treatment of specific diseases. But however important individual genetic susceptibilities to disease may be, the common causes of the ill health that affects populations are environmental: They come and go far more quickly than the slow pace of genetic change because they reflect the changes in the way we live."

The variance in health risks between various social categories is known as health inequity/inequality. Health inequity measures the regular and consistent divergences in health expectations of differing social groupings as opposed to the random and non-systematic disparities in health status between individuals.

Using 2004 data, Mackenback et al estimated that health inequalities were responsible for reducing the average life expectancy across the EU25 by 1.8 years, or 11.4 million years in total. Healthy life expectancy was reduced by an average 5.1 years, or 33 million years in total. In total, health inequities resulted in over 700,000 deaths per year and 33 million cases of ill health.

These social determinant-derived health inequalities entail a significant economic cost, equivalent to 20 percent of total healthcare costs and 15 percent of social security benefits.

One of the most important social determinants is poverty. As the WHO Regional Committee for Europe explained, "Whether defined by income, socioeconomic status, living conditions or educational level, poverty is an important determinant of mental disability and is associated with lower life expectancy and increased prevalence of alcohol and drug abuse, depression, suicide, antisocial behavior and violence."

Policy implications

Social determinants will arguably have the greatest impact on mental health policy. Whereas in the past mental health policy has concentrated on how to provide medical care at an optimal cost, it is now understood that mental health promotion involves a panoply of social and economic sectors.

Taking a determinants approach to mental health promotion will require action across the width and breadth of society and economy. Future mental health should not be limited to the health sector. Instead, there will be a need for "coherent action" across a range of social determinants.

Dr. Margaret Chan, director-general of the WHO, explained, "Health inequity really is a matter of life and death. ... Health systems will not naturally gravitate towards equity. Unprecedented leadership is needed that compels all actors, including those beyond the health sector, to examine their impact on health."

Furthermore, the mental health sector will need to advocate and provide assistance to key economic and social sectors so they can play their part in improving public mental health. According to Amnesty International, "As well as granting an entitlement to a system of mental healthcare, the state must protect other rights, such as housing, employment and education. These other rights are sometimes described as the underlying determinants of health because enjoying these rights can contribute to enjoying the right to health."

The individual and uncoordinated tackling of isolated social determinants will not be sufficient. Coherent and holistic policies and programs of action need to be developed so as to respond to the unequal distribution of negative social determinants amongst the various socio-economic categories. Of primary importance will be the drawing-up and implementation of inter-departmental policies and plans of action to eradicate structural inequality and endemic poverty.

Tackling the social determinants that contribute to mental health problems will reap benefits in a wide range of areas. The WHO explained that "by tackling some of the material and social injustices, policy will not only improve health and well-being, but may also reduce a range of other social problems that flourish alongside ill health and are rooted in some of the same socioeconomic processes."

Addressing the social determinants that impact negatively upon mental health requires a long-term agenda. Moreover, it may well entail a radical revision of Europe´s current social and economic structures and systems. Failure to do so, however, will not only lead to many European citizens suffering from potentially avoidable mental health problems but also result in a substantial drain on the region´s economic resources.

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