THE CENTRE FOR MENTAL HEALTH HAS PRODUCED A NEW ANALYSIS OF COSTS WHICH FINDS THAT THE BIGGEST EXPENSE TO SOCIETY OF MENTAL ILLNESS IS NOT IN FACT THE IMPACT ON EMPLOYMENT, CLAIMING BENEFITS OR EVEN THE COST TO THE HEALTH SERVICE…
New figures from the Centre for Mental Health finds that the costs to society of mental illness have been vastly underestimated.
Dr Raj Persaud FRCPsych Consultant Psychiatrist
The Centre for Mental Health published a policy paper published in 2003 which estimated the total economic and social costs of mental health problems in England in the financial year 2002/03 amounted to £77.4 billion. Using the same statistical approach, an updating of this figure by the Centre, now finds that the aggregate cost of mental health problems in England leapt to £105.2 Billion in 2009/10.
The Centre reminds us that their 2003 policy paper demonstrated mental health problems represented a larger cost to society than crime. Yet generally falling crime rates since then would naturally imply that the difference in the cost to society between mental illness and crime, is now an even wider yawning gulf.
And yet it’s difficult to envisage the tabloid press getting as exercised about David Cameron spending less on law enforcement, as it might do on impoverished health care for the mentally ill.
One key reason the figures are so startling is that the Centre for Mental Health has dared to bring an economic assessment to an area of healthcare that has avoided it up until now – an attempt to put a monetary value on the adverse effects of mental ill-health on the quality of a person’s life.
Before, policy makers only had data on how much mental illness cost the health and social services, as well as the economy, in terms of absenteeism and benefits paid out. Despite this limitation, it’s important to recall in this regard, that these numbers were considered of a scale large enough to famously partly drive Lord Layard’s argument that paying for more Cognitive Behavioral Therapy (CBT) in the NHS would get so many back to work, the initiative would pay for itself.
But that figure (£30.3 Billion) of economic output losses, is dwarfed by this new calculation now of the human costs of mental illness, which come in at a staggering £53.5 Billion – a number entirely excluding economic output losses.
It is notable that the direct annual costs to society of providing health and social care, for example covering such expenditures as NHS and local authorities services for people with mental health problems (£21.3 Billion) were somewhat overshadowed by the Centre’s estimate for the personal and commercial penalty paid for mental illness. These costs include output losses to the economy that result from the debilitating impact of mental health problems on ability to work (£30.3 Billion).
These figures suggest that if GPs, physicians and Psychiatrists want to convince the electorate, and the Government, that more needs to be spent on Cinderella services of mental health, the brutal economic argument might be more arresting than previously realized. When someone is claiming long term sickness benefit for mental illness, they are not only absorbing the tax paid by those in work, but in not contributing to the exchequer themselves, revenue is reduced which would otherwise fund better public services for all.
But larger still than that last cost, is the Centre’s monetary valuation of less tangible, but what the Centre argues are crucially important, human price of mental health problems, representing their negative impact on the quality of life (£53.6 Billion).
The Centre for Mental Health argues their figures represent a valuation of how much better off we would be as a society if there were no mental illness. We would clearly be financially healthier off in terms of money in the Bank because we would earn more, and consume less health and social care resources. But our lives would also be vitally enhanced in terms of less pain and suffering, as well as a reduced risk of premature death. All of these improvements in well-being can be valued financially by Economists. The costs of mental illness as calculated by The Centre for Mental Health thus correspond to a measure of the benefits (in money terms) gained if all mental illness were eliminated.
This latter cost is not uncontroversial in how to economically evaluate. However, it is undoubtedly the case that many suffer from psychiatric symptoms which adversely effect theirs and their family’s mental health and yet they turn up at work, and would not appear as representing an economic cost to society.
One way these human costs are calculated is from estimates of the preferences populations express for various health conditions, as measured by their valuation of wellbeing. For example, how much they would be prepared to spend, in order to attain a particular state – absence of certain symptoms. You might be prepared to spend more to avoid excruciating pain, compared to mild breathlessness.
However, this kind of approach breaks down when people are asked how much they would be ready to spend to avoid predicaments like death.
The other reason the calculation could be open to dispute is that it hinges on a valuation of a Quality Adjusted Life Year (QUALY) of £30,000. However, one reason for using this figure, the Centre argues, is that this is how the notorious National Institute for Clinical Excellence (NICE) bases all its calculations on whether to sanction NHS treatment. NICE decides that if a particular intervention is going to set the NHS back £30,000 or more for each QALY gained, as a result of the intervention it’s evaluating, it is not regarded as cost effective, and is therefore not approved for NHS use.
A representative of the Centre for Mental Health who spoke to me, pointed out that while costs to Employers and the Health Service are favourite figures amongst policy makers juggling budgets and electoral popularity, these kind of ‘miss the point’. It’s the final figure added into their calculation – human costs in terms of adverse consequences on quality of life, which are probably by far the most important impact of mental illness on the lives of millions. You might suffer inordinately and yet never bother and employer or a GP with your problem.
The Centre for Mental Health calculates that about 70 per cent of the costs of mental illness fall on those who suffer from it and their families, while about 30 per cent on the rest of the population, mainly in the form of higher taxes, or reduced provision of other public services. It’s this imbalance which might explain the political inertia in doing more about this social problem, the sheer size of which has only now been properly calculated by these new figures.
The Centre for Mental Health defended its adding in of the massive human cost of mental illness, by pointing out that another grave weakness of the traditional approach – of sticking to more tangible costs to employers of days of work lost and benefits paid out – is no ‘cost of illness’ using that approach are ever ascribed to those who are outside the labour market, for example children or older people.
But then again, children don’t vote.