Investing in mental health care and workplace mental health programs takes money, and in the short term, that can be an obvious deterrent. However, it can really pay off in the longer term. A number of organizations have each put together solid economic cases for investment in mental health, and this post will take a look at some of them.
For those of us dealing with mental illness, it’s about so much more than dollars and cents. Still, governments care about $$$, and the money argument is on our side.
The World Health Organization’s perspective
In a 2013 report, the World Health Organization (WHO) pointed out that mental illness is associated with significant social costs. Mental disorders contribute to premature mortality due to suicide and an increased risk of developing and prematurely dying from other health conditions. The costs associated with accessing care can be high, and this can have a devastating impact on families.
International figures have shown that people with mental illness are over-represented among those living in poverty. There are high rates of unemployment and underemployment among people with mental illness. This limited labour participation and output has a negative impact on gross domestic output (GDP). Improved mental health outcomes can mean more people getting back to work and decreased welfare payments.
The report concludes with this cautionary statement: “For each year of inaction and underinvestment, the health, social and economic burden will continue to rise. Doing nothing is therefore not a viable option.”
The case for investment in different countries
The Mental Health Commission of Canada (MHCC) has identified mental health promotion and early intervention in childhood and adolescence is an important way to offset both lasting negative impacts on quality of life and economic losses associated with illness.
A 2017 MHCC report stated that it’s important to focus on mental health promotion and early intervention. It also indicated that improvements at the primary level should be able to serve the needs of many people with mild to moderate illnesses, who make up the majority of people who are affected by mental illness. About 1.5% of the population would need specialized or intensive services.
In 2015, mental health spending accounted for about 7.2% of overall health spending in Canada. This is much lower than in many other Western countries; for example, in the UK’s National Health Service, it’s around 13%.
The MHCC identified a number of areas where mental illness can have indirect economic costs:
- employer costs related to absenteeism, presenteeism, and turnover
- public and private disability costs
- costs of government income assistance and social supports for people who are unable to work
- lost tax revenue from unemployment and underemployment
Practices that reduce overall costs
These are some of the practices that the MHCC found were associated with overall cost savings:
- community-based rapid response teams for youth experiencing suicidal thoughts
- early psychosis intervention programs reduce health care costs and increase the likelihood of clients having paid employment
- improving access to psychotherapy can save $2 for every $1 spent
- offering timely collaborative care to people off work on short-term disability can result in fewer days spent on disability per person and fewer people transitioning to long-term disability
- for high-end service users, an investment of $22K per person for a housing first approach with assertive community treatment can save $42K in costs that would have otherwise been incurred (based on data from the MHCC’s large At Home/Chez Soi study)
- incorporating peer support into discharge planning related to long-term hospital stays can facilitate earlier discharges
- community crisis resolution teams can be a cost-effective alternative to hospital admission
- crisis houses have a lower daily cost than hospital admission and are associated with greater client satisfaction
A 2011 report from the Centre for Mental Health in the UK pointed out that most mental health spending is on dealing with illnesses that have already reached the crisis stage and require long-term support, yet 50% of mental health conditions are already present by age 14. Focusing investment on mental health promotion, prevention, and early intervention often costs less than intervening at a later stage. It’s also likely to have a wide range of payoffs for the public sector and society more broadly.
The report added that some payoffs are spread out over a long time frame, but the costs of intervening can be recouped in a relatively short time frame. For some interventions, cost recovery occurred within 1 year, while many others paid off within 2-5 years).
Modelling by Australia’s National Mental Health Commission identified a number of mental health prevention and early intervention strategies that would improve national productivity and lead to savings for the health care system. One such intervention was the broader implementation of the online MoodGYM program to prevent anxiety disorders in young people.
Workplace mental health
The American Psychiatric Association Foundation’s Center for Workplace Mental Health reports that 80% of employees who receive treatment for mental illness report higher levels of work efficacy and satisfaction. Treatment can lead to lower overall medical costs, increased productivity, less absenteeism, and decreased disability-related costs. Their website has cost calculators for employers to get estimates of how much depression, alcohol, and substance misuse could be costing them.
A 2020 report by Deloitte UK identified screening and early, targeted intervention yielded the greatest return on investment. Proactively addressing workplace culture and improving awareness of workplace mental health tended to yield a greater ROI than trying to be reactive in supporting employees once their mental health had worsened.
Deloitte also identified stigma as an important ongoing issue to address. Their report mentioned a finding in a Business In The Community survey that 9% of employees who disclosed mental health problems being either fired, demoted, or disciplined.
Short-sightedness costs $$$
Given that many politicians’ main priority seems to be getting re-elected, it’s not surprising that long-term thinking isn’t much of a priority. However, short-term thinking is shitty for those of us dealing with mental illness, plus it’s expensive for society.
While it would be nice to see change because it’s the right thing to do, dollars and cents speak pretty loudly, so the economic case for investment is a pretty important one to be able to make.
What do you think would have to change to get the powers that be to pay more attention to mental health?
- Australian Government National Mental Health Commission. (n.d.). The economic case for investing in mental health prevention: Summary.
- Center for Workplace Mental Health. (n.d.). Making the business case.
- Centre for Mental Health. (2011). Mental health promotion and mental illness prevention: The economic case.
- Deloitte. (2020). Mental health and employers: Refreshing the case for investment.
- Mental Health Commission of Canada. (2017). Strengthening the case for investing in Canada’s Mental Health System: Economic considerations.
- Mental Health Commission of Canada. (2013). Making the case for investing in mental health in Canada.
- World Health Organization. (2013). Investing in mental health: Evidence for action.