Monday, 26 September 2011

The financials of mental ill-health

Health is a funny old thing. The old adage goes that you don't realise how important good health is until you don't have it. For many people when they think of health, they generally think of physical health and the onwards connotations of disease, infection and other things related to doctors and hospitals. Modern day health and its word partner in crime 'well-being' (hyphenated or not?) however reflects much more than the various physical and somatic conditions that might affect us, it also encompasses our mental health and its consequences to our lives and indeed, to our physical health.

A few reports and studies led me to this post on mental health and ill-health worthy of some consideration and comment. Today (26/09/11) the BBC website links to a paper published in the The Lancet Oncology by Sullivan and colleagues* (many colleagues!) on the unsustainable financial burden of cancer care in the developed world. The figures banded around are absolutely astronomical in terms of the costs of care, medication and new technologies implemented on our war against cancer as more cases are diagnosed and more comprehensive treatments are developed. To quote from the authors: "we spend more because we can do more to help patients".

Contrast this with another couple of reports, the first from Wittchen and colleagues** on the size and burden of mental 'disorders' in Europe. The article (full-text available) suggests that Europe-wide the numbers of people with mental ill-health, covering a wide range of conditions, is high and represents Europe's largest health challenge in the 21st century. The financial costs: don't even go there.

The second report is this paper published by Ramin Mojtabai*** on the rates of self-reported mental health disability in the United States. The bottom-line: rates of mental ill-health are rising; over a 10-year period estimated at an extra 2 million people who reported mental ill-health in the US. Again the financials: don't even go there.

The point I want to make with these comparisons is that the monetary costs of our physical ill-health on things like screening, treatment and loss to the economy from things like time off work are significant and growing. Having said that the impact of a growing population reporting mental health issues potentially represents an even greater economic burden, which perhaps due to various issues such as 'not-knowing' what causes mental ill-health and how to effectively tackle it, will likely further stretch the seemingly dwindling National finances available. Please note that I am not saying that we should pit physical health against mental health in some kind of Doug McClure 'Land that Time Forgot' gladiatorial funding contest. Merely that we need to recognise how mental ill-health rivals physical ill-health in terms of numbers but funding for research and treatment may not necessarily reflect the parity.

The last word goes to Prof. Til Wykes, who last year, spelled out how bleak the situation was and might become: "In these austere times, it is worth bearing in mind that in England alone mental health issues cost us £77bn a year".

Food for thought.

Additional note 28/09/11: Tom Insel at the NIMH carries an interesting entry on his Director's blog about the global cost of mental ill-health (here).

* Sullivan R. et al. Delivering affordable cancer care in high-income countries. Lancet Oncology 12(10): 933-980. September 2011.

** Wittchen HU. et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology 21: 655-679. 2011.

*** Mojtabai R. National trends in mental health disability, 1997-2009. American Journal of Public Health. September 2011.