MENTAL HEALTH
Following a recent report into the social and economic implications of mental illness, Professor Bob Grove, joint chief executive of the Centre for Mental Health, discusses its impact on the workforce.
I
n 2006, the Scottish Association for Mental Health (SAMH) published a re- port, called ‘What’s It Worth?’, which pre- sented high-level estimates of the social and economic costs of mental health prob- lems in Scotland for the year 2004/05.
These included estimated costs of the out- put losses in the Scottish economy that result from the adverse effects of mental health problems on people’s ability to work.
Annual cost of mental ill-health
As part of SAMH’s ‘Dismissed?’ campaign for fairness in employability and mental health, the Centre for Mental Health has updated the estimates of social and eco- nomic costs given in the 2006 publication, with a particular focus on the employment- related costs of mental ill-health, both in work and out of work.
The costs of mental health problems were described and evaluated in our 2006 report under three headings:
• The costs of health and social care for people with mental health problems, in- cluding services paid for by the NHS and local authorities and also the informal care provided by family and friends;
• The costs of output losses in the econo- my that are linked to the impact of men- tal health problems on work and employ- ment; and
• The human costs of mental health prob- lems, representing their negative impact on the quality of life.
On the basis of this classification it was es- timated that the total cost of mental health problems in Scotland in 2004/05 amount- ed to £8.6bn. A straightforward updating of the figures to 2009/10 indicates that the total cost of mental health problems in Scotland has increased to around £10.4bn.
Costs of mental health problems, Scotland, 2009/10
Health and social care Output losses Human costs
Total
£bn 1.9 2.9 5.6
10.4 52 | national health executive May/Jun 11
% of total 18.5 27.9 53.6
100.0
There is a particularly high degree of per- sistence or continuity between adverse mental health states in childhood and those in adult life. Most children who have men- tal health problems will also have mental health problems as adults, and conversely most adults who have mental health prob- lems will also have had mental health prob- lems as children.
One British study found that 71% of peo- ple with depression and anxiety as adults displayed symptoms during childhood, and that of all children with depression or anxi- ety, 85% continued to have these problems in adult life.1
Conduct disorder is the most common mental health disorder in childhood, af- fecting 5.5% of all children in Scotland between the ages of 5 and 16,2
and there is
strong evidence to suggest that prevalence has increased significantly over the last 30 years.3
The condition is predictive of a wide
range of adverse outcomes in later life, in- cluding not only continuing mental health problems (uniquely, childhood conduct disorder is associated with increased risk for all types of adult psychiatric disorder), but also poor educational and labour mar- ket performance, substance misuse, crimi- nality, disrupted personal relationships and even reduced life expectancy.4
The lifetime costs of childhood conduct disorder, relative to individuals with no conduct problems, may be of the order of £225,000 per case, taking into account such factors as reduced lifetime earnings, poor mental and physical health and costs relating to crime. Such figures graphically illustrate the enormous potential benefits
Lifetime costs
These figures measure the costs of mental health problems as they arise in a single year. As an alternative, there is growing interest in measuring costs on a lifetime basis, building on a substantial body of evi- dence from longitudinal studies in Britain and elsewhere that, in the absence of ef- fective intervention, many mental health problems tend to be highly persistent and recurrent.
of effective early intervention, costing an average of just £1,200 per child.
Whether measured on an annual or life- time basis, it is clear that mental health problems impose very high costs, both on individuals and their families and on so- ciety as a whole. The scale of these costs reflects three key features of mental ill- health:
1. Mental health problems are extremely common, affecting more than one in five of the adult population at any one time; many of these problems go undiagnosed and untreated;
2. Mental health problems often have their origins in early life, with a high tenden- cy towards persistence and recurrence throughout the life course;
3. The consequences of mental ill-health are often pervasive, adversely affecting many
different aspects of people’s
lives, and these adverse consequences are often compounded by stigma and discrimination.
Mental health and work
The consequences of mental ill-health are particularly important in the world of work. Mental ill-health is now the domi- nant health problem of working age. The prevalence of mental ill-health is highest when people are in their twenties and thir- ties and then declines steadily with age.
Poor mental health has a major impact on individuals and the economy. For indi- viduals, it can mean difficulties in finding employment, increased risk of losing a job, frequent or prolonged periods of sickness absence and, at worst, long-term unem- ployment and detachment from the labour market, leading to a downward cycle of low income, worsening health and social exclu- sion. The longer people are out of work, the lower their chances of ever getting back. For the economy, there are enormous costs because of the lost production of people who are unable to work or whose attend- ance and performance at work are disrupt- ed by their mental health condition.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84