What do we get back by investing in mental health?
Investment, rates of return and cost-benefit ratios are common enough terms in the world of business and finance, but not part of the everyday language of the mental health community. In an analysis prepared for the recent World Bank-WHO meeting ‘Out of the Shadows: Making mental health a global development priority’, however, it was exactly these terms that were used to explain the ”business case” for scaling up treatment and care for common mental disorders.
Invest US$ 1 in treatment for depression and anxiety, get a US$ 4 return in better health and ability to work
Our analysis, published in The Lancet Psychiatry (and openly accessible to all), focused on just two conditions – depression and anxiety – but we threw the net wide in terms of geographical scope: 36 low-, middle- and high-income countries, which between them account for 80% of the world’s population … and 80% of the global burden of common mental disorders. The “bottom line” of our analysis was that that for every US$ 1 invested in scaling up treatment for depression and anxiety – primarily psychosocial counselling and antidepressant medication provided in non-specialised health settings – we see a return of US$ 4 in better health and ability to work. Put another way, the monetised benefits of treatment – not just restored productivity but also the intrinsic value of being in a better state of health – were found to be 3-5 times greater than all the costs associated with treatment scale-up.
Scaling up treatment for less than US$ 2.50 per capita annually
Looking at the numbers behind this fourfold return, the estimated costs of scaling up treatment in these 36 large countries over a period of 15 years out to 2030 (as for the Sustainable Development Goals) amounted to US$ 147 billion. A lot, yes. But when converted into an annual amount per capita, it looks far less daunting: less than US$ 2.50. This investment also pales into insignificance when considered against the cost of not taking action: we estimated that a staggering US$ 1 trillion is lost globally per year due to diminished labour participation and productivity; that’s more than US$130 for every person on the planet! Crucially, we also find that the returns on investment are favourable: US$ 399 billion follows from just a 5% improvement in labour participation and productivity, and an additional US$ 310 billion in terms of improved health.
There is an investment case, but who will pay?
The study therefore provides a strong argument for greater investment in mental health services in countries of all income levels. This still leaves the difficult question of who will pay for this investment and thereby reduce or overcome the enormous funding gap that exists today. According to WHO’s Mental Health Atlas 2014 survey, governments spend on average 3% of their health budgets on mental health, ranging from less than 1% in low-income countries to 5% in high-income countries.
Given the ever-present pressure on government resources, there are no simple answers. For eligible low-income countries, inclusion of mental health into applications for funding through schemes such as the Global Financing Facility (with its focus on maternal, child and adolescent health) represents one clear opportunity; overall, however, there is an increasing push for governments to raise additional resources for health from domestic sources, through for example enhanced revenue generation and stronger taxation collection systems. This strongly suggests that the most productive approach for many countries will be through integration of mental health into existing health and development priorities, including early child development, maternal health and, more broadly, the progressive realisation of universal health coverage and enhanced well-being. Significant opportunities also exist to integrate mental health programming in countries or populations beset by conflict and/or migration, natural disasters or infectious disease outbreaks.
In short, while decent mental health care is a ‘product’ that makes economic sense, there is still a lot of work to be done to market it in such a way that it becomes available to all those in need.
Chisholm, D., K. Sweeny, P. Sheehan, B. Rasmussen, F. Smit, P., Cuijpers, S. Saxena (2016). “Scaling up treatment of depression and anxiety: a global return on investment analysis.” The Lancet Psychiatry. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30024-4/abstract