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The cost of poor mental health

Overall costs

It has been estimated that the economic and social costs of mental health problems in England was £105 billion in 2009-10 – taking into account costs for health and social care, loss of output and human costs. (2) Those who developed this estimate think it is likely to be an underestimate. (3)

Additional estimates put the cost of mental illness for Northern Ireland at around £3 billion, Wales £7 billion and Scotland £9 billion. (4) NHS spend on mental health services alone came to around £10 billion in 2008-09. It has been estimated that optimal treatment for mental disorders will only avert 28% of the burden of mental illness, (5) highlighting the need for prevention.

Mental illness and lack of mental wellbeing impact on communities and individuals’ lives in many ways, and economic studies assign costs to these different impacts. Most studies include costs due to mental health service usage, but not the additional costs to other health services due, for example, to chronic illness.

Costs to social services are usually included, but only some studies include costs to criminal justice and probation services. Studies may cover sickness absence due to mental illness but not the costs of presenteeism which may be greater. The costs presented therefore provide a very useful baseline but are usually regarded as underestimates for these reasons.

Workplace


In the world of work, one study estimates that sickness absence due to mental ill health costs around £8 billion per year (70 million working days missed each year, or an average of 2.8 days per year per UK employee). Lost productivity (including presenteeism, where mental health issues lessen work performance) costs £15 billion, and replacing staff who leave their posts because of mental illness costs employers £2 billion. (6)

Unemployment


Government figures show that 43% of those on long-term benefits due to health issues have a primary mental health problem. (7)

Costs of related physical health problems


Poor mental health is associated with physical health problems. Of those with a long-term physical health condition around 30% will also have a mental health problem, and of those with a mental health problem, around 45% will also have a long-term physical health condition. (8) This has an impact on the cost of providing care – treating the physical health issues of patients with a mental health problem is more expensive (even after removing the cost of treating the mental health issue, such as for antidepressants or mental health services). (9)

This can increase costs of healthcare for physical problems by more than 45%, according to some international studies. If applied to NHS expenditure in England, this could mean that £8-13 billion of long-term physical health care costs are due to poor mental health. (10)

Costs to the individual and their families


Poor mental health impacts on individuals and their families, in terms of lost income, lower educational attainment, quality of life and considerably shorter life span.(11) (12)

The economic benefits of mental wellbeing

The economic benefits of mental wellbeing are not as well established as the costs of mental illness. However, mental health promotion has an important contribution to make to overall public health through increasing psychosocial functioning, lowering use of healthcare (13) and reducing morbidity and premature mortality. (14)

As an example, one study estimates that promoting mental wellbeing in a single year cohort of children in Wales could lead to benefits worth over £1billion, (15) while this figure could be nearly £24billion for the whole of the UK. (16) Since benefits accrue across the lifecourse, promoting mental wellbeing in children provides more economic benefits than promoting mental wellbeing at other ages. What does economic evidence tell us about public mental health?

References

1. Friedli L, Parsonage M. Promoting mental health and preventing mental illness: the economic case for investment in Wales. All Wales Mental Health Promotion Network. 2009.

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2.Centre for Mental Health. The economic and social costs of mental health problems in 2009/10. 2001.

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3. Centre for Mental Health. The economic and social costs of mental health problems in 2009/10. 2001.

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4. Cyhlarova E. Economic burden of mental illness cannot be tackled without research investment. Mental Health Foundation. 2010. 

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5. Andrews G, et al. Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders. British Journal of Psychiatry 2004; 184:526-533.

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6. Sainsbury Centre for Mental Health. Mental health at work: developing the business case. 2007.

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7.HM Government. No health without mental health. 2011

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8. Naylor C et al. Long term conditions and mental health – the cost of co-morbidities. King’s Fund and Centre for Mental Health. 2012. 

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9. Welch C A et al, Depression and costs of health care. Psychosomatics, 2009 Jul-Aug; 50(4): 392-401.

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10. Naylor C et al. Long term conditions and mental health – the cost of co-morbidities. King’s Fund and Centre for Mental Health. February 2012. 

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11. WHO. Investing in mental health. 2003. 

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12. HM Government. No health without mental health. 2011. 

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13. Keyes C L M. Promoting and protecting mental health as flourishing. American Psychologist 2007, 62(2): 95-108.

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14. Chida Y, Steptoe A. Positive psychological well-being and mortality: a quantitative review of prospective observational studies. Psychosom Med 70:7, 2008.

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15. Friedli L, Parsonage M, Promoting mental health and preventing mental illness: the economic case for investment in Wales. All Wales Mental Health Promotion Network. 2009. 

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