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Below are examples of interventions where the economic benefits (as opposed to other benefits such as improved quality of life) have been shown to outweigh the costs. This section draws heavily on the publication Mental Health Promotion and Prevention: The Economic Case. (1) Further information on many of the interventions below can be found in that document.
Note that activities that promote mental wellbeing usually also prevent mental illness but the reverse is not always true. Some of the interventions shown here may do both.
Public mental health interventions can have a lifecourse impact on health, social and economic wellbeing, and reduce spending in health services, social services, educational services, welfare and criminal justice systems. As with costing studies, most economic studies capture only a few of these expenditures – and usually for a limited period of time.
At present, these studies are likely to greatly underestimate the benefits. Many of the studies quoted below are based on models which indicate potential savings, as opposed to studies that determine actual savings. Further research and evaluation will improve estimates of the economic benefits of different types of interventions. In the meantime, existing studies point to interventions that are highly likely to prove to be a sound investment in times of limited resources.
Economic studies require that both interventions and outcomes can be accurately costed, and this is true at present of only a limited selection of interventions or approaches to public mental health. Interventions that are effective in promoting mental wellbeing and preventing mental illness – but which have not necessarily been subjected to cost-benefit analysis – are discussed in the interventions section of this resource.
Parenting programmes to prevent conduct disorder (2)
Conduct disorder involves a range of antisocial behaviours that can interfere with a child or young person’s ability to lead a normal life. (3) It is estimated to affect around 5% of children aged 5 to 10 years, and 50% of those may go on to have antisocial behaviour problems in adulthood.
Interventions which have been subject to economic analyses are aimed at parents of children who have or are at risk of developing conduct disorder, and the economic benefits include reduced use of mental health services, social care and special education services, as well as reduced crime. Based on data drawn from a number of studies, and looking at impacts in the first 30 years of life, it is estimated that this intervention could return nearly £8 for every £1 invested.
A wide range of evidence-based parenting programmes have been developed which aim to impact not just on conduct disorder but also on other aspects of mental and social health and wellbeing throughout life.
At present it is only the programmes to prevent and treat conduct problems which have been subjected to this type of economic analysis.
School-based social and emotional learning programmes to prevent conduct problems in childhood (4)
Other interventions aimed at reducing conduct problems are based in schools. These increase emotional awareness and relationship skills, enhancing behaviour and academic attainment. Economic analysis shows that these programmes can save costs even from the first year. The savings included are those that impact on mental health services, the criminal justice system and schools, as well as other costs related to crime. It is estimated that £83 are saved in the first year by the public sector for every £1 invested, with £39 of that total relating to NHS costs.
Conduct problems are only one of a number of outcomes which school-based social and emotional learning programmes – and indeed school-based mental health promotion programmes more generally – aim to influence. The others include educational attainment, social skills, school absence, depression and anxiety.
School-based anti-bullying interventions (5)
As well as poor mental health, bullying can lead to poor physical health, poor educational attainment and low long-term earnings. Nearly 40% of children report being bullied each year. (6) School-based programmes for 11 to 16 year olds cost less than £20 per pupil per year and can lead to increased lifetime earnings of £1080 per pupil.
Anti-bullying programmes can stand alone, or the issue can be addressed in the context of school-based mental health promotion programmes.
Workplace wellbeing programmes (7)
A multi-component health promotion programme accessed by employees through their workplace showed savings of around £9.70 for every £1 invested. The programme included personalised information provision and health appraisal, access to an online resource and workshops and seminars. It led to reduced stress levels and sickness absence, as well as improved productivity. Included in the economic analysis were costs saved by the NHS due to mental illnesses avoided.
Few workplace interventions have been subject to controlled trials because companies do not usually require this level of evidence before implementation. Companies who have implemented a range of interventions have maintained them because they are perceived to be cost saving. (8)
Debt advice services (9)
Unmanageable debt is a social determinant of mental illness that can often be overlooked. However, those who are unable to manage their debts are at much higher risk (33%) of depression and anxiety compared to those without debt problems. Interventions can be face-to-face, over the telephone or internet based, with widely varying costs associated with each.
The economic calculation is also affected by who pays for the intervention – for example, creditors often contribute to the costs of the service. Most modelled scenarios led to savings from face-to-face services over five years of around £3 per £1 invested.
Active labour markets
Economic downturns can have a negative impact on mental health – for example, in England, the number of suicides in men has increased as unemployment benefit claims have gone up in recent years. (10) However, there are steps that can be taken to alleviate the mental health impacts of economic crises, and one of these is to support active labour markets. (11)
This involves activities such as helping people to find employment (including young people just leaving school) and psychological support for unemployed people and those who lose their jobs. It has been shown in an American study that where US $190 is spent per person per year on these activities, there is no negative effect from rising unemployment on suicide rates. (12) It has been estimated that each time a working aged adult in England takes their own life, it has an economic cost of £1.7m (13).
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References
1) Knapp M et al (eds). Mental health promotion and mental illness prevention: the economic case. Department of Health. 2011.
2) This section drawn from Knapp M et al (eds). Mental health promotion and mental illness prevention: the economic case. Department of Health. 2011.
3) Royal College of Psychiatrists. Behavioural problems and conduct disorder: information for parents, carers and anyone who works with young people. (last accessed 25 May 2013).
4) This section drawn from Knapp M et al (eds). Mental health promotion and mental illness prevention: the economic case. Department of Health. 2011.
5) This section drawn from Knapp M et al (eds). Mental health promotion and mental illness prevention: the economic case. Department of Health. 2011.
6) Ofsted. TellUs3 National Report. 2008.
7) This section drawn from Knapp M et al (eds). Mental health promotion and mental illness prevention: the economic case. Department of Health. 2011.
8) Litchfield P. Public mental health and wellbeing – the workplace. Presented during Public Mental Health Masters module at Warwick University. Coventry.,2013.
9) Knapp M et al (eds). Mental health promotion and mental illness prevention: the economic case. Department of Health. April 2011.
10)Barr B et al. Suicides associated with the 2008-10 economic recession in England: time trend analysis. BMJ 2012;345:e5142.
11) Wahlbeck K, McDaid D. Actions to alleviate the mental health impact of the economic crisis. World Psychiatry 2012; 11:139-145.
12) Stuckler D et al. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 2009; 374:315-323.
13) Knapp M et al (eds). Mental health promotion and mental illness prevention: the economic case. Department of Health. 2011.
