1. Better Mental for All Economics and Public Mental Health

2. Thinking about economics
Rapid review (in 2s and 3s/10 minutes): - what concepts come to mind when you hear the word “economics”? - what use is it to you in your work? - what do you need to know more about?

3. Economics of mental health - 5 ways of thinking
1. Political economy and globalization
2.The economy and its impact on peoples` lives – wider determinants and behaviours
3.The direct public services costs of poor mental health
4.The wider costs of poor mental health
5. Investing in better public mental health

4. Public Economics 101 microeconomic concepts
Supply and demand
Administrative and market mechanisms, transaction costs
Scarcity, choice, efficiency, effectiveness
Opportunity cost, return on investment , social return on investment, public value
Cost-effectiveness, cost-benefit
Outsourcing, privatization, regulation

5. Public Economics 101 macroeconomics and trade
Systems models – Neoclassical and Keynesian
Fiscal and monetary instruments of policy
Financialization of economy - debt, derivatives and futures, and role of banking
General trade agreements, free trade, open markets, private property and free movement of capital and labour – “Washington Consensus” (international corporations)
Shift to services and the impact of offshoring
Innovation and IT – lean manufacturing and robotics
Political economy – who benefits, who pays? – “does politics make you sick?” (Schrecker and Bambra 2016)

6. Public Economics 101 some alternatives
Communism, libertarianism, corporatism
Co-operatives and social enterprises
Catholic social teaching – justice and subsidiarity
Economics as though women and children mattered
Ecological economics and sustainability
Scope of markets and competition
Post-industrial prospects and guaranteed minimum incomes (GMIs)

7. The costs of poor mental health 10 Questions
1. Estimate the direct health and social care costs of mental health problems in the UK ? 2. Optimal treatments for mental disorders will avert what proportion of the burden of direct health and care costs? 3.And the wider costs including employment, benefits, housing and criminal justice? 4. Employment costs from sickness, absenteeism, “presenteeism”? 5. Percentage of people on L-T benefits due to health problems with a primary MH problem? 6.Cost of a single suicide of a person of working age? 7. Of every £8 spent on L-T conditions, how much can definitely be linked to poor MH? 8.Percentage of those with MH problems with a L-T physical condition? 9. By how much is this likely to increase costs of physical healthcare? 10. What proportion of spending goes on the prevention of poor mental health? .

8. The Economic Case for preventing and mitigating poor mental health
Direct health and social care costs £21bn+
Estimated economic and social costs of mental health problems in England (health, social care, loss of output, human costs) £105bn+
For NI, Scotland and Wales £19bn+
Indirect costs from unemployment, absenteeism and “presenteeism” £30bn+
MH adds to physical healthcare £10bn+
L-T conditions MH component £1/£8+
Cost of a single working age suicide £1.6m (?)

9. What is to be done?
Where would you invest to improve mental health and wellbeing (and reduce costs)?
What would a good investment look like? (certainty; timescales; alternatives)
Would it be economically better, eg, to invest more in preventing loneliness or in early intervention in psychosis?
What about early intervention to minimise childhood distress in relation to improved mental and physical health in later life
How would you know?

10. Suicide Prevention Exercise (15 minutes) – 2 groups
What is the cost of a single suicide of an employed man aged 30 from a motorway bridge at 8am on a working day?:
Estimate the direct costs to public services
What is the cost to members of the public and businesses?
What is the financial effect on families, friends and employers ?
What might be the impact on MHRC and benefits?
What would it cost to prevent?

11. Some pay-offs from prevention (1)
1:1 befriending for older adults
Early intervention for depression in diabetes
Early intervention for medically unexplained symptoms
Health visitor interventions for postnatal depression
Debt advice services
Early diagnosis and treatment of depression at work
(Knapp M et al (eds.) 2011)

12. Some pay-offs (2) workplace health promotion
screening for alcohol misuse
early detection of psychosis
school-based interventions to reduce bullying
early intervention in psychosis
suicide training for GPs
bridge safety barriers
prevention of conduct disorder via SELPs
(Knapp M et al (eds.) 2011)

13. Examples 1.Parenting programmes for children with conduct disorder
- Between 2.8 and 6.1 times intervention cost
- 25 year pay-off period
- Crime reduction shows biggest benefits (Bonin et al, in Knapp et al 2011)

14. Examples 2.Loneliness and social isolation
- Between 1.3 and 1.91times intervention cost
5 year pay-off period
NHS and social care benefit most
(CTEL 2014)

15. Complications! Valuing wellbeing as well as mental ill health
Looking at total benefits as well as benefit per case
Researching the gains to physical health from early mental health prevention/ intervention
Marginal cost of additional numbers and marginal gains from additional activity
Impact on population segments and impact on health inequalities
Who gains from the investment?

16. Who benefits?: (1) the NHS (2) other public organizations (3) non-public sector? (illustration)
Interventions 1.NHS 2.POs 3.N-PS Workplace health promotion Debt advice Loneliness Early intervention in psychosis Safety barriers Conduct disorder

17. Who benefits?: (1) the NHS (2) other public organizations (3) non-public sector? (illustration from Knapp)
Interventions £s per £ 1.NHS 2.POs 3.N-PS Workplace health promotion - ? - ? 9.69 Debt advice Loneliness ? ? - Early intervention in psychosis Safety barriers Conduct disorder SELP

18. Some considerations Scope of studies – the research questions
Research challenges – methods and models
Small (large) effects over large (small) populations (Rose)
Timescale for impact and return on investment
Overlapping effects – co-morbidity
Marginal additional efforts on top of existing interventions

19. Some Conclusions
Poor mental health is damaging and costly (Knapp et al)
Investments in preventive mental health can be justified by the evidence (Knapp et al) for both mental and physical health
It pays to invest in wellbeing and positive mental health as well as severe and enduring mental illness (Bellis et al)
Early stages of the life-course are a really good time to invest (Bellis et al) for lifelong health
and
It can be right to invest even if the returns are apparently low or non-existent – the moral argument and research bias!
There is a wider field of health and political economy (Schrecker and Bambra 2015)

20. References (1) : the economics of mental health
CMO Annual Report 2013, Knapp et al. Chapter 9
Friedli L, Parsonage M Promoting mental health and preventing mental illness: the economic case for investment in Wales. AWMH Promotion Network. October 2009 Keyes C L M.Promoting and protecting mental health as flourishing. American Psychologist 2007, 62(2):
Knapp M et al (eds). Mental health promotion and mental illness prevention: the economic case. Department of Health April 2011
Naylor C et al. Long term conditions and mental health – the cost of co-morbidities. Kings Fund and Centre for Mental Health
Sainsbury Centre for Mental Health. Mental health at work : developing the business case. December Welch C A et al. Depression and costs of health care. Psychosomatics, 2009 Jul-Aug; 50(4) :

21. References (3): some science, politics and economics
Hillman A.L., Public Finance and Public Policy. CUP.
Rodrick D Economics Rules – why economics works, when it fails and how to tell the difference. Oxford University Press.
Schrecker T. and Bambra C How Politics Makes Us Sick – Neoliberal epidemics. Palgrave Macmillan.