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Martin KnappLondon School of Economics
Institute of Psychiatry, King’s College London
Mental Health:the
Economic Dimension
Brussels 13 June 2008
Presentation structure
Adults of working age – costs impacts and solutionsChildren and young people –economic impacts and solutions
C. Older people– economic impacts and solutions
D. Efficiency, opportunity, equity
Adults of working
age
Adults of working ageHow many people are affected?
20 million people in EU-25 in 2004 had affective disorders; 40 million had anxiety disordersMany other family members are affected
With what consequences?Impoverished quality of lifeDamaged family relationsDestroyed careersHigh costs to businesses, State, wider economy
Prevalence figures from European Brain Council, 2005
Costs of depression (adults) in England, 2000
Day care0%
General practitione
1%
Mortality61%
Out-patient2%
In-patient3%
Primary care medication
33%
Thomas & Morris Brit J Psychiatry 2003
Excluding ‘morbidity’costs
Costs of depression (adults) in England, 2000
Productivity90%
Mortality6%
Service cost4%
Total cost = £9 billion
Thomas & Morris Brit J Psychiatry 2003
The business costs of mental ill-health
Absenteeism (UK)The average employee has 7 ‘sick days’ off per year … and 40% are for mental health problemsCost to business = £8.4 billion
‘Presenteeism’ (UK)Mental health problems can make people less productive in the workplaceCost to business = £15.1 billion
Staff turnover (UK)Replacing staff who leave because of mental ill-healthCost to business = £2.4 billionSainsbury Centre for Mental Health,
Policy Paper, 2007
Adults of working ageHow many people are affected?
20 million people in EU-25 in 2004 had affective disorders; 40 million had anxiety disordersMany family are also affected
With what consequences?Impoverished quality of lifeDamaged family relationsDestroyed careersCosts to businesses, State, wider economy
What can we do about it?Better access to evidence-based treatmentsBreak links with economic hardship: debt, povertyTargeted employment support
Prevalence figures from European Brain Council, 2005
Better access to recommended treatments: costs and benefits
0
1000
2000
3000
4000
53% in2000
65% 70% 75% 80% 85% 90% 95% 100%
Service costs Incapacity benefit Lost taxes
Knapp, McCrone, Capdevielle, unpublished, 2008
Working-age adults, England 2008Depression treatment as in NICE guidelinesAverage costs for all people with depression (£)
0
5000
10000
15000
53% in2000
65% 70% 75% 80% 85% 90% 95% 100%
Service costs Incapacity benefit Lost taxes Lost productivity
Knapp, McCrone, Capdevielle, unpublished, 2008
There are also important health and quality of life gains
Better access to recommended treatments: costs and benefits –adding the productivity benefits
Children and young
people
Children and young peopleHow many people are affected?
10-20% of European children and adolescents suffer from mental health problemsSuicide is one of the 3 most common causes of deathOther family members are affected
With what consequences?Poor quality of life; damaged family relationsDisrupted education; failure to fulfil potentialEnduring problems into adulthoodHigh costs to individuals, families, State & economy
See Jane-Llopis & Braddick, consensus paper for EC, 2008
Children with persistent antisocial behaviour: costs in childhood
Family costs45%
Education5%Voluntary
2%
Benefits43%
Social care0%
Health care5%
Total cost excluding benefits averaged £5960 per child per year, at 2000/01 prices (benefits = £4307)
Romeo, Knapp & Scott, Brit J Psychiatry, 2006
0
5000
10000
15000
20000
25000
None Beh Emo Cog Beh +Emo
Beh +Cog
Cog +Emo
Beh +Cog +Emo
Long-term consequencesEarnings (£) at age 30 by childhood
‘problem’ at age 10
Knapp, King, Yeh, work in progress, 2008
Beh = behavioural
Emo = emotional
Cog = cognitive
Children and young peopleHow many people are affected?
10-20% of European children and adolescents suffer from mental health problemsSuicide is one of the 3 most common causes of deathOther family members are affected
With what consequences?Poor quality of life; damaged family relationsDisrupted education; failure to fulfil potentialEnduring problems into adulthoodHigh costs to individuals, families, State & economy
What can we do about it?Parenting supportPrevent bullying & violenceSupport in schools
See Jane-Llopis & Braddick, consensus paper for EC, 2008
Work with communitiesTackle povertyBetter treatment access
Older people
Older peopleHow many people are affected?
5 million or more older Europeans have dementia10-15% of people aged 65+ have depressionSuicide rate is highest for older people
With what consequences?Again – devastating impacts on quality of lifeHeavy burdens falling to family carersBut often these consequences remain hiddenHigh costs to individuals, families, State & economy
See Jane-Llopis & Gabilondo, consensus paper for EC, 2008
Accommodation41%
Social care15%
Health services8%
Informal care36%
Costs of dementia in the UK
Knapp, Prince et al, Dementia UK, 2007
Care-giving reduces employment rates
Spiess & Schneider:Starting or increasing care-giving reduces women’s (paid) working hours in northern European countries; less effect in southern Europe
Henz:About 1/3 carers in Britain reported effects on their work routines – most commonly they stopped work
Heitmueller & Michaud:Employment rates for co-resident carers in England reduced by up to 6 percentage points
Spiess & Schneider, Ageing & Society, 2003
Henz, Ageing & Society, 2004
Heitmuller & Michaud, IZA Discussion Paper, 2006
Expenditure on long-term care for older people, 2000-2050 (% of GDP)
0
1
2
3
4
Germany Italy Spain UK
2000 2050
Long-term care (home care and institutional care) for people aged 65+Projected public & private expenditure as % of GDP
Comas-Herrera et al, Ageing & Society, 2006
Older peopleHow many people are affected?
5 million or more older Europeans have dementia10-15% of people aged 65+ have depressionSuicide rate is highest for older people
With what consequences?Again – devastating impacts on quality of lifeHeavy burdens falling to family carersBut often these consequences remain hiddenHigh costs to individuals, families, State & economy
What can we do about it?Better treatment accessBetter preventative effortsSupport for carers
See Jane-Llopis & Gabilondo, consensus paper for EC, 2008
Biomarkers?Social integrationChoice and control
Efficiency, opportunity,
equity
Mental health problems are often …
devastating - for individuals
burdensome - for families
challenging - for communities
very expensive - for economies
But – with personal, national and European action – we can do something about it … in pursuit of EU objectives.
This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.