The economic costs of mental illness in Ireland

Dr Brendan Kelly writes that the economic downturn makes investing in mental health even more pressing — for both patients and society as a whole.
The next few years are likely to see a much more considered approach to healthcare spending in Ireland. There is likely to be increased emphasis on value for money and evidence-based spending, focusing resources on those programmes that are demonstrably most likely to produce lasting benefit in terms of the personal wellbeing of individuals with mental illness and the economic wellbeing of Ireland as a whole.

In the above context, it is especially useful that the past year has seen several significant studies of the economic costs of mental illness in Ireland, all of which demonstrate an urgent necessity for enhanced focus on this relatively neglected area.
h4. The cost of mental illness
In 2006, the cost of mental health problems in Ireland exceeded €3 billion (O’Shea and Kennelly, 2008). This figure includes just over €1 billion for the cost of healthcare, social care and other forms of direct care.
The greater part of this €3 billion, however, stems from lost economic output, which amounts to over €2 billion, and comprises €1044.6 million due to non-employment and under-employment, €207 million due to premature mortality, and €751.1 million due to unpaid work.
These estimates do not, of course, reflect the psychological suffering of individuals with mental illness, nor the psychological suffering experienced by their families and friends.
Specific illnesses present specific challenges. In 2008, Behan et al. (2008) used cost-of-illness procedures to study the economic cost of schizophrenia in Ireland, and estimated that the total cost of the illness in 2006 was €460.6 million.
This comprised €117.5 million for direct costs of care and €343 million for indirect costs, including €43.8 million for informal care provided by families. Lost productivity due to absence from work, unemployment and premature mortality came to €277 million. These enormous costs highlight the pervasive effects of schizophrenia not only on individuals with the illness, but also their families and carers, and society as a whole.
Turner et al. (2009) took an especially close look at employment status amongst individuals presenting with mental illnesses characterised by psychosis (e.g. schizophrenia or mood disorders with psychosis) and found that the unemployment rate in this group was nine times the local rate.
Amongst these individuals, unemployment was associated with a longer duration of untreated illness, more negative symptoms (such as social withdrawal) and lower quality of life.
Overall, this timely study highlighted the strong associations between mental illness, unemployment and quality of life, and demonstrated the existence of a complex network of interacting factors that clearly needs to be addressed both in the interests of this group of individuals and the interest of society as a whole.
h4. Addressing the issues
Policy-makers can no longer afford to ignore issues related to mental healthcare (O’Shea and Kennelly, 2008). The first and most important justification for investment in this area stems from the suffering of individuals with mental illness, and their families: inaction is not an option.
But there is also a compelling economic rationale for enhanced investment in mental healthcare: in the midst of an economic recession, the enormous cost of mental health problems to Ireland’s economy can no longer be swept under the carpet – and this argument becomes even more compelling in light of the availability of effective, cost-efficient interventions that combine therapeutic improvement for the individual with economic benefits for society.
In the United Kingdom, Richard Layard has made a strong case for dramatically improving access to psychological treatment centres, aimed at reducing symptoms of certain types of mental illness and enhancing the possibility of individuals returning to work (Layard, 2006).
Layard points out that a course of psychological treatment for anxiety or depression costs approximately €874 and, as well as reducing the individual’s troubling symptoms, such treatment greatly increases the possibility of a return to work, and results in an average increased economic output of €2190 per person, within two years. On this basis, this form of mental healthcare will reduce the individual’s symptoms, pay for itself within two years, and increase economic output for society as a whole.
h4. Mental healthcare during a recession…
Given the enormous economic cost of mental illness to the Irish economy, urgent consideration needs to be given to enhancing investment in mental healthcare and increasing access to psychological therapies for individuals with specific disorders (e.g. anxiety and depression).
Regrettably, the past two decades have seen a substantial fall in the proportion of Ireland’s health budget devoted to mental health: in 1984, 14 per cent of Ireland’s health budget was devoted to mental health, but by 2007 this had fallen to less than 8 per cent (Kelly, 2008).
These recent studies of the cost of mental illness to the Irish economy highlight an urgent need to invest in this area, not only in order to relieve the suffering of individuals with mental illness and their families, but also in order to expedite economic recovery.
In the UK, there are already strong signs of a political move in this direction, with a recent governmental commitment to train an additional 3,600 psychological therapists and establish psychotherapy centres in every primary care trust by the end of 2010 (Helm, 2009).
While identical solutions may not suit every country’s requirements, there is now an unanswerable need for a similar level of focus and engagement with mental healthcare in many other countries, including Ireland. Indeed, as the full extent of Ireland’s economic woes continues to become apparent, the case for enhanced investment in mental healthcare becomes ever more compelling by the day.
* Dr Brendan Kelly is a senior lecturer in psychiatry at University College Dublin.
* References on request.
Behan C, Kennelly B, O’Callaghan E. The economic cost of schizophrenia in Ireland: a cost of illness study. Irish Journal of Psychological Medicine 2008; 25: 80-87.
Helm T. Victims of recession to get free therapy. The Observer, 8 March 2009.
Kelly BD. Mental healthcare more than pays for itself. The Irish Times (HealthPlus), 30 December 2008.
Layard R. The case for psychological treatment centres. BMJ 2006; 332: 1030.
O’Shea E, Kennelly B. The Economics of Mental Health Care in Ireland. Galway and Dublin: Irish Centre for Social Gerontology and Department of Economics, NUI Galway/ Mental Health Commission, 2008.
Turner N, Browne S, Clarke M, Gervin M, Larkin C, Waddington JL, O’Callaghan E. Employment status amongst those with psychosis at first presentation. Social Psychiatry and Psychiatric Epidemiology (Epub ahead of print) (DOI 10.1007/s00127-009-0008-6)