Benefits of Mental Health Treatment Far Outweigh Costs: WHO

Nancy A. Melville

April 13, 2016

For every dollar spent on improving treatment for depression and anxiety, the return on the investment could be fourfold or higher in terms of increased productivity and health, new research shows.

"This analysis sets out, for the first time, a global investment case for a scaled-up response to the massive public health and economic burden of depression and anxiety disorders," the authors, led by Dan Chisholm, PhD, of the WHO's Department of Mental Health and Substance Abuse, in Geneva, Switzerland, write.

"Previous international economic studies of mental health have assessed the economic effect of these disorders, the cost-effectiveness of different intervention strategies, and the cost of scaling up care, but not the value of both economic and health benefits of intervention scale up," they add.

The study was published online April 12 in Lancet Psychiatry.

Makes Economic Sense

For the analysis, investigators used the WHO's OneHealth Tool to calculate the treatment costs of improving care for depression and anxiety disorders, as well as health outcomes, in 36 countries by 2030. These 36 countries account for 80% of the world's population.

The total cost, including counseling and medication, was estimated to be a somewhat daunting $147 billion.

The payoff, however, in terms of an estimated 5% improvement in the ability to work and labor force productivity, would amount to $399 billion. Improvements in health add an additional $310 billion in returns, according to the analysis.

The estimated costs included use of nonspecialist physicians, nurses, and community health workers, in addition to antidepressant medication. The benefit-to-cost ratio of the investment would be 2.3-3.0 in terms of workforce improvement and as much as 3.3-5.7 when years of health gains are considered.

The study cited estimates of $2.5 to $8.5 trillion in lost output attributed to mental, neurologic, and substance use disorders in 2010.

"This sum is expected to nearly double by 2030 if a concerted response is not mounted," the authors write.

"In view of this concern, the promotion of mental health and well-being have been explicitly included in the United Nations' 2015-30 Sustainable Development Goals."

The publication of the report was timed to coincide with the first-ever joint meeting of the World Bank and the WHO in tackling the global economic effect of depression and anxiety.

Margaret Chan, MD, DSc, director-general of the WHO, commented that the study underscores the need for more focus on the issues.

"We know that treatment of depression and anxiety makes good sense for health and well-being. This new study confirms that it makes sound economic sense too," she said in a WHO press statement.

"We must now find ways to make sure that access to mental health services becomes a reality for all men, women, and children, wherever they live."

The WHO reported that rates of depression and anxiety worldwide increased nearly 50% from 1990 to 2013, from 416 million to 615 million. These conditions currently affect nearly 10% of the world's population.

A Mental Health Atlas survey conducted by the WHO in 2014 showed that governments spend on average only 3% of their healthcare budgets on mental health. The amount ranges from less than 1% in low-income countries to 5% in high-income countries.

Human Rights Issue

In an accompanying editorial, Paul Summergrad, MD, of Tufts University School of Medicine, in Boston, Massachusetts, noted that the joint WHO/World Bank meeting represents "a very important initial step, but only a predicate to overdue and much needed bold action."

He pointed out that although the return on investment described in the study is less than has been reported with some other medical interventions, there are many additional benefits of mental health interventions.

"These include the effect of treated depression and anxiety on maternal-child health, or the effect on other general health disorders that are more prevalent and costly in people with mental disorders," Dr Summergrad writes.

"The Chisholm study brings rigour to the economic case, but there are many other important reasons to consider enhanced investment in global mental health, not least of which are justice, equity, human rights, and the reduction of suffering."

The study's authors report no relevant financial relationships. Dr Summergrad has received personal fees from the American Psychiatric Association and CME Outfitters and from universities and associations for nonpromotional speaking not related to the submitted work.

Lancet Psychiatry. Published online April 12, 2016. Full text, Editorial

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