Author: Greg Lydall

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Money talks: the economic argument for preventing mental illness

In addition to the human cost, the suffering, and the lives lost to suicide, there is a strong evidence-based economic argument for investing in mental health prevention, health promotion, early intervention and high quality care. This 2 minute read covers the costs, the paybacks, and the potential for smaller jurisdictions to become test bed nations for solving global complex challenges.

 

The costs

The human numbers are significant. The World Health Organization (WHO) estimates that around 300 million people worldwide have depression and 50 million have dementia. Schizophrenia is estimated to affect 23 million people, and bipolar disorder around 60 million.

Globally, mental illness and neurological disorders cost the global economy a trillion US dollars per year. This figure is likely to rise to $16 trillion between 2010 and 2030 if a collective failure to respond is not addressed, according to the Lancet Commission on Global Mental Health.

 

In the UK, England spends some £19Bn per year on mental health services. Serious mental illness costs America $193.2 billion in lost earnings per year.

Even in well-resourced countries, the best mental healthcare systems are only able to meet about 50% of the demand. This has been called the Mental Health Gap by the WHO (mhGAP).

Prevention pays

There is strong evidence that for every Pound/Dollar spent on prevention, society saves money. However the savings are often not seen immediately, so a minimum of 1-2 years are required for the full economic benefit. The examples below have been demonstrated in high quality scientific publications, and are focused on risk factors for mental illness in children, the workplace, adults and older people.

Examples of mental health prevention ROI:

  • Children: whole school anti bullying programme – every £1 invested results in an estimated saving to society of £1.58 (over 4 years)
  • Children: social and emotional learning – every £1 invested results in an estimated saving to society of £5.08 (over 3 years)
  • Workplace: wellbeing programme – every £1 invested results in an estimated saving to society of £2.37 (over 1 year)
  • Workplace: stress prevention – every £1 invested results in an estimated saving to society of £2.00 (over 2 years)
  • Collaborative care for physical health problems – every £1 invested results in an estimated saving to society of £1.52 (over 2 years)
  • Older people: tackling loneliness through volunteering and social activities – every £1 invested results in an estimated saving to society of £1.26 (over 5 years)
  • Adults: debt and welfare service – every £1 invested results in an estimated saving to society of £2.60 (over 5 years)
  • Adults: suicide prevention – every £1 invested results in an estimated saving to society of £2.93 (over 10 years)

 

 

Next steps

While these are impressive figures, there are two main challenges:

  1. Convincing Governments to invest in prevention.

Because political cycles are every 4-5 years, and budgets annual, it can be a real challenge in convincing governments to invest in prevention.  The Lancet Commission advocate a Human Rights based approach to help governments see the importance of investing in treatment. We would argue that the same approach is valid for investing in prevention.

2. Deciding which programmes to implement

This is where the Thrive Foundation comes in. Our scientifi advisor board of international experts will together work out a reasonable set of prevention interventions, across the life course, and implement these across a whole population.

Our first chosen site is the island of Guernsey, home of the Dandelion Foundation and Thrive2020. Guernsey is also positioning itself as a “test bed nation”. We see that smaller jursdictions can be used to simplify complex challenges like mental health, and demonstrate scaleable solutions for larger similar jurisdictions, at lower cost.

 

Conclusions

Mental health problems are preventable, with good evidence that prevention programmes work and save money. The Thrive Foundation intends to bring together a suite of prevention interventions across a whole population and rigorously monitor the results. In so doing we intend to shift our population’s overall mental health away from suffering and towards thriving.

 

Further reading

 

For the interested reader, Public Health England have developed a Return on Investment (ROI) Tool and they have also written some excellent guidance on making the most of your budget.

Public Health England: Commissioning Cost-Effective Services for Promotion of Mental Health and Wellbeing and Prevention of Mental Ill-Health.

We are indebted to PHE and the WHO for inspiring much of our thinking.

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Thrive participants

Impact: Reimagine a whole mental health ecosystem

Background

The Thrive Foundation is an accelerator for solving mental health. It uses scientific evidence, cutting-edge innovation, and the power of human community, to solve mental health in a community.

Mental health is dependent on structural determinants: mental wellbeing is best achieved in equitable, just and non-violent societies (Patel 2014). Few Western countries truly harness people power within their communities to improve their societies.

We have been running Thrive2020 events and project support since 2015. In 3 years we have achieved significant impact in our community, and learned an enormous amount about reimagining a mental health ecosystem.

Currently, the Thrive Foundation is the only organisation in the world that openly sees mental health as a solvable challenge.

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Thrive2020 participants

Approach

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The 3 keys to “solving” mental health

“Mental health is a societal issue long before it becomes a clinical one.”

 – Greg Lydall, co-founder Thrive2020.org and the Thrive Foundation.

 

Can we reduce population mental illness and addiction to zero? This is not an easy task, but it is an essential one.

We have previously argued that mental health needs to be “solved” urgently and globally. Only an intersectoral, systemic, intentional and co-ordinated effort will shift the needle on the barometer of mental health.

To “solve” mental health at a technical level, a complete reimagining of the complex societal mental health ecosystem is needed across the life course.

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Can tiny Guernsey, an island test bed nation state, “solve” mental health?

 

One recurring innovation challenge is finding the right location to test out ideas, interventions, new technology and social change. The ideal space is accessible, well regulated, international and ring-fenced.

Could public- and private-sector innovation be accelerated by the co-ordinated use of “smart specialisation” by smaller countries? Nesta has pointed previously to the advantages of smaller scale in national innovation capacity.

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Why we need to solve mental health (globally and urgently)

 

Mental ill health is one of the world’s greatest complex challenges. The Thrive Foundation is, we believe, the only organisation in the world that openly believes mental health is a “solvable” problem.

Before we put a man on the Moon or ran the four-minute mile, humankind deemed these goals impossible. Once they had been proven possible, expectation shifted and progress was exponential. The Thrive Foundation believes we can do the same for “solving” global mental health by demonstrating that it is possible, starting in a self-governing island nation.

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