According to an article in the Daily Mail (28 November 2022) British prime minister Rishi Sunak has declared war on mental health.
“Rishi Sunak has declared war on cancer, obesity, mental health and addiction with a blueprint inspired by the Covid vaccine rollout.”
Does that mean that we can expect his policies to drive people deeper into despair? It’s a thought, but I expect the Daily Mail writers are simply using the term “mental health” as an euphemism for “mental illness”. Other reports on the same theme use terms such as “mental ill-health”, “mental health problems” and “poor mental health”.
The story came from a government press release:
“The government has today announced over £113 million to fund research into 4 healthcare missions – cancer, obesity, mental health and addiction – to unlock the next generation of medicines and diagnostics to save lives, transform patient care and ensure UK patients are the first to benefit from medical breakthroughs…. In addition, tackling these healthcare challenges could save the NHS and the economy billions of pounds – it is estimated obesity costs the NHS £6.1 billion a year and poor mental health costs the economy £118 billion a year.”
Poor mental health costs the economy £118 billion a year! That is an awful lot of money. In fact it is about £4,000 for every household in the United Kingdom. Where does the figure come from? How is it calculated?
The Government press release does not give us the source of this figure, but it is not difficult to track down. A quick search comes up with a news item from the London School of Economics (LSE): “Mental health problems cost UK economy at least £118 billion a year – new research”. The research, published in March 2022, was a collaboration between the LSE and the Mental Health Foundation (MHF).
“Almost three quarters of the cost (72%) is due to the lost productivity of people living with mental health conditions and costs incurred by unpaid informal carers who take on a great deal of responsibility in providing mental health support in our communities.”
Now it is beginning to make sense. The £118 billion is not what the government actually spends on mental health, but consists largely of an estimate of what the government loses in lost productivity and also an estimate of the costs incurred by unpaid carers. But I was still intrigued by how these figures are calculated. So let’s turn to the LSE/MHF report.
The report is called “The economic case for investing in the prevention of mental health conditions in the UK”. Note the word prevention. The new government initiative is about spending £40.2 million for “research into mental health to develop and introduce digital technologies to support patients”, rather than anything to do with prevention. But as the report is only being used as the source of the £118 billion figure, that does not really matter. We already have the treatment with, for example, nearly one in five adults being prescribed anti-depressants in a year and millions getting cognitive behavioural therapy (CBT) via the increased access to psychological therapies (IAPT). And yet “poor mental health” is still costing £118 billion.
On page 11 the report gives a breakdown of that figure of £118 billion:
£36.4 billion – informal care costs
£36.2 billion – costs of economic inactivity
£26.1 billion – lost quality of life
£13 billion – specialist mental health services
£2.5 billion – educational services
£2.3 billion – GP services
£1.2 billion – social care services
The largest cost is informal care. This is not an actual cost; informal carers are defined as unpaid and any loss of productivity they experience as a result of their caring responsibilities does not appear to have been included in these costs. So how is that figure arrived at? The authors explain:
We have drawn on literature, plus a recent survey we conducted for the European Federation of Associations of Families of People with Mental Illness on informal care, to make some estimates of the cost of informal care. In this study values were elicited from carers on their willingness to accept payment to provide one extra hour of care (McDaid D, Park A-L. Understanding the value and impacts of informal care for people living with poor mental health. London: Care Policy and Evaluation Centre, London School of Economics and Political Science; 2020). We have used these values to value each hour of informal care.
And then, in the absence of data, there is an estimate of how many people with mental health problems receive informal care. As for the hours each person receives – I could find no mention of how this is estimated.
But anyway, how is this £40.2 million for “research into mental health to develop and introduce digital technologies to support patients” going to be spent? According to the government press release: “This could include technology allowing patients to monitor their mental health at home and instantly report to their doctor if in need of help.” Meanwhile the government is paying advertising agency M&C Saatchi up to £28.6 million for a campaign to discourage people from visiting their GP.
To finish on a brighter note – neither the Daily Mail article, the government press release, the LSE news item nor the LSE/MHF report are illustrated with a picture of someone with their head in their hands. The Daily Mail has a picture of Rishi Sunak; the government press release has a picture of someone in a laboratory; the LSE news item has Scrabble letters arranged to spell mental health; the LSE/MHF report has a picture of people in a balloon floating through clouds and giant gold coins.