Mental health is often considered secondary in health policy and health institutions. The below discussion and the studies referenced within are a good start at showing the financial costs (putting aside the moral arguments) for paying attention to the co-morbidity of mental and physical illnesses. The study is about the UK and the NHS, but clearly has implications for countries around the world.
You can go to the original blog site here.
Posted: 10 May 2012 08:31 AM PDT
Michael Parsonage explores the impact on health outcomes and costs of mental and physical ill health. Michael is Senior Policy Adviser, Centre for Mental Health, and Visiting Senior Fellow, PSSRU.
About 70% of all NHS expenditure goes on the treatment and care of people with long-term conditions (LTCs) such as diabetes, asthma, arthritis, dementia and chronic cardiovascular disease (Department of Health 2010). More than 15 million people in England have one or more such conditions (Department of Health 2011) and multi-morbidity, i.e. the co-existence of two or health problems at the same time, is very common, particularly among older people. For example, multi-morbidity has an estimated prevalence of 60% among all people aged 55 to 74 (Fortin et al. 2005), rising to 83% among those aged 75+, including 58% with three or more conditions at the same time and 33% with four or more (Britt et al. 2008).
It is thus no exaggeration to say that multi-morbidity is the rule rather than the exception among people with poor health, but despite this the problem is given relatively little attention, whether in policy and service design or in published research. For example, it has been estimated that for every one article in the medical literature on multi-morbidity, there are 74 on asthma, 94 on hypertension and 38 on diabetes (Fortin et al. 2005).
The most common form of multi-morbidity is the co-existence of mental and physical ill health. Research evidence consistently shows that people with long-term physical conditions are two to three times more likely than the general population to experience mental health problems such as depression or anxiety, and a recent study jointly produced by the King’s Fund, the Centre for the Mental Health and the LSE has conservatively estimated that some 4.6 million people suffer from co-morbid mental and physical health conditions – about 30% of all those with LTCs (Naylor et al. 2012).
The mechanisms underlying the relationship between mental and physical health are complex and lines of causation undoubtedly run in both directions. Notwithstanding this complexity, two things are abundantly clear from the available evidence: co-morbid mental health problems lead to much poorer health outcomes for people with long-term physical conditions and they add significantly to NHS costs. To give a couple of examples of the adverse impact on health outcomes: mortality rates for individuals with co-morbid asthma and depression are twice as high as among people with asthma on its own (Walters et al. 2011); and patients with chronic heart failure are eight times more likely to die within 30 months if they also have depression (Junger et al. 2005).
Concerning the impact on NHS costs, evidence reviewed in the joint study mentioned above found that co-morbid mental health problems are typically associated with increases of 45-75% in the costs of physical health care for long-term conditions (Naylor et al. 2012). Increases of this order are observed across a wide range of LTCs and are based on costs measured after adjustment for the severity of physical disease. Much of the excess is associated with higher rates of acute hospital bed use.
Taking a mid-point of 60% for this cost mark-up, it may be estimated that at the aggregate level mental health co-morbidities cost the health service around £10.6 billion a year in additional spending on physical health care, or 10% of the total NHS budget. At the individual patient level, average cost per case is about £6,170 a year for a patient with a long-term physical condition and co-morbid mental health problem, compared with £3,855 a year for someone with a long-term physical condition on its own – a difference of £2,315 a year.
Much of this huge excess cost could be avoided by better management of the mental health needs of people with long-term physical conditions. Two key requirements are:
A separation of mental and physical health is hard-wired into the NHS as presently constituted. The evidence briefly reviewed above demonstrates that one consequence of this separation – namely, a common failure to identify and address mental health problems among people with long-term physical conditions – is not only leading to poorer clinical outcomes and lower quality of life but is also imposing a very large burden on the NHS in avoidable healthcare costs. Improved integration of services offers the prospect of better health at lower cost on a significant scale.