Mental health budgets under pressure Cuts to mental health budgets - - PDF document

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Mental health budgets under pressure Cuts to mental health budgets - - PDF document

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03/06/2016 Making mental health count: an economic perspective David McDaid PSSRU, LSE Health & Social Care London School of Economics and Political Science E-mail: d.mcdaid@lse.ac.uk Open Minds, Congres geestelijke gezondheid Brussels,

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Making mental health count: an economic perspective

David McDaid PSSRU, LSE Health & Social Care London School of Economics and Political Science E-mail: d.mcdaid@lse.ac.uk

Open Minds, Congres geestelijke gezondheid Brussels, May 26 2016

Mental health budgets under pressure

  • Cuts to mental

health budgets more visible during austerity

  • But also an
  • pportunity to meet

challenge

  • Economic

arguments can help

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Importance of economic case for decision making

  • Historically mental health services have been vulnerable when

funding pressures in health care systems

  • Economic arguments can help mental health to be judged on a

level playing field vis a vis other potential interventions

  • Using economic techniques can be used to look at the short, mid

and long term costs and benefits of effective interventions.

  • Can also be used to quantify benefits that go beyond health

sector – very important for encouraging cross sectoral investment

Economics can be used to influence reforms

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5

Programme of work for the Dept of Health in England. Aim: to inform national policy development and local commissioning. Short timescale, no

  • pportunity for new

data collection … so again we used decision modelling.

Knapp, McDaid, Parsonage, Mental Health Promotion …, Department of Health, 2011

Example : Mental health promotion

6

Economic pay-offs per £1 investment

NHS Other public sector Non- public sector Total Early identification and intervention as soon as mental disorder arises Early intervention for conduct disorder 1.08 1.78 5.03 7.89 Health visitor interventions to reduce postnatal depression 0.40

  • 0.40

0.80 Early intervention for depression in diabetes 0.19 0.14 0.33 Early intervention for medically unexplained symptoms 1.01 0.74 1.75 Early diagnosis and treatment of depression at work 0.51

  • 4.52

5.03 Early detection of psychosis 2.62 0.79 6.85 10.27 Early intervention in psychosis 9.68 0.27 8.02 17.97 Screening for alcohol misuse 2.24 0.93 8.57 11.75 Suicide training courses provided to all GPs 0.08 0.05 43.86 43.99 Suicide prevention through bridge safety barriers 1.75 1.31 51.39 54.45 Promotion of mental health and prevention of mental disorder Prevention of conduct disorder through social and emotional learning programmes 9.42 17.02 57.29 83.73 School-based interventions to reduce bullying 14.35 14.35 Workplace health promotion programmes

  • 9.69

9.69 Addressing social determinants and consequences of mental disorder Debt advice services 0.34 0.58 2.63 3.55 Befriending for older adults 0.44

  • 0.44

Economic pay-offs per £1 invested in each intervention

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Policy impact

Commissioned by Labour government; published by Coalition government Multiple impacts in mental health policy in England Heavily cited in English national mental health policy Influenced policy on health visitors for maternal depression; suicide prevention strategy; debt management services; early intervention for children Cited numerously in local government policies & internationally

Making mental health count: some further areas for exploration

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Making mental health count: some examples

  • Benefits of early intervention in the community
  • Benefits of early action to protect physical health
  • Partnership with police to provide immediate support for people

in crisis

  • Partnerships with the housing sector in supporting recovery

The economic case for action

  • Builds on Schizophrenia Commission

Report Looking at:

  • Early Detection for Psychosis
  • Early Intervention for Psychosis
  • Intervention in Psychosis
  • Protection of Physical Health
  • Individual Placement and Support

(IPS) for Employment

  • Supported Education
  • Family Therapy
  • Criminal Justice System Diversion
  • Crisis Resolution Home Treatment

Teams

  • Housing interventions
  • Social welfare advice

Knapp, Andrew, McDaid, Park et al 2014

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Early intervention for first episode psychosis

Economic argument

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Economic benefits of EI programmes including vocational services

Park, McCrone & Knapp et al Early intervention in Psychiatry 2016 Impact of employment support Small reduction in suicidal behaviour

Embedding EI Within Community Mental Health Centres

RCT of integrated multi- component psychosocial care for first episode psychosis Community Mental Health Centres Veneto, Emilia-Romagna, Florence, Milan, Bolzano. Specialist training for CMHC staff Suggests that service model is feasible and effective but longer term follow up analysis needed. No impacts on hospital admissions

  • r length of stay

Ruggeri et al 2015 Sachizophrenia Bulletin

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Protecting physical health

Overlap between long term conditions and mental health problems

Long Term Conditions and Mental Health,Kings Fund - Naylor, Parsonage, McDaid et al 2012 £1 in every £8 for long term conditions due to mental health needs

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Impacts on chronic disease management

In Long Term Conditions and Mental Health - Naylor, Parsonage, McDaid et al 2012

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Reducing contacts with criminal justice system

The economic case for action

  • Partnership working

across sectors

  • High costs of criminal

justice system

  • Potential economic

benefits of working more closely with the police to divert appropriately from criminal justice system Knapp, Andrew, McDaid, Park et al 2014

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Department of Health 2014. https://www.gov.uk/government/news/extra-funding-for- mental-health-nurses-to-be-based-at-police-stations-and-courts-across-the-country

Partnership working: Street Triage

  • Police and community mental

health services work together to ensure people get appropriate care when police are called to a person in distress.

  • Pilot schemes around England
  • perating 7 days per week – late

afternoon to early morning

  • Provided advice and guidance to

aid decision making / manage risk.

  • Identify where mental illness

likely to exist and enable most appropriate pathway to care.

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Street Triage in Oxfordshire

1 mental health professional working with mobile police team in Oxford city 40% reduction in detentions under S 136 Mental Health Act Improvement in service user experience Cost savings to police over 1 year of €50,000 Savings to health system have not been quantified Additional funding provided to run service after pilot phase

Accommodation and Housing Support

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Focus in England on Relative Cost of Acute Beds

Source: Crisp N et al (eds). Old Problems, New Solutions: Improving Acute Psychiatric Care for Adults in England. Royal College of Psychiatrists 2016.

Summary of evidence from local studies reviewing the number of service users in bed-based services who no longer require service

Source: Crisp N et al (eds). Old Problems, New Solutions: Improving Acute Psychiatric Care for Adults in England. Royal College of Psychiatrists 2016.

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Opportunities for the Housing Sector on Path to Recovery

McDaid & Park 2016. Mental Health and Housing: potential economic benefits of improved transitions along the acute care pathway to support recovery for people with mental health needs (Housing Associations Charitable Trust London) McDaid & Park 2016. Mental Health and Housing: potential economic benefits of improved transitions along the acute care pathway to support recovery for people with mental health needs (Housing Associations Charitable Trust London)

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Financial and economic incentives to promote integrated care

Making the case

  • In making mental health count will not be enough to identify

economic costs and benefits. Must also

  • Identify who pays and who benefits from mental health services
  • Distinguish between realisable cash savings and freeing up health

and other system resources

  • Identify physical health as well as mental health benefits
  • Identifying time frame for benefits and costs
  • Identify resource implications of reform and reorganisation
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Promoting partnership working and integrated care

  • The way in which mental health services are funded, as well as

payment mechanisms, will have a profound impact on partnership working and pace towards integrated care

  • Potentially can be a major barrier or facilitator to system reform
  • Mechanisms where funding linked to individual service users,

rather than to service providers, can help promote continuity of care

  • In the English system, detailed contracts are still needed to

encourage partnership working (and share costs and risks) across sectors

  • Making an economic argument can help mental health count!
  • There are economic benefits to partnership working between

specialist and primary care services and with other sectors

  • Examples include mental health promotion services, e.g. in

schools, early intervention for psychosis, early intervention in the criminal justice system, better partnerships with housing sector organisations

  • Important to look at ways of incentivising many different

actors in fragmented mental health system to work together.

Making the case