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Statistics 5: The financial aspects of mental health problems
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Introduction
The total cost of mental health problems in England
NHS expenditure on mental health care
Provision of inpatient care
Inpatient care provided by the private/independent sector
Mental health in prisons
Cost of psychiatric drugs
Cost implications of specific mental health problems
Depression
Schizophrenia
Bipolar disorder
Dementia and Alzheimer’s disease
The cost of mental health problems to industry
Introduction
This factsheet explores some of the financial aspects associated with mental health problems across the UK. Figures have been obtained from a variety of sources in an effort to present the most recent data available. However, some statistics are older, depending on the availability of research material or how often a particular survey is conducted. Although it is aimed primarily at mental health professionals, journalists and students, we hope that this factsheet will be helpful to anyone interested in mental health issues.
Note: The language used in this factsheet reflects the sources referred to. The use of such language does not automatically imply Mind’s acceptance of it.
The total cost of mental health problems in England
The Sainsbury Centre for Mental Health has reported that the total cost of mental health problems in England is currently more than £77 billion a year, [1] which is double previous estimates. The costs include NHS and private care for people with mental health problems. The total cost of care is estimated to be over £12 billion. A further £23 billion is lost as many people diagnosed with a mental health problem are unable to work. Reduced quality of life and loss of life may account for nearly £42 billion every year.
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NHS expenditure on mental health care
NHS and local authorities spent about £5 billion on adult mental health services in 2006/07, [2] an increase from £3.6 billion in 2001/02. It has been estimated that improved mental health care could save the Government as much as £3.1 billion a year. [3]
Provision of inpatient care
Although 90 per cent of people who get help for mental health receive this in primary care, about 80 per cent of NHS total expenditure on adult mental health services is for inpatient care. [4]
Inpatient care provided by the private/independent sector
The private/independent sector sees mental health as their strongest area of growth. It has been estimated that about 67 per cent – or more than £350 million – of private sector revenue from mental health care provision is paid for by the NHS. [5]
Mental health in prisons
The NHS spends about £20.8 million a year on mental health care for prisoners in publicly run prisons via inreach teams. [6] This is about 11 per cent of the total spent on health care for prisoners, and equivalent to £300 for each person in prison. Because the prevalence of mental illness is much higher in prisons than in the general population, much more money is needed. The Sainsbury Centre for Mental Health has estimated that the NHS needs to treble spending on mental health in prisons to meet this need. [7]
Cost of psychiatric drugs
Spending on drugs used to treat psychotic disorders in England was about £270 million in 2007. [8] The total cost of antidepressants was over £276 million.
About one-third of drugs prescribed for mental disorders are selective serotonin re-uptake inhibitors (SSRIs). These antidepressants account for just over half of all antidepressants prescribed drugs in UK. Prescribing of SSRIs has increased by about 36 per cent over the last five years, [9] although the actual cost of these drugs has gone down by around 60 per cent in the same period. [10] This is mainly because the patent has expired and competing drug companies can produce the same drugs as generic products. [11]
Anxiolytics (minor tranquillisers used to treat anxiety) account for about 16.2 million prescriptions per year. [12] The cost has trebled in the last five years to about £6.2 million per year. The most frequently prescribed of these drugs is diazepam.
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Cost implications of specific mental health problems
The chart below shows NHS expenditure on different areas of mental health services in 2006/07. [13] The largest category, ‘other mental health disorders’, accounts for about 61.5 per cent of expenditure and includes spending on depression and anxiety, the two most common disorders.
Depression
A study carried out in 1993 estimated that depression alone was costing £3 billion each year when lost productivity and the cost of benefits were taken into account. [14] Of this, the cost to the NHS was estimated at £420 million. [15]
Costs had increased sharply by 2003, estimated to be more than £9 billion per year in England. [16] A report published in 2008 suggests that the total annual cost of depression, including lost employment, is now about £7.5 billion. [17] The cost of services for people with depression is about £1.7 billion. Estimates suggest that by 2026 the cost of services for people with depression will have increased to about £3 billion per year.
Depression accounts for the loss of more than 100 million working days each year: more than 2,615 deaths per year are due to depression. [18]
Schizophrenia
The cost of treatment for schizophrenia is high because many patients require inpatient care. A study published in 1997 suggested that the total cost per year in England was about £2.6 billion. [19] The direct cost to the NHS of treating schizophrenia in England is estimated to be about £2.2 billion per year. [20] When lost employment is taken into account, the cost is estimated to add up to more than £4 billion. Most of the money allocated for treatment is spent on hospital inpatient care. [21] If crisis resolution and home treatment services were provided for those who needed them, costs might be reduced by £4–22 million. [22]
Bipolar disorder
One study suggests that the annual cost of bipolar disorder to society is about £2 billion. [23] About 10 per cent (£199 million) is paid by NHS resources, 35 per cent of which is accounted for by hospital admissions. Another study suggests that the total annual cost of services for bipolar disorder is £1.6 billion. [24] When the cost of lost employment is added, the bill per year for society is about £5.2 billion. As with schizophrenia, bipolar disorder affects less than one per cent of the population, but inpatient treatment is costly for this group. It is estimated that savings of between £1.9 and £9.8 million could be made if crisis resolution and home treatment services were offered to all those who need them. [25]
Dementia and Alzheimer’s disease
Dementia is most common in older people, but can affect people of any age. The Alzheimer’s Society suggests that about 700,000 people have dementia in the UK. [26] Of these, about 62 per cent have Alzheimer’s, which is the most common form of dementia. The total annual cost per person with dementia is estimated to be £25,472, higher than for any other mental disorder. The total cost of care for patients with dementia in the UK is therefore estimated to be about £17 billion a year. [27] The number of people with dementia is expected to rise as the population ages; by 2026 the cost of dementia could be as high as £34.8 billion. A large proportion of this is the estimated cost of informal care provided by friends and family.
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The cost of mental health problems to industry
The cost of mental health problems to industry has increased significantly over the last decade. However, it has proved difficult to find a reliable method that accurately measures mental ill-health and conditions such as stress. For example, some people will say that they are suffering from stress rather than disclose that they feel depressed. Furthermore, people’s perceptions and experiences of stress, anxiety and depression may differ markedly. Despite this, however, several surveys show similar levels for cost of mental ill-health to industry.
Stress, anxiety and depression are the most common causes of sickness absence from paid employment in the UK, together accounting for about 60 million lost working days every year. [28] The Sainsbury Centre for Mental Health suggests that the cost of work-related mental health problems in 2004 was about £23.1 billion a year. In 2008, King’s Fund suggested that the cost of lost employment was about £26.1 billion, [29] which is likely to increase to about £28.1 billion by 2026.
A ‘stress and health at work’ study from 1998 found that nearly one in five, or around 20 per cent, of working individuals considered their job to be very or extremely stressful. [30] This proportion has gradually gone down over the past 10 years: in 2007 about 13 per cent of people considered their job to be very or extremely stressful. So although the cost of lost employment due to mental health problems is increasing, fewer people feel that their job is causing them severe stress.
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References
[1] The economic and social cost of mental illness, 2003, Sainsbury Centre for Mental Health.
[2] Mental Health Strategies 2007, The 2006/07 national survey of investment in mental health services, Department of Health.
[3] National Institute for Mental Health in England 2005, Making it possible: improving mental health and well-being in England.
[4] NHS Confederation 2007, About mental health trusts.http://www.nhsconfed.org/mental-health/mental-health-1759.cfm, accessed 25 June 08.
[5] Laing’s Healthcare Market Review 2004–05.
[6] Sainsbury Centre for Mental Health, 2008, Short-changed, Spending on prison mental health care.
[7] Sainsbury Centre for Mental Health, 2008, Short-changed, spending on prison mental health care.
[8] The Information Centre 2008, Prescription Cost Analysis, England 2007 http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/prescriptions/prescription-cost-analysis-2007 accessed 18 June 2008.
[9] Prescription Pricing Authority 2008, ‘Drugs used in mental health’, Prescribing review. www.ppa.org.uk accessed June 2008.
[10] Prescription Pricing Authority 2008, ‘Drugs used in mental health’, Prescribing review downloaded from www.ppa.org.uk in June 2008
[11] Prescription Pricing Authority 2008, ‘Drugs used in mental health’, Prescribing review. www.ppa.org.uk accessed June 2008.
[12] Prescription Pricing Authority 2008, ‘Drugs used in mental health’, Prescribing review. www.ppa.org.uk accessed June 2008.
[13] McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S, 2007, Paying the price, The cost of mental health care in England to 2026, King’s Fund
[14] Kind P. 1999, ‘The Cost of Depression’. International clinical psychopharmacology vol. 7 (3–4), pp. 191–195 and in 1993 in ‘Hitting the Target – the role of medicines in achieving the Government’s public health objectives’ ABPI 1999.
[15] Kind, P. & Sorenson, J. 1993, ‘The Cost of Depression’, International clinical psychopharmacology, vol. 7, pp. 191–195.
[16] Thomas, C. & Morris, S. 2003, ‘Cost of depression among adults in England in 2000’, The British Journal of Psychiatry, vol. 183, pp. 514–519.
[17] McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S. 2007, Paying the price, The cost of mental health care in England to 2026, King’s Fund.
[18] Thomas, C. & Morris, S. 2003, ‘Cost of depression among adults in England in 2000’, The British Journal of Psychiatry vol. 183, pp. 514–519.
[19] Knapp, M. 1997, ‘Cost of Schizophrenia’, The British Journal of Psychiatry, vol. 171, pp. 509–518.
[20] McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S, 2007, Paying the price, The cost of mental health care in England to 2026, King’s Fund.
[21] Rodgers, T. 2002, ‘NICE recommends newer antipsychotic drugs as one of the first line options for schizophrenia’, NICE press release.
[22] McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S. 2007, Paying the price, The cost of mental health care in England to 2026, King’s Fund.
[23] Gupta, R.D. & Guest, J.F. 2002, ‘Annual cost of bipolar disorder to UK society’, British Journal of Psychiatry, vol. 180, pp. 227–233.
[24] McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S. 2007, Paying the price, The cost of mental health care in England to 2026, King’s Fund.
[25] McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S, 2007, Paying the price, The cost of mental health care in England to 2026, King’s Fund.
[26] Knapp,M. and Prince, M, 2007, Dementia UK, Alzheimer’s Society
[27] Knapp, M. & Prince, M, 2007, Dementia UK, Alzheimer’s Society.
[28] The Sainsbury Centre for Mental Health and The Northern Ireland Association for Mental Health 2004, ‘Counting the Cost’ available at: http://www.scmh.org.uk/publications/counting_the_costs.aspx?ID=542.
[29] McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S, 2007, Paying the price, The cost of mental health care in England to 2026, King’s Fund.
[30] Health & Safety Executive 2008, Stress-related and psychological disorders.
This factsheet was written by Inger Hatloy, Mind, and was updated in July 2008.
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