The need for a fair deal
Mental disorders cause enormous human
suffering for individuals and their families and impose major economic costs for the population.
The lack of understanding of mental illnesses and other conditions
contributes to the stigma experienced by patients and influences
the quality of service provision and availability of effective
treatments. It is essential that funding of both research and
service provision is increased in line with the funds allocated to improving physical
health. This will improve people’s overall quality of life and
reduce the social costs of mental health
problems, including those related to economic
inactivity.
While all governments in the UK have
increased their spending on mental health in recent years it is
still not in proportion to the level of disability or prevalence of
mental health disorders. Financial uncertainty and pressures on
resources can result in low quality, lack of choice and gaps in
service provision. Commissioning of mental health services is
variable and local differences and regional variations in funding
result in uneven service reform and implementation.
What we are calling for
- Major increase in research funding to
improve understanding of mental disorders and lay the foundations
for better treatments and services and reduced stigma.
- Continued increases in public expenditure on
mental health services to reflect the human and economic costs of
mental illnesses in society.
- Development of long-term sustainable funding
strategies for mental health service provision at every level
(including commissioning and payment by results) to make the
delivery of these services realistic.
- The comissioning practice of mental health
services to be fairer, more transparent and based on the best
evidence available.
Examples of what the College will do
- The College will strive to improve the
awareness among professionals, politicians and the public of the
need for substantially increased funding for research into mental
disorders.
- We will work with partners to facilitate the
establishment of a major research charity that will focus on the
understanding of mental disorders.
- We will work with partners to promote
commissioning of mental health services that meet the needs of
people with mental disorders.
Knowledge for action: mental health research funding
There are few data sources on levels of
mental health research funding. A review of the 2004/5 research
portfolios of the largest UK funders of health research indicates
that mental health research received 6.5 % of total funding
(compared with 25 % for cancer, 15 % for neurological diseases, and
9 % for cardiovascular conditions).1 When considered
relative to its influence on an individual’s quality of life,
mental health is allocated substantially less funding than its
impact on overall health should
demand.2
Unlike for other common diseases, there is
no disease-specific charity in the UK that funds research into
mental disorders. In contrast, diseases of comparable health burden
have major research charities that fund research centres,
professorships, fellowships and major grants. For example, Cancer
Research UK provides £315 m per year for cancer research and the
British Heart Foundation £50.4 m per year for research in
cardiovascular disease.3,4
Thus, although both
Medical Research Council and the Wellcome Trust provide grant
support for mental illness research, the field cannot reach the
level of funding available for research in other common
illnesses. If mental illnesses are to benefit from the major
scientific advances and improved public profile and understanding,
as for example cancer and heart disease did over the last
generation, it will be important to establish a major research
charity that will support research to improve understanding of the
causes, diagnosis and treatment of mental disorder.
Case for change: human and economic costs
Mental health problems affect people across
the life-span. In the UK, around one in ten children and young
people aged 5–16 have a clinically recognised mental
disorder.5 Among older people, the number with mental
health problems in the UK will increase by a third over the next 15
years to 4.3 million, or 1 in every 15 people.6
Meanwhile, about 11 million people of
working age in the UK experience mental health problems and about
5.5 million have a common mental disorder, with anxiety and
depression being the most prevalent.7,8 Even people with
such common mental disorders are four to five times more likely to
be permanently unable to work than the rest of the
population.9
They often live on low incomes, are three
times more likely to be receiving benefit payments, frequently are
of poorer physical health and overall well-being, and also report
social exclusion and discrimination.10 Severe mental
health problems – such as schizophrenia, bipolar disorder or severe
depression – affect about 1 % of the working-age
population.8 People with these conditions usually
require continuing and sometimes intensive treatment and care, and
only an estimated 10 % to 20 % of this group are in paid
employment.9,10
The effect of poor mental health on the
general population can be measured in human and economic cost. The
World Health Organization estimates that mental health problems
account for 13 % of all lost years of healthy life globally and as
much as 23 % in high-income countries.11,12
Mental health conditions are only second to
HIV/AIDS in terms of making an individual the object of
discrimination.13 Monetary estimates of the adverse
effects of mental illness on people’s quality of life range through
£41.8 billion in England,14 £4.6 billion in
Scotland15 and £1.6 billion in Northern
Ireland.16
The economic costs of mental disorder
related to people’s ability to work have ranged through £789
million in Northern Ireland,16 £2.3 billion in
Scotland15 and £23.1 billion in
England.14
These account for non-employment
(unemployment and economic inactivity), sickness absence, unpaid
work and premature mortality. Around 60 % of people who have a
common mental disorder are working, compared with 70 % of people
who do not have a common mental disorder.10 Only 10 % of
people with a psychotic disorder are working full-time and about
20 % part-time.10
Resources for change: expenditure on mental health
Despite recent improvements, governments do
not spend enough of the total NHS and social services budgets on
mental health given the extent of the burden of mental illnesses.
Only 9 % of total spending in Northern Ireland,16 11 %
in Scotland15 and 12 % in England14 is
allocated to mental health services. We were unable to obtain
comprehensive data on funding for mental health in Wales, though a
figure of 12 % has been estimated.17
In England, since 2003, geographical
inequalities have emerged in NHS spending on mental health
services, with considerable differences between the south and the
north of the country.18 Inequalities are also reported
across England in the funding of prison in-reach services, where
the same specialist community mental health services provided to
the general population are also offered to prisoners.19
In London and in the North-East, Yorkshire and Humber, the NHS
spends more than twice as much per prisoner than it does in the
East Midlands and the South-West. These differences cannot be
explained by needs or costs that vary across the country, but
rather represent a ‘postcode lottery’ in mental healthcare.19 Meanwhile,
mental health services for older people often receive unequal and
unfair funding and may frequently be more vulnerable to financial
cuts than other services.6
Need for vision: long-term strategy
The development of long-term policies for
mental health is welcomed. However, from the outset, such policies
need to be based on a realistic estimation of the future costs of
delivering health and social care services for people with mental
disorders. For instance, a recent analysis of financial assumptions
underpinning the 10-year National Service Framework for Mental
Health in England found a shortfall in
mental health services funding of approximately 20 % and
indicated that to fully deliver the National Service Framework in
2010/ 2011 a 38 % increase in the number of staff was
required.20
Similarly, the King’s Fund estimates of the
cost of providing mental healthcare in England up to 2026 indicate
that current service costs are set to rise 111 % (from £22.5
billion in 2007 to £47.5 billion in 2026, taking into account real
pay and price increases).21
This increase is primarily due to the
estimated rise in the number of people with dementia in England and
the accompanying increase in service costs. Further work is needed
in England to assess the
implications of these estimated costs and
find ways of addressing the problems thus incurred, while
similar estimates and projections are called for in Scotland, Wales
and Northern Ireland.
Case study
Dr Dave Anderson,
Chair of the Old Age Faculty, Royal College of
Psychiatrists
Since the publication of the
National Service Framework for Mental
Health & Older People, older people with mental illness
have been excluded from service developments and investments. Cuts
in services are occurring at a time of unprecedented rise in the
number of older people. They not only have not received investment
commensurate with increasing numbers but are instead seeing their
services reduced.
The ageing population presents one
of the most pressing challenges to the health and social care
economies of the world. Having been a leader in developing
specialist services for older people, the UK is now going backwards
along a disastrous path that will relegate older people to the
inferior care they received three decades ago when the specialty of
old age psychiatry had to develop to address that neglect. This is
age discrimination reborn and the injustice experienced by older
people is unfortunately set to
grow.
References
1 UK Clinical Research
Collaboration (2006) UK Health Research Analysis. UKCRC.
2 Kingdon, D. (2006) Health research funding. Mental
health funding continues to be underfunded. BMJ, 332, 1510.
doi:10.1136/bmj.332.7556.1510
PMid:16793825 PMCid:1482351
3 Cancer Research UK (2007) Annual Report and Accounts
2006/07. Cancer Research UK.
4 British Heart Foundation (2007) Annual Review 2007.
British Heart Foundation.
5 Green, H., McGinnity, A., Meltzer, H., et al (2005)
Mental Health of Children and Young People in Great Britain, 2004.
Palgrave Macmillan.
6 Lee, M. (2007) UK Inquiry into Mental Health and
Well-Being in Later Life. Improving Services and Support for Older
People with Mental Health Problems. Age Concern.
7 Lelliott, P., Boardman, J., Harvey, S., et al (2008)
Mental Health and Work. A Report for the National Director for Work
and Health. Working for Health.
(http://www.workingforhealth.gov.uk/documents/mental-health-and-work.pdf).
8 Singleton, N., Bumpstead, R., O’Brien, M., et al
(2001) Psychiatric Morbidity Among Adults Living in Private
Households, 2000. TSO (The Stationery Office).
9 Meltzer, H., Gill, B., Petticrew, M., et al (1995)
Economic Activity and Social Functioning of Adults with Psychiatric
Disorders, OPCS Surveys of Psychiatric Morbidity in Great Britain.
Report No. 3. HMSO.
10 Meltzer, H., Singleton, N., Lee, A., et al (2002)
The Social and Economic Circumstances of Adults with Mental
Disorders. TSO (The Stationery Office).
11 World Health Organization (2004) The World Health
Report 2004: Changing History. WHO.
12 Harnois, G. & Gabriel, P. (2000) Mental Health
and Work. Impact, Issues and Good Practices. World Health
Organization/International Labour Organisation.
13 Roeloffs, C., Sherbourne, C., Unutzer, J., et al
(2003) Stigma and depression among primary care patients. General
Hospital Psychiatry, 25, 311–315.
doi:10.1016/S0163-8343(03)00066-5
PMid:12972221
14 The Sainsbury Centre for Mental Health (2003) The
Economic and Social Costs of Mental Illness. Policy Paper 3.
Sainsbury Centre for Mental Health.
15 Scottish Association for Mental Health &
Sainsbury Centre for Mental Health (2007) What’s it Worth? The
Social and Economic Costs of Mental Health Problems in Scotland.
Scottish Association for Mental Health & Sainsbury Centre for
Mental Health.
16 Northern Ireland Association for Mental Health and
The Sainsbury Centre for Mental Health (2007) Counting the Cost.
The Economic and Social Costs of Mental Health Problems in Northern
Ireland. Northern Ireland Association for Mental Health &
Sainsbury Centre for Mental Health.
17 Burrows, M. & Greenwell, S. (2007) The Other End
of the Telescope. A Refocusing of Mental Health and Well Being for
Service Users and Carers. All-Wales Review of Mental Health
Services
(http://new.wales.gov.uk/dhss/publications/health/reports/2278708/mentalhealthreviewe.pdf?lang=cy).
18 Glover, G. (2004) Mental Health Care Funding in
England. National Institute for Mental Health in England.
19 Brooker, C., Duggan, S., Fox, C., et al (2008)
Short-Changed. Spending on Prison Mental Health Care. Sainsbury
Centre for Mental Health.
20 Boardman, J. & Parsonage, M. (2007) Delivering
the Government’s Mental Health Policies. Services, Staffing and
Costs. Sainsbury Centre for Mental Health.
21 McCrone, P., Dhanasiri, S., Patel, A. et al (2008)
Paying the Price. The Cost of Mental Health Care in Eng