Economic burden of mental illness cannot be tackled without research investment - so why is there a rumour that the EU will exclude it from the next 7th Framework Programme call?
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Economic burden of mental illness cannot be tackled without research investment - so why is there a rumour that the EU will exclude it from the next 7th Framework Programme call?
Mental illness is a leading cause of suffering, economic loss and
social problems. It accounts for over 15% of the disease burden in
developed countries, which is more than the disease burden caused by all
cancers (1). In the EU at least 83 million people (27%) suffer from mental
health problems (16.7 million in the UK) (2). So why are we now hearing
rumours that there will be a cut in mental health research funding in the
next 7th Framework Programme (FP7) call from the EU?
The cost of mental illness incurred by individuals, employers and
governments is enormous; in England alone, it is over GBP 105.2 billion a
year, through the costs of medical or social care, production output
losses, and a monetary valuation of the intangible human cost of
disability, suffering and distress (3). In the EU, the cost of mental
illness in 2004 has been estimated at EUR 240bn (excluding dementia) (4).
Mental illness accounted for a quarter of all disability-adjusted life
years lost (5). The impact on the EU economy was estimated to be
equivalent to a reduction of 3-4% of total GDP (6).
Despite the recognised levels of burden on individuals, the community
and the economy, mental health research investment is relatively small. In
the UK, in 2008-9, the MRC spent 3.5% (GBP 24 million) on mental health
research (including neurosciences), in comparison to over USD 2 billion
(7%) spent on mental health by National Institute of Health in the US.
Even in the US and Canada, only about 7% of research spend is on mental
health, while the level of burden is nearer to 15%. The EU has an even
lower profile for mental health research, and in its recent funding rounds
has spent less than 2% on mental health research.
Furthermore, when research spend is calculated, the category of
mental health is often combined with neurological disorders or
neuroscience (as seen in Mayor, 2006) (7). The resulting figures are
therefore misleading, as the funding available for mental health research
usually accounts for a small proportion of this category, with the bulk
being spent in neurosciences.
The need for increased research in mental illness applies across the
spectrum of mental health promotion, prevention, treatment and
rehabilitation. We need a stronger understanding of what interventions can
increase resilience and reduce mental illness. Lifetime effects are
particularly important as intervention in childhood is most promising but
it is costly to demonstrate outcomes. Once mental illness is established,
we need a better understanding of the course of the illness and how this
can be changed through medical, psychological and social interventions.
Finally, we also need a much deeper understanding of the profound links
between mental and physical health and also medically-unexplained illness,
as this could yield generalised health gains as well as large cost
savings.
Research centres in the UK are well known for high quality research
in mental health, particularly in basic research on the underlying causes
of mental illness, the translation of basic research into treatments, and
the implementation of effective treatments into health services. The
universal health care system in the UK provides the platform for this high
quality research. Studies conducted in the UK can capture large
geographical cohorts linked to a record system within the National Health
Service, and can potentially examine the determinants of mental illness.
The geographical coverage with continuity of in-patient and out-patient
care also allows representative samples of patients to be recruited to
clinical trials, which is sometimes difficult in other health services
configurations.
In 2008, the total rate of return on investment was calculated at 37%
for UK public and charitable mental health research in 1975-92 (8). This
suggests that every GBP 1 investment in public and charitable mental
health research produces benefits equivalent to earning GBP 0.37 per year
in perpetuity. In addition, each GBP 1 of extra public/charitable
investment in UK medical research yields GBP 2.20-5.10 of extra
pharmaceutical company investment, which together earns an extra GBP 1.10-
2.50 GDP per year for the UK economy.
Conditions which have achieved significant breakthroughs with an
impact on treatment and recovery are cancer and cardiovascular disease,
both of which have condition-specific research funds available. These
advances followed an increased investment in research in these diseases,
which pose similar burden to mental illness. Mental health research cannot
deliver similar advances until the investment in research reflects the
enormous health, social and economic burden imposed by mental illness.
Mental illness is the cause of huge economic burden; however,
research funding is disproportionately low and lags significantly behind
other health research with high levels of burden (9). There is an acute
need for a substantial increase in mental health research funding. The
scale of the problem is clear, as is the associated economic cost. With
the current trajectory, even the developed countries will not be able to
afford the current level of care for their mentally ill population in the
future. We need to determine investment priorities in mental health
research and propose a more rational use of funds in this under-resourced
and under-investigated area. There is still time for the EU to support
mental health research in the next FP7 call.
1. Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR et al.
No health without mental health. Lancet. 2007;370:859-77.
2. Wittchen HU, Jacobi F. Size and burden of mental disorders in
Europe: a critical appraisal of 27 studies. European
Neuropsychopharmacology. 2005 July;15(4):357-376.
3. Centre for Mental Health. Economic and social costs of mental health
problems in 2009/10. London; 2010.
4. Andlin-Sobocki P, Jonsson B, Wittchen HU, Olesen J. Cost of
disorders of the brain in Europe. European Journal of Neurology.
2005;12(1):1-27.
6. Gabriel P, Liimatainen MR. Mental health in the workplace:
Introduction. International Labour Office, Geneva; 2000.
7. Mayor S. Report gives snapshot health research funding in the UK.
BMJ. 2006 May 27; 332:1114.
8. Health Economics Research Group, Office of Health Economics, RAND
Europe. Medical Research: What's it worth? Estimating the economic
benefits from medical research in the UK. London: UK Evaluation Forum;
2008.
9. Kingdon D. Health research funding: mental health research
continues to be underfunded. BMJ. 2006;332:1510.
Rapid Response:
Economic burden of mental illness cannot be tackled without research investment - so why is there a rumour that the EU will exclude it from the next 7th Framework Programme call?
Mental illness is a leading cause of suffering, economic loss and
social problems. It accounts for over 15% of the disease burden in
developed countries, which is more than the disease burden caused by all
cancers (1). In the EU at least 83 million people (27%) suffer from mental
health problems (16.7 million in the UK) (2). So why are we now hearing
rumours that there will be a cut in mental health research funding in the
next 7th Framework Programme (FP7) call from the EU?
The cost of mental illness incurred by individuals, employers and
governments is enormous; in England alone, it is over GBP 105.2 billion a
year, through the costs of medical or social care, production output
losses, and a monetary valuation of the intangible human cost of
disability, suffering and distress (3). In the EU, the cost of mental
illness in 2004 has been estimated at EUR 240bn (excluding dementia) (4).
Mental illness accounted for a quarter of all disability-adjusted life
years lost (5). The impact on the EU economy was estimated to be
equivalent to a reduction of 3-4% of total GDP (6).
Despite the recognised levels of burden on individuals, the community
and the economy, mental health research investment is relatively small. In
the UK, in 2008-9, the MRC spent 3.5% (GBP 24 million) on mental health
research (including neurosciences), in comparison to over USD 2 billion
(7%) spent on mental health by National Institute of Health in the US.
Even in the US and Canada, only about 7% of research spend is on mental
health, while the level of burden is nearer to 15%. The EU has an even
lower profile for mental health research, and in its recent funding rounds
has spent less than 2% on mental health research.
Furthermore, when research spend is calculated, the category of
mental health is often combined with neurological disorders or
neuroscience (as seen in Mayor, 2006) (7). The resulting figures are
therefore misleading, as the funding available for mental health research
usually accounts for a small proportion of this category, with the bulk
being spent in neurosciences.
The need for increased research in mental illness applies across the
spectrum of mental health promotion, prevention, treatment and
rehabilitation. We need a stronger understanding of what interventions can
increase resilience and reduce mental illness. Lifetime effects are
particularly important as intervention in childhood is most promising but
it is costly to demonstrate outcomes. Once mental illness is established,
we need a better understanding of the course of the illness and how this
can be changed through medical, psychological and social interventions.
Finally, we also need a much deeper understanding of the profound links
between mental and physical health and also medically-unexplained illness,
as this could yield generalised health gains as well as large cost
savings.
Research centres in the UK are well known for high quality research
in mental health, particularly in basic research on the underlying causes
of mental illness, the translation of basic research into treatments, and
the implementation of effective treatments into health services. The
universal health care system in the UK provides the platform for this high
quality research. Studies conducted in the UK can capture large
geographical cohorts linked to a record system within the National Health
Service, and can potentially examine the determinants of mental illness.
The geographical coverage with continuity of in-patient and out-patient
care also allows representative samples of patients to be recruited to
clinical trials, which is sometimes difficult in other health services
configurations.
In 2008, the total rate of return on investment was calculated at 37%
for UK public and charitable mental health research in 1975-92 (8). This
suggests that every GBP 1 investment in public and charitable mental
health research produces benefits equivalent to earning GBP 0.37 per year
in perpetuity. In addition, each GBP 1 of extra public/charitable
investment in UK medical research yields GBP 2.20-5.10 of extra
pharmaceutical company investment, which together earns an extra GBP 1.10-
2.50 GDP per year for the UK economy.
Conditions which have achieved significant breakthroughs with an
impact on treatment and recovery are cancer and cardiovascular disease,
both of which have condition-specific research funds available. These
advances followed an increased investment in research in these diseases,
which pose similar burden to mental illness. Mental health research cannot
deliver similar advances until the investment in research reflects the
enormous health, social and economic burden imposed by mental illness.
Mental illness is the cause of huge economic burden; however,
research funding is disproportionately low and lags significantly behind
other health research with high levels of burden (9). There is an acute
need for a substantial increase in mental health research funding. The
scale of the problem is clear, as is the associated economic cost. With
the current trajectory, even the developed countries will not be able to
afford the current level of care for their mentally ill population in the
future. We need to determine investment priorities in mental health
research and propose a more rational use of funds in this under-resourced
and under-investigated area. There is still time for the EU to support
mental health research in the next FP7 call.
Full report:
http://www.mentalhealth.org.uk/campaigns/researchmentalhealth/
References
1. Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR et al.
No health without mental health. Lancet. 2007;370:859-77.
2. Wittchen HU, Jacobi F. Size and burden of mental disorders in
Europe: a critical appraisal of 27 studies. European
Neuropsychopharmacology. 2005 July;15(4):357-376.
3. Centre for Mental Health. Economic and social costs of mental health
problems in 2009/10. London; 2010.
4. Andlin-Sobocki P, Jonsson B, Wittchen HU, Olesen J. Cost of
disorders of the brain in Europe. European Journal of Neurology.
2005;12(1):1-27.
5. Kaplan W, Laing R. Priority Medicines for Europe and the World.
World Health Organization, Geneva; 2004. Available from:
http://whqlibdoc.who.int/HQ/2004/WHO_EDM_PAR_2004.7.pdf (accessed 20 Oct
2010).
6. Gabriel P, Liimatainen MR. Mental health in the workplace:
Introduction. International Labour Office, Geneva; 2000.
7. Mayor S. Report gives snapshot health research funding in the UK.
BMJ. 2006 May 27; 332:1114.
8. Health Economics Research Group, Office of Health Economics, RAND
Europe. Medical Research: What's it worth? Estimating the economic
benefits from medical research in the UK. London: UK Evaluation Forum;
2008.
9. Kingdon D. Health research funding: mental health research
continues to be underfunded. BMJ. 2006;332:1510.
Competing interests: No competing interests