Making Mental Health Count

The Social and Economic Costs of Neglecting Mental Health Care

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Despite the enormous burden that mental ill-health imposes on individuals, their families, society, health systems and the economy, mental health care remains a neglected area of health policy in too many countries. Mental disorders represent a considerable disease burden, and have a significant impact on the lives of the OECD population, and account for considerable direct and indirect costs. This report argues that even in those OECD countries with a long history of deinstitutionalisation, there is still a long way to go to make community-based mental health care that achieves good outcomes for people with severe mental illness a reality. The disproportionate focus on severe mental illness has meant that mild-to-moderate mental illnesses, which makes up the largest burden of disease, have remained overwhelmingly neglected. This book addresses the high cost of mental illness, weaknesses and innovative developments in the organisation of care, changes and future directions for the mental health workforce, the need to develop better indicators for mental health care and quality, and tools for better governance of the mental health system. The high burden of mental ill health and the accompanying costs in terms of reduced quality of life, loss of productivity, and premature mortality, mean that making mental health count for all OECD countries is a priority.

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Advancing the organisation, payment and integration of care for people with severe mental illness

While the prevalence of severe mental illness is small relative to mild-to-moderate mental illness, severe mental illness tends to dominate the organisation of mental health systems in OECD countries and consume the majority of resources. This chapter describes policies that have been put in place to improve care for such illnesses, and highlights areas where attention is still needed. Co-morbidities of severe mental illness and somatic illnesses are a cause for concern, and some efforts have been made to counteract the negative consequences that arise from co-morbidities. In particular, GPs can play an important role in co-ordinating the physical and mental health care of people with severe mental illness but require effective co-operation with specialist care. While specialist care is increasingly delivered by multi-disciplinary teams in a multitude of community-care settings, inpatient care still has a role to play especially in times of crisis. This chapter examines how reliance on inpatient beds varies considerably across OECD countries. Finally, this chapter explores the potential for innovative payment systems for specialist mental health care to evolve beyond a primary focus on inpatient settings to reflect the multiplicity of care settings available and promote an integrated and cross-sectoral approach to providing care.



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