Best Practice in Mental Health GP Led Commissioning
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Best Practice in Mental Health GP Led Commissioning 25 March 2011. Investing in Mental Health: the Economic Case. Martin Knapp & Paul McCrone PSSRU, London School of Economics King’s College London, Institute of Psychiatry. Current & projected future prevalence.

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Martin knapp paul mccrone pssru london school of economics

Best Practice in Mental Health GP Led Commissioning

25 March 2011

Investing in Mental Health: the Economic Case

Martin Knapp & Paul McCrone

PSSRU, London School of Economics

King’s College London,Institute of Psychiatry


N of people by disorder england 2007 2026

Current & projected future prevalence

N of people by disorder, England 2007 & 2026

McCrone, Dhanasiri, Patel, Knapp, Lawton-Smith, Paying the Price, King’s Fund, 2008


Context current projected future costs

Context: current & projected future costs

Cost by disorder, England 2007 & 2026

McCrone, Dhanasiri, Patel, Knapp, Lawton-Smith, Paying the Price, King’s Fund, 2008


Our approach

Our approach

Aim - model the costs and economic pay-offs of initiatives to prevent mental illness and promote mental well-being.

  • Look at evidence-based mental health interventions (incl. non-NHS) – must have well-established outcomes

  • Looked at 16 different areas and interventions

  • Use simple decision analytic modelling

  • Close liaison with DH officials; consultation with experts

    As far as the robust evidence base allows:

  • Include promotion, primary & secondary prevention

  • Look at widest range of economic impacts

  • Estimate impacts over long time periods

  • If in doubt, adopt conservative estimates


Please note

Please note …

  • Examine interventions from 2 perspectives:

    - pay-offs to society as a whole and

    - cash savings to the public sector

  • The wider impacts are important, given the high ‘external’ costs of many MH problems … but are they considered?

  • Over and above the economic pay-offs estimated here there are health and QOL benefits to individuals (‘patients’ etc)

    Please be aware that …

  • The findings are not definitive – they provide platform for discussion

  • These are simple, partial and incomplete models

  • The interventions modelled are not necessarily the only ones that are economically attractive


What economic case needs to be made

What economic case needs to be made?


What economic case needs to be made1

What economic case needs to be made?


What economic case needs to be made2

What economic case needs to be made?


What economic case needs to be made3

What economic case needs to be made?


What economic case needs to be made4

What economic case needs to be made?


Many causes widespread impacts

Many causes; widespread impacts

Genes

Health care

NHS

Social care

Family

LAs

CLG

Mental health

Housing

Income

Emply’t

Education

DfE

Crim justice

MoJ

Resilience

Trauma

Benefits

DWP

Phys env

Employment

Firms

Events

Vol sector

CVOs

Chance

Income

Indiv

Mortality

All

Each of these links is evidence-based


Parenting for conduct disorder

Parenting for conduct disorder


Early intervention teams for psychosis

Early intervention teams for psychosis


Martin knapp paul mccrone pssru london school of economics

Early detection of psychosis


Workplace well being programmes

Workplace well-being programmes


Other interventions examined

Other interventions examined

  • Post-natal depression – health visitors (universal or targeted)

  • School-based social and emotional learning programmes

  • School-based anti-bullying initiative

  • Workplace screening for depression risk, then CBT

  • Debt counselling

  • Alcohol misuse - GP screen and advice

  • Suicide – population awareness scheme + CBT for people at risk

  • Suicide – ‘hotspots’ - e.g. safety barriers on bridges

  • Co-morbid diabetes and depression – collab. care

  • Medically unexplained symptoms – CBT

  • Older people – befriending schemes (various)

  • Dementia - physical exercise programmes

  • [previously done] Anti-stigma campaigns


Martin knapp paul mccrone pssru london school of economics

Summary of findings


Conclusions

Conclusions

  • Very conservative models even so, many interventions look good value for money.

  • Some are self-financing from NHS perspective

  • Some are very low cost: a small shift in expenditure from treatment to prevention/promotion could generate efficiency gains

  • Many have broad pay-offs - both within public sector, and more widely (educational performance, employment/earnings, crime).

  • Pay-offs may span many years; need to invest for the longer term

  • Process parameters - targeting, take-up rates, drop-out rates – are important. It may be most cost-effective to increase take-up among high-risk groups, or improve ‘completion’ rates.

  • Each modelled intervention is evidence-based – each has been shown to be effective (to achieve good outcomes) …

  • … which means that there are health and QOL gains to individuals over and above the economic pay-offs here


Team and further information

Team; and further information

Iris Molosankwe 2

Gerald Mullally 1

A-La Park 1

Michael Parsonage3

Margaret Perkins 1

Andres Roman 1

Marya Saidi 1

Azuso Sato 1

Madeleine Stevens 1

Jamie Vela 1

1 PSSRU, LSE

2 KCL, IOP

3 Centre for Mental Health

4 PSSRU, Univ of Kent

5 Royal Coll. Psychiatrists

Further details of work to date:

Report published by the DH, Jan 2011

More work likely to be undertaken in 2011

Contact:

[email protected]

[email protected]

Rebeea’h Aslam 1

Florence Baingana 1

Annette Bauer 1

Jennifer Beecham 1,4

Eva-Maria Bonin 1

Sarah Byford 2

Adelina Comas 1

Sara Evans-Lacko 2

Chris Fitch 5

Nika Fuchkan 1

Derek King1

Martin Knapp1,2

Canny Kwok 1

Paul McCrone 2

David McDaid1


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