LSE research has contributed to efforts to introduce cost-effective policies that improve the lives of people who experience mental illness.
What was the problem?
Mental health problems affect one in four people in the UK and globally. Three-quarters of lifetime mental illness (excluding dementia) starts before people reach their mid-20s, often with adverse consequences for many years thereafter. Mental health problems can affect many aspects of people’s lives, including their education and employment, their social contacts and roles, their personal relationships and family dynamics, and of course their overall wellbeing.
As well as the impact on individuals and their families, there are economic and social dimensions to consider for policymakers, both in terms of the causes of poor mental health and the consequences.
What did we do?
Long-term research by Professor Martin Knapp and LSE’s Care Policy and Evaluation Centre (CPEC, formerly PSSRU) has focused on the causes and consequences of poor mental health, particularly the economic dimensions of mental illness. The team evaluate preventative and ameliorative actions, develop tools to support informed decision-making, and work with policy and practice communities to support the implementation of their findings.
CPEC research on the economic consequences of perinatal maternal mental illness estimated that mental health problems in women during pregnancy or in the months following childbirth cost the UK £8.1 billion for each annual cohort of births. A high proportion of this cost stems from adverse impacts on the cognitive, emotional, and behavioural development of children, often extending over many years into adulthood. The research demonstrated how interventions can help women recover from mental illness or prevent these problems occurring in the first place, generating important health and wellbeing benefits, as well as large financial improvements for the health, social care, education, employment, and welfare benefits sectors.
As part of the Big Lottery Fund’s A Better Start initiative, CPEC developed economic evaluation tools and guidance (“Preventonomics”) to help local bodies make early assessments of interventions for parents and children aged 0 to 3 to improve child outcomes, and to help understand costs and potential downstream savings in an economic framework.
CPEC work on public mental health, commissioned by Public Health England (PHE, now the Office for Health Improvement and Disparities), has produced new economic evidence on investing in effective mental illness prevention to support local public health, social care, and NHS decision-making. This research calculated cost and cost-effectiveness implications and produced a return-on-investment tool covering eight different interventions.
The study found strong economic arguments for interventions in schools (anti-bullying programmes; social and emotional learning), workplaces (wellbeing programmes; stress alleviation), healthcare settings (collaborative care approaches in the community; better assessment of individuals presenting at accident and emergency departments), and communities (loneliness alleviation for older people; debt and welfare advice). The quality-of-life and economic case for action is particularly strong for schools, and for suicide prevention through better liaison between different parts of the NHS. This study built on two earlier CPEC studies, one which analysed the scale and distribution of costs and pay-offs for 15 preventative and early interventions, and another which focused on interventions that promoted recovery for people with psychosis.
CPEC research for the Campaign to End Loneliness found that for every £1 spent in preventing loneliness for older people, there are £3 of savings, spread across sectors. CPEC had previously conducted a major evidence review to inform the National Institute for Health and Care Excellence (NICE) guidance on promotion of mental health and independence in older people, particularly highlighting the value of interventions that addressed social isolation and loneliness.
CPEC research has informed policy discussions and provided evidence (sometimes accompanied by toolkits) for decision-making by local and national health and care bodies.
CPEC’s work on perinatal maternal mental illness provided evidence that underpinned government decisions to increase public spending in this area. The high-profile 2014 report was launched at the Palace of Westminster, with two government ministers responding. Subsequently, the Chancellor of the Exchequer allocated £75 million in his 2015 Budget to addressing perinatal mental illness, with the Prime Minister announcing an additional £290 million for specialist maternal support in 2016. CPEC researcher Annette Bauer was asked to join NHS England’s research group on the subject and has since established an economics subgroup advising on research to inform intervention spending.
The work on perinatal mental health was cited in the Coalition government’s taskforce on children and young people’s mental health and wellbeing in 2015, and by NHS England in its 2016 mental health strategy, which also asked CPEC researchers to carry out cost-benefit analysis of best practice for perinatal mental health. CPEC’s estimated economic impacts were quoted by NHS England and NICE in their “Perinatal Mental Health Care Pathways”. In 2019, the NHS’s “Long Term Plan” cited CPEC research to support 10-year plans for developing better maternal mental health care.
Beyond maternal mental health, CPEC research on the costs and pay-offs of mental health interventions has informed several other NHS England strategies. In 2016, its evidence on recovery-focused support for people experiencing psychoses informed budgeting for enhanced early intervention psychosis services, and the work is also cited in the 2019 NHS “Long Term Plan”, which emphasises early intervention services, improved physical health care, employment support, and suicide prevention – all of which were analysed in CPEC studies.
This work was also used by PHE to develop mental health and wellbeing joint strategic needs assessments to be used by local authorities and NHS clinical commissioning groups, and to help develop their approaches to improving children and young people’s mental health. The toolkit is one of the resources in the government’s “Prevention Concordat for Better Mental Health” and is cited in local strategy and policy documents. The Preventonomics tools are being used by at least five sites (Blackpool, Bradford, Lambeth, Nottingham, Southend), enabling local authorities to link information on service costs with impacts on children and young people. Research for NICE on the effectiveness of interventions to promote the mental wellbeing and independence of older people also fed into NICE guidance.
CPEC researcher David McDaid has been consulted by the Cabinet Office, the Chief Scientific Adviser, and the Office for National Statistics on CPEC’s work on measuring loneliness. Earlier work on the economic benefits of alleviating loneliness was cited in the final report of the Jo Cox Commission on Loneliness, and CPEC’s evidence review for NICE was key to its guidance that recommended tailored group-based social activities to address loneliness.
Beyond these examples in England, CPEC work has influenced policy discussions on mental health in the World Health Organization, and in the US, Canada, Australia, Belgium, Brazil, and beyond. Overall, CPEC research has made significant contributions to efforts to prevent mental health problems, and to improve the lives of individuals who experience them, at local, national, and international levels.