IPA Task Forces

Mental Health Economics

Click here to access the Mental Health Economics website

Background

Peter Petersen, an economist and the writer of the book ‘Gray Dawn’, elucidated the global policy challenge of the twenty-first century, a social, political, and economic time bomb in the aging world – the unsustainable, multi trillion-dollar unfunded liabilities for health care and social security around the world. Limited budgets and a seamless demand for resources suggest that a formula for allocating resources among the various competing sectors is needed. It is obvious for either government or local authority to use the methodology of health economics such as cost minimization, cost-effectiveness, and cost-benefit to reduce budgets for health care and social security as the time for explosion of the time bomb is approaching. Mental health, especially in the elderly, has traditionally been a low priority health issue among the competing demands.

An American doctor has put it: “It is incumbent on the physician to practice not ‘cost effective’ medicine but that which is as safe as possible for that patient under the particular circumstances. Optimization of survival and not optimization of cost effectiveness is the only ethical imperative...A physician who changes his or her way of practicing medicine because of cost rather than purely medical considerations has indeed embarked on the ‘slippery slope’ of compromised ethics and waffled priorities.”¹ Most clinicians may be positive about it. However, in a randomized double-blind trial in the UK, AD 2000 group reported that donepezil was not cost effective, with benefits below minimally relevant thresholds. About 650,000 people have dementia, of whom 400,000 have Alzheimer’s disease in the UK. Annual costs of dementia care are estimated to be £6.1 billion (US$ 11 billion; at 1998/99 prices), with £3.3 billion direct spending on health and social services. The AD 2000 study report seems to indicate on the change in health policies putting greater emphasis on the cost-effectiveness of cholinesterase inhibitors for the treatment of Alzheimer’s disease than clinical efficacy itself.

In clinical trials, improvement has been expressed as differences in scores of the rating scales for cognition, behavior, function, and global assessment between baseline and endpoint or between control group and treatment group. However, non-professional stakeholders, such as health authorities, health policy makers, and consumers may find it is difficult to understand. Therefore, outcomes should be translated into more understandable ones. This economic evaluation is a way to establish the “value for money” of health care technologies. Health care decision makers are placing increasing emphasis on the “value for money” from health care intervention, and are expecting more realistic outcomes (i.e., cost saving, cost benefit) instead of increased or decreased scores of the rating scales.

Developing countries are at a stage of initiating primary health care. The World Health Organization (WHO) population projections predict an increase of 38 and 100 million elderly people between 1980 and 2000 in developed and developing countries respectively. The demographic change in developing countries implies a need for planning and developing cost-effective services in geriatric psychiatry. Treatment of the elderly appears to vary in many cases with the level of affluence a society enjoys. In very poor societies, elderly people may be left to die. In nomadic societies, they may be seen as a burden. In peasant societies, little may be expected of them, with consequences for the identification and care of the elderly with dementia. Increasing urbanization, the breakdown of closely-knit communities, the breakdown of joint families with formation of nuclear families, greater longevity in women and social class differences are of particular importance in geriatric psychiatry. Thus mental health economic studies are likely to play an important role in the development of geriatric psychiatry for both developing and developed countries.

Economy of mental health in the elderly has been insufficiently discussed in the field of geriatric psychiatry. It may be the lost piece of geriatric psychiatry. We are living in an era where mental health economics becomes more and more important. International Psychogeriatric Association has good reason to focus on the economy of mental health in the elderly in this rapidly ageing world.

Goal for the Mental Health Economics Task Force

IPA Board Committee has approved the Mental Health Economics Task Force to examine and seek consensus regarding the common mental health problems posed by aging in terms of economy. Our goal, where the knowledge base allows it, is to make recommendations for action. Where uncertainty precludes consensus, we will identify areas for further study and advocacy.

Guk-Hee Suh, South Korea

IPA is proud to announce the launch of a new web site that works to advance Mental Health Economics. This initiative is led by Guk-Hee Suh, member of the IPA Board of Directors. Click here to visit the site.

For more information or if you are interested in this initiative, please contact the IPA Secretariat
at info@ipa-online.org.

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