The Value Of Mental Health Care At The System Level: The Case Of Treating Depression

PROLOGUE: Oscar Wilde once wrote that a cynic is a “man who knows the price of everything, and the value of nothing.” Bearing that in mind, we might conclude that there are many cynics when it comes to the provision of mental health services. For, while critics often observe that mental health expenditures have climbed steadily over the past quarter-century, the value of these services has proved to be an elusive quantity, and so the debates are more often informed by myths and half-truths than by hard evidence. Into this breach step Richard Frank and colleagues, proposing a new method of using administrative data to study the value of mental health services and presenting some early results. The authors boast a wealth of experience in the mental health arena and awards and publications too numerous to list here. Frank is a professor of health economics at Harvard Medical School and a research associate with the National Bureau of Economic Research. He earned a doctorate in economics from Boston University. Thomas McGuire, also an economist, is a professor at Boston University. He holds a doctorate from Yale University. Sharon-Lise Normand is associate professor of biostatistics at Harvard Medical School. She has a doctorate in biostatistics from the University of Toronto. Howard Goldman, a psychiatrist, is director of the Mental Health Policy Studies Program at the University of Maryland School of Medicine. He holds advanced degrees in medicine and public health from Harvard University and a doctorate in social welfare research from Brandeis University. ABSTRACT: The value of mental health services is regularly questioned in health policy debates. Although all health services are being asked to demonstrate their value, there are special concerns about this set of services because spending on mental health care has grown markedly over the past twenty years. We propose a method for using administrative data to develop a comprehensive assessment of value for mental health care, which we call systems cost-effectiveness (SCE). We apply the method to acute-phase treatment of depression in a large insured population. Our results show that SCE of treatment for depression has improved during the 1990s.