Mental health economics: bridging research, practice and policy

The WPA Section on Mental Health Eco­nomics focuses on economic factors in the provision, organization and use of ser­vices for mental and addictive disorders in countries across the world. The Section was founded in 1998 and given permanent status approval by the WPA in 1999. By that time, a group of health economists had established the field of mental health economics, with substantial research knowledge about psychiatric practice and mental health policy. Two primary aims of the Section are to en­courage interdisciplinary research among psychiatrists, health economists and other mental health professionals, and to facili­tate communication among those who fi­nance, organize, provide and use mental health ser­vices. Over the last three decades, clinicians have felt it increasingly necessary to become familiar with the conceptual frameworks of health economics and its applied research. This was considered necessary because economic analysis is an important part of how policy-makers and payers assess the recommendations of clinicians regarding the need for more services or for funding research to develop new treatments. For example, in many countries, the government health system or commercial insurance decides whether to pay for certain types of pharmacological or psychosocial treatments based in part on economic evaluations of alternative treatment approaches such as cost-effectiveness analysis. Over the years, several other issues have been addressed by the Section's official journal, The Journal of Mental Health Policy and Economics (www.icmpe.org); by its international biennial Workshops, and by its Symposia organized for WPA Meetings. The first research topic in mental health economics has been to document the eco­nomic burden of mental disorders. Over time, the World Health Organization (WHO)’s Global Burden of Disease Study has re­fined the methodology, and identified men­tal disorders as a major contributor to the global burden of disease1. It has been also pointed out that, in the case of schizophrenia, a large portion of societal cost is due to lost worker productivity2. A further activity has been the assessment of the cost-effectiveness of different treatment approaches. For example, some economic analyses concluded that atypical antipsychotics delivered little or no additional health benefits, despite their substantial additional cost3. This work has involved adapting measurement and statistical approaches to some specific features of mental health system data. Another research focus has been the lack of parity in how health systems finance mental health compared to other diseases. In the US, parity refers to attempts to equalize insurance coverage of mental disorders to coverage of other care, and many papers have examined these attempts4. These studies provided the evidence to policy-makers for supporting the economic feasibility of the Mental Health Parity and Addiction Eq­uity Act (2008). Elsewhere, broader inequal­ities in resource allocation and related clin­ical outcomes have also been document­ed5. The role of financial incentives in influ­encing decision-making concerning men­tal health treatment has also been investigated. Examples include incentives around how providers are paid and what consum­ers are expected to pay themselves6. Currently, in the provider payment area, researchers and others are designing payment approaches that reward value, not just volume of inpatient and outpatient ser­vices, and developing performance mea­sures appropriate to mental health treatment. For instance, the research paper that won the 2019 Willard Manning Award presented by the Section's journal focused on costs and performance of mental health pro­viders7. Most recently, several studies are considering the determinants of individuals’ mental health. Some projects examine how mental health treatment use is affected by government or commercial insurer policies8. More broadly, researchers are studying how individuals’ mental health is influenced by several social determinants, including macroeconomic conditions9. Since 1999, the WPA Section on Mental Health Economics has organized Symposia at the World Congresses of Psychiatry and International WPA Meetings. The top­ics of these sessions concentrated on im­portant policies and practices, such as the financial consequences of deinstitutionalization (Yokohama, 2002); the cost-effec­tiveness of depression interventions in de­veloping countries (Cairo, 2005); the eco­nomic case for prevention strategies in mental health (Prague, 2008); the impact of national health reforms on adults with mental disorders (Buenos Aires, 2011); predictors of clinical treatment choice (Madrid, 2014); treatment choice in adolescent depression (Berlin, 2017); and hospital payment and inpatient psychiatric readmissions (Lisbon, 2019). The Section also holds biennial Workshops on Costs and Assessment in Psychiatry. The next Workshop is scheduled for the Spring of 2021 in Venice, Italy. The topic is Mental Health Services, Economics, and Policy Research. Abstracts of papers presented at the Workshops are disseminated through supplements to The Journal of Mental Health Policy and Economics. This is a quarterly peer-reviewed indexed journal. It publishes applied research using advanced economic and policy analysis methodologies. The Section's current international, interdisciplinary leadership builds upon the previous achievements in establishing research capacity and regional professional and social networks. The Section encourages research about disparities in financing of mental and medical health care, the economic burden of mental disorders on the non-medical sectors of society (includ­ing workplace, education, family), and the potential role of digital health and electronic health records in reducing the disparities in global mental health. The Section strives for excellence in mental health economics research and education to promote the mission and fulfill the goals of the WPA.