Study: Higher mental wellbeing (in 2016) seen to lower healthcare costs (in 2017)

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There are many rea­sons why men­tal well­be­ing is impor­tant. Not only is it pro­tec­tive against phys­i­cal ill­ness­es and linked to greater pro­duc­tiv­i­ty, but the men­tal well­be­ing of a pop­u­la­tion is essen­tial for a country’s sus­tain­abil­i­ty, long-term growth and development.

But despite the clear ben­e­fits, gov­ern­ments tend to focus pub­lic spend­ing on treat­ing and pre­vent­ing dis­ease, and pro­vid­ing care for those who are ill. While this is impor­tant and should con­tin­ue to be pri­ori­tised, such strate­gies alone won’t increase lev­els of men­tal well­be­ing overall.

Not only would enhanc­ing men­tal well­be­ing across all seg­ments of the pop­u­la­tion lead to bet­ter health on aver­age, it would also be ben­e­fi­cial from an eco­nom­ic perspective.

In our lat­est study, we explored the link between men­tal well­be­ing and gov­ern­ment expen­di­ture. We found that each increase in men­tal well­be­ing in a pop­u­la­tion was asso­ci­at­ed with low­er health and social care costs the fol­low­ing year. In oth­er words, the great­est sav­ings could be made by max­imis­ing everyone’s men­tal wellbeing.

Approaching mental health as a continuum:

Men­tal health may be con­sid­ered an umbrel­la term for a con­tin­u­um – with men­tal ill­ness or dis­or­der at one end and men­tal well­be­ing at the oth­er. Men­tal ill­ness may describe var­i­ous con­di­tions – such as depres­sion or anx­i­ety – which affect emo­tion, think­ing, and behav­iour. Symp­toms may include sad­ness, fatigue, feel­ing alone, or not being able to focus on impor­tant things. A com­mon fea­ture is that men­tal ill­ness involves feel­ing bad and func­tion­ing poorly.

Men­tal well­be­ing, on the oth­er hand, is defined as feel­ing good and func­tion­ing well. Char­ac­ter­is­tics may include opti­mism, feel­ing ener­getic, relat­ing well to oth­ers, or being able to think clear­ly. Impor­tant­ly, men­tal well­be­ing is more than the absence of men­tal ill­ness. Not feel­ing depressed or fatigued does not mean that you will auto­mat­i­cal­ly feel opti­mistic or energetic.

Eco­nom­ic assess­ments have tend­ed to focus on the costs of men­tal ill­ness – not the sig­nif­i­cant sav­ings that men­tal well­be­ing may gen­er­ate. Yet, men­tal well­be­ing is pre­dic­tive of phys­i­cal health and longevi­ty – for exam­ple bet­ter immune func­tion, being more phys­i­cal­ly active, and faster recov­ery from phys­i­cal ill­ness – includ­ing car­dio­vas­cu­lar dis­ease, heart attack, and stroke.

Men­tal well­be­ing also implies resilience – the abil­i­ty to cope with the nor­mal stress­es of life. This is an impor­tant pro­tec­tive com­po­nent against var­i­ous men­tal and phys­i­cal health prob­lems. Tak­ing all these ben­e­fits into con­sid­er­a­tion, it’s not sur­pris­ing that men­tal well­be­ing will have impli­ca­tions for health and social care costs.

Can higher mental wellbeing help lower healthcare costs?

In our study, we assessed the men­tal well­be­ing of 3,508 Dan­ish par­tic­i­pants in 2016 by using the War­wick-Edin­burgh Men­tal Well-Being Scale (WEMWBS). This scale con­sists of 14 pos­i­tive­ly word­ed ques­tions (ask­ing about a person’s degree of opti­mism, feel­ings of con­fi­dence, whether they feel relaxed or inter­est­ed in new things). This results in a score between 14 and 70 for each par­tic­i­pant. The high­er the score, the bet­ter the men­tal wellbeing.

We then looked at two types of Dan­ish gov­ern­ment expen­di­ture: health­care expen­di­ture per per­son (includ­ing mon­ey spent on gen­er­al prac­ti­tion­ers or spe­cial­ists, hos­pi­tal­i­sa­tions, out­pa­tient ser­vices, pre­scrip­tion med­i­cines), and sick­ness ben­e­fit trans­fers per per­son (this is gov­ern­ment-com­pen­sat­ed sick leave from the work­place). We adjust­ed for expen­di­ture from the pre­vi­ous year, along­side oth­er rel­e­vant fac­tors – includ­ing whether par­tic­i­pants had a diag­nosed men­tal dis­or­der. We did this to make sure our results would not be inflat­ed due to ongo­ing ill­ness, or sim­ply reflect the high­er costs that are gen­er­al­ly asso­ci­at­ed with men­tal illness.

We found that men­tal well­be­ing in 2016 pre­dict­ed both expen­di­ture out­comes in 2017. Each point increase in men­tal well­be­ing for each per­son was asso­ci­at­ed with US$43 (£31) less in health­care costs, and US$23 (£17) less in sick­ness ben­e­fit transfers.

This may not sound like much. But let’s say the inhab­i­tants of a town with a pop­u­la­tion of 50,000 were to each expe­ri­ence a sin­gle point increase in men­tal well­be­ing. Accord­ing to our esti­mates, the col­lec­tive improve­ment in men­tal well­be­ing would be asso­ci­at­ed with about $2m (£1.4m) less in health­care costs, and about $1m (£700k) less in sick­ness ben­e­fit trans­fers over the fol­low­ing year for this town.

This exam­ple – albeit hypo­thet­i­cal – is con­sis­tent with oth­er research show­ing that munic­i­pal­i­ties or zip-codes with high­er lev­els of aver­age well­be­ing have sig­nif­i­cant­ly low­er health­care expen­di­ture. Our results indi­cate that increas­ing lev­els of men­tal well­be­ing would, even over a short peri­od of time (i.e., one year), curb care costs for phys­i­cal as well as men­tal illness.

Promoting mental wellbeing at a population level:

But in order to improve men­tal well­be­ing for every­one, gov­ern­ments will need to inter­vene and work with com­mu­ni­ty organ­i­sa­tions and munic­i­pal­i­ties to cre­ate envi­ron­ments or fos­ter behav­iour that pro­tects men­tal health and enhance wellbeing.

On an indi­vid­ual lev­el, things such as self-care, mind­ful­ness, as well as con­cen­tra­tion and flow (the state of being com­plete­ly absorbed, focused and involved in some­thing), are all effec­tive ways of enhanc­ing men­tal wellbeing.

Stay­ing phys­i­cal­ly, men­tal­ly and social­ly active, main­tain­ing close social ties, and get­ting involved in mean­ing­ful chal­lenges or caus­es (such as char­i­ty or vol­un­teer work) are all essen­tial prin­ci­ples for improv­ing men­tal wellbeing.

Pro­mot­ing men­tal well­be­ing uni­ver­sal­ly may not only help peo­ple on an indi­vid­ual lev­el, but can lead to men­tal well­be­ing spread­ing from per­son to per­son. This is very impor­tant, because ulti­mate­ly the more peo­ple there are in a com­mu­ni­ty with high lev­els of men­tal well­be­ing, the more like­ly it is that those with men­tal health prob­lems or oth­er dif­fi­cul­ties can be sup­port­ed by those around them.

By curb­ing expen­di­ture through the pro­mo­tion of men­tal well­be­ing, sav­ings could in due time be allo­cat­ed to oth­er areas with­in and beyond the health­care sec­tor where there is a need. As we see it, invest­ing in men­tal well­be­ing should not be a ques­tion of “can we afford to?”, but infi­nite­ly more a ques­tion of “can we afford not to?”.The Conversation

– By Zig­gi Ivan San­ti­ni, Men­tal Health Researcher at Uni­ver­si­ty of South­ern Den­mark (and study’s cor­re­spond­ing author); David McDaid, Asso­ciate Pro­fes­so­r­i­al Research Fel­low at Lon­don School of Eco­nom­ics and Polit­i­cal Sci­ence; Sarah Stew­art-Brown, Chair of Pub­lic Health at Uni­ver­si­ty of War­wick, and Vibeke Jen­ny Koushede, Pro­fes­sor and Head of the Depart­ment of Psy­chol­o­gy at Uni­ver­si­ty of Copen­hagen. This arti­cle was orig­i­nal­ly pub­lished on The Con­ver­sa­tion.

The Study:

Eco­nom­ics of men­tal well-being: a prospec­tive study esti­mat­ing asso­ci­at­ed health care costs and sick­ness ben­e­fit trans­fers in Den­mark (The Euro­pean Jour­nal of Health Eco­nom­ics). From the Abstract:

  • Back­ground: Pre­vi­ous lit­er­a­ture has exam­ined the soci­etal costs of men­tal ill­ness, but few stud­ies have esti­mat­ed the costs asso­ci­at­ed with men­tal well-being. In this study, a prospec­tive analy­sis was con­duct­ed on Dan­ish data to deter­mine 1) the asso­ci­a­tion between men­tal well-being (mea­sured in 2016) and gov­ern­ment expen­di­ture in 2017, specif­i­cal­ly health­care costs and sick­ness ben­e­fit transfers.
  • Con­clu­sions: Esti­mat­ed reduc­tions in costs relat­ed to men­tal well-being add to what is already known about poten­tial sav­ings relat­ed to the pre­ven­tion of men­tal ill­ness. It does so by illus­trat­ing the sav­ings that could be made by mov­ing from low­er to high­er lev­els of men­tal well-being both with­in and beyond the clin­i­cal range. Our esti­mates per­tain to costs asso­ci­at­ed with those health-relat­ed out­comes that were includ­ed in the study, but exclud­ing oth­er social and eco­nom­ic out­comes and ben­e­fits. They cov­er imme­di­ate cost esti­mates (costs gen­er­at­ed the year fol­low­ing men­tal well-being mea­sure­ment) and not those that could fol­low improved men­tal well-being over the longer term. They may there­fore be con­sid­ered con­ser­v­a­tive from a soci­etal per­spec­tive. Pop­u­la­tion approach­es to men­tal health pro­mo­tion are nec­es­sary, not only to poten­ti­ate dis­ease pre­ven­tion strate­gies, but also to reduce costs relat­ed to low­er lev­els of men­tal well-being in the non-men­tal ill­ness pop­u­la­tion. Our results sug­gest that use­ful reduc­tions in both health care resource use and costs, as well as in costs due to sick leave from the work­place, could be achieved from invest­ment in men­tal well-being pro­mo­tion with­in a year.

The Study in Context: