Across the OECD an estimated 20% of the working-age population suffer from mental ill-health, and the social and economic impacts of this burden of illness are huge, according to the OECD’s recent publication Making Mental Health Count. Together, the direct and indirect costs of mental ill-health can exceed 4% of GDP across the OECD, driven by expenditure on medical needs and social care costs, as well as higher rates of unemployment and more absences from work. According to OECD’s Sick on the Job report, people with severe mental illness are 6 to 7 times more likely to be unemployed, while those with a mild-to-moderate illness are 2 to 3 times more likely to be unemployed.
World Mental Health Day should also be a time to look beneath these striking statistics, and think about the millions of individuals living with mental ill-health across the OECD, and worldwide.
The reality of mental ill-health is often a grim one. Mild and moderate mental illnesses such as depression or anxiety are estimated to affect around 50% of people in their lifetime. For society and economies the costs are clearly significant, but for individuals the strain can be crippling. The heavy weight of depression and anxiety can stop individuals reaching their full potential in education or at work and put huge strain on relationships with loved ones. If untreated, individuals suffering from depression or anxiety can quickly find themselves out of work and dependant on sickness or disability benefits. Sick on the Job shows that after long periods of sickness absence, individuals find it harder and harder to return to work. Furthermore, the stigma around mental illness can lead people to hide their suffering, leaving them to struggle alone.
Individuals with severe mental illnesses, like bipolar disorder or schizophrenia, experience symptoms such as hallucinations and big swings in mood, which are hard to understand and tough to control. In too many instances, treatment is restricted to ‘what’s available’, rather than the care that best suits the individual’s needs or preferences. Individuals with severe mental illness also have poorer physical health, and higher rates of cardiovascular disease, diabetes and cancer. For health systems this means higher spending on services, and for individuals having a physical and a mental illness together can mean dying up to 20 years earlier than the average for people born around the same and in similar circumstances to them.
What, then, needs to be done?
The high social and economic costs of mental ill-health demand a more robust policy response. Individuals with mental ill-health should be offered care that is timely and appropriate for their needs, which puts them at the centre of care delivery, and makes treatment choice a reality. Sick on the Job stresses the importance of making employment a core desired outcome for mental health care and the need for employment services to address widespread mental health needs among jobseekers. With appropriate training, guidance and resources, the ability of teachers and managers to provide support with mental health problems can make a huge difference to individual wellbeing, and can be decisive in whether a student or worker stays in education or work or not.
The structure of mental health services, how they are set up, funded, and delivered to the individuals who need them, needs to be strengthened. Even as national pressures, costs and priorities bear down, OECD mental health systems need enough services, enough investment, enough evidence-based care, and enough cleverly designed service delivery to make patient-centred high quality care a reality for every individual that needs it.
Making mental health a policy priority would have significant and economic benefits, but most importantly it would enhance people’s lives. We can hope that by the next World Mental Health Day we are further along the road to societies where all individuals with mental health needs get the treatment, care and support that they need.
Depressing depression: mental illness at work OECD Insights
Work-life imbalance OECD Insights
Dementia: a modern killer OECD Observer