April 2, 2014
by Jennifer Beecham
Resources for supporting children and adolescents with psychiatric disorders continue to be scarce. The publication of a new article by Jennifer Beecham in the Journal of Child Psychology and Psychiatry examines this scarcity and reviews the progress of economic studies across different disorders.
The release of this article is timely following recent media coverage into the lack of mental health services for children and adolescents. A recent BBC News report highlighted that there are at least 850,000 children in the UK with a diagnosed mental health condition, and called for much more help, particularly within schools. A Times article from the beginning of March 2014 reported that mental health problems among the young are escalating.
The first review of the economics of child and adolescent mental health was published over 15 years ago (Knapp, 1997), and since then there have been three subsequent reviews. This latest review examines peer-review journal articles published in English between 2005 and 2012. It highlights a number of key points that have important implications for commissioners of services and practitioners:
- There are far fewer economic studies for child and adolescent psychiatric disorders than for adult disorders. Earlier reviews have found the quality of studies that combine costs and outcomes to be poor and, while improvements have been made, there is much still to do.
- Both UK and US research has shown that children and adolescents with mental health conditions can have health care costs at least twice as high as their peers with other conditions.
- There are considerable costs from childhood mental health conditions falling to non-health agencies such as those providing social care, education and justice, but these costs are rarely assessed. Family-borne costs can also be high.
- High non-health costs in childhood and poor economic outcomes in adulthood make a strong case for increased investment in treatment for childhood psychiatric disorders. UK research by Knapp, King, Healey and Thomas in 2011 demonstrated that economic outcomes for adults were poorer for those who had had childhood mental health problems. Work by Snell et al, 2013 concludes that “there are huge costs to the public sector associated with child psychiatric disorder, particularly the education system. There is a pressing need to explore ways to reduce these costs while improving health and well-being.”
- Many more good quality economic studies, including cost-effectiveness analyses of new and existing interventions, are required to provide sufficient evidence to help commissioners and providers make decisions about resource allocation.
This article concludes that, while the evidence base for child and adolescent mental health interventions is improving, we still do not know enough about the economic implications of support and treatment for specific disorders. There is a growing need for better economic evidence to inform policy and practice, particularly with the backdrop of government cutbacks increasing the need to show value for money, challenging commissioners and service providers across Europe and the US.
A thought-provoking piece from The King’s Fund’s blog highlights the need to think differently regarding mental health issues and that all too often people are turned away in crisis.
A wealth of information relating to mental health is available at The Royal College of Psychiatrists website.
Beecham, J. (2014) “Annual Research Review: Child and adolescent mental health interventions: a review of progress in economic studies across different disorders”, Journal of Child Psychology and Psychiatry
About the author:
Jennifer Beecham is Professor of Health and Social Care Economics at the Personal Social Services Research Unit at the University of Kent and a Professorial Research Fellow at the London School of Economics and Political Science. She is also a senior member of the Childhood Wellbeing Research Centre.