HE2.1
Service Provision for Mental Health
Mental Health
Health
Service Provision for Mental Health
According to the Global Burden of Disease (GBD) study mental disorders rank among the top 10 causes of health loss globally. Anxiety and depressive disorders are the most prevalent across all age groups and regions. The GBD 2019 report includes the following mental disorders:
- depressive disorders (major depressive disorder and dysthymia),
- anxiety disorders (a combined estimate of all subtypes),
- bipolar disorder (a combined estimate of all subtypes),
- schizophrenia,
- autism spectrum disorders,
- conduct disorder,
- attention-deficit hyperactivity disorder (ADHD),
- eating disorders (anorexia nervosa and bulimia nervosa),
- idiopathic developmental intellectual disability (or broader intellectual disability impairment r),
- and other mental disorders (an aggregate group of personality disorders).
Service provision for mental health disorders captures a range of professionals including psychiatrists, psychologists, mental health nurses, support staff and peer support workers. The total economic and social costs of mental ill health in England in 2022 was £300 billion according to the report called “The Economic and Social Cost of Mental Ill Health” by the NHS Confederation’s Mental Health Network as part of the Mental Health Economics Collaborative.
Key Value
Fiscal and economic value of £7,600
The average annual fiscal , and economic cost per year, for service provision to 1 person (including dementia (all ages, including children, adolescents and adults).
The headline value for service provision for mental health disorders is from the Greater Manchester Combined Authority (GMCA)* Unit Cost Database (v.2.3.1).
The average annual fiscal cost of service provision per person suffering from any type of mental health disorder, including dementia is the average across all age groups, including children, adolescents and adults (but excluding children under five years of age). In addition, the economic value quoted comprises lost earnings (£3,019 per person on average, at 2007-08 prices) and costs falling to informal carers (an estimated £736 per person); other social costs (e.g. from reduced well-being) are not monetised in the base report, the King’s Fund report: “PAYING THE PRICE: The cost of mental health care in England to 2026”.
The following conditions (with relevant ICD-10 codes where appropriate) were included in the King’s Fund report, covering most major mental health problems:
- depressive disorders (F320 to F31X)
- anxiety disorders (F400 to F411, F418 to F42X)
- schizophrenia and other functional psychoses (F200 to F29X)
- bipolar disorder and related conditions (F300 to F31X)
- eating disorders (F500 to F503)
- personality disorders (F600 to F61X)
- conditions affecting children and adolescents (hyperkinetic disorders, conduct disorder, emotional disorders)
- dementia (F000 to F03X)
| Description | Unit | Fiscal value in 2007/2008 prices | Fiscal value in 2022/2023 prices | Economic value in 2007/2008 prices | Economic value in 2022/2023 prices | Total value in 2022/2023 prices |
| Average cost of service provision for people suffering from mental health disorders, per person per year, including dementia (all ages, including children, adolescents and adults) – fiscal and economic costs | Per person per year
|
£1,866 | £2,530 | £3,755 | £5,091 | £7,621 |
Fiscal value is defined in the GMCA Unit Cost Database as the costs or savings that fall to public sector agencies and relate to public expenditure (e.g. delivery of additional services or reduced health, police or education costs). Economic value is defined as the costs or savings that fall to individuals (e.g. relating to earnings or personal expense), employers (e.g. profit, turnover) or the wider economy (e.g. growth).
The sum of fiscal and economic cost of service provision for people suffering from mental health disorders, per person per year, including dementia (all ages, including children, adolescents and adults) is £7,621. This is rounded to £7,600.
*The Greater Manchester Combined Authority(GMCA) is made up of the ten Greater Manchester councils and Mayor, who work with other local services, businesses, communities and other partners to improve the city-region.
The ten councils (Bolton, Bury, Manchester, Oldham, Rochdale, Salford, Stockport, Tameside, Trafford and Wigan) have worked together voluntarily for many years on issues that affect everyone in the region, like transport, regeneration, and attracting investment.
If you’re just starting out, start with Bronze first. The result of a Bronze measurement is just an estimate, but requires the least effort; whereas Silver and Gold give more accurate results but require more effort.
Each level has an effort to accuracy indicator, choose the one that’s right for you.
Bronze
Effort
Accuracy
Monetised value:
Monetised fiscal and economic value: Times the number of people in your stakeholder group by the average cost of service provision for people suffering from mental health disorders, of £7,600.
APPLYING THE VALUE: Consider the proportion of your participants you expect to be accessing service provision for mental health disorders.
If you are running an initiative that is aiming to improve people’s mental health and therefore reduce their need for mental health services, you can estimate the number of people that you expect to stop using mental health services and times this number by the proxy value to estimate the fiscal and economic savings because of your initiative.
If you can’t ask people directly about their age, because you’re unable to survey them, or this is a plan for a future project, then you can use this value as a proxy for service provision for mental health disorders, or for those that you are reducing the use of services for, for a group of generalised people.
Here’s an example
Let’s assume that there is a mental health initiative, and 10 people will be benefitting from this initiative and will not be using mental health services anymore that they were previously.
The total fiscal and economic savings of this initiative for 10 people over a year will be 10*£7,600= £76,000.
Silver
Effort
Accuracy
Monetised value:
Monetised social value: Consider the type of mental health and age of the people who access the service provision for mental health disorders.
If you have information about the type of mental health disorder or age of the people who are using the mental health service provision, you can make a more accurate calculation of the cost-of-service provision, or cost saving of reduced service use.
| Age | Description | Fiscal value in 2022/2023 prices | Economic value in 2022/2023 prices | Total value in 2022/2023 prices |
|---|---|---|---|---|
| Adults | Average cost of service provision for adults suffering from depression and/or anxiety disorders, per person per year - fiscal and economic costs | £1,125 | £5,208 | £6,333 rounded to £6,300 |
| Children/adolescents* | Average cost of service provision for children/ adolescents suffering from mental health disorders, per person per year - total fiscal cost (to the NHS) | £312 | NA | £312 rounded to £300 |
| *The age range of children in the surveys was 5–15. |
| Type of Mental Health Condition | Age | Fiscal value in 2022/2023 prices | Economic value in 2022/2023 prices | Total value in 2022/2023 prices (Average cost of service provision per person per year) |
|---|---|---|---|---|
| Depression | Adult** | £ 1,837 | £ 6,364 | £8,201 rounded to £8,200 |
| Anxiety disorders | Adult | £ 738 | £ 4,579 | £5,317 rounded to £5,300 |
| Schizophrenic disorders | Adult | £ 10,798 | £ 15,092 | £25,890 Rounded to £25,900 |
| Bipolar disorder and related conditions | Adult | £ 1,405 | £ 4,793 | £6,198 rounded to £6,200 |
| Eating disorders | Adult | £ 186 | £ 405 | £591 rounded to £600 |
| Personality disorder | Adult | £ 384 | £ 3,952 | £4,336 rounded to £4,300 |
| Dementia | Adult | £ 22,217 | £ 12,497 | £34,714 rounded to £34,700 |
| **Adults aged 16+. |
| Type of Mental Health Condition | Age | Fiscal, economic and social costs combined*** (Average cost of service provision per person per year) |
|---|---|---|
| Dysthymia (persistent depressive disorder) | All ages | £ 9,836 rounded to £9,800 |
| Autism | All ages | £ 16,832 rounded to £16,800 |
| ADHD (attention deficit hyperactivity disorder) | All ages | £ 1,189 rounded to £1,200 |
| Conduct disorder | All ages | £ 11,616 rounded to £11,600 |
| *** The entry relates to overall public value, combining the fiscal, economic and social elements, rather than separating these out as is the general approach across the unit cost database. For more information, please see GMCA Unit Cost Database. |
Here’s an example
You have set up a mental health support programme, and 20 people will be accessing support from this initiative.
It is known that 10 people joining the programme are adults suffering from depression and/or anxiety disorders and 10 are children/adolescents suffering from mental health disorders. All of the participants in the programme are currently accessing mental health services support.
The total fiscal and economic cost of the current service provision for the 20 people is estimated as (10*£6,300) +(10*£300) = £66,000.
After the mental health support programme 5 of the adults and 5 of the children do not need mental health service support anymore for the whole following year. This is estimated as a fiscal and economic cost saving of (5*£6,300) +(5*£300) = £33,000
A note on calculating tax loss: We assumed that the tax lost because of the economically inactive people due to mental disorders are counted under the economic value. Therefore, we have not added the tax loss into the headline value to avoid double counting. However, if you are specifically interested in tax loss due to mental health disorders you can benefit from the report of the NHS Confederation’s Mental Health Network as part of the Mental Health Economics Collaborative. In that report, the estimated total tax loss per unemployed person is £7,083 per year in 2022 prices. Therefore, £817 in tax revenue is lost for a person who is economically inactive for 6 weeks, £3,950 in tax revenue is lost for a person who is economically inactive for 29 weeks, and £7,083 in tax revenue is lost for a person who is economically inactive for 52 weeks.
Gold
Effort
Accuracy
Monetised value:
At Gold level you are looking to build on your silver estimations by engaging with the person or people affected.
For this value the main question to ask is in relation to the type of mental health disorder the person or people are experiencing, and whether or not they are accessing mental health service support.
This could also be combined with assessing the change in people’s mental health and their overall wellbeing as outlined in the MeasureUp value HE2 Improved Mental Health .
Mental health is a sensitive issue for many people so we recommend careful planning for any direct engagement with people around this topic.
For more information on stakeholder engagement please visit Gold: Surveys and measurements of actual results.
Support in developing your Gold survey approach is available through the Measure Up partners, so please do reach out to Impact, State of Life or PRD.
Gold+
Effort
Accuracy
Monetised value:
At the Gold+ level, you are building on your Gold value calculation by assessing the value against the counterfactual, or ‘what would have happened anyway’.
To do this you should identify a control group suitable to assess in line with your intervention, in order to more accurately attribute any changes to your intervention.
For example, with any mental health intervention you could look for a comparable group that have not accessed the support through your programme. This could be through a national dataset, comparable research covering a similar intervention to your own, or another group within your own stakeholders.
| Value Type: | Activity |
What's this?
This is the type of value. Some values are outcomes, which means many different interventions might lead to them, others are specific interventions that have a set value. |
|---|---|---|
| UN SDG Categories: |
|
What's this?
The UN Sustainable Development Goals are global goals adopted in 2015 for all signed up nations to achieve for us to have a sustainable global future by 2030. There are 17 Goals that address the global challenges we face, including those related to poverty, inequality, climate change, environmental degradation, peace and justice. The Goals are all interconnected, and in order to leave no one behind, it is important that we achieve them all by 2030. |
| PN06/20 Categories: |
|
What's this?
PPN 06/20 Taking account of social value in the award of central government contracts introduced the Central Government Social Value Model in 2020 which all Central Government contracting authorities must use in their in scope procurements. It consists of 5 themes, 8 policy outcomes, and 24 Model Award Criteria which outline key priority areas to achieve more social value. |
Evidence
Measure Up focuses on empowering you to numerically measure the impact you’re having. We recommend that numeric reports are backed up with stories and other types of evidence to help illustrate, in human terms, the impact that’s being made on individuals.
We recommend seeing consent from one or more participants in your intervention to collect and tell their story. This should include a little background on the participant, a summing up of life before the intervention, the human impact of the intervention, and the longer term (if known) impact on the person’s life outside of, and after, the intervention.
Providing photographs, audio recordings, video interviews or even artefacts from the intervention (for example, writing, paintings, music, etc from creative interventions) can add more colour, and convey the emotional impact of interventions more directly.
In some cases it’s appropriate to anonymise or abbreviate the personal information of case study participants. No story should be published or shared without the recorded consent of the individual(s) it concerns. Individuals continue to own the rights to their stories and if they request you stop sharing the story or making it available online you should do so promptly and without need for justification.
Feedback
Measure Up is an open, collaborative and transparent. If you have any suggestions or feedback on our pragmatic, recommended approach to measuring and valuing social value, including wellbeing, economic, and fiscal impact, and effects on our environment, please get in touch so we can share and discuss this at our next Advisory Group meeting.
More help
We want to empower anyone to perform and improve their impact measurement – without needing a degree in economics.
If you need any more help, or just someone to do the legwork for you we can help signpost you to software, training and consultancy to help you get to grips with the impact you’re having.
