Mental ill-health imposes a huge burden on individuals, their families, society, health systems and the economy. Yet mental health care remains a neglected area of health policy in far too many countries. This state of affairs should not be accepted. The social and economic costs of neglecting mental health care are too high. More must be done to make mental health count.

Despite the enormous epidemiological, social and economic burden of mental ill-health, mental health care is still not a priority in most health systems. The current weak state of mental health care is unacceptable. More must be done to make mental health count and improve the lives of those suffering from mental ill-health: policy makers must give mental health the importance it demands in terms of resources and policy prioritisation.

The epidemiological, social and economic burden of mental ill-health in OECD countries is enormous.

This chapter draws on national data, OECD data, and other international data sources to explore the economic burden of mental ill-health in OECD countries. This chapter looks at direct, indirect and intangible costs, and seeks to identify some of the trends and features of the cost of mental illness in OECD countries, as well as highlighting the great need to improve data availability. This chapter explains that expenditure on mental health has, generally, been rising in OECD countries, and while a significant proportion of expenditure remains in inpatient settings, expenditure on community and outpatient services is increasing. Although there are significant data challenges, it is possible to establish that mental ill-health represents a significant cost.

This chapter explains that mild-to-moderate disorders are highly prevalent in OECD countries, and widely undertreated. The costs of untreated mild-to-moderate disorders are high, and countries need to strengthen and scale-up treatment for common conditions, such as depression and anxiety. The experiences of some OECD countries suggest that cost-effective treatments are available, but their adoption is not widespread. This chapter looks at ways that existing care delivery, particularly at the primary care level, can be improved. Examples of successful ways of ensuring that organisational and financial incentives align with desired outcomes of care provision for mild-to-moderate disorders are given. The growing range of cost-effective initiatives, particularly initiatives that promote access to psychological therapies, which are highly promising for delivery of better care for mild-to-moderate disorders, are explored.

While the prevalence of severe mental illness is small relative to mild-to-moderate mental illness, severe mental illness tends to dominate the organisation of mental health systems in OECD countries and consume the majority of resources. This chapter describes policies that have been put in place to improve care for such illnesses, and highlights areas where attention is still needed. Co-morbidities of severe mental illness and somatic illnesses are a cause for concern, and some efforts have been made to counteract the negative consequences that arise from co-morbidities. In particular, GPs can play an important role in co-ordinating the physical and mental health care of people with severe mental illness but require effective co-operation with specialist care. While specialist care is increasingly delivered by multi-disciplinary teams in a multitude of community-care settings, inpatient care still has a role to play especially in times of crisis. This chapter examines how reliance on inpatient beds varies considerably across OECD countries. Finally, this chapter explores the potential for innovative payment systems for specialist mental health care to evolve beyond a primary focus on inpatient settings to reflect the multiplicity of care settings available and promote an integrated and cross-sectoral approach to providing care.

Mental disorders account for a large burden of disease and addressing unmet need by delivering high-quality targeted interventions will greatly improve the outcomes and efficiency of mental health services. Mortality indicators such as suicide and premature mortality provide important information on mental health status and the interplay of mental and physical health, but more specific indicators are necessary to reflect the quality of mental health care. Measuring and improving the quality of mental health care is a key challenge not least given the need to capture complex care pathways and encompass a range of outcomes. Numerous ongoing and completed projects seek to measure and benchmark the quality and outcomes of mental health care at an international level in spite of the many challenges faced by such endeavors. Moreover, considerable progress in developing quality and outcomes indicators as well as mental health targets and standards has occurred at a national level. Better quality and outcome indicators are crucial for measuring and improving the quality and efficiency of mental health care yet progress in developing such data has fallen far behind other disease areas.

The composition of the mental health workforce in OECD countries is diverse, and this chapter examines how OECD countries differ in terms of the numbers and mix of mental health professionals, which can in turn impact on the access, quality and cost of care provided. Cross-country comparisons of the human resources available to respond to mental health care needs are, however, hampered by the non-standardisation of data, the overlapping roles and tasks of different providers, and the challenge in properly measuring the input of primary care providers (notably general practitioners) in diagnosing and treating different mental health problems. The training, accreditation and continuing professional education of the mental health workforce plays a critical role in the supply, remuneration and mobility of mental health professions as well as the quality of care provided. Changing models of human resources and mental health care delivery have increased the potential for the provision of more efficient and effective services that promote better quality and service integration. As mental health care has become more integrated into community settings, service users and family caregivers play an increasing and critical role in supporting people with mental health problems.

Good governance and leadership in OECD countries is crucial to drive changes in structures and planning for mental health, and to make mental health count. Mental health has been traditionally neglected and underfunded, especially when the significant burden of disease accountable to mental disorders is considered, and there is a need for governments to keep mental health high on the health agenda. A number of key stakeholders are involved, including governments at various administrative levels, user and carers organisations, and professional organisations, and this chapter considers their various roles. Mental health policy makers are using a variety of tools to improve mental health systems and lead system-wide improvements, including legislative frameworks, mental health strategies, and vertical initiatives to deliver mental health services to target population groups.