Is psychiatry different? An economic perspective

Abstract

Compared with the general health system, the mental health system faces distinct challenges. Perennial flashpoints include issues of stigma, coercive treatment, and nosology, which generate heated ethical and policy debates. Often overlooked, however, is another characteristic of the mental health sector: its financial dependence on the public purse. People with chronic behavioural health needs rarely have the means to afford their own care. Mental disability inhibits workforce entry, limiting the income available to cover private and out-of-pocket health-care costs. Moreover, long-term mental health treatment requires different, often more complex resources than other health treatments.1Frank RG McGuire TG Chapter 16: economics and mental health.in: Culyer AJ Newhouse JP Handbook of health economics. Elsevier, Amsterdam2000: 893-954http://linkinghub.elsevier.com/retrieve/pii/S1574006400800293Date accessed: January 18, 2019Google Scholar Public financing of these costs is therefore common and necessary. Governments around the world usually pay for mental health services regardless of whether the rest of the health sector is publicly or privately financed. The extent of public general health financing predicts the general bed supply by 6%, whereas the extent of public mental health financing predicts the psychiatric bed supply by almost 40% (author's calculation; figure). In other words, how much a government spends on health usually does not determine the overall supply of care. Conversely, in the mental health sector, more government spending is associated with more care. I analysed general and mental health markets in terms of the relationship between public spending, estimated by general government health expenditure and public mental health expenditure, and supply, estimated by the number of hospital beds (an adequate indicator in both markets). Data sources are the WHO Mental Health Atlas2WHOMental health atlas 2011. World Health Organization, Geneva2011https://www.who.int/mental_health/evidence/atlas/profiles/en/Date accessed: February 25, 2019Google Scholar and Organisation for Economic Co-operation and Development (OECD) data at OECD.Stat. There is no correlation between the general health-care supply and public spending (figure A). However, there is a positive correlation between mental health-care supply and public mental health spending (figure B). To promote better practice, providers, researchers, and policy makers should first acknowledge psychiatry's dependence on public investment. The allocation of additional government resources to behavioural health will help to attract and retain providers and expand consumer access to long-term treatments. A robust supply of services is otherwise impossible to achieve. I declare no competing interests.