Economic costs, detection problems and access to mental health professionals

There are many challenges and difficulties we face when talking about mental health management and related problems. Considering the high prevalence of mental disorders worldwide, a first factor to take into account is the high economic cost both for those affected and for any health system, including the social burden this entails. In addition to the difficulties that this type of problem generally entails, we must consider that their treatment requires a detection capacity that is not covered by the health system, where there is also a serious lack of qualified mental health professionals. Finally, mental disorders are more harmful than common chronic medical disorders, for example, in terms of loss of work productivity, and present a greater deterioration, particularly in the areas of family and social functioning and close relationships (Druss et al., 2009). An example of this is that mental disorders are associated with more than half of the days of functional disability (Merikangas et al., 2007).

In addition to these widespread interpersonal difficulties, mental health problems are often more difficult to detect than physical health problems, which means that they have traditionally received less attention, and therefore fewer financial resources have been invested (WHO, 2013). Some specific examples of health expenditure related to mental health problems will be specified below.

In the United States, alcohol use and abuse disorder affects about 20 million Americans, and places an economic burden of approximately 500 trillion annually (Horgan, Skwara, Strickler, Andersen, & Stein, 2004), including medical costs of justice, accidents, and lost earnings. Other studies have indicated that the lost time and other work-related effects associated with major depressive episodes are associated with an average economic loss of approximately $36 trillion annually (Kessler et al., 2006).

In the European Union, they cause costs that are estimated at 3-4% of GDP, mainly due to productivity losses due to incapacity to work. Mental disorders are one of the main causes of early retirement and disability pensions (Commission of the European Communities, 2005). In 2010, direct and indirect costs related to mental disorders were estimated at 798 trillion euros per year (Gustavsson et al., 2011) In Spain it is estimated that 2.2% of total GDP expenditure is devoted to mental health, and specifically to depressive, anxiety and somatization disorders (Parés-Badell et al., 2014; Ruiz-Rodríguez et al., 2017)

The current situation, which is already extremely worrying, may worsen significantly in the coming decades. In 2010, the WHO and the World Economic Forum warned that Western economies would not be able to withstand these rising costs, and that by 2030, these costs could increase by a factor of 2.4, leading to economic losses of up to $6 quintillion worldwide (Bloom, 2012).

In addition, the two agencies mentioned above urged the development of more effective and cost-efficient methodologies for the early detection and treatment of mental disorders (Bloom, 2012). And this, connects us to the next problem, access to mental health professionals and deficits to correctly detect mental health problems. One of the main stumbling blocks for patients with mental health problems is access to psychological therapy. According to the United Nations, globally there is less than one mental health professional for every 10,000 people. In Spain, a retrospective study of 64,000 patients found that approximately 17% of the reasons for consultation in Primary Care involved mental health problems(Sicras Mainar et al., 2007), with anxiety and/or depression being the most frequent. One of the main problems in meeting this growing demand lies in the shortage of clinical psychologists in the Spanish National Health System, which is estimated at an average of 5.7 clinical psychologists per 100,000 inhabitants(WHO, 2013), so access to psychological treatment is restricted to a small percentage of patients who are referred to specialist care. This leads to a significant percentage of patients either receiving only pharmacological treatment, sometimes without adequate monitoring by a mental health professional, or receiving no treatment at all.

In addition, numerous studies have indicated that there are significant limitations to the detection of mental health problems and/or disorders. For example, 50-70% of patients with major depression are not detected in primary care (Coyne, Thompson, Klinkman, & Nease, 2002). Furthermore, in Spain, 26.5% of patients were misdiagnosed with depression, without meeting criteria for a mood disorder (Aragonés, Piñol & Labad, 2006). With respect to anxiety disorders, the detection capacity is even lower: Only between 20% and one third of anxiety problems are recognized in primary care(Roy-Byrne, Wagner & Scraunfnagel, 2005). In the case of the child and adolescent population, it is equally alarming how few cases (estimated at less than 10%) end up receiving specialized care for this type of mental disorder. And again, it is attributed to the fact that most children, who meet the criteria of emotional or behavioral problems, are not correctly detected in primary care (Sheldrick, Merchant, & Perrin, 2011).

These errors can be caused by the lack of training of professionals and/or by the lack of material resources and time available to correctly assess and detect this type of problem in the context of Primary Care. Therefore, it is essential that mental health professionals are more involved in this type of context. And on the other hand, it is also essential to implement new tools for psychopathological risk assessment to improve the detection of problems and disorders related to mental health. The role of new technologies can be fundamental in this aspect.

What can the Psiconexia Predict assessment tool contribute? Our grain of sand.

PSICONEXIA PREDICT is a digital tool that, in contexts with a high load of patients, could improve some of the problems described above. For example:

Improve psychological evaluation: Guide mental health professionals in the evaluation and psychopathological orientation of their patients, through a very complete psychopathological risk tool (which includes multiple modules, questions and examples) and, therefore, improve errors in the detection of mental health problems.

Reduce economic costs: Reduce administration time, collect a large amount of data in a simple, flexible and fast way and have the results immediately available. Therefore, speed up the whole evaluation process, in a much more efficient way.

Access to mental health professionals: Finally, although the evaluation tool is initially intended to be used by professionals, our long-term goal is to develop a simpler and free version for the general population. This future version of screening will have as its main objective to guide the person to find the most appropriate mental health professional according to the problem he or she presents. And in this way give a direct and free answer to improve the problem of access to mental health professionals.

References:

• Aragonès, E., Piñol, J. L., & Labad, A. (2006). The overdiagnosis of depression in non-depressed patients in primary care. Family practice, 23(3), 363-368.
• Asamblea mundial de la salud (2013). Plan de acción sobre salud mental 2013-2020. Organización Mundial de la Salud, Ginebra, Suiza.
• Bloom, D. E., Cafiero, E., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L. R., Fathima, S., … & O’Farrell, D. (2012). The global economic burden of noncommunicable diseases (No. 8712). Program on the Global Demography of Aging.
• Comisión de las Comunidades Europeas. (2005). LIBRO VERDE: Mejorar la salud mental de la población: Hacia una estrategia de la Unión Europea en materia de salud mental. Recuperado de: https://consaludmental.org/publicaciones/LibroVerdeSM.pdf
• Coyne, J. C., Thompson, R., Klinkman, M. S., & Nease Jr, D. E. (2002). Emotional disorders in primary care. Journal of Consulting and Clinical Psychology, 70(3), 798.
• Druss, B. G., Hwang, I., Petukhova, M., Sampson, N. A., Wang, P. S., & Kessler, R. C. (2009). Impairment in role functioning in mental and chronic medical disorders in the United States: results from the National Comorbidity Survey Replication. Molecular psychiatry, 14(7), 728-737.
• Gustavsson, A., Svensson, M., Jacobi, F., Allgulander, C., Alonso, J., Beghi, E., … & Gannon, B. (2011). Cost of disorders of the brain in Europe 2010. European neuropsychopharmacology, 21(10), 718-779.
• Horgan, C., Skwara, K. C., Strickler, G., & Andersen, L. (2004). Substance abuse: The nation’s number one health problem. Diane Publishing Company.
• Kessler, R. C., Merikangas, K. R., & Wang, P. S. (2007). Prevalence, comorbidity, and service utilization for mood disorders in the United States at the beginning of the twenty-first century. Annu. Rev. Clin. Psychol., 3, 137-158.
• Merikangas, K. R., Ames, M., Cui, L., Stang, P. E., Ustun, T. B., Von Korff, M., & Kessler, R. C. (2007). The impact of comorbidity of mental and physical conditions on role disability in the US adult household population. Archives of general psychiatry, 64(10), 1180-1188.
• Pares-Badell, O., Barbaglia, G., Jerinic, P., Gustavsson, A., Salvador-Carulla, L., & Alonso, J. (2014). Cost of disorders of the brain in Spain. PloS one, 9(8).
• Roy-Byrne, P. P., Wagner, A. W., & Schraufnagel, T. J. (2005). Understanding and Treating Panic Disorder in the Primary Care Setting. The Journal of Clinical Psychiatry, 66(Suppl4), 16–22.
• Ruiz-Rodríguez, P., Cano-Vindel, A., Navarro, R. M., Medrano, L., Moriana, J. A., Aguado, C. B., … & de Investigación PsicAP, G. (2017). Impacto económico y carga de los trastornos mentales comunes en España: una revisión sistemática y crítica. Ansiedad y Estres, 23(2-3), 118-123.
• Sheldrick, R. C., Merchant, S., & Perrin, E. C. (2011). Identification of developmental-behavioral problems in primary care: a systematic review. Pediatrics, 128(2), 356-363.
• Sicras Mainar, A., Rejas Gutiérrez, J., Navarro Artieda, R., Serrat Tarrés, J., Blanca Tamayo, M., & Díaz Cerezo, S. (2007). Costes y patrón de uso de servicios en pacientes que demandan atención por problemas mentales en asistencia primaria. Gaceta Sanitaria, 21, 306-313.