Mental health: A Particular Challenge Confronting Policy Makers and Economists

  • Peter ZweifelEmail author
Current Opinion


The first objective of this paper is to expound the particular challenge posed by the occurrence of inconsistency in the expression of preferences by mental health patients to both economists and policy makers. Since this difficulty cannot be resolved, the second aim of the paper is to identify agents who may be counted upon to identify the true patient preferences. A decision rule is developed to help identify these agents who may be family members or judges in court, who have the ability and incentive to make these decisions. No single agent is found to dominate with respect to the five dimensions of preference distinguished, constituting a major challenge to policy makers.



The author is grateful for comments by Richard Frank (Harvard), Bruno Lenzhofer (Villach, Austria) as well as participants in the CINCH workshop at the University of Essen (Germany) on 25/26 June 2018 and the Traveler Seminar at St. John´s University (New York) on 29 Jan. 2019. Moreover, suggestions and criticisms from three anonymous reviewers are greatly appreciated. The usual disclaimer applies.

Compliance with Ethical Standards

Conflict of interest

No funding of this study has been received, and there is no conflict of interest.


  1. 1.
    Sonuga-Barke EJS, Cortese S, Fairchild G, et al. Annual research review: transdiagnostic neuroscience of child and adolescent disorders—differentiated decision-making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety. J Child Psychol Psychiatry. 2016;57(3):321–46.CrossRefGoogle Scholar
  2. 2.
    Yechiam E, Hayden EP, Bodkins M, et al. Decision making in bipolar disorder: a cognitive modelling approach. Psychiatry Res. 2008;161(2):146–52.CrossRefGoogle Scholar
  3. 3.
    Mas-Collel A, Whinston MD, Green JR. Microeconomic theory. New York: Oxford University Press; 1995.Google Scholar
  4. 4.
    Rubinstein A. Modeling bounded rationality. Cambridge: MIT Press; 1997.Google Scholar
  5. 5.
    Wedig GJ. Health status and the demand for health: results on price elasticities. J Health Econ. 1988;7(2):151–63.CrossRefGoogle Scholar
  6. 6.
    Zweifel P. Preference measurement: relieving health economics of its Achilles heel. In: Culyer AJ, Kobelt G, editors. Portrait of a health economist. Essays by Colleagues and Friends of Bengt Jönsson. Lund: IHE Swedish Institute of Health Economics; 2014. p. 209–17.Google Scholar
  7. 7.
    Mondarelli G, Sabatello U, Lappori E, et al. Treatment decision-making capacity in children and adolescents hospitalized for an acute mental disorder: the role of cognitive functioning and psychiatric symptoms. J Child Adolesc Psychopharmacol. 2016;27(5):1–4.Google Scholar
  8. 8.
    Tray N. Depression and indecision: trouble making decisions. Healthy Place. 2016.
  9. 9.
    Chalkley M, Malcomson J. Contracting for health services with unmonitored quality. Econ J. 1998;108(449):1093–110.CrossRefGoogle Scholar
  10. 10.
    Holt CC, Modigliani F, Simon HA. A linear decision rule for production and employment scheduling. Manag Sci. 1955;2(1):1–30.CrossRefGoogle Scholar
  11. 11.
    Zweifel P. The triple challenge of mental health (Editorial). Eur J Health Econ. 2017;19(3):309–13.CrossRefGoogle Scholar
  12. 12.
    National Institute of Aging. Legal and financial planning for people with Alzheimer’s. 2017.
  13. 13.
    Campbell LA, Kisely SR. Advance treatment directives for people with severe mental illness. London: Cochrane; 2009.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Emeritus University of ZurichZurichSwitzerland
  2. 2.Bad BleibergAustria

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