Introduction to Mental Health Economics



Health Economics (HE) emerged in healthcare in the 1950s but was only applied in Mental Health mainly after the 1990s. One of the reasons for such a delay was the previous approach to psychiatric care based exclusively in hospitals. With the shift from a hospital to community care model, and with the availability of new, expensive treatments and a growing demand for treatment, HE became a powerful tool to guide mental health policies and to assess the costs and benefits of mental health interventions. HE has its origins on the principles of the welfare theory, which aims to maximize welfare (well-being and happiness) underpinned by a cost-benefit analysis. Because methodologies measure health in monetary units, the health sector adapted economic principles to an extra-welfarist approach through cost-effectiveness and cost-utility analyses in order to maximize health outcomes and guide public health resource allocation. In this chapter we present the main concepts of HE and how economic principles can be applied in mental health care. Economic evaluation is the most important method to verify benefits over costs, demonstrating which of several alternatives is the best value for the money. Regarding some peculiarities of mental health care, this chapter raises some challenging issues of applying HE methods and how the social and economic burden of mental disorders exert influence on the type of economic evaluation chosen.


  1. 1.
    Murray CJL, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injutries, and risk factors in 1990 and projected to 2020. Boston: Harvard School of Public Health; 1996.Google Scholar
  2. 2.
    Weehuizen R. Mental capital: the economic significance of mental health. Maastricht: University of Maastrich; 2008. Available:
  3. 3.
    United Nations. Transforming our world: the 2030 Agenda for sustainable development. United Nations; 2015. Report No.: A/RES/70/1.Google Scholar
  4. 4.
    Knapp M. Economic evaluation and mental health: sparse past. Fertile future? J Ment Health Policy Econ. 1999;2(4):163–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Singh B. The role of economic evaluation in mental health care. Aust N Z J Psychiatry. 2001;35:104–17.CrossRefPubMedGoogle Scholar
  6. 6.
    Shearer J, Byford S. The basics of economic evaluation in mental healthcare. Brit J Psych Advances. 2015;21:345–53.Google Scholar
  7. 7.
    World Health Organization. The World Health Report. Mental health: new understanding. Geneve: New Hope; 2001.Google Scholar
  8. 8.
    Knapp M, Beecham J, McDaid D, Matosevic T, Smith M. The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience. Health Soc Care Community. 2011;19(2):113–25.PubMedGoogle Scholar
  9. 9.
    Mushkin SJ. Toward a definition of health economics. Public Health Rep. 1958;73(9):785–93.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Chisholm D, Stweart A. Economics and ethics in mental health care: traditions and trade-offs. J Ment Health Policy Econ. 1998;1:55–62.CrossRefPubMedGoogle Scholar
  11. 11.
    Acemoglou D, Autor D. Lectures in labour economics: the basic theory of human capital. Lectures in labour economics. Cambridge: Massachusetts Institute of Technology Department of Economics; 2011. Available: http://economics. mit. edu/files/4689Google Scholar
  12. 12.
    Rebelo LP. The origins and the evolution of health economics: a discipline by itself? Led by economist, practitioners or politics? 2007.Google Scholar
  13. 13.
    Chisholm D, Evans D. Economic evaluation in health: saving money or improving care? J Med Econ. 2007;10:325–37.CrossRefGoogle Scholar
  14. 14.
    Knapp M. The economic evaluation of mental health care. 1st ed. Aldershot: Ashgate Publishing Limited; 1995.Google Scholar
  15. 15.
    Begg D, Fischer S, Dornbusch R. Economics. 8th ed. Berkshire: McGraw-Hill; 2005.Google Scholar
  16. 16.
    Parkin D. Health economics. [4]. 2009. London: Health knowedge. 28 Jan 2016.
  17. 17.
    Baujard A. Welfare economics. Working paper GATE −33.2013.<halshs-00906907>. 2013. 28 Jan 2016.Google Scholar
  18. 18.
    Slothuus U. Economic evaluation: theory, methods and application. Health economics paper. University Southern od Denmark; 20052 Feb 2016.Google Scholar
  19. 19.
    Hazlitt H. Understanding “Austrian” economists. Fondation for Economic Evaluation; 1981. 28 Jan 2016.Google Scholar
  20. 20.
    Kahneman D, Wakker P, Sari R. Back to bentham? Explorations of experienced utility. Q J Econ. 1997;112(2):375–405.CrossRefGoogle Scholar
  21. 21.
    Stigler G. The development of utility theory. J Polit Econ. 1950;58(4):307–27.CrossRefGoogle Scholar
  22. 22.
    Rothbard M. Toward a reconstruction of utility and welfare economics. The logic of action one. Edward Elgar Publishing Limited; 1997. p. 211–54.
  23. 23.
    Read D. Utility theory from Jeremy Bentham to Daniel Kahneman. Working paper No: LSEOR 04–64. London: London School of Economics and Political Science; 2004. 28 Jan 2016.Google Scholar
  24. 24.
    Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2007.Google Scholar
  25. 25.
    Palmer S, Togerson D. Definitions of efficiency. Br Med J. 1999;318:1136.CrossRefGoogle Scholar
  26. 26.
    Andrews G. Efficacy, effectiveness and efficiency in mental health service delivery. Aust N Z J Psychiatry. 1999;33:316–22.CrossRefPubMedGoogle Scholar
  27. 27.
    Arrow K. Uncertainty and the welfare economics of medical care. Am J Econ Rev. 1963;LIII(5):941–73.Google Scholar
  28. 28.
    Ferraz MB. Health economics, equity, and efficiency: are we almost there? ClinicoEcon Outcome Res. 2015;7:119–22.CrossRefGoogle Scholar
  29. 29.
    Drummond M, McGuire A. Economic evaluation in health care: merging theroy with practice. 2nd ed. New York: Oxford University Press; 2004.Google Scholar
  30. 30.
    Byford S, McDaid D, Sefton T. Because it’s worth it: a practical guide to conducting economic evaluations in the social welfare field. 2003. London, York Publishing Services Ltd.Google Scholar
  31. 31.
    McIntosh E, Clarke P, Frew EJ, Louviere JJ. Applied methods of cost-benefit analysis in health care. New York: Oxford University Press Inc; 2011.Google Scholar
  32. 32.
    Byford S, Sefton T. Economic evaluation of complex health and social care interventions. Natl Inst Econ Rev. 2003;186:98–108.CrossRefGoogle Scholar
  33. 33.
    Luyten J, Naci H, Knapp M. Economic evaluation of mental health interventions: an introduction to cost-utility analysis. Evid Based Ment Health. 2016;19(2):49–53.CrossRefPubMedGoogle Scholar
  34. 34.
    Gray A, Clarke P, Wolstenholme J, Worsworth S. Applied methods of cost-effectiveness analysis in health care. 1st ed. Oxford: Oxford University Press; 2011.Google Scholar
  35. 35.
    Gray AM. Cost-effectiveness analyses alongside randomised clinical trials. Clin Trials. 2006;3(6):538–42.CrossRefGoogle Scholar
  36. 36.
    Mauskopf JA, Paul JE, Grant DM, Stergachis A. The role of cost-consequence analysis in healthcare decision-making. PharmacoEconomics. 1998;13(3):277–88.CrossRefPubMedGoogle Scholar
  37. 37.
    Jönsson B. Ten arguments for a societal perspective in the economic evaluation of medical innovations. Eur J Health Econ. 2009;10:357–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Knapp M. Economic outcomes and levers: impacts for individuals and society. Int Psychogeriatr. 2007;19(3):483–95.CrossRefPubMedGoogle Scholar
  39. 39.
    Frank G, McGuire TG. Economics and mental health. In: Culyer A, Newhouse J, editors. Handbook of health economics volume 1B. Oxford: Elsevier; 2000. p. 894–945.Google Scholar
  40. 40.
    McCrone P. Mental health economics: current methodological issues. Epidemiol Psychiatr Sci. 2011;20(3):239–43.CrossRefPubMedGoogle Scholar
  41. 41.
    Brazier J. Measuring and valuing mental health for use in economic evaluation. J Health Serv Res Policy. 2008;13(Suppl3):70–5.CrossRefPubMedGoogle Scholar
  42. 42.
    Chisholm D, Healey A, Knapp M. QALYs and mental health care. Soc Psychiatry Psychiatr Epidemiol. 1997;32(2):68–75.CrossRefPubMedGoogle Scholar
  43. 43.
    Beecham J, Knapp M. Costing psychiatric interventions. In: Thornicroft G, editor. Measuring mental health needs. London: Gaskell; 2001. p. 200–24.Google Scholar
  44. 44.
    Stant AD, Buskens E, Jenner JA, Wiersma D, TenVergert EM. Cost-effectiveness analysis in severe mental illness: outcome measures selection. J Ment Health Policy Econ. 2007;10(2):101–8.PubMedGoogle Scholar
  45. 45.
    Bonney S, Stickley T. Recovery and mental health: a review of the British literature. J Psychiatr Ment Health Nurs. 2008;15(2):140–53.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Centre of Economic Mental Health, Department of PsychiatryUniversidade Federal de Sao PauloSão PauloBrazil

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