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Paying the Price: the Cost of Mental Health Care in England in 2026

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Paying the Price: the Cost of Mental Health Care in England in 2026 PAYING THE PRICE The cost of mental health care in England to 2026 Paul McCrone Sujith Dhanasiri Anita Patel Martin Knapp Simon Lawton-Smith © King’s Fund 2008 First published 2008 by the King’s Fund Charity registration number: 207401 All rights reserved, including the right of reproduction in whole or in part in any form ISBN: 978 1 857175 714 A catalogue record for this publication is available from the British Library Available from: King’s Fund 11–13 Cavendish Square London W1G 0AN Tel: 020 7307 2591 Fax: 020 7307 2801 Email: [email protected] www.kingsfund.org.uk/publications Edited by Edwina Rowling Typeset by Andrew Haig & Associates Printed in the UK by Charlesworth Contents List of figures and tables vii About the authors xiii Foreword xv Executive summary xvii Background xvii Methods xvii Findings xviii 1 Introduction 1 Background 1 Rationale for the review 5 Aims of the review 6 Structure of report 6 2 Methods 7 Quantifying mental health need 7 Estimation of service provision 8 Estimation of service and total costs 9 Intervention modelling 9 3 Projected demographic change in England, 2007–2026 11 Population projections by ethnic group 13 Summary 14 4 Depression 15 Summary 15 Introduction 15 Prevalence estimates 16 Population estimates 18 Service costs and lost employment 20 Projected costs 25 Scenario modelling 27 5 Anxiety disorders 35 Summary 35 Introduction 35 Prevalence estimates 36 Population estimates 38 Service costs and lost employment 38 Projected costs 43 Scenario modelling 43 6 Schizophrenic disorders 51 Summary 51 Introduction 51 Prevalence estimates 52 Population estimates 54 Service costs and lost employment 56 Projected costs 61 Scenario modelling 63 7 Bipolar disorder and related conditions 69 Summary 69 Introduction 69 Prevalence estimates 70 Population estimates 71 Service costs and lost employment 72 Projected costs 77 Scenario modelling 77 8 Eating disorders 81 Summary 81 Introduction 81 Prevalence estimates 82 Population estimates 83 Service costs and lost employment 84 Projected costs 88 Scenario modelling 88 9 Personality disorders 91 Summary 91 Introduction 91 Prevalence estimates 92 Population estimates 94 Service costs 94 Projected costs 98 Scenario modelling 98 10 Disorders affecting children and adolescents 99 Summary 99 Introduction 99 Prevalence estimates 100 Population estimates 102 Service costs and lost employment 104 Projected costs 109 Scenario modelling 110 11 Dementia 111 Summary 111 Introduction 111 Prevalence estimates 113 Population estimates 113 Service costs and lost employment 113 Projected costs 115 Scenario modelling 115 12 Conclusions, discussion and recommendations 117 Introduction 117 Conclusions 117 Summary of results from scenarios modelling 119 Discussion 121 Recommendations 124 Appendix 1 Feedback from consultation 127 Appendix 2 Treatment recommendations 129 References135 List of figures and tables Figure 1 Distribution of NHS spending on mental health services, 2006/7 1 Figure 2 Distribution of planned investment in adult mental health services in England, 2006/7 2 Figure 3 Change in number of people in England by age group, 2007 to 2026 11 Figure 4 Proportion of population who are male in England, 2007 to 2026 12 Figure 5 Percentage of population aged 16–44 by ethnic group 12 Figure 6 Percentage of population aged 45–59 by ethnic group 13 Figure 7 Percentage of population aged over 60 years old by ethnic group 14 Figure 8 Prevalence of depressive disorders by age group and gender 16 Figure 9 Prevalence of depression in general practice by age group and gender 17 Figure 10 Prevalence of depression by gender and age group 18 Figure 11 Projected change in number of people with depression, 2007 to 2026 19 Figure 12 Percentage of people with depression by ethnic group and gender 19 Figure 13 Number of psychiatric inpatient bed days by age and gender, 2004/5 21 Figure 14 Average service costs for depression, 2005/6 22 Figure 15 Average service and total costs for depression by age group, 2005/6 23 Figure 16 Aggregate costs of depression by age group, 2005/6 24 Figure 17 Distribution of service costs for depression 25 Figure 18 Projected service costs for depression, 2007 to 2026 26 Figure 19 Projected total costs for depression, 2007 to 2026 26 Figure 20 Decision model of costs of reducing non-treatment among people with depression in contact with services 28 Figure 21 Impact of providing medication to those who are in contact but not receiving treatment for depression 29 Figure 22 Impact of providing psychological therapy and medication to those who are in contact but not receiving treatment for depression 30 Figure 23 Cost savings due to providing medication for those in contact with services but not currently receiving treatment for depression 31 Figure 24 Cost savings due to providing psychological therapy and medication for those in contact with services but not currently receiving treatment for depression (assuming a 2 per cent annual real earnings increase) 31 Figure 25 Cost savings due to providing psychological therapy and medication for those in contact with services but not currently receiving treatment for depression (assuming a 1 per cent annual real earnings increase) 32 Figure 26 Impact on total service costs of increasing proportion in treatment for depression (increase occurs immediately) 33 Figure 27 Impact on total service costs of increasing proportion in treatment for depression (increase occurs gradually) 33 Figure 28 Prevalence of anxiety disorders in the community by age group 36 Figure 29 Prevalence of anxiety disorders in general practice by age group and gender 37 vii Figure 30 Prevalence of anxiety disorders by age group and gender 37 Figure 31 Projected change in number of people with anxiety disorders, 2007 to 2026 38 Figure 32 Average service costs for anxiety disorders, 2007 39 Figure 33 Distribution of service costs for anxiety disorders 40 Figure 34 Service costs for anxiety disorders by gender and age, 2005/6 40 Figure 35 Average service and total costs for anxiety disorders by age, 2005/6 41 Figure 36 Aggregate costs for anxiety disorders by age group 42 Figure 37 Projected service costs for anxiety disorders, 2007 to 2026 42 Figure 38 Projected total costs for anxiety disorders, 2007 to 2026 43 Figure 39 Decision model of costs of reducing non-treatment among people with anxiety disorders in contact with services 44 Figure 40 Impact of providing medication to those who are in contact but not receiving treatment for anxiety disorders 45 Figure 41 Impact of providing medication and psychological therapy to those who are in contact but not receiving treatment for anxiety disorders 46 Figure 42 Cost savings due to providing medication for those in contact with services but not currently receiving treatment for anxiety disorders, 2007 to 2026 46 Figure 43 Cost savings due to providing combined medication and psychological therapy for those in contact with services but not currently receiving treatment for anxiety disorders (assuming a 2 per cent annual real earnings increase), 2007 to 2026 47 Figure 44 Cost savings due to providing combined medication and psychological therapy for those in contact with services but not currently receiving treatment for anxiety disorders (assuming a 1 per cent annual real earnings increase), 2007 to 2026 48 Figure 45 Impact on service costs of increasing proportion in treatment for anxiety disorders (increase occurs immediately), 2007 to 2026 49 Figure 46 Impact on service costs of increasing proportion in treatment for anxiety disorders (increase occurs gradually), 2007 to 2026 49 Figure 47 Prevalence of schizophrenic disorders per 1,000 population 53 Figure 48 Number of people with schizophrenic disorders by age and gender, 2007 55 Figure 49 Projected change in number of people with schizophrenic disorders, 2007 to 2026 55 Figure 50 Inpatient bed days per person with schizophrenic disorders 57 Figure 51 Mean annual service costs for people with schizophrenic disorders, 2005/6 58 Figure 52 Distribution of service costs for schizophrenic disorders 59 Figure 53 Distribution of service costs by age for schizophrenic disorders, 2005/6 59 Figure 54 Projected service costs for schizophrenic disorders, 2007 to 2026 60 Figure 55 Distribution ofsocietal costs of schizophrenic disorders by age 61 Figure 56 Projected societal costs of schizophrenic disorders, 2007 to 2026 62 Figure 57 Projected growth in costs of schizophrenic disorders, 2007 to 2026 62 Figure 58 Potential savings from expanding provision of crisis resolution teams for schizophrenic disorders, 2007 to 2026 63 Figure 59 Model to assess economic impact of early intervention services for schizophrenic disorders 64 Figure 60 Potential savings from expanding provision of early intervention teams for schizophrenic disorders, 2007 to 2026 65 Figure 61 Potential savings from expanding provision of early detection services for schizophrenic disorders, 2007 to 2026 66 viii PAYING THE PRICE Figure 62 Twelve-month prevalence of bipolar disorder and related conditions by age group 70 Figure 63 Twelve-month prevalence of bipolar disorder and related conditions by gender 71 Figure 64 Projected change in number of people with bipolar disorder and related conditions, 2007 to 2026 72 Figure 65 Inpatient bed days per person with bipolar disorder 73 Figure 66 Mean annual service costs for people with bipolar disorder and related conditions, 2005/6 74 Figure 67 Distribution of total service costs for people with bipolar disorder and related conditions
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