Mental health policy and practice across Europe: an overview

82 Mental health policy and practice
effective, for example, if he or she has access to a suitable range of psychological
and pharmacological therapies and is based in a multidisciplinary
team. Poor target efficiency is inevitable if efforts are not made to identify
and prioritize needs and to encourage people to come forward for treatment.
Another reason for inefficiency could simply be that little is known about the
relationship between resources expended and outcomes achieved. This is where
cost-effectiveness analyses can contribute.
Cost-effectiveness evidence
Although our primary concern when looking at a new policy or intervention
should be to ask whether it is effective in terms of symptom alleviation and
quality of life enhancement, we clearly also need to know what it would cost to
implement. If two options are equally effective, which of them uses the fewer
resources? Or if they cost the same amount, which is the more effective? Or if
one of them is simultaneously more effective and more costly, does society
consider that it is worth paying the additional amount in order to achieve those
better outcomes?
These are the questions which cost-effectiveness analysis was designed to
address. Such analyses look at both outcomes and costs for two or more promotion
strategies, treatments, service arrangements or policies. In the terms of the
production of welfare framework, they compare the two ends of the chain in
Figure 4.1 that links what gets spent to what gets achieved.
Given what we have discussed already in this chapter, it is obviously important
that any evaluation in the mental health field should be measuring both
costs and outcomes quite broadly:
• Have all the relevant costs been taken into account? As we have seen, there are
many and various inputs to a mental health system – from health, social care,
housing, social security and other agencies – plus economic impacts in
terms of lost productivity, premature mortality and family ‘burden’. It might
be necessary to measure all of these, depending on the policy or practice
question that needs to be addressed.
• Are all the dimensions of effectiveness taken into account? Good mental
health care is not just about tackling clinical symptoms, but also about
improving an individual’s ability to function in ways that are valued by them
(such as getting back to work) and of course about promoting quality of life.
What do we know?
Had there been a version of this book published 30 years ago, it would have
taken very little time or space to summarize what was known about the costeffectiveness
of mental health treatments, interventions or policies because at
that time there was virtually no evidence at all. Nowadays, robust evidence is
accumulating at an encouraging rate, although not evenly across countries or
diagnostic areas.
Most studies have been undertaken in North America, some parts of western