Mental health policy and practice across Europe: an overview

The WHO perspective 429
isolation, but rather as an integral part of the challenge posed by communicable
diseases.
Economic and social costs of mental disorders
The economic and social costs of mental disorders fall on societies, governments,
people with mental disorders and their carers and families. Given the
long-term nature of mental disorders, the most evident economic burden is
that of direct treatment costs. For example, the most important contributor
to direct costs of depression is hospitalization, accounting for around half
of the total in the United Kingdom and three-quarters in the United States
(Berto et al. 2000).
The indirect costs attributable to mental disorders (from unemployment,
increases in absenteeism and decreased productivity) outweigh the direct treatment
costs by two to six times in developed market economies (Greenberg et al.
1993; Kind and Sorensen 1993), and are likely to account for an even larger
proportion of the total costs in developing countries, where the direct treatment
costs tend to be low (Chisholm et al. 2000). In the United Kingdom, mental
health problems were found to be the second most important category of
ill health, resulting in 5–6 million working days lost annually (Gabriel and
Liimatainen 2000). In the European Union (EU), it is estimated that the cost of
mental problems may amount to 3–4 per cent of gross national product (GNP)
(Gabriel and Liimatainen 2000).
In most countries, families bear a significant proportion of these economic
costs because of the absence of publicly-funded, comprehensive mental health
service networks. However, ultimately governments and societies pay a price
in terms of reduced national income and increased expenditure on social
welfare programmes. Thus, the economic logic for societies and countries is
simple: treating and preventing mental disorders is expensive but leaving them
unattended can be more so.
In addition to the obvious suffering caused by mental disorders there is a
hidden burden of stigma and discrimination, and human rights violations.
Rejection, unfair denial of employment opportunities and discrimination in
access to services, health insurance and housing are common, as are violations
of basic human rights and freedoms, as well as denials of civil, political, economic
and social rights, in both institutions and communities. Much of this
goes unreported and therefore the burden remains unquantified.
Families and primary care providers also incur social costs, such as the emotional
burden of looking after disabled family members, diminished quality of
life, social exclusion, stigmatization and loss of future opportunities for selfimprovement.
The risk of developing a mental disorder is also higher among
carers. The end result of high health care costs, lost productivity and social costs
is the creation of, or worsening of, poverty.