Investing in mental health pays off — so why aren’t we doing it?
We know that depression is the world’s leading cause of disability. We know that suicide is the leading cause of death for young people globally. And we know that investing in mental health is worth it — the average return on investment in common mental health conditions is roughly 5:1, meaning for every dollar invested, the benefit to society is worth five.
Most investors would take that kind of return any time, but especially right now where the ongoing pandemic is wreaking havoc on financial markets. Yet despite the clear incentives, less than 2% of national health budgets are spent on mental health. So why aren’t governments spending more on mental health?
I am a passionate mental health advocate obsessed with health financing and, to be honest, the standard argument for public and private investment in mental health that I and many before me have used is weak
A rethink is needed. A change in our argument.
Yes, there is some decent existing data about mental health financing. But how much is that knowledge worth when the experiences of individuals haven’t been factored into the equation? How compelling is the argument to invest more in mental health really without the stories of those people we want to help? If there’s anything we can learn from today’s tumultuous political landscape, it is that stories, not numbers, win arguments.
So, I believe, this is the time to put faces to the macro stats and bring the individuals out of the shadows these incomprehensible numbers cast, to look at the impacts of investment beyond just dollars and cents. At United for Global Mental Health, we launched our Speak Your Mind campaign last year, bringing together mental health advocates from 19 countries calling for greater action on mental health. We’ve now articulated our approach in a new report: The Return on the Individual.
Instead of looking at the traditional return on investment in mental health, measured in just financial terms, our report puts the human being at the centre and highlights the wider return on the individual that can’t be easily quantified. To give you an example, I want to tell you Sodikin’s story.
What statistics can’t capture
Sodikin was a young man when his mental health first started to deteriorate. He was living with his family in Cianjur, a town 100km south of the Indonesian capital Jakarta, and they didn’t know how to support him. First, his family took him to a faith healer, then a mental hospital a day-and-a-half walk from their home. They were given drugs to help his condition, which worked for a little while, but when he needed his prescription renewed, there was no help to get. After being sent back and forth between the local healthcare centre and hospital, they lost hope. That’s when the shackling began.
Sodikin spent more than eight years in shackles in a tiny hut outside of his family home, until an NGO came to rescue him. He had to be carried from the hut because his muscles had wasted away so much he couldn’t walk. He stayed at a shelter for seven months while he received the full support he needed to recover.
Now, Sodikin is the main breadwinner in his family and has a stable job in a clothing factory. I could link this story to some numbers about Sodikin’s increased contribution to the economy, but that’s not the story. Sodikin’s experience is about rights, dignity and having a fulfilled life — no statistic can capture that.
The return for society
The effects of good and poor mental health in society — the ability of individuals to fully participate in society, whether in their social networks, workplaces, schools, communities or families — are endless and not yet fully understood.
Most of these elements and their effects are not easily quantifiable but are woven into society and are intrinsic to each of us, and so by again putting the individual at the centre of our thinking, the positive impact of mental health investment on society can be seen. For brevity, we limited our research to three areas that are key:
Physical health: The link between mental health and physical health is well-established — people with poor mental health also have poorer physical health. Improved mental health can lead to reduced tobacco, alcohol and substance abuse, reduced vulnerability to infectious diseases such as HIV and Tuberculosis (TB), and reduced obesity and chronic health conditions. Around half of all people with TB have depression. This makes them ten times more likely to stop treatment, leaving them at higher risk of death and of contributing to increased drug resistance.
The family unit: Poor mental health affects entire families. The mental wellbeing of parents and carers influences the outcomes of the children they are responsible for: from reduced birth weights to educational attainment. Globally, 10-20% of children and adolescents experience mental disorders, while 15-23% of children live with a parent with a mental illness.
Social cohesion: Just as the mental health of children and parents impacts on families, so too does the mental health of individuals impact on society. Poor social connections can be considered both a risk factor for and a consequence of poor mental health. People with weak social connections are more likely to develop mental health illnesses while those who join social groups are less likely to have conditions such as depression. Well-integrated societies have less crime, lower mortality and better physical and mental health.
The return for the economy
Often the economic case for mental health is framed at the national or global level. This is understandable when you consider that, unless things change dramatically, by 2030 the global economy will forego US$6 trillion each year in lost productivity due to poor mental health. But what impact does that have on employers who are well under-used agents of change? Do employers know that companies on average receive a $5 return for every $1 invested in employee mental health and wellbeing? With a sixth of the workforce having some form of mental health condition at any given time, the workplace should be an important frontline of mental health service delivery. The mental health of colleagues should be a strong enough argument of itself and, although companies are becoming increasingly responsible employers, I am not expecting them to be completely altruistic. So yes, business can improve staff ‘wellbeing’, but in doing so these interventions can also yield substantial financial benefits.
After the pandemic
So, what’s next?
Well, now is COVID. The substantial mental health impact of COVID-19 is a cause of huge concern — for governments, companies and individuals. There is no doubt that our immediate response needs to include mental health support to all those affected, led by WHO guidance.
Then, when we emerge from the Great Isolation and push the global reset button, there will be a global economic downturn to address. And we know that mental ill health typically rises during economic recession. Governments, businesses and other funders need to fully integrate mental health into their programmes for individual citizens and employees, primarily through mental health being at the core of universal health coverage reforms that will surely be called for with increased vigour.
Longer-term, in my hazy optimistic view, there will be some positives to emerge over time from COVID-19. We will be provided with the opportunity to right global wrongs — the requirement to increase investment in mental health needs to be high on this list.
Now, more than ever, the case is clear for revolutionary investment in mental health worldwide. We can make this case by showing the financial gains. But that will only get us so far. By turning ‘return on investment’ on its head and redefining it as the ‘return on the individual’, we put people at the heart of our argument, to tell a more compelling and powerful story that can make a lasting, wholesale increase in funding for mental health.