Evaluation of Mental Health Interventions

Abstract

Mental illnesses are highly prevalent and can have considerable, enduring consequences for individuals, families, communities, and economies. Despite these high prevalence rates, mental illnesses have not received as much public policy commitment or funding as might be expected. One result is that mental illness often goes unrecognized and untreated. The resultant costs are felt not only in healthcare systems, but across many other sectors, including housing, social care, criminal justice, welfare benefits, and employment. This article sets out the basic principles of economic evaluation, with illustrations in this mental health context. It also discusses the main practical challenges when conducting and interpreting evidence from such evaluations. Decisions about whether to spend resources on a treatment or prevention strategy are based on whether it is likely to be effective in avoiding, reducing, or curing symptoms, improving quality of life, or achieving other individual-level outcomes. The economic evaluation question is whether the outcomes achieved are sufficient to justify the cost that is incurred in delivering the intervention. An economic evaluation has five elements: clarification of the question to be addressed; specification of the intervention to be evaluated and with what alternative it is being compared; the outcomes to be measured; the costs to be measured (including the cost of implementing the intervention and any savings that might accrue); and finally, how outcome and cost findings are to be blended to make a recommendation to the decision-maker. Sometimes, if an evaluation finds that one intervention has better outcomes but higher costs, then the evaluation should also how one (the outcomes) might be trade-off for the other (the costs). The article illustrates how economic evaluations have been undertaken and employed to address a range of questions, from the very strategic issue to the more specific clinical question. The purpose of the study can, to some extent, determine the type of evaluation that is needed. Examples of evaluations are given in a number of areas: perinatal maternal mental illness; parenting programs for conduct disorder; anti-bullying programs in schools; early intervention services for psychosis; individual placement and support; collaborative care for physical health problems; and suicide prevention. The challenges of economic evaluation are discussed, specifically in the mental health field.