Woman sitting on couch at home using mobile phone

commentary

(The BMJ)

October 19, 2016

Thinking Outside the Box to Find Solutions to Mental Health Problems

Photo by Monkey Business Images/Fotolia

by Christian Van Stolk and Joanna Hofman

Reducing mental health problems in the UK remains a significant policy challenge for government. Just over 6 million working-age people have mental health problems, with 39 per cent of those seeking help and 24 per cent receiving treatment. However, a recent report from the National Audit Office (NAO) indicated that access to mental health services is limited with patients having little choice over the services they receive and often enduring long waiting times.

At the same time, these services can incur significant costs to governments. In 2016, the Mental Health Task Force (PDF) valued the current costs of mental health support and services across government departments in England at £34 billion a year. However, even this high number was seen by the task force as being insufficient to meet current demand.

A way to reduce these costs is helping people with common mental health problems, such as depression, anxiety and insomnia, to gain or maintain employment. Besides the obvious health benefits for the individual, helping common mental health sufferers has financial benefits for governments, with fewer people using health services and claiming benefits and more people contributing tax.

Given the pressures on the UK budget, it is logical to consider different ways of funding and delivering services. RAND Europe has explored a number of innovative approaches to mental health services, which aim to provide benefits to the individual, industry, government and the wider economy.

A report from 2014 showed how four different policy options could improve a range of outcomes for mental health patients. These included: providing employment support for people with severe mental health problems called Individual Placement and Support; offering group therapy intervention for people with common mental health problems and employment needs; providing online assessment and support; and offering a telephone-based assistance service. All of these different options could potentially lower the costs of providing care to patients with mental health needs, while also helping businesses and the UK economy through enabling more people to get back to work.

Common mental health problems are often the most significant barrier preventing people on benefits from taking up or staying in employment. Therefore, it can be argued that resources available to the benefit system should go towards improving mental health outcomes. Often additional investment could be justified through the savings made to the benefit system.

The study also looked at policy measures to provide people with more access to online mental health tools. Such availability could reach a large proportion of the UK population with mental health needs at a relatively low cost. There are examples of apps and websites set up to help children with mental health needs, such as Silent Secret, a social enterprise that provides a free app for people aged 11-19 to share their thoughts anonymously and HeadMeds, a website to help young people find about mental health medication rather than asking their parents or doctors.

Another example is the use of computerised cognitive therapy tools (cCBT), which are online applications to help tackle common mental health illnesses among the adult population. A recent RAND Europe study looked at the scope of cCBT available worldwide and their impact on people with mental health needs. These tools have a positive impact on a range of different users. However, there is a danger that some groups with mental health needs are less likely to participate in cCBT treatments. For example, well-educated, middle-aged women in full-time employment were more likely to use the tools compared to unemployed men. There is also a discussion about how cCBT is integrated into other treatments and mental health services.

The findings and recommendations from our studies have led to the Department for Work and Pensions trialling a number of pilot programmes to build an even greater evidence base for these approaches in action. These pilots look at addressing both employment and mental health needs; introducing more integration between current services; providing early access to specialist services; and using technology to deliver services to individuals with mental health needs.

Clearly tackling mental health problems requires a range of approaches and some innovation in service delivery. This will require industry, government, mental health groups and service users to work together to find appropriate solutions for those with differing mental health problems and needs. The use of technology to deliver mental health services is one area of particular interest and is being explored in more detail by government. The overall aim is helping people get access to the mix of services they need, while also helping them get back to or stay in work.


Christian van Stolk is vice president and research group director of the home affairs and social policy team and Joanna Hofman is a research leader at RAND Europe.

This commentary originally appeared on The BMJ on October 19, 2016. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.