The cost of child and adolescent mental health services

Skokauskas, Norbert; Lavelle, Tara A.; Münir, Kerim; Sampaio, Filipa; Nystrand, Camilla; McCrone, Paul; McDaid, David; Chisholm, Dan; Byford, Sarah; Ganguli, Poushali; Feldman, Inna; Belfer, Myron L.

doi:10.1016/s2215-0366(18)30089-0

Cited by 14 publications

(12 citation statements)

References 3 publications

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“…Some recent developments can be noted to address the paucity of economic evidence in this area. In 2017, the Greenwich Expert Group proposed directions for future research focusing on LMICs, to make suggestions for “a cost‐effective mental health care system that optimally improves the future outcomes of children and adolescents”.…”

Section: Current Economic Evidence and Key Events In Mental Health Carementioning

confidence: 99%

Economics and mental health: the current scenario

2020

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Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill‐health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget‐holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost‐effectiveness analysis, cost‐utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification‐plus‐treatment; risk‐reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community‐based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.

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Section: Current Economic Evidence and Key Events In Mental Health Carementioning

confidence: 99%

Economics and mental health: the current scenario

2020

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“…6 Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management (IGM), Neuherberg, Germany. 7 Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. 8 German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.…”

Section: Supplementary Informationmentioning

confidence: 99%

“…Besides the risk of chronicity, there is also the risk of developing comorbidities [ 3 , 4 ]. Moreover, these conditions can be of economic burden for families and healthcare systems [ 5 – 7 ]. Therefore, MHP are of high public health relevance in all countries of the world [ 1 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“We’re in good hands there.” - Acceptance, barriers and facilitators of a primary care-based health coaching programme for children and adolescents with mental health problems: a qualitative study (PrimA-QuO)

et al. 2020

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Background 11.5 % of girls and 17.8 % of boys are affected by a mental health problem (MHP). The most prevalent problem areas are behavioural problems (girls/boys in %: 11.9/17.9), emotional problems (9.7/8.6) and hyperactivity problems (4.8/10.8). Primary care paediatricians are the first in line to be contacted. Nevertheless, even for less severely affected patients, referral rates to specialised care are constantly high. Therefore, a major statutory health insurance fund introduced a Health Coaching (HC) programme, including a training concept for paediatricians, standardised guidelines for actions and additional payments to strengthen primary care consultation for MHP and to decrease referrals to specialised care. The aim of this study was to examine how the HC is perceived and implemented in daily practice to indicate potential strengths and challenges. Methods During a one-year period starting in November 2017, a series of guideline-based interviews were conducted by phone with HC-developers, HC-qualified paediatricians, parents and patients (≥14 years) treated according to the HC programme. Paediatricians were selected from a Bavarian practice network with a total of 577 HC qualified paediatricians. Parents of patients with the four most common MHP diagnoses were approached by their health insurance: [World Health Organization, 2013] developmental disorder of speech and language [Wille N, et al., 2008] head/abdominal pain (somatoform) [Holling H, et al., 2003-2006 and 2009-2012] conduct disorder [Plass-Christl A, et al., 2018] non-organic enuresis. 23 paediatricians, 314 parents and 10 adolescents consented to be interviewed. Potential participants were selected based on purposeful sampling, according to principles of maximum variance. All interviews were recorded and transcribed verbatim. Two researchers analysed the transcripts independently of each other. Structuring content analysis derived from Mayring was used for analysis. Results 11 paediatricians, 3 co-developers, 22 parents and 4 adolescents were included. Families were generally satisfied with paediatric care received in the programme’s context. The HC supported paediatricians’ essential role as consultants and improved their diagnostic skills. Lack of time, financial restrictions and patients’ challenging family structures were reported as major barriers to success. Conclusion The HC programme is perceived as a facilitator for more patient-centred care. However, structural barriers remain. Starting points for improvement are further options to strengthen families’ resources and expanded interdisciplinary networking.

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“…It is clear that mental health problems represent a substantial proportion of the global burden of disease. Child and adolescent mental health (CAMH) is slowly becoming recognized as a growing public health priority as exemplified by the WHO resolution on autism spectrum disorders in 2014 [ 1 ], recent special issues on CAMH and adolescent health in the Lancet [ 2 ] and focus on mental health in the sustainable development goals [ 3 ]. However, this recognition alone is not enough to influence policy development and implementation for CAMH services.…”

Section: Introductionmentioning

confidence: 99%

Child and adolescent mental health policy in South Africa: history, current policy development and implementation, and policy analysis

Mokitimi

Schneider

Vries

2018

Int J Ment Health Syst

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BackgroundMental health problems represent the greatest global burden of disease among children and adolescents. There is, however, lack of policy development and implementation for child and adolescent mental health (CAMH), particularly in low- and middle-income countries (LMICs) where children and adolescents represent up to 50% of populations. South Africa, an upper-middle income country is often regarded as advanced in health and social policy-making and implementation in comparison to other LMICs. It is, however, not clear whether this is the case for CAMH. The national child and adolescent mental health policy framework of 2003 was developed to guide the establishment of CAMH policies provincially, using a primary care and intersectoral approach. This policy provided a framework for the nine South African provinces to develop policies and implementation plans, but it is not known whether this has happened. The study sought to examine the history and current state of CAMH policy development and implementation, and to perform a systematic analysis of all available CAMH service-related policies.MethodsA comprehensive search was performed to identify all provincial mental health and comprehensive general health policies across South African provinces. The Walt and Gilson policy triangle framework (1994) was used for analysis.ResultsNo South African province had a CAMH policy or identifiable implementation plans to support the national CAMH policy. Provincial comprehensive general health policies addressed CAMH issues only partially and were developed mainly to address the challenges with HIV/AIDS, TB, maternal and child mortality and adherence to the millennium development goals. The process of policy development was typically a consultative process with internal and external stakeholders. There was no evidence that CAMH professionals and/or users were included in the policy development process.ConclusionsIn spite of South Africa’s upper-middle income status, the absence of any publically-available provincial CAMH policy documents was concerning, but in keeping with findings from other LMICs. Our results reinforce the neglect of CAMH even at policy level in spite of the burden of CAMH disorders. There is an urgent need to develop and implement CAMH policies in South Africa and other LMICs. Further research will be required to identify and explore the barriers to policy development and implementation, and to service development and scale-up in CAMH.

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The cost of child and adolescent mental health services

Cited by 14 publications

References 3 publications

Economics and mental health: the current scenario

Economics and mental health: the current scenario

“We’re in good hands there.” - Acceptance, barriers and facilitators of a primary care-based health coaching programme for children and adolescents with mental health problems: a qualitative study (PrimA-QuO)

Child and adolescent mental health policy in South Africa: history, current policy development and implementation, and policy analysis

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