Building an economic case for mental health promotion: part I
| DOI | https://doi.org/10.1108/17465729200700017 |
| Date | 01 September 2007 |
| Published date | 01 September 2007 |
| Pages | 14-23 |
| Author | Lynne Friedli,Michael Parsonage |
| Subject Matter | Health & social care |
Keywords
economic analysis
mental health
promotion
prevention
cost-effective
conduct disorders
This paper uses economic analysis to develop the case for greater investment in mental health
promotion. One example of a common mental health problem for which there is robust evidence
of effective interventions is conduct disorder.The paper estimates that preventing conduct disorders
in those children who are most disturbed would save around £150,000 per case (lifetime costs),and
that promoting positive mental health in those children with moderate mental health would yield
lifetime benefits of around £75,000 per case. Investment in support for parents is therefore the top
priority in a provisional list of ‘best buys’in promoting mental health.
Building an economic case for
mental health promotion: part I
Lynne Friedli
Mental health
promotion specialist
Michael Parsonage
Senior policy advisor
Sainsbury Centre for
Mental Health
Correspondence to:
Lynne Friedli
22 Mayton Street
London N7 6QR
lynne.friedli@
btopenworld.com
ANALYSIS
14 journal of public mental health
vol 6 • issue 3
This paper analyses the case for mental
health promotion from an economic
perspective. Developing the economic
case for mental health promotion is a
challenging undertaking, raising a
number of complex methodological problems. In
addition, the published evidence on the cost-
effectiveness of different interventions is extremely
limited, although the wider (non-economic)
literature on mental health promotion is now very
substantial. It is nevertheless possible to identify
some clear messages that we hope will be of value to
policy makers and practitioners, particularly in
stimulating debate and raising awareness.
What is positive mental health?
‘People who are happy with their lives are not
inevitably satisfied when they judge the
conditions in society; satisfaction with one’s life
and with society and government are distinct.’
(Lyubomirsky et al, 2005; p844)
Although there is widespread agreement that
mental health is more than the absence of clinically
defined mental illness (WHO, 2004a; 2004b), there
is ongoing debate about what constitutes the
necessary or sufficient elements that make up
positive mental health or well-being (Keyes, 2002;
Huppert, 2005; Lyubomirsky et al, 2005; Carlisle &
Hanlon, 2007). These generally include skills or
attributes associated with emotion (feeling) and
cognition (thinking), and their influence on social
function (relating). Key indicators in scales designed
to measure positive mental health include resilience,
self-esteem, self-efficacy, optimism, life satisfaction,
hopefulness and social integration (Speight et al, in
press; Mauthner & Platt, 1998).
Keyes describes the combination of positive
feelings and positive functioning as ‘flourishing’
(Keyes, 2002). Others categorise the key elements
slightly differently: eg. a sense of autonomy, a sense
of competence and a sense of relatedness (Ryan &
Deci, 2001). Lyubomirsky et al (2005) focus on the
experience of frequent positive emotion and less
frequent (but not absent) negative emotion.
Clearly, how positive mental health is defined
influences how it is measured and any cost benefit
that can be attached to it.
Rationale for mental health promotion
The economic rationale for mental health
promotion is based on the case for preventing
mental illness and the case for promoting positive
mental health: ie. fostering the skills and attributes
associated with positive mental health.
Improved mental health and well-being is seen as:
●a worthwhile goal in itself
●leading to better outcomes, for example in
physical health, health behaviours, educational
performance, employability and earnings, crime
reduction. (NIMHE, 2005)
Making the case for promoting positive mental
health involves demonstrating that these outcomes
are not just the result of the absence of mental illness,
but are due, wholly or in some degree, to aspects of
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