The social and economic impact of mental health
According to the World Health Organization, one billion people worldwide, or one in eight, are living with a mental disorder. Although this is not a new issue, the unusual situation generated by Covid‑19 and the associated lockdowns caused the number of cases reported to rise sharply. However, it also helped shed light upon a subject that has not typically been discussed in public. Far from being a matter that only affects individuals, mental health is one of the great healthcare challenges of our times. It is also one with profound socioeconomic consequences, which requires a rethinking of the way in which it is managed.
Mental health does not just mean the presence or absence of mental disorders. This difference can be seen in the film A Beautiful Mind, in which Russell Crowe plays John Nash, a mathematical genius and winner of the Nobel Prize in Economics, who also suffered from paranoid schizophrenia. Despite his diagnosis, Nash was able to find success in his professional and personal life, and he can be seen as an example of someone who experienced mental illness but who also, with help, was able to maintain a positive state of mental health. It is therefore best to understand mental health as a dynamic state of well‑being, which can change over time in response to many different factors.
This is how the concept has been explained in a recent report issued by the Geneva Association (GA), a group representing the global insurance industry. That report, which also emphasizes the importance of learning to live with mental health disorders, is entitled Promoting Peace of Mind: Mental health and insurance, and it is based on a study in which MAPFRE participated. It provides an assessment of the magnitude of the problem, while also presenting some ideas about how to find solutions when addressing such a complex subject.
Women and young people are most commonly affected
To begin, it should be noted there is a clear upward trend in the number of people experiencing mental illness, and the pandemic represented an additional turning point, with a sudden spike in cases being reported. In less than a year and a half, Covid‑19 led to 53 million new cases of depression and 76 million new cases of anxiety worldwide, according to the Institute for Health Metrics and Evaluation. Although traditionally the image we have of mental illness is associated more with schizophrenia, bipolar disorder, or similar conditions, anxiety and depression have become those with the greatest prevalence, and the number of people experiencing them continues to show a worrying increase.
Women and young people have been the demographic groups most heavily affected. Specifically, two‑thirds of new cases are being reported in women, and in terms of age, the number of cases reported among younger people has been particularly striking, with the largest increase seen among those under 25 years old. The levels of new cases resulting from the pandemic remain high until reaching those in their 50s, and after that the numbers progressively decrease as age increases. Mental health disorders have become one of the most serious health problems for young people and working-age adults: for those between 10 and 24 years of age, self-harm and depression have become the third and fourth most common types of disease and injury, while among those between 24 and 49 years of age, depressive disorders are now the sixth most prevalent type.
The cost of mental health
These figures in themselves tell a story of extensive social and human impact, but unfortunately, there is more: it is estimated that globally, the cost of poor mental health will reach $6 trillion by the year 2030, which is higher than the GDP of most countries. In 2010, that figure was less than half, at $2.5 trillion, and the direction of this evolution suggests that this economic impact could continue to increase exponentially.
But the cost of mental health problems goes far beyond the corresponding health care spending. For example, according to the OECD, this cost represents 4.1% of the total GDP in the European Union. Out of that percentage, direct health care costs represent 1.3%, while indirect costs represent 2.8%, divided between Social Security benefits paid (1.2%) and lost productivity and unemployment (1.6%). That study was performed using data from 2015, which means that these proportions may now be even higher.
Through its direct involvement with healthcare services and life insurance (for disability, payment protection, etc.), the insurance industry has a direct role to play in all of this. Mental health problems are already the most frequent cause of disability affecting employment, and each year insurance companies pay about $15 billion just for indemnification of this type. Other industry studies have emphasized that among users of healthcare services, the proportion making use of those services in relation to mental illnesses continues to rise.
What is future of mental health treatment?
In view of these current realities, it would be nice to think that now that the pandemic has ended, worldwide mental health will improve. Unfortunately, there are still no signs pointing in that direction. “If we fail to address this problem now, we risk grave social and economic consequences. Covid has left us with a very difficult legacy, in terms of our social relationships and behaviors, with social anxiety being especially prevalent among young people… And our socio-economic circumstances are at present rather gloomy, with a war in Europe, the ongoing cost of living crisis and climate change”, explains Adrita Bhattacharya-Craven, lead author of the Geneva Association’s report.
She is also that organization’s Director of Health and Aging, and she emphases three points that could help us move forward in the right direction. The first is the very close relationship between mental health and physical health: people suffering from chronic illnesses show notably higher levels of mental health disorders, and people with mental health disorders often experience a worsening of their physical health.
In relation to this, Alma Fernández, Medical Director for Savia, which is MAPFRE’s digital health platform, says that in Spain, about one‑third of all patients with high blood pressure, diabetes, or cancer also have depression, and more than 20% of those experiencing depression have cancer. Furthermore, the risk factors for developing non‑contagious chronic illnesses (poor dietary habits, sedentary lifestyle, and consumption of tobacco or alcohol) can be worsened if an individual also suffers from a mental health disorder. “We can consider mental health disorders, in themselves, as a risk factor for developing chronic illnesses”, she explains.
This is a perspective that has given rise to groundbreaking programs such as the one implemented by MAPFRE Salud ARS, which is MAPFRE’s health division in the Dominican Republic. That program includes mental health treatment as one of the strategies used to address chronic illnesses such as high blood pressure, diabetes, and various types of cancer, in persons with two or more serious illnesses and those receiving palliative care. Those patients, who tend to be the most vulnerable, are being given preventive care that helps them improve their self‑esteem and understand how their illness could be affecting their social and family relationships, as a way of mitigating the mental impact of their physical conditions.
According to Ms. Bhattacharya-Craven, another issue that must be taken into account is one that she says goes right to the core of the problem: “the vast majority of mental health problems represent cases of anxiety or depression”, she explains. And these are conditions which require a broad set of interventions.. “There is a tendency to overmedicalise these problems, and to see them as something that requires psychiatric care or even hospitalization. We need to expand the range of services we are using to manage these conditions, and put our focus on specific strategies in those areas”, she says. Sometimes this may indeed mean clinical support but in other cases, it may also mean social or financial wellbeing interventions.
From a more general perspective, a significant part of the solution may be related to eliminating stigma. This is not just a task for the healthcare sector, but one that also involves multiple actors and society as a whole. However, Ms. Bhattacharya-Craven emphasizes that companies can also play a very important role. The workplace, in combination with financial circumstances, is one of the main sources of mental health difficulties. “Companies are already carrying out vaccination campaigns, or campaigns on subjects like healthy living or dietary improvement. Why not also have campaigns to improve mental health?”, she asks. Taking a proactive approach to mental health problems can also have a positive impact from an economic perspective, because it can help individuals identify problems before they become too extensive and result in serious life disruptions, such as years of work leave.