The role of health economics in meeting increased mental health needs due to COVID-19

COVID-19 has had an undeniable impact on mental health, both from the perspective of living through the pandemic itself, but also as a result of the economic impact of a global recession.^1-5 This will likely require an increase in resources allocated to support mental health needs,⁶ thereby shaping existing health economic models.⁷

In many ways, COVID-19 is the ‘perfect storm’, affecting health economics on several fronts:

• First, the disease itself is driving an increase in COVID-19-related healthcare expenditure, while deferred care during lockdowns may place an additional financial burden on future health budgets^7,8
• Second, the fallout of COVID-19 has led to an economic downturn, leading to rising unemployment, declining tax revenues, and a reduction in GDP, which may affect future healthcare expenditure⁷
• Third, the long-term physical and mental health impacts of the disease (and the economic downturn it has caused) are likely to continue to rise long after the COVID-19 curve has flattened, placing continued pressure on healthcare budgets for years to come^7,8‍‍

The potential mental health impact of COVID-19 should not be underestimated. Prior to COVID-19, depression and anxiety disorders were estimated to cost the global economy US $1 trillion each year in lost productivity, with unemployment being a major risk factor.⁹ Following the Global Financial Crisis of 2007–2008, many countries reported higher rates of depression, anxiety, suicide and alcohol and drug use. In the 2008 recession, the 13 percent increase in suicide rate attributable to unemployment and income inequality led to the reported loss of 46,000 lives.¹⁰ Comparable outbreaks (the Spanish Flu and the 2003 severe acute respiratory syndrome outbreak) have also been associated with an increase in suicide attributed to social isolation, psychological distress and anxiety.¹¹

With COVID-19, isolation, contact restrictions and economic shutdown has completely transformed the psychosocial environment,^3,12 disrupted the care of those with existing mental health or substance abuse disorders, and placed a greater proportion of the population at risk of developing mental health disorders.⁸ In the first two months of the UK lockdown, mental health worsened by 8.1% with young women disproportionately affected.⁵  In the US, 35 million+ additional people may experience mental health conditions, including over 1.6 million people directly affected by COVID-19 illness or loss.⁸ This may mean that the demands on mental health services will exceed the existing capacity of the system.^1,8

So how might health economic models address the rising mental health burden of COVID-19? In the short term, we will likely see an increase in health spending in many countries financed through the reallocation of currently available resources,¹³ with a proportion allocated to mental health. Investment in mental health interventions will require a thorough assessment of existing health and service-use outcomes in clinical practice to determine which practices should be further developed and which discontinued.² We may see increased investment to extend the mental healthcare system workforce or in subsidising mental health support services for public and frontline health workers, and in research into novel interventions.^2,14 Virtual health or telehealth offerings may expand following their rapid adoption and initial success in response to the pandemic.^2,7  This may supplement mental health services in areas where there is restricted access to healthcare resources, and the approach could be further adapted to treat patients with chronic or episodic conditions. ^2,7 Over the longer term, greater community monitoring and mental health screening may be required, and the role of community support groups may expand. ² Resource allocation to mental health requires continued monitoring of needs, and assessment of quality and efficiency to ensure that interventions are not implemented based on affordability alone.² As such, health economics will play a vital role in determining how to best manage the mental health burden of COVID-19.

• Türközer HB, Öngür D. A projection for psychiatry in the post-COVID-19 era: potential trends, challenges, and directions. Mol Psychiatry. 2020;25(10):2214-2219. doi:10.1038/s41380-020-0841-2
• Moreno C, Wykes T, Galderisi S, et al. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry. 2020;7(9):813-824. doi:10.1016/S2215-0366(20)30307-
• Kola L. Global mental health and COVID-19. Lancet Psychiatry. 2020;7(8):655-657. doi:10.1016/S2215-0366(20)30235-2
• Banks J, Xu X. The mental health effects of the first two months of lockdown and social distancing during the Covid-19 pandemic in the UK: IFS Working Paper W20/16. Available from https://www.ifs.org.uk/uploads/The-mental-health-effects-of-the-first-two-months-of-lockdown-and-social-distancing-during-the-Covid-19-pandemic-in-the-UK.pdf. Accessed 2 October 2020
• Campion J, Javed A, Sartorius N, Marmot M. Addressing the public mental health challenge of COVID-19. Lancet Psychiatry. 2020;7(8):657-659.
• The Economist. Covid-19: the impact on healthcare expenditure. Available from: https://www.eiu.com/n/campaigns/covid-19-the-impact-on-healthcare-expenditure/ Accessed 2 October 2020
• Coe EH, Enomoto K, Finn P, et al. Healthcare Systems and Services Practice: Understanding the hidden costs of COVID-19’s potential impact on US healthcare. Available from: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/understanding-the-hidden-costs-of-covid-19s-potential-impact-on-us-healthcare?cid=soc-app Accessed 2 October 2020
• World Health Organisation. Mental Health in the Workplace. Information Sheet. Available from: https://www.who.int/mental_health/in_the_workplace/en/ Accessed 2 October 2020
• Coe, E.H., Enomoto, K. Returning to resilience: The impact of COVID-19 on mental health and substance use. Available from: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/returning-to-resilience-the-impact-of-covid-19-on-behavioral-health Accessed 2 October 2020
• Sher L. The impact of the COVID-19 pandemic on suicide rates [published online ahead of print, 2020 Jun 15]. QJM. 2020;hcaa202.
• Fegert JM, Vitiello B, Plener PL, Clemens V. Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child Adolesc Psychiatry Ment Health. 2020;14:20. Published 2020 May 12.
• Gheorghe A, Chalkidou K, Glassman A, et al. COVID-19 and Budgetary Space for Health in Developing Economies. Available from https://www.cgdev.org/publication/covid-19-and-budgetary-space-health-developing-economies Accessed 2 October 2020
• Brake M. The lifesaving dollar — how will COVID-19 impact our mental health from a health economics perspective? Available from https://disruptr.deakin.edu.au/health/the-lifesaving-dollar-how-will-covid-19-impact-our-mental-health-from-a-health-economics-perspective/ Accessed 2 October 2020