Despite the enormous burden that mental ill-health imposes on individuals, their families, society, health systems and the economy, mental health care remains a neglected area of health policy in too many countries. Mental disorders represent a considerable disease burden, and have a significant impact on the lives of the OECD population, and account for considerable direct and indirect costs. This report argues that even in those OECD countries with a long history of deinstitutionalisation, there is still a long way to go to make community-based mental health care that achieves good outcomes for people with severe mental illness a reality. The disproportionate focus on severe mental illness has meant that mild-to-moderate mental illnesses, which makes up the largest burden of disease, have remained overwhelmingly neglected. This book addresses the high cost of mental illness, weaknesses and innovative developments in the organisation of care, changes and future directions for the mental health workforce, the need to develop better indicators for mental health care and quality, and tools for better governance of the mental health system. The high burden of mental ill health and the accompanying costs in terms of reduced quality of life, loss of productivity, and premature mortality, mean that making mental health count for all OECD countries is a priority.

1. Making Mental Health Count
THE SOCIAL AND ECONOMIC COSTS OF NEGLECTING
MENTAL HEALTH CARE
Mark Pearson, Deputy Director for Employment,
Labour and Social Affairs

2. One in five have a mental disorder

3. One in two experience a mental
disorder in their lifetime

4. People with severe mental
disorders die up to 20 years
earlier

5. Since 1990 OECD
suicide rates have
fallen more than 20%...
… but increased 100%
in Korea

6. In Korea 40 people die from suicide
every day

7. The costs of mental ill-health can
amount to more than 4% of GDP

8. Mental health spending doesn’t
match the burden of
mental disorders

9. People with a mental disorder are…
…less effective at work…
… more likely to be absent
from work…
… more likely to be out
of work.

10. People with mild-to-moderate illness
are 2-3 times more likely to be
unemployed
People with severe mental illness
are 6-7 more likely to be unemployed
No disorder
Mild-to-moderate
disorder
Severe disorder

11. THE POOR STATE OF
MENTAL HEALTH CARE

12. How mental health care should be delivered:
community based, well coordinated
Primary Care + Workplaces + Schools + Community
Specialist community care
Inpatient care

13. The state of mental health care now:
fragmented, not enough of the right services

14. 300
250
200
150
100
50
0
Hospital beds falling, but some countries still
rely on inpatient care
• Inpatient psychiatric beds falling across
OECD; rose in Korea
• Average stay in psychiatric beds falling
across OECD; rose in Korea
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Psychiatric care beds per 100 000 population
Finland France Ireland Italy Korea Sweden OECD

15. Care has been shifting to community settings
• Multi-professional teams
delivering care in the
community for severe
mental illness
• Hospitals used for short
acute stays and emergency
care
• Coordination across care
settings is very important
and often weak

16. There is an important role for primary care
• Primary care is first port of call for mental health concerns
• Key provider of care for mild and moderate illness
• Coordinating role for severe mental illness
92 92
90
81 81
78 76 75 75
73 73 71 71 71 71
67 67 67
64
61
57
53
8 8
5 6
14
11 12 13
17
7
11
14
0
12 12
8
11
17
14
11
21
6
17
8
10
6
10
17
12
38
8
7
14 14
7
18
24
8
11
8
21 22
14
24
100
90
80
70
60
50
40
30
20
10
0
General practitioner Psychiatrist Psychologist
%
Type of provider(s) consulted for mental health problems, selected EU countries, 2010
Note: The question asked during the interview was: “In the last 12 months, did you seek help from a professional because of a psychological or
emotional problem? If yes, indicate who in the provided list (multiple answers possible)”.
Source: OECD (2011), Health at a Glance 2011 – OECD Indicators, OECD Publishing, Paris, http://dx.doi.org/10.1787/health_glance-2011-en.

17. Support can come from schools and
workplaces
• For good mental wellbeing, good
support from workplaces and
schools is needed
• Involvement of occupational
health services
• Need good integration of health
and workplace services
• Good support in schools can have
positive impact on educational
attainment
• Need good teacher competence
and awareness

18. WHAT NEEDS TO BE DONE?

19. OECD countries need to make mental
health count
Measure mental health
Increase evidence-based services for
mild and moderate disorders
Better outcomes for severe mental
illness
Make the link between work and
mental health

20. Measure mental health
• Identify people who need care
• Better understand the cost of mental
illness
• Improve reporting on quality and
outcomes

21. Increase evidence-based services for
mild and moderate disorders
• For mild-to-moderate disorders, scale-up
evidence-based services
• Improve the competency and capacity of
primary care practitioners
• Provide good support in workplaces and
schools

22. Better outcomes for severe mental
illness
• Focus on outcomes
• Better coordination between care settings
• Pay attention to physical health needs
• Keep building high quality community
services

23. Make the link between work and mental
health
• Better competence among and support for
key actors – e.g. employers, teachers
• Early intervention to prevent long-term
costs
• Better integrated health and employment
services

24. Thank you
Contact: Mark.Pearson@oecd.org
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Website: www.oecd.org/health
Newsletter: http://www.oecd.org/els/health-systems/oecd-health-update.htm