The triple challenge of mental health

Mental health: A Particular Challenge Confronting Policy Makers and Economists

The first objective of this paper is to expound the particular challenge posed by the occurrence of inconsistency in the expression of preferences by mental health patients to both economists and policy makers. Since this difficulty cannot be resolved, the second aim of the paper is to identify agents who may be counted upon to identify the true patient preferences. A decision rule is developed to help identify these agents who may be family members or judges in court, who have the ability and incentive to make these decisions. No single agent is found to dominate with respect to the five dimensions of preference distinguished, constituting a major challenge to policy makers.

Variation in spend on young mental health across Clinical Commissioning Groups in England: a cross-sectional observational study

OBJECTIVES

To investigate whether the rate of spend on child and adolescent mental health is influenced by demand for other competing services in local commissioning decisions.

DESIGN

Analysis of spend data by Clinical Commissioning Groups (CCG), including other publicly available data to control for variation in need.

SETTING

Local commissioning decisions in the National Health Service.

PARTICIPANTS

Commissioning of health services across 209 CCGs.

MAIN OUTCOME MEASURES

Association between the rate of child and adolescent mental health spend and demand for child and adolescent mental health services (CAMHS), adult mental health services and physical health services after adjusting for confounding factors.

RESULTS

An additional percentage point in the proportion of children in care is associated with 4% higher child and young person mental health (CYP MH) spend per person aged 0-18 (ratio of means: 1.04; 95% CI 1.00 to 1.07). Spending £100 more on physical health services was associated with 9% lower spend in CYP MH per person aged 0-18 (ratio of means: 0.91; 95% CI 0.84 to 0.99).

CONCLUSIONS

Healthcare commissioners in England face a challenge in balancing competing needs. This paper contributes to our understanding of this by quantifying the possible extent of the trade-off between physical health and CYP MH when allocating budgets. Any attempt to explain the variation in CAMHS spend must also take account of demand for other services.