reducing inequalities in health policies · 2 • sector organisation of • more than 100 member...

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Chris Nas, senior policy advisor cnas@ggznederland.nl

EuroHealthNet Round Table

Brussels, May 19th 2015

Mental health and well being Reducing inequalities in health policies

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• Sector organisation of

• more than 100 member organisations that

• provide specialist mental health care to 815,800 clients.

• Together they have 89,500 staff and an

• annual turnover of € 5.4 billion and

• They deliver € 14.6 billion ROI

• This is 95% of specialist mental health care

• And 6.1 % of Dutch health care expenditure

Source: GGZ Nederland (2013), GGZ in de Zorgverzekeringswet

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The fight against stigma is long and difficult, but slowly making progress

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In Portugal, the fight against stigma starts early in life

Source: ENCONTRAR+SE (www.encontrarse.pt)

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In Portugal, the fight against stigma starts early in life

Source: ENCONTRAR+SE (www.encontrarse.pt)

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Children learn of diversity in personalities and mental health, e.g. through the stories of A.A. Milne

Source: Shea, S. Gordon, K. Hawkins, A. Kawchuk, J. Smith, D. (2000) Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne. Canadian Medical Association Journal, December 12, 2000; 163 (12) 1557 - 1559

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In the Netherlands population 16.8 million • Mental ill health in lifetime: 43,5% of population • People with mental ill health in lifetime: 8.4 million • People with mental ill health in a year: 1.9 million • People using specialist mental health care: 0.8 million In WHO Europe: • affect more than a third of the

population every year • 1-2% of population with

diagnosis psychotic disorders • 5.6% of men and 1.3% of women

have substance abuse disorders

Mental ill health is very common …

Sources: GGZ Nederland (2013), GGZ in de Zorgverzekeringswet; WHO (2013), European Mental Health Action Plan; De Graaf et al (2010), De psychische gezondheid van de Nederlandse bevolking (Nemesis-2).

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… starting in youth …

Source: OECD (2012), Sick on the job? Myths and realities about mental health and work, page 178.

People aged 15-24 with a mental disorder as a percentage of the total youth population, late 2000s and mid-1990s

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… affecting their education.

Source: OECD (2012), Sick on the job? Myths and realities about mental health and work, page 138.

0

5

10

15

20

25

30

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Denmark Netherlands Sweden Belgium United Kingdom

EU-21 Austria

Severe disorder Moderate disorder No mental disorder (↗)

Share of people who stopped full-time education before age 15, by severity of mental disorder, 2010

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Mental disorders have a serious impact on the quality of life of people …

0,0 5,0 10,0 15,0 20,0 25,0 30,0 35,0 40,0 45,0

Respiratory infections

Skin diseases

Genitourinary diseases

Congenital anomalies

Intentional injuries

Maternal conditions

Perinatal conditions

Endocrine disorders

Oral conditions

Malignant neoplasms

Infectious and parasitic diseases

Diabetes mellitus

Nutritional deficiencies

Digestive diseases

Respiratory diseases

Unintentional injuries

Musculoskeletal diseases

Cardiovascular diseases

Sense organ diseases

Neuropsychiatric conditions

Source: WHO (2013) European Mental Health Action Plan

Years lived with disability in the WHO European Region

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Source: RIVM (2013) Nationaal Kompas Volksgezondheid. Translation: Depression, Diabetes, Lung cancer, Dementia, Reumatological conditions, Alcohol abuse.

Disability Adjusted Life Years in the Netherlands for selected conditions

Mental disorders have a serious impact on the quality of life of people …

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… their employability ...

Source: OECD (2012), Sick on the job? Myths and realities about mental health and work, page 30.

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… and their income.

Source: OECD (2012), Sick on the job? Myths and realities about mental health and work, page 31.

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The majority of people with ill mental health are NOT disabled, not even they have a severe condition …

Source: OECD (2012), Sick on the job? Myths and realities about mental health and work, page 27.

Proportion of people with a mental ill health, by severity and co-morbidity, who also report a disability

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… competitive work even reduces the length of psychiatric inpatient stays.

Source: OECD (2012), Sick on the job? Myths and realities about mental health and work, page 119.

Length of stay (in days) of hospitalisations in a psychiatric clinic by employment status and illness severity, Switzerland, 1998-2006a, b

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The impact of mental health problems on Europe’s economy is huge...

Annual direct costs (work-related) € 610 billion • employers (absenteeism and presenteeism) € 270 billion

• economy (lost output) € 240 billion

• healthcare systems (treatment) € 60 billion

• social welfare (disability benefit payments) € 40 billion

Sources: Matrix (2013), Economic analysis of workplace mental health promotion and mental disorder prevention programmes and of their potential contribution to EU health, social and economic policy objectives; OECD (2014) Mental Health at Work: Netherlands, page 22.

Costs of mental disorders as a percentage of the country’s GDP, 2010

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… also in the United States and Africa.

Source: Global Health Action 2014, 7: 23431; New York Times (Print July 7, 2013: page MM14 of the Sunday Magazine); http://www.iol.co.za/business/news/mental-disorders-cost-sa-economy-r35bn-1.1777376#.VGC4yMZgXmg

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Economic and financial crisis: • People who experience unemployment, poverty, social exclusion

• have greater risk of developing mental health problems (depression)

Work-life balance is changing: • A smaller working population

• Has to provide for their children AND their parents

Nature of work itself is changing • Transition industrial to knowledge economy

• Cognitive work is becoming more important

Societal changes will increase the economic impact of mental disorders in Europe

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Good mental health care boosts productivity…

• Evidence-based interventions to promote mental health at the workplace could save € 135 billion each year.

• In the Netherlands, the present treatment of patients with depression yields each year € 436 million through increased productivity alone.

• In the UK, return on investment of best practices was huge: – Prevention conduct disorder: 83.72 (9.42 NHS) – Workplace health promotion programmes: 9.69 (0,00 NHS)

Sources: European Commission (2013), Social investment Package; Van Geldrop (2013) , The economic value of depression treatment; Knapp et al (2011) Mental health promotion and mental illness prevention: the economic case.

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OECD: no single country has a well functioning system to address issue work and mental health

• Early identification and intervention needed: • teachers, family doctors,

employers and employment caseworkers

• they lack knowledge

• Health, work and income are financial silo’s • Lead to conflicting policies

and incentives

• Treatment gap • Interventions are too late • Interventions are not

appropriate

Source: OECD (2015) Fit Mind, Fit Job

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• Limited access: – Just 50% of recipients of disability benefits with severe mental

disorders are in treatment

– Only 40% with illness-related work-problems are in treatment.

• Inadequate treatment: – Less than 1 in 4 of depressed population receives minimally

adequate treatment

– In Dutch primary care, only 42% of persons suffering depressive symptoms are treated in accordance with guidelines.

– In Dutch schizophrenia care, an estimated 25–50% of patients receive guideline-concordant care.

Sources: OECD (2012), Sick on the job? Myths and realities about mental health and work; Franx, G. (2012), Quality Improvement in Mental Health Care, the transfer of knowledge into practice;

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GGZ Nederland and Employee Insurance Agency signed a convenant in 2012

• Goal is to keep people at work or get them to work: – working relationship between regional UWV agencies and

mental health care providers – in order to help clients as much as possible with job

retention or to promote an optimal reintegration process.

• Key areas for collaboration include: – sharing knowledge about function of work as part of

effective treatment; – increasing in-depth knowledge about (severe) psychiatric

illnesses for UWV professionals; – tailoring efficient treatments that facilitate job retention and

effective reintegration.

Sources: GGZ Nederland en UWV (2012).

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Good practice Fit-4-Work: outflow 40% compared to 13% control group

• Social assistance beneficiaries with multiple psychosocial problems in 5 major municipalities in the Netherlands

• Municipality is in the lead. • Diagnosis and discussion in multidisciplinary team

(social services; UWV; mental health sector). • Integral service package:

– psychological treatment (without waiting times) – social interventions (debt relief, housing services, activation)

• Problem solving approach. • Quick job placement (comparable with IPS). • Coaching client AND employer during and after

placement.

Source: OECD (2014), Mental Health and Work: the Netherlands, OECD Publishing, Paris.

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In December 2014, an evaluation research was published

• Out of 77 regions of the Employee Insurance Agency

• At first glance 10 were interesting enough for consideration

• Of which only 2 functioned according to expectations

• And could be a model for nationwide implementation

• What is the difference between successful and unsuccessful regions?

Source: Holwerda, A et al (2014) Samenwerkingsverbanden tussen GGZ en UWV gericht op re-integration van mensen met een matige tot ernstige psychische stoornis. Groningen, december 2014.

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• Where do we want to go to ? – respect human rights

– shared decision making

– promotion and prevention at schools and workplace

– (balanced) care = best service model

– recovery for persons with enduring and severe mental illnesses

• How are we going to get there ? – every country its own legislation, systems and actors

– what are the change drivers in specific situations

– who are the change agents

Improving mental health care is at best a very difficult process in most countries

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Change does not come easy, adoption of cost effective health innovations takes 17 years…

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What did I share with you today ?

• Mental ill health is common (part of human condition)

• Mental ill health has direct relation with physical health

• Mental ill health does have a huge social / economic impact

• This impact will increase in the next few years.

• We can’t afford to do nothing

• Change doesn’t come easy

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What will be the role of public health organisations ?

• Promotion of mental health and well being

• Prevention of mental ill health

• Mental health literacy across the lifespan

• Data collection on incidence / prevalence of mental ill health

• Integrating mental health and well-being in all policies

• Others

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Seated in Amersfoort, its 66 employees represent the interests of its members in an on-going and constructive dialogue with client organisations, health insurers, national and local governments, professional associations and trade unions.

contact: GGZ Nederland

PO Box 830,

3800 AV Amersfoort

e-mail: cnas@ggznederland.nl

website: www.ggznederland.nl/pagina/english