mental h e a lt h...david elliott, linda smith, mike joyce, john campbell and emily somers (ns...

�MENTAL HEALTH ECoNoMiC sTATisTiCs

IN YOUR POCKET

M E N TA L H E A L T HE C O N O M I C S TAT I S T I C S

2006

MENTAL HEALTH ECoNoMiC sTATisTiCsISBN 0-9780024-1-5 (print)ISBN 978-1-926929-48-4 (online)

The Alberta Mental Health Board is a provincial health authority

that oversees and advances Alberta’s mental health system, serves

in an advisory capacity to the Minister of Health and Wellness, and

works with health regions and others to address system-wide mental

health priority issues that span national, provincial, regional and

organizational boundaries.

The institute of Health Economics (iHE) is an independent, not-for-

profit organization that performs research in health economics and

synthesizes evidence in health technology assessment to assist health

policy making and best medical practice.


It is estimated that one in three Canadians will have a mental health problem at some point in their life. Many Canadians do not realize the impact that poor mental health has on families, communities, health systems, and the economy.

Mental health is as important as physical health to a person’s well-being, but understanding and awareness of mental illness is lagging far behind other health conditions such as cancer, diabetes or heart disease. In part, this is because the information available about mental health is fractured, and in part it is because people do not want to talk about mental illness. For these reasons it is difficult to see the full impact that poor mental health is having on Canada.

This Mental Health Economic Statistics booklet brings together information that demonstrates the burden of mental illness and where Canada’s mental health system ranks among other developed countries. In order to improve the system and address its needs, we need to understand the prevalence of mental health problems and where mental health resources are currently being used. We need to see the national picture and put policies and systems in place to address the gaps and reduce the social and economic burden of mental illness.

Mental Health Economic Statistics provides important consolidated information on key indicators that depict the state of our mental health system. We hope that the information in this booklet will prompt discussion and move people to take action to give mental health the same attention as other health conditions. In doing so, we can reduce the impact of mental illness on Canadians.

Ray Block Egon JonssonPresident and CEO Executive Director and CEOAlberta Mental Health Board Institute of Health Economics

FORwARd

MENTAL HEALTH ECoNoMiC sTATisTiCs�

Mental Health Economic Statistics is a compendium of economic statistics about mental health in Canada. A large amount of information is available on the topic, but much is in raw form or is scattered and difficult to locate. The Alberta Mental Health Board and the Institute of Health Economics (IHE) have brought that information together.

By piecing together the numerous threads that comprise resource allocation in mental health care, we produced a booklet that we hope will help policy makers, planners, and managers to gain a broad economic perspective of the current mental health system. It is comprehensive and logically organized, but at the same time we have limited the amount of material, focusing on highlights, so that the information that is provided can fit into your mind, as well as your pocket.

We hope that you will find this volume to be useful. We would appreciate suggestions about the booklet as well as any data that we may have overlooked. Please send us your comments and suggestions by emailing us at [email protected], by faxing us at 780-448-00�8 or by calling us at 780-448-488�.

Project staffPhilip Jacobs, DirectorCarolyn Dewa, AdvisorRoger Bland, AdvisorKen EngArto OhinmaaRita YimAnderson ChuckJanice Varney

PREFACE


We would like to thank the large number of people who helped us to formulate our analysis and obtain data. We received advice on contents of the document from Revekka Kakoullis (Capital Health), Nawaf Madi (Canadian Institute for Health Information), Bruce McKee (Saskatchewan Health), Brenda Waye Perry (Alberta Mental Health Board), Donald Schopflocher (Alberta Health and Wellness) and Mel Slomp (Alberta Mental Health Board). We received help in obtaining data from Mike Doyle and Ed Hunt (Newfoundland Department of Health and Community Services), Nadine MacLean (PEI Department of Health), Patrick Crawford (PEI Department of Social Services and Seniors), David Elliott, Linda Smith, Mike Joyce, John Campbell and Emily Somers (NS Department of Health), Kenneth Ross, John Estey, Leanne Jardine and James Ayles (New Brunswick Department of Health), Jacques Legroulx, Jacques Rheaume, Andre Delorme and Carole Hince (Quebec Sante et Services Sociaux), Val Barnby and Tom Czycko (Manitoba Health), Donna Edhart (Alberta Seniors and Community Supports), Sandy Patterson (Alberta Mental Health Board), and David Scott (BC Ministry of Health). George Lambert (Health Canada) kindly guided us through the federal bureaucracy. Other information was obtained from Jeremy Beach (University of Alberta), Anyk Glussich (CIHI), Irene Klatt (Canadian Life & Health Insurance Association), Nancy Lawand (Canada Pension Plan), Gerald Thomas (Canadian Centre on Substance Abuse), Bill Wilkerson (Global Business and Economic Roundtable), Pat Martens (University of Manitoba), Chad Mitchell (Alberta Health and Wellness). James Butler helped us track down data from Australia.

ACKNOwLEdGEMENTS

MENTAL HEALTH ECoNoMiC sTATisTiCs4

FigurE 1

FLOWS OF FUNDS AND SERVICES IN MENTAL HEALTH

Service Providers

(psychiatrists, psychologists, social workers, hospitals, etc.)

Persons withMental Illness

Persons without

Mental Illness

Employers

Government,Insurers,VoluntaryAgencies

Reimbursement to Providers

Taxes, Premiums,Donations

ServicesCash Payments

Self-pay


HOW TO USE THIS BOOKLET

Mental Health Economic Statistics synthesizes a large amount of data into indicators on the various economic aspects of the mental health system. Readers can scan material in a comparative light and make their own assessments on how specific jurisdictions are performing, provincially and internationally. Information is also provided for population subgroups so that equity can be assessed. And in those instances where only scant data is available, readers can use what is available to gain an impression of the order of magnitude of the indicator.

Notes found either under the graphs or at the back of the booklet give detailed sources, definitions, and comments regarding any data quality issues.

HOW THIS BOOKLET IS ORGANIzED

Mental Health Economic Statistics is organized around three fundamental questions:

• What is the burden of mental illness?• What resources do we as a society commit to address this burden?• How does the system perform in allocating resources to the mentally ill population?

Our view of the Canadian mental health system is shown graphically in Figure �. The three basic groups in this figure are consumers and businesses (who provide and receive funds and receive services), financial intermediaries (governments, insurers, and voluntary agencies), and service providers. Mental Health Economic Statistics tracks data on the status of the mentally ill and available resources, and the flow of money and services between the groups.

INTROdUCTION

MENTAL HEALTH ECoNoMiC sTATisTiCs�

HOW DATA WAS COLLECTED

Data for this compendium came from a wide variety of sources. Where possible we used data on mental health that has been routinely collected and reported by public agencies both in Canada and abroad. In addition, we used information from one-time studies in government reports or scientific publications. We also collected and organized unpublished data from health ministries and from the national community health surveys; in these instances we are reporting new results. Finally, in a few instances, we could only find rough estimates from a single source. We included this information where we felt that is was important to address these areas.

International comparisons are of importance in this booklet. We selected the following countries for comparison purposes, because they are at a level of economic development similar to Canada’s: Australia, New zealand, England (or the United Kingdom), the United States, Finland, Sweden, Germany, France, Netherlands, Switzerland and Japan. In many cases, data on national and international sources may not be the same, because they come from different sources or they come from different years.

INTROdUCTION

7MENTAL HEALTH ECoNoMiC sTATisTiCs

TABLE OF CONTENTS

sECTioN 1 BurDEN 9

sECTioN 2 rEsourCEs 27

sECTioN 3 PErForMANCE 53

NoTEs To THE CHArTs 59


SECTION �

BURD

EN

BURDEN

MENTAL HEALTH sTATisTiCs Prevalence of Mental Disorders 10Quality Adjusted Life Years (QALY) score 13suicide rates 14

MENTAL HEALTH FiNANCE Consumer out-of-Pocket Costs 16Private insurance 17Workers’ Compensation 18Canada Pension Plan 19

MENTAL HEALTH soCiAL CosTs Labour Force Effects 20Alcohol and illegal Drugs 24Economic Burden of illness for selected Diagnoses 26

MENTAL HEALTH ECoNoMiC sTATisTiCs�0

BURDEN

MENTAL HEALTH STATISTICS

ADULT MENTAL HEALTH DISORDER PREVALENCE CANADA, 2001

Estimates of One-Year Prevalence

Percentage of Adult Conditions Population (Age 18+) Number

Mood Disorder Major (Unipolar) depression 4.� - 4.8% �44,�7� - �,�0�,�� Bipolar disorder 0.� - 0.�% 4�,08� - ��8,�4� Dysthymia 0.8 - �.7% �84,��8 - 8��,��

Schizophrenia 0.�% ��,��

Anxiety Disorders ��.�% �,8�0,��7

Personality Disorders Not available

Eating Disorders - Anorexia, Bulimia Anorexia 0.7% women 8�,��8 0.�% men ��,�77 Bulimia �.�% women �78,��8 0.�% men ��,��8

Source: Health Canada. Table �-� Estimated one year prevalence of mental illness among adults in Canada. Report on mental illness in Canada. Ottawa, ON: Health Canada; �00�. Available at: www.phac-aspc.gc.ca/publicat/miic-mmac/. Accessed June �, �00�.

��MENTAL HEALTH ECoNoMiC sTATisTiCs

BURD

EN


CHILD MENTAL HEALTH DISORDER PREVALENCE CANADA, 2001

Source: Waddell C, Offord D, Shepherd C, Hua J, McEwan K. Child psychiatric epidemiology and Canadian public policy making: the state of the science and the art of the possible. Can J Psychiatry �00�;47(�): 8��-��. Note: Children aged 0 to �� are in the sample.

disorder Estimated Approximate Prevalence(%) Number in Canada

Any anxiety disorder �.4 �07,000

Attention deficit hyperactivity disorder 4.8 �80,000

Conduct disorder 4.� ��,000

Any depressive disorder �.� �77,000

Substance abuse 0.8 ��,000

Pervasive developmental disorder 0.� �4,000

Obsessive-compulsive disorder 0.� ��,000

Any eating disorder 0.� 8,000

Tourette syndrome 0.� 8,000

Schizophrenia 0.� 8,000

Bipolar disorder <0.� <8,000

Any disorder �4.� ��4,000

MENTAL HEALTH ECoNoMiC sTATisTiCs��

BURDEN

Source: Spady D, Schopflocher D, Svenson L, Thompson A. Prevalence of mental disorders in children living in Alberta, Canada, as determined by physician billing data. Arch Pediatr Adolesc Med �00�;��:��-�. Note: Subsidy refers to a provincial health premium subsidy for low income wage earners. Treaty status refers to Aboriginal status. Welfare refers to those who received social welfare payments. Children in sample were between age ranges 0 and �7.

CHILDHOOD PREVALENCE OF MENTAL DISORDERS ACCORDING TO SOCIOECONOMIC STATUS ALBErTA, 1995/96

0 2 64 12 16 17148 18

200

150

100

50

101 53 11 15137 9

0

50

100

150

200

No SubsidySTATUS: Subsidy Treaty Status Welfare

PREVALENCE RATE BY AGE



BURD

EN


0.66

0.817

0.844

0.709

0.862

0.899

Stroke

Mental Illness

Heart Disease

Diabetes

Asthma

No Chronic Diseases

0 0.2 0.60.4 0.8 1.0

0.0 0.2 0.4 0.6 0.8 1.0

Source: Canadian community health survey. Cycle �.� [CD-ROM]; �00�. Note: Mental illness (MI) is excluded from other comorbidities. QALY score varies from 0 (death) to � (healthy).

QUALITY ADJUSTED LIFE YEARS (QALY) SCORE FOR PERSONS WITH SELECTED HEALTH STATES CANADA


BURDEN


0 3 96 12 15 18

11.3

11.3

9

13.2

10

10.4

11.4

16.5

7.7

14.1

Canada

Prince Edward Island

Nova Scotia

New Brunswick

Quebec

Ontario

Manitoba

Saskatchewan

Alberta

British Columbia

0 3 6 9 12 15 18

Source: Suicide (ICD-�0 X�0-X84, Y87.0), age standardized rate per �00,000 population and confidence interval, by sex, three year average, Canada, provinces, health regions and peer groups, �00�, Catalogue no 8�-��, vol �00� no. �. Ottawa ON: Statistics Canada; �00�. Available at: http://www.statcan.ca/english/freepub/82-221-XiE/2005001/tables/pdf/14193_01.pdf Accessed August �, �00�.Note: rates for NWT �0.8, YK �8.� and Nunavut 80.� per �00 000.

SUICIDE RATES PER �00 000 POPULATION ProviNCEs, 2001


BURD

EN


Source: OECD health data, �00�.

SUICIDE RATES PER �00 000 POPULATION sELECTED CouNTriEs, 2001

5.6

11.3

6.5

8

6.4

15

11

10

10.8

11.9

Italy

Spain

United Kingdom

Netherlands

United States

Canada

Germany

Sweden

Australia

France

0 5 1510 20 25

15.4

20.7

18.5

Switzerland

Japan

Finland

Quebec

0 5 10 15 20 25


BURDEN

MENTAL HEALTH FINANCE

CONSUMER OUT-OF-POCKET COSTS CANADA, 2003

Of the entire population age >�0,

�.� per cent (484,000) indicated they had ever seen a psychologist.

Of these, the source of payment:

Per cent who had insurance (Public or Private) to pay any portion of costs 70.�%

Per cent who paid entirely Out-of-Pocket (i.e., no insurance coverage) ��.7%

Source: Canadian community health survey. Cycle �.� [CD-ROM]; �00�

�7MENTAL HEALTH ECoNoMiC sTATisTiCs

BURD

EN

Source: An agenda for progress. Global Business and Economic Round Table on Mental Health. �00� Business and economic plan for mental health and productivity. Toronto, ON: Global Business and Economic Round Table on Addiction and Mental Health; �00�. Available at: www.mentalhealthroundtable.ca. Accessed: July ��, �00�. Note: All figures are approximate.


MENTAL ILLNESS-RELATED DISABILITY SETTLEMENTS FROM PRIVATE INSURANCE CANADA

Total direct private insurance claims, Canada (�004), for all causes

• Short term income loss $4�� million

• Long term income loss $�.� billion

�0 per cent of disability claims are related to mental illness

(Great West Life)

Source: Canadian life and health insurance facts. Canadian Life and Health Insurance Association, Inc.; �004.


BURDEN


MENTAL DISORDER CLAIMS ACCEPTED BY WORKERS’ COMPENSATION ProviNCEs, 2004

Mental disorder % of TotalProvince Claims (#) Claims in Province

Newfoundland 4 0.08% Nova Scotia �� 0.��%New Brunswick �� 0.��%Quebec �,�87 �.�4%Ontario ��4 0.�7%Manitoba 4� 0.�7%Saskatchewan �� 0.4�%Alberta �07 0.�0%British Columbia �77 0.��%Northwest Territories/Nunavut � 0.�4%

Total �,0�4

Source: National work injury and disease statistics, �00�-�004. Mississauga, ON: Association of Workers’ Compensation Boards of Canada.AWCBC – National work injury/disease and fatality statistics program (NWISP). Mississauga, ON: Association of Workers’ Compensation Boards of Canada. Available at: http://awcbc.org/english/NWisP_stats.asp.200� Accessed: August �, �00�. Note: Data for Prince Edward Island and Yukon are unavailable.


BURD

EN

Source: Personal communication. Lawand N. Data on CPPD clients with mental illness. Forecasting, information and analysis – Human Resources and Social Development Canada [email] to Philip Jacobs July ��, �00� .Note: Data does not include CSC and International Agreements numbers.


CANADA PENSION PLAN – NUMBER RECEIVING DISABILITY PAYMENTS FOR MENTAL ILLNESS AND DOLLAR AMOUNTS CANADA, BY YEAr

71,925

74,521281,345

78,264291,226

2003/04

2004/05

2005/06

0 100,00050,000 250,000200,000150,000 300,000

0 500 1000 1500 2000 2500 3000 3500 0 50000 100000 150000 200000 250000 300000

Total Benefits Paid for Mental Illness Total Benefits Paid to CPP Disability Clients

# of CPPD Clients with Mental Illness Total CPP Disability Clients

284,213

Number of Clients

$691

$735$2,815

$795$3,074

2003/04

2004/05

2005/06

0 1,000500 2,5002,0001,500 3,5003,000

$2,919

Benefits Paid (Million $)


BURDEN

MENTAL HEALTH SOCIAL COSTS

Source: Canadian community health survey. Cycle �.� [CD-ROM]; �00�. See Note at end of book.

PER CENT OF CANADIAN POPULATION AGE �0-�4 WHO ARE NOT WORKING, BY MENTAL HEALTH STATUS CANADA, 2003

5.3%

4.2%

14.1%

19.9%42.6%

20-34

35-49

50-64

0 2010 4030 50 60

0 10 20 30 40 50 60

0 10 20 30 40 50 60

MALE

No Mental Illness Mental Illness

24.7%

13.4%

14.6%

18.2%

36.3%51.0%

20-34

35-49

50-64

0 2010 4030 50 60

FEMALE

23.4%


BURD

EN


WORK - ABSENTEEISM DAYS PER YEAR, BY MENTAL HEALTH STATUSCANADA, 2003

19.63

27.13

54.56

20.1057.58

20-34

35-49

52-64

0 2010 4030 50 8060 70

0 10 20 30 40 50 60 70 80

0 10 20 30 40 50 60 70 80

MALE

No Mental Illness Mental Illness

73.65

28.68

20.76

79.01

30.677.7

20-34

35-49

52-64

0 2010 4030 50 8060 70

FEMALE

72.62

Source: Canadian community health survey. Cycle �.� [CD-ROM]; �00�. Note: Mental illness refers to a condition diagnosed. See Note at end of book.

ANNUAL DAYS ABSENT FROM WORK PER EMPLOYEE


BURDEN


Source: See Note at end of book. Note: GPP is the total value of production of all final goods and services in the province.

LOST WAGES DUE TO MENTAL ILLNESS AS A PERCENTAGE OF GROSS PROVINCIAL PRODUCT (GPP)ProviNCEs, 2003

0.56 0.31

1.05 0.37

0.150.36

0.190.24

0.210.46

1.06 0.13

0.94 0.35

0.080.71

0.72 0.41

0.72 0.25

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

New Brunswick

Nova Scotia


Newfoundland

0 0.3 0.90.6 1.2 1.5

0.66 0.22Canada

0.0 0.3 0.6 0.9 1.2 1.5

Unemployment Absenteeism

PERCENTAGE OF GDP


BURD

EN


PER CENT OF MENTAL ILLNESS RELATED SICK LEAVES OF ALL SICK LEAVESsELECTED CouNTriEs

Source: See Note at end of book.

4.2%

14%

20%

6.9%

25%

27%

Austria

Germany

United Kingdom

Canada

Finland

Sweden

29%

35%

Belgium

Netherlands

0 5 2010 15 3025 35

0 5 10 15 20 25 30 35


BURDEN

Reference: Rehm J, Baliunas D, Brochu S. The cost of substance abuse in Canada, �00� [CD-ROM]. Ottawa, ON: Canadian Centre on Substance Abuse; �00�.Note: Social costs include: direct health care costs, direct law enforcement costs, direct costs for research and prevention, other direct costs (e.g. fire, accidents), and indirect costs (lost productivity due to disability and premature mortality).


SOCIAL COSTS OF ALCOHOL AND ILLEGAL DRUGSProviNCEs

PER CENT OF GROSS PROVINCIAL PRODUCT

1.11

0.651.64

0.761.45

British Columbia

Alberta

Saskatchewan

0 1.00.5 2.01.5 2.5

0.0 0.5 1.0 1.5 2.0 2.5

Drugs % of GDP Alcohol % of GDP

1.09

0.74

0.671.23

Manitoba

Ontario1.42

0.67

1.252.14

Quebec

New Brunswick1.28

0.76

0.781.4

Nova Scotia

Prince Edward Island1.58

0.78

0.711.26

Newfoundland and Labrador

Canada1.51


BURD

EN


Source: See Notes at end of book.Note: Social costs include: direct health care costs, direct law enforcement costs, direct costs for research and prevention, other direct costs (e.g. fire, accidents), and indirect costs (lost productivity due to disability and premature mortality). Different countries have some differences in the categories included and criteria used to calculate the costs.

SOCIAL COSTS OF ALCOHOL AND ILLEGAL DRUGSsELECTED CouNTriEs

PER CENT OF GDP

0.5

0.70.7

0.11.3

Netherlands

Canada

France

0 1.00.5 2.0 2.51.5 3.0

0.0 0.5 1.0 1.5 2.0 2.5 3.0

Drugs % of GDP Alcohol % of GDP

1.3

1.3

1.71.9

England & Wales

Australia1.6

1.7

0.52.9

United States

Finland2.3


BURDEN

Source: Moore R, Dejardins S. Table �: Summary – Economic burden of illness in Canada by diagnostic category, ��8. Economic burden of illness in Canada, ��8. Ottawa, ON: Health Canada; �00�. Available at: http://www.phac-aspc.gc.ca/publicat/ebic-femc98/pdf/ebic1998.pdf. Accessed July �, �00� Note: Direct costs refer to medical expenses. Indirect costs refer to the value of lost time. Total amounts for all conditions are $8�.�� billion direct costs and $7�.48 billion indirect costs.


ECONOMIC BURDEN OF ILLNESS FOR SELECTED DIAGNOSES BY COST COMPONENT CANADA,1998

Genitourinary

Endocrine & Related

Digestive

Mental Disorder

Nerv Sys/Sense Org

Respiratory Diseases

Injuries

Cancer

Musculoskeletal

Cardiovascular

0.922.60

11.762.46

2.313.54

4.68 3.19

1.881.58

11.656.82

9.513.22

5.482.82

5.073.46

13.732.65

0 5 1510 20

0 5 10 15 20

Direct Cost Indirect Cost

COST (BILLIONS OF DOLLARS)

RESO

URCE

S

SECTION �

RESOURCES

MENTAL HEALTH rEsourCEs Psychiatric Beds (mental and general hospitals) 28Psychiatrists 30Psychologists 32Psychiatric Nurses 34social Workers 36

MENTAL HEALTH uTiLiZATioN Hospital separations 38Hospital Days 41Cost Per Person of Mental Health services 42visit rates to Psychiatrists 43All-Cause Hospital separation rates 44

MENTAL HEALTH EXPENDiTurEs Provincial governments 46National Mental Health Expenditures 49Drug Expenditures 50unit Costs for specific Mental Health services 52


RESOURCES

Source: Personal communication: McKee B (Mental Health Inpatient Services Saskatchewan). Mental health inpatient services Saskatchewan: current situation and trends, �00�-�00� [power point presentation sent via email to Philip Jacobs July �8, �00�]. Note: Ratios are estimated. The Canadian Psychiatric Association recommends a ratio of �0 beds per �00 000.

PSYCHIATRIC BEDS (MENTAL AND GENERAL HOSPITALS) PER �00 000 POPULATIONWEsTErN CANADiAN ProviNCEs

0 10 4020 30 50 60 70

48.5

48

43

38

65

Western Canada

British Columbia

Alberta

Saskatchewan

Manitoba

0 10 20 30 40 50 60 70

MENTAL HEALTH RESOURCES


RESO

URCE

S


38

58

60

39

61

75

Australia

Finland

France

Germany

Canada

Japan

77

100

Netherlands

New Zealand

120

132

Sweden

United Kingdom

187

193

United States

Switzerland

0 10050 150 200

0 50 100 150 200

TOTAL PSYCHIATRIC BEDS (PSYCHIATRIC AND GENERAL HOSPITALS) PER �00 000 POPULATIONsELECTED CouNTriEs

Source: Mental health atlas. Singapore: World Health Organization; �00�.Source for Canada: Hospital mental health services in Canada �00�-�00�. Ottawa, ON: Canadian Institute for Health Information; �00�.


RESOURCESSource: See Notes at end of book.

PSYCHIATRISTS PER �00 000 POPULATIONProviNCEs, 1999


0 5 2010 15 25 30 35

15.22

13.76

5.8

16.64

11.6

11.51

16.75

9.31

15.83

8.45

Canada

Newfoundland


Nova Scotia

New Brunswick

Quebec

Ontario

Manitoba

Saskatchewan

Alberta

15.87

32.56

3.24

British Columbia

Yukon

North West Territories

0 5 10 15 20 25 30 35


RESO

URCE

S


6.6

9.4

11.0

9.0

11.8

12.0

New Zealand

Netherlands

Japan

United Kingdom

Germany

Canada

13.7

14.0

United States

Australia

20.0

22.0

Sweden

Finland

22.0

23.0

France

Switzerland

0 105 15 20 25

0 5 10 15 20 25

PSYCHIATRISTS PER �00 000 POPULATIONsELECTED CouNTriEs

Source: Mental health atlas. Singapore: World Health Organization; �00�.


RESOURCES

Source: Table �: Provincial and territorial total (urban and rural) populations, total number of psychologists and psychiatrists, and ratio of population to health professionals. Geographic locations survey of clinical psychologists in Canada. Canadian Psychological Association; ��. Available at: www.cpa.ca/documents/geographic_survey.html. Accessed March 8, �00�.

PSYCHOLOGISTS PER �00 000 POPULATIONProviNCEs, 1999


0 20 8040 60 100

38.8

18.5

11.9

21.6

14.3

52.5

86.6

24.0

18.6

7.1

Canada

Newfoundland


Nova Scotia

New Brunswick

Ontario

Quebec

Manitoba

Saskatchewan

Alberta

22.1

14.7

British Columbia


Yukon

Nunavut

0 20 40 60 80 100


RESO

URCE

S


0

5.0

7.0

9.0

5.0

28.0

28.0

Australia

France

Japan

United Kingdom

Netherlands

New Zealand

31.1

35.0

United States

Canada

40.8

51.5

Switzerland

Germany

76.0

79.0

Sweden

Finland

4020 60 80

0 10 20 30 40 50 60 70 80

PSYCHOLOGISTS PER �00 000 POPULATIONsELECTED CouNTriEs



RESOURCES

Source: Workforce trends of registered psychiatric nurses in Canada, �004. Ottawa ON: Canadian Institute for Health Information; �00�. Available at: http://dsp-psd.pwgsc.gc.ca/Collection/H115-10-2004E.pdf. Accessed May ��, �00�.Note: Registered Psychiatric Nurses are educated and regulated as distinct professions in the above provinces.

PSYCHIATRIC NURSES PER �00 000 POPULATIONsELECTED ProviNCEs, 2004


0 20 8040 60 100

86

38

54

96

Manitoba

Saskatchewan

Alberta

British Columbia

0 20 40 60 80 100


RESO

URCE

S


PSYCHIATRIC NURSES PER �00 000 POPULATIONsELECTED CouNTriEs


6.5

44.0

46.0

32.0

52.0

53.0

United States

Sweden

Canada

Switzerland

Germany

Australia

59.0

74.0

Japan

New Zealand

98.0

99.0

France

Netherlands

104.0

180.0

United Kingdom

Finland

0 10050 150 200

0 50 100 150 200


RESOURCES

Source: Personal communication: Adachi R (Executive Director & Registrar for the Alberta College of Social Workers). Social work. Email to Phil Jacobs �00� May �8. Note: Social workers work in areas other than mental health.

SOCIAL WORKERS PER �00 000 POPULATIONProviNCEs, 2005


0 50 100 150 200

40

176

97

51

192

159

175

101

79

195

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

New Brunswick

Nova Scotia

Newfoundland


0 50 100 150 200


RESO

URCE

S


SOCIAL WORKERS PER �00 000 POPULATIONsELECTED CouNTriEs


5.0

35.3

58.0

15.7

100.2

106.0

Australia

Japan

United States

United Kingdom

Canada

Switzerland

150.0

176.0

Finland

Netherlands

477.0Germany0 10050 150 200

0 100 200 300 400 500


RESOURCESSource: Personal communication. Li J. Mental health hospital services in Canada �00�/4. (email) to Phil Jacobs May ��, �00�.Canadian Institute for Health Information. Hospital mental health services in Canada. �00� – �004. Ottawa, ON: Canadian Institute for Health Information; �00�. (in press).

PSYCHIATRIC HOSPITAL SEPARATIONS PER �00 000 POPULATIONProviNCEs, 2003/04

MENTAL HEALTH UTILIzATION

0 300 1,500600 900 1,200 1,800

642

716

1,262

675

497

680

597

820

642

675

Canada

Newfoundland


Nova Scotia

New Brunswick

Quebec

Ontario

Manitoba

Saskatchewan

Alberta

680

715

British Columbia

Yukon

1,627

295


Nunavut

0 300 600 900 1200 1500 1800


RESO

URCE

S


PSYCHIATRIC HOSPITAL SEPARATIONS PER �00 000 POPULATIONsELECTED CouNTriEs

Source: See Note at end of booklet.Note: Years for each country are different. Australia �00�-0�, US �000, England �004, Nz �00�, Canada �00�-04, Finland �004.

338

642

722

768

1,052

England

920Finland

Canada

Australia

United States

New Zeland

0 800600400200 1,000 1,200

0 200 400 600 800 1000 1200


RESOURCES

Source : Figure �: Hospital separation rate for mental illness by type of hospital, ��4-�� to �00�-�00� (figure i in report). Hospital mental health database. Ottawa, ON: Canadian Institute for Health Information, �00�. Available at: www.cihi.ca/cihiweb/en/media_12oct2005_fig1_e.html. Accessed August 4, �00�. Note: Crude rates based on the number of separations per �00,000 population. Population counts based on Statistics Canada’s population estimates for �00�. Hospital types include psychiatric and general hospitals.

HOSPITAL SEPARATION RATE FOR MENTAL ILLNESSCANADA, 1994/95 To 2002/03


0 200 400 600 800

715.4

615.4

690.3

703.5

677.9

607.0

637.7

639.3

651.4

606.0

1994-1995

1995-1996

1996-1997

1997-1998

1998-1999

1999-2000

2000-2001

2001-2002

2002-2003

2003-2004

0 100 200 300 400 500 600 700 800

SEPARATIONS PER �00 000 POPULATION

4�MENTAL HEALTH ECoNoMiC sTATisTiCs

RESO

URCE

S


MENTAL ILLNESS HOSPITAL DAYS PER �00 000 POPULATIONBY ProviNCE, 2003/04

Source: Canadian Institute for Health Information. Hospital mental health services in Canada. �00� – �004. Ottawa, ON: Canadian Institute for Health Information; �00�. (in press).

0 5,000 25,000 30,00010,000 15,000 20,000 35,000

22,256

34,121

14,129

24,150

11,587

20,340

16,847

21,893

32,938

12,675

Canada

Newfoundland


Nova Scotia

New Brunswick

Quebec

Ontario

Manitoba

Saskatchewan

Alberta

21,492

4,991

British Columbia

Yukon

31,065

935


Nunavut

0 5000 10000 15000 20000 25000 30000 35000

MENTAL HEALTH ECoNoMiC sTATisTiCs4�

RESOURCES

Source: Based on data from Alberta Health and Wellness and Alberta Mental Health Board. Personal communication: Wang C (Alberta Mental Health Board). MH compendium – information from RAG study. (email) to Arto Ohinmaa August �, �00�.Note: Subsidy refers to a provincial health premium subsidy for low income wage earners. Aboriginal refers to treaty status. Welfare refers to those who received social welfare payments. The ��+ category includes all socioeconomic groups.

COST PER PERSON OF MENTAL HEALTH SERVICES ACCORDING TO SOCIOECONOMIC STATUSALBErTA, 2002/03


<15

15-24

25-34

35-44

45-54

55-65

65+

0 500 1000 1500 2000 2500 3000

0 1,000 1,500500 2,5002,000 3,000

RegularSocioeconomic Status: Aboriginal Subsidized Welfare

CAPITATION RATE ($) BY AGE BAND


RESO

URCE

S


POPULATION VISIT RATES TO PSYCHIATRISTS FOR THOSE WITH MENTAL DISORDERS BY REGIONAL INCOME LEVELS MANiToBA, 1997/98-2001/02

Source: Martens P, Fransoo R, McKeen N, Burland E, Jebamani L, Burchill C, et al. Figure 4.4.4 Visit rates to psychiatrists for mental illness disorders for those with cumulative disorders by income quintile. Patterns of regional mental illness disorder diagnoses and services use in Manitoba: a population-based study. Winnipeg, MB: Manitoba Centre for Health Policy, �004. p. �48. Notes: Subjects are those with cumulative disorders, i.e. persons with any utiization for mental illness during the entire observation period. Utilization is measured by age-adjusted annual rate of visits per resident aged �0 years + during the entire observation period. Urban and rural areas are ordered from lowest to highest income levels, e.g. U� is highest and U� is lowest.

1.07

0.690.88

0.660.72

U5 Highest Urban

U4

U3

0 0.40.2 1.00.80.6 1.2

0.0 0.2 0.4 0.6 0.8 1.0 1.2

Males U= Urban R=RuralFemales

0.69

0.70

0.740.68

U2

U1 Lowest Urban 0.69

0.29

0.140.14

R5 Highest Rural

R40.31

0.15

0.090.13

R3

R20.16

0.10 Lowest RuralR10.10

URBAN

RURAL


RESOURCES

Source: Martens P, Fransoo R, McKeen N, Burland E, Jebamani L, Burchill C, et al. Figure �.�.8 All-case hospital separations for females with and without cumulative disorders by income quintile, ��7/�8 – �00�/0�. Patterns of regional mental illness disorder diagnoses and services use in Manitoba: a population-based study. Winnipeg, MB: Manitoba Centre for Health Policy, �004. p. ��4.Note: Subjects are those with cumulative disorders, i.e. persons with any utilization for mental illness during the entire observation period. Utilization measured as age – adjusted annual rate of separations per �,000 residents aged ten years and over during the entire observation period Urban and rural areas are ordered from lowest to highest income levels. Urban and rural areas are ordered from lowest to highest income levels.

POPULATION ALL-CAUSE HOSPITAL SEPARATION RATES FOR FEMALES WITH / WITHOUT MENTAL DISORDERS, BY REGIONAL INCOME LEVELS MANiToBA, 1997/98-2001/02


190.09

212.54107.81

227.16126.75

U5 Highest Urban

U4

U3

0 200100 500400300 600

0 100 200 300 400 500 600

With Disorder No Disorder

118.63

259.68

315.06154.01

U2

U1 Lowest Urban136.96

288.67

330.32164.48

R5 Highest Rural

R4139.26

391.89

447.72193.12

R3

R2173.46

503.94R1 Lowest Rural248.45

URBAN

RURAL

U= Urban R=Rural


RESO

URCE

S


ALL-CAUSE HOSPITAL SEPARATIONS FOR MALES WITH AND WITHOUT CUMULATIVE MENTAL DISORDERS BY INCOME QUINTILE MANiToBA, 1997/98-2001/02

Source: Martens P, Fransoo R, McKeen N, Burland E, Jebamani L, Burchill C, et al. Figure �.�.4 All-case hospital separations for males with and without cumulative disorders by income quintile, ��7/�8 – �00�/0�. Patterns of regional mental illness disorder diagnoses and services use in Manitoba: a population-based study. Winnipeg, MB: Manitoba Centre for Health Policy, �004. p. ��0.Note: Utilization measured by age-adjusted annual rate of separations per �000 residents aged �0 years +.

154.19

167.5276.08

185.5887.61

U5 Highest Urban

U4

U3

0 200100 400300 500

0 100 200 300 400 500

With Disorder No Disorder

80.43

210.16

244.1392.53

U2

U1 Lowest Urban91.58

241.76

277.06111.17

R5 Highest Rural

R493.86

310.81

377.91129.01

R3

R2124.64

431.24R1 Lowest Rural152.34

URBAN

RURAL

U= Urban R=Rural

MENTAL HEALTH ECoNoMiC sTATisTiCs4�

RESOURCES

MENTAL HEALTH ExPENdITURES

Source: Jacobs P, Dewa C, Bland R, et al. Expenditures on mental health for Canadian provinces, �00�/4. Edmonton, AB: Institute of Health Economics; �00�.

PROVINCIAL GOVERNMENT MENTAL HEALTH EXPENDITURES PER CAPITAProviNCEs, 2003/04

Newfoundland


Nova Scotia

New Brunswick

Quebec

Ontario

Manitoba

Saskatchewan

Alberta

British Columbia

0 50 200100 150 250 300

Total

0 50 100 150 200 250 300

Hospital Physician Community Mental HealthOutpatient other Pharmaceuticals Addiction

DOLLARS PER CAPITA

47MENTAL HEALTH ECoNoMiC sTATisTiCs

RESO

URCE

S


DISTRIBUTION OF PROVINCIAL MENTAL HEALTH EXPENDITURESALBErTA, 2002

Source: Block R, Slomp M, Jacobs P, Ohinmaa A. The direct public-sector costs for mental health in Alberta. Health Manage Forum �00�;�8(�):��-8. Table 4.8 Alberta Blue Cross non-group membership average gross cost per prescription by broad drug category (direct bill and reimbursement claims) for recipients in all groups for the year ending March ��, �00�. Alberta Health Care Insurance Plan Statistical Supplement �00�/�00�. Edmonton, AB: Alberta Health and Wellness; �00�. p. 8�. Available at: www.health.gov.ab.ca/resources/publications/ahcip-statsup_02_03.pdf Accessed June �, �00�. Note: “Other Outpatient” includes emergency department.

Hospital Inpatient37%

Community Mental Health Clinic14%

Provincial Drugs12%

Physicians20%

Other Outpatient10%

OtherProvincial

7%


RESOURCES

Source: Jacobs P, Dewa C, Bland R. Expenditures on mental health for Canadian provinces, �00�/4. Edmonton, AB: Institute of Health Economics; �00�. Note: Public ratio refers to total public mental health spending divided by all provincial health spending. Total ratio refers to total mental health spending (public and private) divided by total health expenditures (public + private).

MENTAL HEALTH SPENDING RATIOSBY ProviNCEs, 2003/04

5.70%

5.70%5.60%

4.90%6.10%

Newfoundland


Nova Scotia

0 42 86 10

0 2 4 6 8 10

Total ratio Public ratio

6.90%

6.50%

5.60%6.50%

New Brunswick

Quebec7.90%

4.70%

6.20%7.00%

Ontario

Manitoba5.90%

3.80%

5.90%7.10%

Saskatchewan

Alberta4.90%

7.20%

5.40%6.70%

British Columbia

Total9.20%



RESO

URCE

S


5.0%

6.7%

6.8%

5.4%

7.5%

8.0%

Italy*

Canada (2004)

Australia (2001)

Ireland*

US (2001)

Denmark*

8.0%

10.0%

Netherlands*

Germany*

12.1%UK (2003)

0 2 84 6 1210 14

0 2 4 6 8 10 12 14

NATIONAL MENTAL HEALTH EXPENDITURES AS A PERCENTAGE OF TOTAL HEALTH EXPENDITURESsELECTED CouNTriEs

Source: See Notes at end of book.Note: *signifies that year of data not known.


RESOURCES

Source: Morgan S, McMahon M, Lam J, Mooney D, Raymond C. The Canadian Rx atlas. Vancouver, BC: Centre for Health Services and Policy Research; �00�. Available at: www.chspr.ubc.ca/rxatlas/canada. Accessed July �, �00�.

PRESCRIPTION PSYCHOTHERAPEUTIC DRUGS AS A PERCENTAGE OF TOTAL DRUG EXPENDITURESProviNCEs

0 3 96 12 15 18

14%

14%

14%

15%

14%

18%

16%

14%

13%

16%

Canada

Newfoundland & Prince Edward Island

Nova Scotia

New Brunswick

Quebec

Ontario

Manitoba

Saskatchewan

Alberta

British Columbia

0 3 6 9 12 15 18



RESO

URCE

S


22

41

44

36

47

55

New Zealand

Japan

Australia

United Kingdom

Germany

Finland

55

62

Sweden

Canada (2004)

0 10 40 5020 30 7060 80

0 10 20 30 40 50 60 70 80

SALES OF CENTRAL NERVOUS SYSTEM DRUGS IN SELECTED COUNTRIES(us DoLLArs, PPP) iN 2003

Source: OECD health data �00�.Source: Morgan S, McMahon M, Lam J, Mooney D, Raymond C. The Canadian Rx atlas. Vancouver, BC: Centre for Health Services and Policy Research; �00�. Available at: www.chspr.ubc.ca/rxatlas/canada. Accessed July �, �00�. Note: Nervous system drugs includes analgesics, anxiolytics, hypnotics and sedatives, and antidepressants. PPP refers to Purchasing Power Parity, an international unit of costs. PPP converts to a common currency and equalize the purchasing power of different currencies.


RESOURCES

UNIT COSTS FOR SPECIFIC MENTAL HEALTH SERVICES ALBErTA

Item Cost

Family Doctor consultation $��.4�Fee code 08.��F

Psychiatrist consultation $�4�.8�Fee code 08.��A

Psychologist visit $��0.00

Inpatient hospitalization

Schizophrenia Average stay: �4.� days CMG 777 $��,080 per case $�� per day

Adjustment disorder Average stay: �.� days CMG 7�� $�,7�� per case $707 per day

Depressive mood disorder Average stay: �0 days CMG 7�� $�,�� per case $478 per day

Daily cost for psychiatric drugs (schizophrenia and bipolar disorder)with highest provincial cost zyprexa (schizophrenia) $7.�� per day Risperdal (bipolar) $�.�7 per day Seroquel (schizophrenia) $7.�0 per day

Source: See Notes at end of book.



RESO

URCE

SPE

RFOR

MAN

CE

SECTION �

PERFORMANCE

WAiT TiMEs Patient Wait to see a Psychiatrist 54Distribution of Average Waiting Times 55

PATiENT sATisFACTioN Patient-Perceived outcomes 56satisfaction with Mental Health services 57

MENTAL HEALTH ECoNoMiC sTATisTiCs �4

PERFORMAN

CE

Source: Esmail N, Walker M. Waiting your turn. Hospital waiting lists in Canada. �� ed. Vancouver, BC: Fraser Institute; �00�.Note: Response rates are: BC=�4%, AB=��%, SK=��%, MB=�4%, ON=�7%, QC=�4%, NB=��%, NS=��%, PEI=NA, Nfld=�7%.

MEDIAN PATIENT WAIT TO SEE A PSYCHIATRIST AFTER REFERRAL FROM A GENERAL PRACTITIONERProviNCEs, 2005

wAIT TIMES

2.0

1.012.0

6.020.0

Newfoundland

Nova Scotia

New Brunswick

0 105 15 20

0 5 10 15 20

Urgent Elective

6.0

1.5

2.08.0

Quebec

Ontario7.0

2.0

2.310.0

Manitoba

Saskatchewan8.0

2.0

8.08.0

Alberta

British Columbia8.0

NUMBER OF WEEKS


PERF

ORM

ANCE

wAIT TIMES

DISTRIBUTION OF AVERAGE WAITING TIME BETWEEN REFERRAL AND SERVICE FOR CHILDREN ENROLLED IN A MENTAL HEALTH CLINIC/ PROGRAMALBErTA, 2005

Source: Information Management. Chart �: Frequency distribution of wait-time. Children’s mental health access standards project: report on data results fiscal year �004/�. Version �.4. Edmonton, AB: Alberta Mental Health Board; �00�. p. �.

0 5 10 15 20 25

20.7%

14.1%

18.4%

19.4%

9.4%

13.0%

5.0%

Same Day

1 to 7 Days

8 to 14 Days

15 to 30 Days

31 to 60 Days

61 to 90 Days

91+ Days

0 5 10 15 20 25

MENTAL HEALTH ECoNoMiC sTATisTiCs ��

PERFORMAN

CE

Source: Lin E, Durbin J, Koegl C, Murray M, Tucker T, Daniel I, et al. Hospital report, �004. Toronto, ON: Hospital Report Research Collaborative, University of Toronto; �00�. Available at: www.hospitalreport.ca Note: Sample consists of �0� inpatients and �� outpatients.

PATIENT-PERCEIVED OUTCOMES FOR MENTAL HEALTH SERVICES USERSoNTArio, 2004

PATIENT SATISFACTION

49.4%40.1%

10.1%

40.1%39.2%

20.7%

70%25.4%

4.6%

Feel better prepared to deal with daily problems

Feel more ready to participate in usual activities

Feel helped by mental health services

0 4020 60 80

0 10 20 30 40 50 60 70 80

Always/Usually Sometimes/Somewhat No/Never

PER CENT RESPONDED


PERF

ORM

ANCE

PATIENT SATISFACTION

SATISFACTION WITH MENTAL HEALTH SERVICES ALBErTA, 2004

Source: Satisfaction with health care services: a survey of Albertans �004: final report. Edmonton, AB: Health Quality Council of Alberta; �004.Note: Responses to question: “How satisfied are you with the mental health services you most recently received?”Base: Persons who received mental health services within the past year (n-��).

44%

18%

24%

7%

7%

Very Satisfied

Very Dissatisfied

0 5 10 15 20 25 30 35 40 45

Dissatisfied14%

Satisfied68%

NOT

ES

TO THE CHARTS

NOTES


NOTES

NOTES

PER CENT OF CANADIAN POPULATION AGE �0-�4 WHO ARE NOT WORKING, BY MENTAL HEALTH STATUS, CANADA �00�

Calculations were conducted using the public use Canadian Community Health Survey database. The population with mental illness is defined as those who self-reported that they were diagnosed by a health professional. The state of employment was defined as having had a job during the past year.

WORK – ABSENTEEISM DAYS PER YEAR, BY MENTAL HEALTH STATUS, CANADA, �00�

Calculations were conducted using the public use Canadian Community Health Survey database. Work absenteeism is obtained from self-reported data on the number of disability days experienced during the previous two weeks by employed persons, adjusted by �/7 to allow for week-ends. The state of employment was defined as having had a job during the past year.

LOST WAGES DUE TO MENTAL ILLNESS AS A PERCENTAGE OF GROSS PROVINCIAL PRODUCT

Calculations were conducted using the public use Canadian Community Health Survey �00� database. Lost work was based on the excess unemployment and excess absenteeism of employed people, as compared between those persons with and without mental illness. The population with mental illness was defined as those who self-reported that they were diagnosed by a health professional. The state of employment was defined as having had a job during the past year. Work absenteeism is obtained from self-reported data on the number of disability days experienced during the previous two weeks by employed persons, adjusted by �/7 to allow for week-ends. The value of unemployment and absenteeism time was based on provincial data from Statistics Canada. We estimated daily wage rates from the report, Labor Force Survey Estimates(�). Weekly wages for all employees in the province, over all occupations, for both sexes, and for ages �� and over, were obtained for June, �00�, and were divided by � to obtain a daily wage statistic(�). Annual wages were obtained from provincial annual earnings for all workers from the �00� census. These were updated to �00� using the general Canada-wide Consumer Price Index(�).


NOT

ES

NOTES

(�) Adapted from: Average earnings of the population �� years and over by highest level of schooling , by province and territory, �00� Census. Ottawa, ON: Statistics Canada; �00�.

(�) Adapted from Table �8�-00�� Labor force survey estimates, wages of employees by type of work. National Occupational Classification for Statistics, sex and age group, unadjusted for seasonality, monthly (dollars). Ottawa. ON: Statistics Canada.

(�) Adapted from Consumer price index historical summary, by province and territory (�00�-�00�). Ottawa ON, Statistics Canada.

PER CENT OF MENTAL ILLNESS RELATED SICK LEAVES FROM ALL SICK LEAVES – SELECTED COUNTRIES

Sources:

sWEDEN, NETHErLANDs, BELgiuM, gErMANY, AusTriA

• Curran C, Knapp M, McDaid D, Tomasson K, MHEEN Group. Mental health and employment: an overview of patterns and policies across �7 MHEEN countries. J Ment Health �00� (forthcoming).

FiNLAND

• Kelan sairausvakuutustilasto. Official Statistics of Finland. Social benefits; �004. Available at: www.kela.fi/tilasto >Verkkotilastot > Vuositilastot. Accessed June �8, �00�.

uNiTED KiNgDoM

• United Kingdom part � page 4. Mental health in the workplace: International Labour Organization. Available at: http://www.ilo.org/public/english/employment/skills/disability/papers/ukcover/ukpart14.htm. Accessed August �, �00�.

CANADA

• Canadian community health survey. Cycle �.� [CD-ROM]; �00�.

° Ratio is days off work for working persons with diagnosed mental illness to days off work for working persons without diagnosed mental illness.


NOTES

NOTES

SOCIAL COST OF ILLEGAL DRUGS AND ALCOHOL – SELECTED COUNTRIES

Sources:

AusTrALiA

• Collins D, Lapsley H. Counting the cost: estimates of the social costs of drug abuse in Australia in ��8-�. Monograph series no. 4�. Canberra: Commonwealth of Australia; �00�.

CANADA

• Rehm J, Baliunas D, Brochu S. The cost of substance abuse in Canada, �00� – full report and tables [CD-ROM]. Ottawa, ON: Canadian Centre on Substance Abuse; �00�.

ENgLAND & WALEs

• Godfrey C, Eaton G, McDougall C, Culyer A. The economic and social costs of class A drug use in England and Wales, �000. Home Office Research Study �4�. London: Home Office Research; �00�.

• Leontaridi R. Alcohol misuse: how much does it cost? London: Cabinet Office; �00�. Available at: http://www.number10.gov.uk/files/pdf/econ.pdf Accessed: July ��, �00�.

FiNLAND

• Hein R, Virtanene S, Wahlforsh. Yearbook of alcohol and drug statistics, �00�. Helsinki, Finland: Stakes; �00�.

FrANCE

• Reitox National Focal Point. �004 National report to the EMCDDA: France: New development trends and in-depth information on selected issues. Lopez D, editor. Observatoire Français des Drogues et des Toxicomanes; �004. Available at: www.emcdda.europa.eu Accessed: July ��, �00�.

• Reynaud M, Gaudin-Colombel A, Le Pen C. Two methods of estimating health costs linked to alcoholism in France. Alcohol Alcohol �00�;��(�):8�-��.


NOT

ES

NOTES

NETHErLANDs

• KPMG Economic Consulting. Excessive alcohol consumption in the Netherlands: trends and social costs. Hoofddorp: KPMG Economic Consulting; �00�. Available at: http://www.eurocare.org/pdf/profiles/netherlands/nl2.pdf Accessed July ��, �00�.

• Van Laar M, van Gageldonk A, Ketelaars T, van Ooyen M, Cruts G, van Gelder P. Report to the EMCDDA by Reitox national focal point – The Netherlands: Drug situation, �004: final version. Utrecht, The Netherlands: Netherlands Focal Point; �00�. Available at: www.emcdda.europa.eu Accessed: July ��, �00�.

uNiTED sTATEs oF AMEriCA

• US Office of National Drug Control Policy. The economic costs of drug abuse in the United States, ��-�00�. (Publication No. �07�0�). Washington, DC: Executive Office of the President; �004. Available at: http://www.whitehousedrugpolicy.gov/publications/economic_costs/economic_costs.pdf Accessed July ��, �00�.

• Harwood H, Fountain D, Livermoore G. The economic cost of alcohol and drug abuse in the United States, ��. Report prepared for the National Institute on drug Abuse (NIDA) and the National Institute of Alcohol Abuse and Alcoholism (NIAAA). NIH publication no. �8-4��7. Rockville, MD: National Institute of Health; �000.

NATIONAL MENTAL HEALTH EXPENDITURES AS A PERCENTAGE OF TOTAL HEALTH EXPENDITURES—SELECTED COUNTRIES

Sources:

uNiTED sTATEs

• Mark T, Coffey R, McKuskick D, Harwood H, King E, Bouchery E, et al. National expenditures for mental health services and substance abuse treatment, ��-�00�. Rockville, MD: Substance Abuse and Mental Health Services Administration; �00�.

° Note: mental health expenditure: $8�.4 billion; substance abuse: $�8.� billion; total health expenditures $�,�7� billion; excludes dementia


NOTES

NOTES

uNiTED KiNgDoM

• Sainsbury Centre for Mental Health. Economic and social costs of mental illness. Policy Paper �. London: Sainsbury Centre for Mental Health; �00�.

° Note: total expenditure by National Health Service (NHS) £�,��, million; estimate includes substance abuse, possibly excludes dementia.

• Department of Health. Departmental report, �004 (summary report). London: Department of Health; �004.

° Note: total NHS spending of health: £�4,�4� million.

AusTrALiA

• Australian Institute of Health and Welfare. Health system expenditure on disease and injury in Australia, �000-0�. Canberra, Australia: Australian Institute of Health and Welfare; �00�.

° Note: estimates exclude dementia and long term residential care.

• Australian Institute of Health and Welfare. Australian expenditure on mental disorders in comparison with expenditures in other countries. Canberra: Australian Institute of Health and Welfare; �00�. Available at: http://www.aihw.gov.au/publications/workingpapers/rwp01.pdf. Accessed: July ��, �00�.

CANADA

• Jacobs P, Dewa C, Bland R. Expenditures on mental health for Canadian provinces, �00�/4. Edmonton, AB: Institute of Health Economics; �00�.

DENMArK, gErMANY, iCELAND, irELAND, iTALY, NETHErLANDs

• Knapp M, McDaid D, Amaddeo F, et al. Financing mental health in Europe. J Ment Health �00� (forthcoming).


NOT

ES

NOTES

UNIT COST FOR SPECIFIC MENTAL HEALTH SERVICES IN ALBERTA

• Consultation with family doctor or psychiatrist

° Alberta Medical Association Practice Management Program. Alberta health care insurance plan schedule of medical benefits. Edmonton, AB: Alberta Medical Association.

• Psychologist visit

° Fee schedule. Edmonton, AB: Psychologists’ Association of Alberta. Available at: http://www.psychologistsassociation.ab.ca/. Accessed July 7, �00�.

• Inpatient hospitalization

° Health Authority Reporting and Costing Branch. Schedule � Inpatient cost results. Health costing in Alberta �00� Annual report. Edmonton, AB: Alberta Health and Wellness; �00�. Available at: www.health.gov.ab.ca.

• Drugs

° Alberta Health and Wellness. Drug benefit list. Rev. ed. July �, �00�. Edmonton, AB; Alberta Health and Wellness; �00�. Available at: http://www.ab.bluecross.ca/dbl/publications.html. Accessed July �4, �00�.

TOTAL PSYCHIATRIC BEDS (PSYCHIATRIC AND GENERAL HOSPITALS) PER �00,000 POPULATION – SELECTED COUNTRIES

Note: The WHO estimate for Canada, �84 beds per �00,000 population cannot be verified. We have replaced it with a rough estimate, �� beds per �00,000, based on total mental illness days in �00�/4 (�,�78,000) (Source: Hospital mental health services in Canada �00�-�00�. Ottawa, ON: Canadian Institute for Health Information; �00�) divided by �� days and the Canadian population (�0,007,000). We assumed �00% occupancy. Occupancy at �0% would result in an estimate of �7 beds per �00,000.


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NOTES

PSYCHIATRIC HOSPITAL SEPARATIONS PER �00 000 POPULATION – SELECTED COUNTRIES

uNiTED sTATEs

Manderscheid R, Henderson M. Mental health, United States, �00�. Washington: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Available at: http://www.mentalhealth.samhsa.gov/publications/allpubs/sMA04-3938/default.asp. Accessed August �, �00�.

ENgLAND

Hospital Episode Statistics Online. London: National Health Service. December, �00�. Available at: www.hesonline.nhs.uk. Accessed August 4, �00�.

FiNLAND

Stakes, Suomen virallinen tilasto, Terveys �00� (Finland official statistics, Health �00�), Tilastotiedote ��/�00�, ��.��.�00�. Available at: http://www.stakes.fi/Fi/Tilastot/Aiheittain/Mielenterveys/index.htm. Accessed July �0, �00�.

See the appendix: http://www.stakes.fi/Nr/rdonlyres/B0D145C0-2B73-4EAD-933C-AECDEB4E3EB8/0/0529taulut.pdf.

AusTrALiA

Australian Institute of Health and Welfare. Table S��: Separation statistics by principal diagnosis, grouped into ICD-�0-AM chapters, private hospitals, �00�-0�. Australia’s health �004: The ninth biennial health report of the Australian Institute of Health and Welfare. AIWH Cat. No. AUS 44. Canberra: Australian Institute of Health and Welfare; �004. Available at: http://www.aihw.gov.au/publications/index.cfm/title/10014. Accessed June �7, �00�.

CANADA

Canadian Institute for Health Information. Hospital mental health services in Canada. �00� – �004. Ottawa, ON: Canadian Institute for Health Information; �00�. [in press]


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NOTES

NEW ZEALAND

New zealand Health Information Service. Health statistics. Publicly funded hospital discharges �00�/�. Available at: http://www.nzhis.govt.nz/stats/index.html. Accessed: August �, �00�.

PSYCHIATRISTS PER �00 000 POPULATION, PROVINCES

General Source:

Provincial Medical Regulatory (Licensing) Authorities. The Royal College of Physicians and Surgeons. Available at: http://rcpsc.medical.org/links/provli_e.php.

NEWFouNDLAND

College of Physicians and Surgeons of Newfoundland and Labrador physician search. Available at: http://www.nmb.ca/FindDoctor.asp.

PriNCE EDWArD isLAND

Personal communication. MacDonald M. College of Physicians and Surgeons of PEI [email to Rita Yim June �, �00�].

NovA sCoTiA

College of Physicians and Surgeons of Nova Scotia physician search. Available at: http://server1.kljsolutions.com/Pr2/search.asp.

NEW BruNsWiCK

College of Physicians and Surgeons of New Brunswick membership database user form. Available at: http://www.cpsnb.org/webdata/drdbase_form.shtml.

QuEBEC

• Collège des médecins du Quebec. �-888-MÉDECIN

• Personal communication. Théberge C (Collège des médecins du Quebec). [email to Rita Yim June �, �00�].


NOTES

NOTES

oNTArio

College of Physicians and Surgeons of Ontario doctor search. Available at: http://www.cpso.on.ca/Doctor_search/dr_srch_hm.htm.

MANiToBA

College of Physicians and Surgeons of Manitoba physician directory. Available at: http://www.cpsm.mb.ca/physician_info/directory.

sAsKATCHEWAN

Saskatchewan Health Information Network. Personal communication. Mazurkewich K. [email to Rita Yim May ��, �00�].

ALBErTA

College of Physicians and Surgeons of Alberta medical directory. Available at: https://host.softworks.ca/agate3/client/cpsa/custom/findaphysician/medical_directory.asp.

BriTisH CoLuMBiA

College of Physicians and Surgeons of BC Physician directory. Available at: https://www.cpsbc.ca/cps/physician_directory/search.

YuKoN

Personal communication. Balsam D (Board and Council Coordinator, Yukon Medical Council). [email to Rita Yim June �, �00�].

NorTH WEsT TErriToriEs

Personal communication. Hall J. (Registrar, Professional Licensing, Department of Health and Social Services). Number of psychiatrists. [email to Rita Yim June �, �00�].


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ihe.caamhb.ab.ca

mental h e a lt h...david elliott, linda smith, mike joyce, john campbell and emily somers (ns...

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