Making the economic case for investing in child and adolescent mental health services

Objectives: As part of work undertaken for the EC supported Child and Adolescent Mental Health in Enlarged Europe (CAMHEE) project, an analysis of the economics of child and adolescent mental health was conducted. Firstly this mapped what was known about both the economic costs of child and adolescent mental disorders and the economic case for investment in services for their prevention and treatment. Secondly, decision analysis models were constructed to illustrate how the potential cost effectiveness of preventive interventions may be determined in countries where, to date, few attempts have been made to determine cost effectiveness. Methods: A systematic literature review was conducted, in line with guidelines developed by the NHS Centre for Reviews and Dissemination. The aim was to identify studies quantifying the economic costs of poor child and adolescent mental health (CAMH) and economic evaluations of CAMH interventions. Database searched included the Applied Social Sciences Index and Abstracts, Pubmed/Medline, ERIC, EMBASE, Psychinfo, International Bibliography of the Social Science, Econlit, and the NHS Economic Evaluation Database. This was complemented by a handsearch of key journals and selected governmental, non-governmental organisation and academic websites. Decision analytical models were constructed using TreeAge Pro software to synthesise data on local costs with information from the literature review on the effectiveness of services to estimate the potential cost effectiveness of preventive interventions across six countries: Bulgaria, England, Germany, Greece, Lithuania and Norway. Local costs and resource use data in six European countries were identified by CAMHEE partners making use of a modified version of the Client Service Receipt Inventory (CSRI). Results: Cost of illness studies identified were of variable quality; only a minority looked at costs outside the health system. However it was clear from those studies that did take a broad perspective that the majority of the economic costs of poor CAMH fall on other sectors including education, criminal justice, employment and social welfare. No cost of illness or cost effectiveness studies in the new member states of the EU were identified. 19 cost effectiveness studies meeting our criteria were identified, nearly all of which were from the United States and the United Kingdom. Two studies focused on the primary prevention of CAMH problems, while the remainder focused on the alleviation of problems in children identified as being at risk. The results of decision analytical models looking at the use of parenting interventions not only indicated that these would be considered cost effective in all six European countries, but in several instances would be cost saving given the substantial long term costs avoided. Conclusions: While knowledge on the costs of poor child and adolescent mental health continues to increase, published studies on the cost effectiveness of interventions to prevent/and or alleviate these problems remain limited. Much of this published literature is from the United States and the United Kingdom raising questions about the extent to which results can be generalised to other contexts and settings. However, making use of local resource data, it is clear that CAMH interventions have the potential to be highly cost effective in a number of high and middle income countries, largely because of the substantial long term economic costs that may be avoided through early intervention

Making the case for investing in child and adolescent mental health: how can economics help?

This paper sets out issues to be considered in making the economic case for investing in child and adolescent mental well-being promotion and prevention/early treatment of mental disorder. We highlight the role that various types of economic tool can play, and the different questions that economic analysis can address. We end by considering how the evidence base can be further strengthened and fed into policy and practice processes across Europe

Cost-effectiveness analysis in child and adolescent mental health problems: an updated review of the literature

Background/Objectives: In this presentation we provide the results of a review of the recent literature on the cost-effectiveness of the prevention or treatment of mental disorders in children and adolescents. Methods: A systematic literature search for publications on the economic evaluation of child and adolescent mental health (CAMH) intervention programmes has been conducted for the years 2001 to 2009, and a literature search for CAMH prevention and promotion programmes has been conducted for the years 2006 to 2009. Results: Two studies on the cost-effectiveness of prevention programmes and 19 studies on the cost-effectiveness of psychiatric interventions were identified. Cost-effectiveness analyses (CEA) based on primary data (14) mainly focused on non-medical interventions, while CEAs based on simulation models (7) were mainly focused on drug treatment. CEA studies were mainly conducted in the USA and the UK. The time period of most CEAs is limited to 12 months. Due to methodological differences the results of CEAs are difficult to compare. Discussion/Conclusions: The findings from this review demonstrate that there is still little knowledge about which programmes for mental disorder prevention, mental health promotion, or treatment for mental disorders in children and adolescents provide the greatest societal benefit for the invested money. This lack of knowledge is especially prevailing in most European countries. Funding: This paper was prepared under the auspices of the CAMHEE (Child and Adolescent Mental Health in Enlarged Europe) project funded by the European Commission Public Health Programme (grant no. 2005311)

European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods

Background: People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design: HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion: A general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities

Major results from the first plasma campaign of the Wendelstein 7-X stellarator

After completing the main construction phase of Wendelstein 7-X (W7-X) and successfully commissioning the device, first plasma operation started at the end of 2015. Integral commissioning of plasma start-up and operation using electron cyclotron resonance heating (ECRH) and an extensive set of plasma diagnostics have been completed, allowing initial physics studies during the first operational campaign. Both in helium and hydrogen, plasma breakdown was easily achieved. Gaining experience with plasma vessel conditioning, discharge lengths could be extended gradually. Eventually, discharges lasted up to 6 s, reaching an injected energy of 4 MJ, which is twice the limit originally agreed for the limiter configuration employed during the first operational campaign. At power levels of 4 MW central electron densities reached 3 1019 m-3, central electron temperatures reached values of 7 keV and ion temperatures reached just above 2 keV. Important physics studies during this first operational phase include a first assessment of power balance and energy confinement, ECRH power deposition experiments, 2nd harmonic O-mode ECRH using multi-pass absorption, and current drive experiments using electron cyclotron current drive. As in many plasma discharges the electron temperature exceeds the ion temperature significantly, these plasmas are governed by core electron root confinement showing a strong positive electric field in the plasma centre.Peer reviewe