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Investing in recovery – translating intervention into action

Worldwide, recovery - defined by the presenter David McDaid, London, UK as the ability of affected individuals to enjoy meaningful and satisfying lives - is considered a key goal in medicine, including mental health. However, no matter how much superb science is done to try and accomplish this, the implications of any scientific findings which accomplish this goal must be adequately communicated to policy makers in different sectors in order to make a broad impact. And, as Dr McDaid told delegates at SIRS 2018, the first thing they will always ask is ‘How much will it cost?’.  In this insightful and entertaining symposium, he explained how to translate interventions into actions.

Opportunities are being missed

The moral and economic arguments for investing in recovery are well-aligned. The long-term impact of mental illness on the physical and mental health of the patient, including a lack or loss of employment opportunities and education coupled with the subsequent impact mental illness has on their loved ones, is already well-known and need to be addressed. However, resources are not unlimited and tough choices about which interventions to support need to be made. Therefore, at the outset of any intervention study it is vital to consider the economic arguments, not least cost-effectiveness and affordability. Many opportunities for gaining support are currently being missed, Dr McDaid suggested. ‘Embed economic arguments into your work,’ he said, ‘It’s not only about saving money but about spending money in a better, efficient way.’

Moral and economic arguments for investing in recovery are well-aligned

However, it’s important to go beyond the narrow use of economic information and make arguments and impacts within the wider system and policy context. This means considering the economics of the impacts of different sectors affected by any mental illness when planning interventional trials and real-world interventions.

One example Dr McDaid cited was that of intervention in psychosis. The annual cost of schizophrenia in England is about £12 billion but health care costs make up only 25% of this amount. Welfare, schools, criminal justice and the police are just some of the sectors directly involved in ‘managing’ schizophrenia. Each sector has a budget holder. Demonstrating cost-benefits to each sectors’ budget holder in contributing to the management of psychosis will more easily facilitate their buy-in and support.

The annual cost of schizophrenia in England is about £12 billion but health care costs make up only 25% of this amount

Back to college?

Dr McDaid also considered supported education for those with psychosis. Currently, however, he noted that there is little economic data to support this strategy which is surprising given that psychosis affects primarily a younger population. It seems obvious, considering the estimated improvement in lifetime productivity returns the attainment of even modest qualifications can make to someone without psychosis, that people with psychosis should be supported to return to education in some form, he argued.

Economic data lacking

Supported employment and housing are other areas where economic arguments could be made to assist recovery in psychosis. In both these areas, getting those with psychosis into employment and out of hospital would suggest immediate benefits not only to the health care provider but to other sectors as well. However, yet again, supportive data are lacking despite it being clear that identifying outcomes and their economic consequences is critical to obtaining buy-in from other sectors.

Researchers need to translate their work into policy papers that are written specifically to influence policy makers

Effective communication

Why is this? Communicating effectively is not a trivial matter nor is it specific to mental health. Good, clear business cases need to be made for any intervention – early or otherwise – to be accepted, funded, and implemented. In order to enhance the breadth of early interventions in schizophrenia and other mental illnesses, it is vital and clinicians and researchers need to further translate their work into policy papers that are written specifically to influence policy makers. Such papers should be written specifically towards this policy maker audience, using accessible language and avoid using too much scientific jargon. As Dr McDaid pointed out, politicians don’t spend all day reading journals!


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