The economic evaluation of mental health care: a review

This paper consists of a review of economic evaluations of mental health care. The conclusion which emerges from this review is that the existing literature is lacking in both quantity and quality. Only seven evaluations of both the costs and effects of alternative forms of mental health care have been carried out on the UK. None of these have involved the appraisal of what is currently the most important choice faced in mental health care, that between institutional and community care, and different types of community care, for individuals with a chronic mental illness. More studies have been completed in other countries, particularly North America, but the evidence provided by these evaluations cannot be expected to always be valid in the UK. The lack of evidence on the efficiency of alternative uses of mental health care resources is even greater than that indicated by the small number of studies carried out, since a number of these evaluations are deficient in design and so do not provide valid evidence. Given this state of the art in economic evaluation of mental health care, there can be little hope that the resources available to provide mental health care in the UK are currently being used most effectively. It appears that choices between competing care options for the mentally ill are usually made in the absence of information on the relative costs and effectiveness of these alternatives.