In June the Labour manifesto made a range of commitments around mental health: support for young people in every community through open access ‘Young Futures Hubs’ and specialist support in every school; support for Armed Forces veterans; more accessible services through increasing capacity with 8,500 extra mental health staff; and reform of the Mental Health Act. The manifesto went as far as stating that ‘Britain is currently suffering from a mental health epidemic that is paralysing lives’, that ‘nothing says more about the state of a nation than the wellbeing of its children’, and pledged to reform the NHS to give mental health parity with physical health.
What we have seen of the Labour government so far, however, does not suggest they are asking themselves: will this policy negatively impact mental health? You only have to look at the decision not to end the two-child benefit cap, or the cessation of the winter fuel payment.
Of course the manifesto’s flagship pledge was to grow the economy, but Labour doesn’t seem to understand the intimate connection between mental health and the economy. The Centre for Mental Health recently published a report on the ‘Economic and Social Costs of Mental Ill Health’ in which they estimated the total cost of mental ill health in England in 2022. This wasn’t the first report of its kind; it updates a report published in June 2003, and it won’t be the last.
The original analysis estimated a cost of £77 billion in 2002/3, or £124.2 billion, adjusting for inflation. The current analysis estimated the costs of mental illness in 2022 to be £300.4 billion. Before we get into the underlying details, let’s take a moment to reflect on the magnitude of these figures. For comparison, the total funding allocated to NHS England for health services in 2022/23 was £155.1 billion.
The tacit admission – even by an elite/political class that refuses to acknowledge it – is that capitalism makes us sick
While the reports urge readers to avoid making comparisons with more orthodox economic measures such as GDP, which don’t – though arguably should – take the same holistic approach, let’s make the comparison anyway. GDP in cash terms for 2023 is reported as £2,690 billion. So crudely, the cost of mental ill health to the economy is equivalent to around 11% of GDP. However, the report makes clear all the ways in which the calculated figure is highly parsimonious and excludes costs that should be included but are difficult currently to capture. For example, the cost of the negative impacts on innovation and creativity, of poor financial decisions, on social trust and emigration (‘brain drain’).
It’s worth noting here that the evidence for the social determinants of mental illness is very powerful. A major study recently published in World Psychiatry (Feb 2024) stated: ‘There is now compelling evidence that the risk of developing any mental health condition is inextricably linked to our life circumstances, meaning that a higher burden of population‐level psychiatric morbidity is disproportionately experienced by those closer to the margins of our societies.’
Comparisons aside, it’s a huge amount of money, which begs the question: why doesn’t the government do more to alleviate the root causes of mental ill health? The answer to this would involve dismantling much of the way in which capitalism operates, and no current or potential UK government is radical, brave or imaginative enough to do that. The tacit admission – even by an elite/political class that refuses to acknowledge it – is that capitalism makes us sick. We all know this, but it’s unusual for it to be so explicit. If mental illness is a necessary or unavoidable side-effect of a late-capitalist society, we will simply have to invest a great deal more in providing sufficient, effective support. So the Labour manifesto at least gets that right, but there are no signs so far of this funding materialising.
The Centre for Mental Health report, while explaining the differences between this and the previous cost estimates, identifies some of the factors that have contributed to mental ill health. It notes the evolving prevalence since 2002/3 (acknowledging that the 2019 levels it relies on in the current calculations are an underestimate, especially for children and young people) alongside the changes in the supply and demand of mental health support. It relates this to macroeconomic trends such as austerity and the ineluctable reduction in state provision that has resulted in greater poverty, deprivation and insecurity for most people.
The report also cites high inflation and the increased costs of living, which, it recognises, have exacerbated wealth, racial and gender inequalities, as well as technological developments, a rise in international conflict and war, climate crisis, and eco-anxiety. Almost all these factors are or have been in the ambit of the UK government to positively alter.
Let’s get wonky for a moment. The headline cost in the latest analysis of £300.4 billion is broken into three macro categories: human costs (around £130.5 billion, or 43%), defined as a monetary equivalent of the reduced quality of life (based on Disability-Adjusted Life Years, or DALYS) for people living with mental ill health; economic costs (around £109.7 billion, or 37%), or losses to the economy of mental illness; and health and care costs (around £60.2 billion, or 20%), or the costs of providing health and social care services to those living with mental illness.
If the Labour government maintains the current course, we must assume that mental health and emotional wellbeing are being attacked with strategic intent, not merely as a side effect
It’s apparent from those macro categories already, but the report also helpfully slices the way these costs land according to sector and reckons that the government bore the smallest part (around £25 billion) for NHS services, other health and care, lost tax revenue, and GP expenditure. The second largest cost was borne by industry (at £100.6 billion), including costs of staff turnover, presenteeism and economic inactivity, while by far the largest part was the personal costs borne by people living with mental illness and their families (£174.7 billion), which included the human costs for the working age population (£90.2 billion), costs of informal health and care (£39.7 billion), and the human costs borne by children and young people (£18.8 billion). It is clear that in both of these configurations, the greatest impact is felt by people (individuals and their families and friends) themselves.
This is no surprise given the ideological enterprise of Conservative Britain, reaching back in recent years to Margaret Thatcher intent on socialising the losses and privatising the gains, and further still to Edmund Burke in his Thoughts and Details on Scarcity (1795). But if the current government is serious about its commitment to growth, mental health and emotional wellbeing are an apodictic area for their attention and investment.
I’m not even referring here to the purported economic returns from building capacity in evidenced based interventions for mental health, which for those people who want them can be life-saving, but simply developing all policy with a mental health test, as the Manifesto For A Mentally Healthier Nation published in February as collaboration between numerous charities and organisations recommends.
If the Labour government maintains the current course, we must assume that mental health and emotional wellbeing are being attacked with strategic intent, not merely as a side effect. A depressed and anxious electorate might be less likely to make trouble, but they will also be less economically active and productive, and this could tip over into anger and rebellion.
