Costing scope and perspective

The clinical and social burden imposed on individuals, families, and communities by mental health problems contains an economic dimension. This economic dimension covers not only the costs associated with health and social care support of users (previously referred to as 'direct' costs), but also the knock-on effects (or 'indirect' costs) of mental disorder, such as the impact on someone's ability to work. Inconsistent definitions of what constitute 'direct' as opposed to 'indirect' costs has led to a move away from the use of these terms, to be replaced by the more useful distinction between health sector costs, other formal sector costs, and patient/family costs.

Since comprehensive mental health care requires multidisciplinary inputs, the adoption of a single-agency perspective is unlikely to be appropriate for most evaluations. Rather, an analysis that seeks to identify the costs falling to the multiplicity of care agencies involved, plus any costs incurred by users or carers (typically lost employment opportunities as well as any payments for medication or institutional care), is likely to represent the most suitable perspective. A final category of costs covering, for example, the anguish or distress of carers or users, may also enter the analysis. Increasingly these costs can be valued by means of techniques such as 'willingness to pay' or measurement of an individual's utility (see above).

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