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Title page 1

Contents 6

Foreword 4

Acknowledgements 5

Executive summary 9

1. Bringing the evidence together: Findings on the economic case for preventing mental ill health 12

The scale of mental ill health is a serious concern 15

Mental ill health places a significant burden on health, quality of life and the broader economy 21

Policies and strategies are in place to improve mental health across OECD countries, with a focus on schools, workplaces and primary care settings 25

Investments in evidence-based actions to prevent mental ill health contribute positively to population health and the economy 29

To achieve impact at scale, implementing effective interventions is not enough: Cross-sectoral action and a stronger focus on best practice design are needed 34

References 36

Notes 42

2. Trends and patterns in mental ill health 43

Mental ill health is a public health concern and has negative impacts on both individuals and the broader economy 44

Rates of mental ill health are high and trending higher 45

Several recent events and factors have adversely affected mental health 51

Mental ill health is inequitably distributed by gender, age, income and socio-economic status 56

Trends and patterns can be seen in access to and unmet needs for mental health services 62

References 65

Notes 76

3. The significant health, social and economic costs of mental ill health 77

The OECD Strategic Public Health Planning for Non-Communicable Disease s model estimates a substantial health and economic burden... 79

Mental ill health shortens healthy life expectancy by an average of 2.5 years and causes around 28,000 premature deaths annually across EU countries 81

Mental ill health will account for 6% of total health expenditure in EU countries, assuming current levels of treatment coverage 84

Closing the treatment gap: Calculating the financial implications of extending coverage for mental ill health 85

Mental ill health affects workforce productivity through increased absenteeism, presenteeism, unemployment and early retirement 86

Significant economic losses result from mental ill health through reduced workforce productivity 88

References 89

4. Policies to prevent and treat mental ill health 92

Mental health has increasingly become an international priority 93

In recent decades, some OECD countries have introduced national programmes to expand community-based care 96

A mental health intervention matrix has been developed, covering mechanism, place, objective and delivery mode 98

References 117

5. The cost-effectiveness of a suite of mental health policy options 130

Investments in evidence-based interventions to promote mental health contribute positively to population health and the economy 132

Six interventions to improve mental health, and prevent and treat mental ill health were identified and modelled 134

Scaling up the six interventions to increase population coverage enhances people's lives 137

The case for investing in interventions to improve mental health and to prevent and treat mental ill health 147

Cross-sectoral action, best-practice design and high coverage are required to achieve meaningful impact 152

References 156

Tables 8

Table 1.1. Interventions modelled in the analysis, including actions in primary healthcare, workplace and school settings 30

Table 2.1. Example of symptom scales and thresholds of severity 47

Table 4.1. WHO's Mental Health Action Plan global targets, objectives and indicators 94

Table 4.2. Matrix of mental health interventions 99

Table 4.3. Key enablers and implementation pitfalls to scale up effective mental health services in primary care 109

Table 5.1. Interventions modelled in the analysis, including actions in primary healthcare, workplace and school settings 134

Figures 7

Figure 1.1. Estimates of prevalence of mental disorders in EU and OECD countries, 2023 15

Figure 1.2. Treatment coverage for mental ill health across OECD and EU countries 20

Figure 1.3. The impact of depression, anxiety and alcohol use disorders on healthy life expectancy and life expectancy 22

Figure 1.4. Impact on mental-health-specific health expenditure, assuming a hypothetical scenario with 100% treatment coverage, per year,... 23

Figure 1.5. The impact of depression, anxiety and alcohol use disorders on the GDP of EU countries 25

Figure 1.6. Policies to improve mental well-being across 43 OECD and EU countries 26

Figure 1.7. Health and economic impact of interventions to prevent mental ill health 32

Figure 1.8. Percentage of countries where interventions are cost-saving, cost-effective or not cost-effective 34

Figure 2.1. Estimates of prevalence of mental disorders in EU and OECD countries, 2023 45

Figure 2.2. Estimates of prevalence of mental disorders in EU and OECD countries, 1990-2023 48

Figure 2.3. Estimated trends in major depressive disorders, anxiety disorders, alcohol use and drug use disorders in EU and OECD countries, 1990-2023 50

Figure 2.4. Estimated trends in major depressive disorders, anxiety disorders, alcohol use and drug use disorders in EU and OECD countries, 2019-2023 52

Figure 2.5. Prevalence of mental disorders by gender and age in EU countries, 2023 57

Figure 2.6. Income-related inequalities in depressive symptoms 60

Figure 2.7. Education-related inequalities in depressive symptoms 62

Figure 2.8. Treatment coverage for mental ill health across OECD and EU countries 64

Figure 3.1. Schematic overview of the modules in the OECD Strategic Public Health Planning for Non-Communicable Diseases model 80

Figure 3.2. Reduction in healthy life expectancy and life expectancy due to major depressive, generalised anxiety and alcohol use disorders, average 2025-2050 82

Figure 3.3. Number of deaths due to major depressive and alcohol use disorders (including deaths by suicide as a result of self-harm)... 83

Figure 3.4. Annual health expenditure due to major depressive, generalised anxiety and alcohol use disorders in EUR per capita and... 84

Figure 3.5. Impact on mental-health-specific health expenditure, assuming a hypothetical scenario with 100% treatment coverage, per year,... 86

Figure 3.6. Impact on the workforce through absenteeism, early retirement, employment and presenteeism, average over 2025-2050 87

Figure 3.7. Percentage difference in GDP due to mental ill health, average over 2025-2050 88

Figure 4.1. Countries with a national mental health policy and/or strategy or action plan 95

Figure 4.2. Core functions of multisectoral mental health networks in Belgium 97

Figure 4.3. Antidepressant consumption by OECD countries in 2021 106

Figure 4.4. Interventions for mental ill health in primary healthcare across OECD countries 108

Figure 4.5. Policies and programmes to prevent and treat mental ill health in school-based settings 112

Figure 4.6. Policies and programmes to prevent and treat mental ill health in workplace-based settings 114

Figure 4.7. Countries that have policies and programmes to enable integration of digital technologies and tools into mental healthcare delivery 116

Figure 5.1. Population effect of interventions on health, life years and disability-adjusted life years gained per 100,000 population annually, 2025-2050 138

Figure 5.2. Costs of interventions and their impact on health expenditure, annually, 2025-2050 141

Figure 5.3. Full-time equivalent worker numbers gained annually, average 2025-2050 144

Figure 5.4. The impact of interventions on GDP, 2025-2050 146

Figure 5.5. Cost-effectiveness ratios, average 2025-2050 148

Figure 5.6. Benefit-cost ratio of the policies, average 2025-2050 150

Boxes 16

Box 1.1. Understanding common mental disorders and their impacts 16

Box 1.2. The OECD Strategic Public Health Planning for Non-Communicable Diseases model 21

Box 1.3. Common interventions to improve mental well-being 28

Box 1.4. Modelling interventions to tackle major depressive disorders and generalised anxiety disorders 29

Box 1.5. Best practices, better results: Evidence from OECD mental health interventions 35

Box 2.1. Screening tools to identify and assess mental ill health 47

Box 2.2. Mental health effects of the Russian Federation's invasion of Ukraine 54

Box 2.3. Digital environments as intensifiers of emotional vulnerabilities 56

Box 2.4. The Relative Index of Inequality 59

Box 3.1. The OECD Strategic Public Health Planning for Non-Communicable Diseases model 79

Box 3.2. The additional cost of mental ill health as a comorbidity: Drivers and mechanisms 85

Box 4.1. WHO's Mental Health Action Plan 2013-2030: Objectives and global targets 94

Box 4.2. The reform of the national mental health system in Belgium: Focus on strengthening primary healthcare service delivery 97

Box 4.3. Universal, school-based mental health literacy programme in Norway 100

Box 4.4. Mindfulness-based group therapy delivered in primary healthcare settings in Sweden 102

Box 4.5. Self-Help Plus: A psychological intervention for Syrian refugees in Türkiye 103

Box 4.6. The cognitive behavioural therapy-based online INTERACT Programme in primary healthcare in the United Kingdom 105

Box 4.7. The need for cross-sectoral collaboration in social services to create effective mental health policy 107

Box 4.8. Operationalising an effective scale-up of mental health services in primary care settings: Principles for success 109

Box 4.9. A "single-session" intervention service delivery model in a primary healthcare setting in Canada 110

Box 4.10. Universal school-based cognitive behavioural skills mental health intervention in Australia 113

Box 4.11. International workplace mental health promotion through literacy and stigma-reduction initiatives in small and medium-sized enterprises 115

Box 5.1. Calculating the value for money of mental health interventions using the OECD Strategic Public Health Planning for Non-Communicable Diseases model 133

Box 5.2. Reducing the impact of unemployment as a root cause of mental ill health: Guidance from the OECD Recommendation of the Council... 155

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