Our vision for Europe
There is considerable evidence to suggest that the economic burden of depression in Europe is substantial and likely to grow over coming decades. In many countries in Europe, depression and its costs remain under-researched, and the condition and its impacts are under-recognised by key decision-makers. Further work is needed on the costs of depression in sub-populations, including women, children and adolescents, and people with comorbid mental health conditions.
Given that a large proportion of the overall cost of depression falls on business, and that there is evidence that interventions at the workplace can be cost-saving for organisations even in the short term, there appears to be an important role for employers in helping to tackle depression. Public sector organisations in many countries are major employers, of course, and should explore opportunities to invest in the mental health of their workforce. In the private sector, many of the established examples of mental health initiatives are in large companies, and policymakers may wish to consider providing financial incentives to encourage small and medium-sized enterprises – which otherwise might not have sufficient resources to invest in effective workplace mental health interventions(i). At the same time, it is imperative that population groups not in the workforce or not seeking employment are not neglected, even though the (narrow) economic case for action might be harder to make.
Based on the above, the following recommendations can be made:
- Existing research on the economic and social costs of depression should be compiled by the European Commission, in cooperation with Member States, in a centralised information resource to serve as a reference base for interventions and further targeted research.
- National decision-makers should ensure that the indirect economic impact of depression in terms of lost productivity is not overlooked, by including indirect costs in health technology assessments.
- As highlighted above, the potential impact of addressing depression in the work place is great. Decision-makers, particularly at European level, therefore, should take the initiative to ensure that benefits that can be won in the workplace setting are fully exploited. The European Commission, for instance, might consider facilitating roundtable discussions between representatives active in mental healthcare, sick funds and employer associations (both large business and small and medium-sized enterprises) to further the development of screening programmes at the work place combined with the availability of adequate support management.
- EU and national policymakers should consult with patients and carers to assess the economic burden of depression on those affected and their family members.
Recommendations for Action
The Expert Platform on Mental Health – Focus on Depression calls upon European and national policymakers, healthcare professionals as well as patient and family organisations to implement the following actions in response to the challenges described above.
Improving the early diagnosis and care of people with depression
The burden of depression could be lowered through early identification and adequate interventions. These should be applied in a personalised manner to ensure that patients and their families receive the care and treatment that best corresponds to their specific needs. Non-personalised tools (e.g. in the field of e-health) can be part of such a personalized approach. In this context, patient and family empowerment, including access to self-help, psycho-education and support to carers, is particularly important. Overall, the appropriate and timely treatment of depression has been shown to be a cost-effective intervention.
Specifically the Platform members recommend the following:
- Agreeing on a consensus paper: Representatives of the different disciplines involved in the diagnosis and management of depression, as well as the representatives of organisations speaking for patients and carers, should be brought together to reach consensus about adequate management of depression and about the arrangements necessary to provide healthcare tailored to the needs of people living with depression. This consensus paper should guide relevant stakeholders.
- Providing guidelines for services and training: Health professional associations should promote the development and implementation of primary and inpatient care guidelines for the diagnosis and treatment of depression based on the aforementioned consensus paper. They should also develop training for primary care professionals, psychiatrists, psychologists, and nurses to deliver healthcare according to those guidelines, in line with the consensus paper. Representatives of people with depression and their family should participate in the development of these guidelines and devising training programmes.
- Dealing with the increasing prevalence of co-morbidity between depression and somatic illness (e.g. diabetes, cardio-vascular disease and cancer): Governments, teaching institutions and other stakeholders should support a comprehensive approach to this problem, including support to relevant research, service and training initiatives.
- Putting the focus on vulnerable groups: Governments, teaching institutions and health professional associations should provide trainings for professionals dealing with groups at high risk from depression (e.g. people with physical illnesses, pregnant women and new mothers, and people that have attempted suicide in the past as well as relatives of suicidal patients).
- Addressing depression at the workplace : The European Commission should facilitate discussions, e.g. in the form of roundtables between health care service providers, patients and family representatives, insurance companies and employer associations to further the development of programmes addressing depression at the workplace (e.g. screening programmes) combined with services that could help people with depression. These roundtables should serve to share experiences, highlight good practice of prevention and treatment, and obtain specific commitments.
- Using innovative options in management of people with depression: Dedicated funding should be made available for international collaborative research exploring the use of innovative options in the management of people with depression (e.g. internet-based therapy or telephone case management).
- Reimbursing innovative treatment interventions dealing with unmet needs: National health budget-holders should assess possibilities for the reimbursement of expenses related to the application of innovative treatment interventions, e.g. those that would help patients who experience residual symptoms of depression which may have a significant negative impact on their functioning at work and in society.
- Raising awareness about problems related to depression among stakeholders outside the healthcare system: National policy-makers should fund initiatives to raise awareness about depression, its consequences and possibilities of intervention amongst those who work with groups that are at risk of depression, such as adolescents, carers of people with mental diseases, pregnant women, old people, and those subject to social care.
- Providing an overview of the services available: the European Commission, in cooperation with the Member States, should collect information about healthcare services available to people with mental illness in each country in a dedicated database, e.g. a European Depression Services Map. This information collected at national level should inform people living with depression about mental healthcare services available to them in their country. This information could also be integrated into the EU Compass on Mental Health and Well-being.
- Explaining the terminology and sharing knowledge: The European Commission, in cooperation with the Member States, should commission the creation of a European dictionary on available practices and terms used in the field of depression to allow better understanding and collaboration among EU Member States.
Involving people living with depression, their families and carers, in the development and evaluation of health care for depression
Policies and support services need to be tailored to the needs of individuals living with depression and their families. In this context, patient and family empowerment are of particular importance. Patients and carers should be equipped with tools to help them to cope with depression and protect their own health.
Specifically the Platform members recommend the following:
- Establishing social services and support programmes: EU and national policymakers should promote social services and support programmes (e.g. training schemes) that will enable families to provide care and at the same time protect their own health. Flexible and inclusive social and workplace policies are critical in this context, as well as the involvement of the employers.
- Involving people with depression and their carers as a source to inform policy-making: EU and national policymakers should actively involve those representing people living with depression as well as representatives of families and carers when developing policies and supporting services, in order to ensure optimal care. They should also consult them when making decisions about reimbursement policies concerning treatment interventions.
- Providing psycho-education: Insurance systems and governments need to provide funds for the psycho-education of people living with depression as well as their families and carers. Plans for psycho-education should be developed in collaboration with representatives of patients and their families.
Improving information about depression and its costs
While recognising that research in the epidemiology, pathogenesis and management of depression is of vast importance in dealing with the problems related to depression, the Platform was particularly concerned by the need to improve information about economic issues related to depression and suicide and therefore, at this point in time recommends the following:
Specifically, the Platform members recommend the following:
- Making health economic research available: Results of existing research on the economic and social costs of depression should be compiled by the European Commission, in cooperation with Member States, and placed in a centralised information resource to serve as a reference base for interventions as well for further, targeted research.
- Considering the indirect costs of depression in cost-effectiveness decisions: National decision-makers should include indirect costs of depression, (e.g. loss in productivity, absenteeism and presenteeism, disability pension) in their reports and intervention plans, whilst bearing in mind that some indirect costs are incalculable (e.g. flawed decisions of depressed top managers, brokers etc.).
- Involving patients and carers as an information source when assessing the burden: EU and national policymakers should actively involve representatives of organisations of patients and carers to assess the economic burden of depression on them and their families.
Commitment of the Expert Platform on Mental Health – Focus on Depression
The Expert Platform is committed to supporting the implementation of these recommendations by the development of an Action Plan.