Tomas Bokström and Dr David McDaid led an inspiring leadership match at IIMHL and IIDL on the way economic modelling, inter-sectoral outcomes and operational models for financing can drive investment and resource allocation for better mental health outcomes. Karla Bergquist reflects.

Visualising potential benefits of investing in prevention and early intervention

Tomas Bokström from the Swedish Association of Local Authorities and Regions and Dr David McDaid from London School of Economics presented concrete modelling work from the English, Danish and Swedish contexts.

All the models aim to assist decision-makers in visualising potential benefits (both social and financial) of investing in prevention and early intervention.

Examples of social investment strategies, social impact bonds and pay-for-performance procurement from Sweden and other contexts were presented.

Cost-effective intersectoral activities

David gave examples of cost-effective intersectoral activities from his published work through the World Health Organisation in 2018:

  • taxes and restrictions on access to alcohol and tobacco
  • making the environment conducive to physical activity
  • reformulation of food and drink to improve diet
  • investing in resilience and literacy programmes in schools to promote physical and mental health
  • investing in workplace health promotion.

View Dr David McDaid's presentation.

He also noted the importance of the document “Commissioning Cost-Effective Services for Promotion of Mental Health and Wellbeing and Prevention of Mental Ill-Health” which gives great examples of mental health prevention in action. An example in this document is the analysis of ‘Return on Investment’ for suicide prevention activities (p.44).

Economic modelling a useful tool

It seems as though economic modelling can be a useful tool to visualise the potential of investing in interventions and services both on a macro and micro level and that there are already quite a few examples of such models. 

As the evidence base is growing and more data is analysed and put to use in modelling, development can be expected to continue.

Economic models should be complemented by an approach where the inter-sectoral perspective is highlighted. This can be done by:

  • forming alliances with other sectors
  • ideally defining as many sector specific benefits as possible
  • emphasising a public health perspective
  • addressing capacity and competence issues in organisations on how to form business cases
  • ultimately implementing interventions and services. 

Incentivising systems to use evidence

It's also important to find ways of incentivising systems to use evidence and invest in changing practices towards better outcomes. The examples of social impact bonds and social outcomes contracts to clarify intervention and incentives models were lifted as cases where this is tested.

There is a collection of outcomes that are closely connected to mental health and wellbeing, but which are also useful for a more holistic assessment of how society works for individuals in different circumstances of life. The workshop identified a preliminary list of such outcomes. More work on definitions and linking outcomes between short and long term as well as to costs (when possible) is needed.

The figure below tries to summarise some of the content of the workshop and to structure the topics in a high level logical framework.

  1. On the left-hand side of the figure, contextual factors and resources for input are listed.
  2. The top circle in the middle indicates operational (micro level) activities while the lower circle indicates more strategic (macro level) activities.
  3. To the right of the figure are the outcomes that activities could seek to improve.

Key learnings for New Zealand from the match 

  • Decisions for investment in mental health are often made by politicians and finance people. This is why it is important that arguments for investment are made in their terms. For example – how do you present a business case to treasury or finance that highlights the connection between mental health and other social sectors?
  • A systematic approach is needed to inform policy and connect mental health to the wider development of a society that promotes health and wellbeing. Hopefully the outcomes of the Government Inquiry into Mental Health and Addiction will lead us there.
  • Economic modelling can be a useful tool to visualise the potential of investing in interventions, so we need to identify people who have these skills.