During the general election campaign, Enda Kenny made a number of statements to the effect that mental health was to be a priority of the current government. It is important to more fully tease out what this might mean. The intersection of economics and mental health is clearly an important part of this for a number of reasons including the extent to which mental health policy involves allocation of resources; the extent to which mental health reacts to economic circumstances; and more generally the extent to which mental health considerations should be factored into how economic policy is conceptualised. Below are some broad areas that should be considered in developing a debate on mental health in Ireland that has an Economics input.
(i) Perhaps the first main consideration is how well-being and mental health should be addressed in the context of developing indicators of broad societal progress. As flagged by Nicolas' earlier post, the Sarkozy commission has been influential in placing broader quality of life of indicators into the recent policy debate. It should be a prime feature of the current debate as to how this might be done in the Irish context, including how to make distinctions between overall well-being and the prevalance of acute psychological distress.
(ii) With regard the current economic situation, a clear area where more research and policy consideration is needed is the extent to which unemployment is related to mental health. It is clear that there is a dual relationship between unemployment and mental health, with psychological distress both being a consequence and cause of unemployment states. There are many subtle interactions between the two that have important consequences for areas like job activation policy.
(iii) The extent to which debt influences psychological distress is another important area for policy. As with unemployment, the relationships are more subtle than just looking at the effect of being heavily indebted on mental health. Debt may influence mental health, but mental health response may also influence how people deal with their debt situation and this may again have important consequences for how debt policy is designed and implemented. (see, for example the work of Sendhil Mullainathan).
(iv) The extent to which economic fluctuations influence suicide rates is another area in demand of further study. There is a large and somewhat inconclusive literature on the extent to which changes in GDP influence suicide rates. Indeed in Ireland, it must be noted that historically high rates of suicide were observed during the highest growth periods of the Celtic Tiger phase. There are many complex factors at play including changes in alcohol and drug consumption that may mediate between economic fluctuations and suicidal behaviour (see, for example, the recent article by Walsh and Walsh 2010). An approach to suicide that focuses on aggregate fluctuations themselves is not likely to be useful for policy. What is more interesting is to examine how different types and motivations for suicide change over the economic cycle and the cross-sectional variation in suicide. The data to do this in Ireland are, predictably, very weak and if the government are serious about mental health policy this is a clear priority in terms of research.
(v) Child mental health is clearly a major issue. A number of recent papers by James Smith have shown dramatic effects of childhood mental health problems on outcomes all across the life-cycle (see his IDEAS page). These papers establish a strong case for addressing childhood mental health from an economic and social perspective. However, far more research is needed on the economics of childhood mental health treatment. There is a paucity of research on the effects of standard psychotherapeutic and pharmacological treatments on the long-run outcomes of children. Showing effects on symptoms may be of clinical interest and may be of broader interest under certain assumptions about the link between proximate and ultimate outcomes. However, if we are going to make a large public economic investment in mental health treatments for children and adolescents it is important to know that these treatments will have a positive effect on life-time outcomes such as employment, life satisfaction and so on. This is clearly a complicated area but it should be put on a more inter-disciplinary footing in Ireland rather than being restricted to clinical discussion.
(vi) The development of an aging population clearly also raises a number of other issues about the links between economics and mental health. A number of studies including SHARE and TILDA in Ireland are examining the interactions between psychological, economic and social outcomes in aging. Issues such as the welfare cost of chronic illness pain, the extent to which psychological outcomes are better in home rather than hospital are, the influence of job environments among older people etc., are all big areas of research and will grow in interest over the next few decades.
Overall, the Economics literature has a lot to contribute in the development of a wide debate on mental health in Ireland. A number of researchers including people like Brendan Kennelly and Eamon O'Shea in NUIG; Orla Doyle, Kevin Denny and others in UCD; researchers on projects such as TILDA and the Growing up in Ireland study; and so on are conducting research relevant to this intersection. It is an important and intellectually exciting area of research with many implications for policy and public debate.