ABSTRACTS November 11 Seminar on Mental Health th Cost-effectiveness of interventions for reducing the burden of neuropsychiatric disorders Dan Chisholm 1,2 and Harvey Whiteford 3 on behalf of Disease Control Priorities II mental health chapter authors and WHO-CHOICE 1 Department of Health System Financing, Expenditure and Resource Allocation, WHO Geneva Department of Mental Health and Substance Abuse, WHO Geneva 2 3 Queensland Centre for Mental Health Research, The University of Queensland, Australia Mental disorders, including substance abuse, affect cognition, emotion and behavioral control, and substantially interfere both with the ability of children to learn and with the ability of adults to function in their families, at work, and in their broader society. In 2001 it was estimated they contributed 12% of the world disease burden and 31% of all years lived with disability. This paper estimates the burden attributed to six major neuropsychiatric conditions (schizophrenia, bipolar disorder, depression, panic disorder, epilepsy and hazardous alcohol use) that could be averted with the introduction of proven, efficacious treatments and the expected cost and cost-effectiveness of such interventions. An analysis at the level of six low- and middle-income geographical World Bank regions is provided. Using the criteria of the WHO Commission for Macroeconomics and Health, the results indicate that interventions for common mental disorders (depression and panic disorder), epilepsy and heavy alcohol use can be considered very cost-effective (each DALY averted costs less than one year of average per capita income). An application of this work in defining a mental health care package for Nigeria is presented. Efficiency is only one of many criteria that shape the allocation of resources. Interventions that successfully reduce disability in schizophrenia, whilst relatively costly, can be expected to have significant other consequences including reduced family burden and also meet the objective of protecting particularly vulnerable members of the population. Six Country Costs and Effectiveness Study of Mental Health Interventions for Conflict Affected Populations Joop de Jong, Director, TPO The current lack of mental health economic evaluative studies in low-income countries is a significant stumbling block to the investment of resources in mental health by governments and international agencies. Research has indicated that formal psychological treatment is generally effective in the West, but the use of western style treatment in low-income countries is still controversial. Moreover, the potential effectiveness of therapy for coping with mass atrocities is largely unknown. This presentation consists of two parts. The first part presents several challenges and core characteristics of a public mental health approach to psychosocial and mental health problems in post-conflict areas. The second part presents data on a six-country cost-effectiveness study that was co-funded by the World bank. The study used an observational naturalistic design and this presentation will focus on psychosocial and mental health interventions in Cambodia, Uganda and Burundi. For each country, data will show whether patients improve in terms of distress, psychiatric symptomatology, and functioning/ disability after receiving individual counseling, psychotropics or group therapy. This study is relevant for community mental health care programs for several reasons. First, in view of the scarcity of mental health professionals in low and middle income countries and in post-conflict areas, it is noteworthy that local trained counselors are able to provide services that are helpful and cost-effective. Second, these findings are important from a public health perspective because there is ongoing disparity in service provision around the globe despite ongoing claims for equity. Third, this study shows that it is feasible to develop community services in peripheral areas affected by conflict and to do outcome research in rural areas in low-income countries. Joop de Jong MD, PhD is Professor of Mental Health and Culture at the Vrije Universiteit in Amsterdam and adjunct Professor of Psychiatry at Boston University. He is the founder and director of the Transcultural Psychosocial Organization (TPO), a relief organization specialized in mental health and psychosocial care of traumatized, (post-) conflict populations in Algeria, Burundi, Congo, Ethiopia, Eritrea, Namibia, Mozambique, Cambodia, India, Sri Lanka, Gaza, Nepal, Indonesia, Sudan, Surinam, Uganda, and Afghanistan. Costs and Cost-effectiveness Analysis of mental health and psychosocial interventions in Burundi Joop de Jong, Director, TPO A history of cyclic tribal wars between Hutu and Tutsi factions in Burundi created hundreds of thousands of refugees and saw the death of 300,000 people as a result of low intensity civil warfare. This paper describes a treatment outcome study on mental health interventions provided by TPO Burundi. The study uses a naturalistic effectiveness design with high external validity enabling the assessment of the public mental health benefits of the interventions. The aims of this paper are (1) to assess the effectiveness of individual psychosocial and psychiatric care and (2) to estimate the costs and financial benefits of these interventions. The overall hypothesis of this research project, co-funded by the World Bank, is that mental health service delivery results in improvement in terms of psychopathology and disability in comparison to a control group. Joop de Jong MD, PhD is Professor of Mental Health and Culture at the Vrije Universiteit in Amsterdam and adjunct Professor of Psychiatry at Boston University. He is the founder and director of the Transcultural Psychosocial Organization (TPO), a relief organization specialized in mental health and psychosocial care of traumatized, (post-) conflict populations in Algeria, Burundi, Congo, Ethiopia, Eritrea, Namibia, Mozambique, Cambodia, India, Sri Lanka, Gaza, Nepal, Indonesia, Sudan, Surinam, Uganda, and Afghanistan. Measuring Mental Health in Post Conflict Societies: An Assessment of the Bosnia and Herzegovina Experiment Kinnon Scott, Senior Economist, DECRG, The World Bank. Major depression is presently the fourth leading cause of the global burden of disease and, within the next 20 years is projected to become the second leading cause of disability. In post-conflict countries, work with refugees has highlighted the negative effect of mass violence on mental health as well as the apparent, long-term nature of the effect. The increased levels of depression, among other ailments, is hypothesized to affect reconstruction and development activities. In an effort to quantify the overall incidence of depression in a post-conflict country and to be able to investigate the linkages among depression and socio-economic outcomes in the country, a series of depression screening questions were added to a national Living Standards Measurement Study Survey in Bosnia and Herzegovina in 2001. The paper first describes the methodology used in measuring adult depression in the context of a national, multi-topic household survey. It then provides an assessment of the feasibility of such a data collection exercise both in terms of survey methodology and clinical validation of the resulting data. Kinnon Scott is a Senior Economist with the Development Economics Group of the World Bank and has worked mainly in the Europe and Central Asia as well as the Latin America and Carribean Regions. Mental Health and Socio-Economic Outcomes in Burundi Florence Baingana a, Andrew Dabalena, Menahem Prywesa, Essimi Menyeb, Michael Rosholmc, a The World Bank, Washington DC, USA Monetary Fund, Washington DC, USA c Department of Economics, University of Aarhus, Denmark b International Abstract Earlier studies demonstrated the linkage between conflict and poor mental health , as well as the linkage between poor mental health and dysfunction. However, there have not been, to our knowledge, any population-wide studies of the linkages between mental health and socio-economic outcomes in poor, conflict-affected countries. This paper presents the analysis of data from a survey of 5,599 respondents aged 10 years and older conducted country-wide in Burundi over 199899. We estimate statistically significant relationships between indicators of poor mental health and several social and economic outcomes. Most importantly, a worsening of mental health is associated with a decline in employment and with a decline in school enrolment of the subject’s children. We find no relationship between mental health and poverty, once adjustments are made for demographic and regional influences. We argue that poor mental health diminishes people’s participation in work and investment in their children’s education through dysfunction resulting from psychiatric trauma and depression. Economic theory holds that investment in human capital, such as in education, will depend in part on expectations about the return on the investment. Combining the psychological and economic theory with our statistical findings suggests that poor mental health is one of the causes of low enrollment of children in primary education. These results suggest that mental health programs could be one of the means for promoting participation in labor and increased investments in education.