To what extent does previous and existing health economics research directly address key health system financing issues facing mental health services in developing countries? By mapping WHO's health systems framework onto mental health, three key financing questions for mental health are identified: the sufficiency of resources for mental health; the protection of individuals or households against the economic consequences of mental ill-health; and the efficient use of available resources for mental health. Research efforts to date have mainly focused on the evaluation of intervention costs in relation to mental health outcomes (the efficiency question). There is a need to achieve a greater balance between economic analysis (aimed at identifying best buys) versus financial planning (scaling up the delivery or implementation of interventions shown to be cost-effective). In addition, a better understanding and clearer articulation of the negative impact of mental disorders at the household level is needed, together with ways of alleviating financial burden via appropriate and affordable pre-payment financing mechanisms.

This paper summarises the use of QALYs in evaluating changes in mental health states, highlighting the benefits and challenges of their use in this field. The general principles underlying the QALY measure and the most common methods of measuring QALYs are discussed briefly. Evidence of the usefulness and problems of using this generic measure of health-related quality of life are provided from a sample of recent studies relating to depression, schizophrenia, attention deficit hyperactivity disorder and dementia. In each case, attempts were made to use QALYs to measure changes in health states. While in principle, the QALY is enormously attractive, its suitability for measuring changes in many mental health conditions remains open to doubt as existing tools for generating QALY scores such as the EQ-5D have tended not to perform sufficiently well in reflecting changes in many mental health states. New developmental work is needed to construct better QALY-measuring tools for use in the mental health field. Both the conceptualisation and measurement of QALYs need to be built on a valid, comprehensive model of quality of life specific to a mental health disorder, to ensure that the resultant tool is sensitive enough to pick up changes that would be expected and seen as relevant in the course of the illness.

To provide an overview of the economic impact of poor mental health in the workplace and assess the extent to which economic evaluation has been used to further the case for investment in workplace based mental health programmes. Rapid scoping review of published and grey literature. The socio-economic costs of poor mental health in the workplace are substantial but conservative, as few studies have included productivity losses from work cutback, as well as absenteeism. While few economic evaluations of workplace based mental health interventions were identified, the available evidence base suggests that they have the potential to be highly cost effective. Much of this evidence may be from the US and be less applicable elsewhere; it may also have been solely published in company documents making assessment of methodological quality difficult. The potential economic case for workplace based mental health interventions appears good. More collaboration between policy makers and the private sector would help facilitate rigorous and transparent economic evaluations. A number of evaluations are planned. The challenge is to build on these initiatives, in order to address what remains a major gap in our knowledge on the economics of mental health.

Aims – This paper aims to describe current trends in the UK primary care management of common mental disorders and explore the appropriateness of differing management approaches in light of the course and common complications of these disorders. Methods – It highlights key findings concerning the course and comorbidity of depression to indicate that depression and associated mental illnesses may often form part of more complex patterns of ill health and that these conditions have a clear potential for chronicity. A narrative review of studies providing detail of depression prevalence in selected comorbid conditions is presented for this purpose. Conclusion – The presentation and course of common mental disorders indicate organizational changes in health service delivery, and - for a sizeable patient group – the use of chronic disease management strategies.

Declaration of Interest: None.

Aims – We evaluated whether short-term depressive symptoms are associated with the 30-day prognosis of hospitalized patients presented with acute coronary syndromes (ACS). Methods – A sample of 6 hospitals located in Greek urban and rural regions was selected. From October 2003 to September 2004, we recorded the non-fatal admissions of ACS. Assessment of depressive symptoms, during past month, was based on the CES-D scale (Radloff S., 1977). Results – 2172 patients were included in the study (1649, 76% were males). The mean CES-D score was 13.5±12 in male patients and 13.6±12 in females (p=0.89). Compared to patients with angina those who had non-Q-wave MI or Q-wave MI had higher CES-D score (12.3±11.6 vs. 15.3±12.8 vs. 13.2±11.9, p=0.001). The number of events during the first 30-day following discharge was 9.2% in males and 9.7% in females. Multivariable logistic regression analysis revealed that 1-unit increase in CES-D was associated with 10% higher odds (95% CI 1.09–1.12) of re-current events (death or re-hospitalization), after adjusting for various socio-demographic, lifestyle and clinical factors. Conclusion – We revealed that short-term depressive symptoms are related to more severe disease and a worsen 30-day prognosis of patients hospitalized for ACS.

Declaration of Interest: None.

Aim – The widespread diffusion of sleep disorders (in particular, insomnia) in the general population and the presence of sleep complaints in many mental disorders and physical illnesses justifies an interest in their assessment and treatment, still today commonly underestimated. This study aims to describe the inexpensive and relatively easy-to-use self-report measures of sleep available in literature. Method – A literature search was conducted throughout the electronic literature database “Pubmed”, selecting the pertinent articles published up to December 2006. Results – The recovered material takes the following fields into account: aspect of sleep measured, statistical population, structure, time frame, sub-scales and psychometric properties. International literature presents somewhat heterogeneous sleep self-evaluation tools, which mainly measure sleep quality and the specific causes of sleep interference. As for the Italian context, the recovered material is somewhat modest, taking into account the number of publications. Conclusions – the critical points met in this review have led us to underline the characteristics of a hypothetical tool for sleep assessment to include in routine diagnoses.

Declaration of Interest: The authors have received no fees or other financial support potentially in conflict of interest with this scientific work.

Aims – The treatment of schizophrenic disorders is the most important challenge for community care. The analysis focuses on packages of care provided to 23.602 patients with a ICD-10 diagnosis of schizophrenic disorder and treated in 2001 by the Departments of Mental Health in Lombardy, Italy. Methods – Packages of care refer to a mix of treatments provided to each patient during the year by different settings. Direct costs of the packages were calculated. Linear Discriminant Analysis has been used to link socio-demographic and diagnostic sub-groups of the patients to packages of care. Results – People with schizophrenic disorders received relatively few care packages: only four packages involved more than 5%. Two thirds of the patients received only care provided by Community Mental Health Centres. In the other two packages with a percentage over 5%, the activity was provided by CMHCs, jointly with General Hospitals or Day Care Facilities. Complex care packages were rare (only 6%). As well as the intensity, also the variety of care provided by CMHCs increased with the complexity of care packages. In Lombardy more than half of the resources were spent for schizophrenia. The range of the costs per package was very wide. LDA failed to link characteristics of the patients to packages of care. Conclusions – Care packages are useful tools to understand better how mental health system works, how resources have been spent and to point out problems in the quality of care.

Declaration of Interest: None.

Aim – To present the Italian version of the OPTION (observing patient involvement) rating scale, developed in UK by Elwyn et al. (2005), and its psychometric characteristics, together with some findings when applied on the consultations transcripts of a group of Italian General Practitioners. Methods – The OPTION scale assesses the extent to which clinicians involve patients in decisions and consists of 12 items to be rated on a 5 point scale (from 0 - behaviour not observed to 4 -high standard). The scale was applied to 235 transcripts of audiotaped consultations conducted by 6 male GPs. Interrater and test-retest reliability and internal validity indices were calculated on a subsample of 30 transcripts. Results – The Italian language version of OPTION showed good psychometric properties, similar to those reported for the original version. The ratings obtained for 235 consultations showed for each OPTION item a skewed distribution: the majority of scores (> 70%) were between 0 (behaviour absent) and 2 (minimum skill level). Conclusions – The Italian language version of OPTION seems a reliable instrument to assess patient involvement in primary care settings also in Italy. The clustering of low scores confirms previous findings that clinicians without a specific training obtain very low levels of patient involvement in the decision making process.

Declaration of Interest: None.