A New Benchmark for Mental Health Systems

Executive summary

The economic and social costs of mental ill-health are significant. On average, half of people experience a mental health condition at some point in their lifetime. Living with a mental health condition makes it harder to stay in school or employment, harder to study or work effectively, and harder to stay in good physical health. These individual and social costs also have a clear economic dimension – up to 4.2% of GDP – with more than a third of these costs driven by lower rates of employment, and lower productivity at work.

With effective mental health services, and well-targeted and comprehensive mental health policies, these costs can be at least in part avoided. But, most OECD countries have struggled to identify whether their mental health system is delivering effective results. This report, A New Benchmark for Mental Health Systems, will help countries to deliver the high-performing mental health systems that are urgently needed.

A benchmark for understanding mental health system performance

The OECD Mental Health System Performance Benchmark answers a call from OECD Health Ministers at their meeting at the OECD in 2017 for better tools to understand and improve mental health system performance. The six dimensions of the Benchmark were developed by stakeholders and experts from across OECD countries. A high-performing mental health system must:

• Be person-centred, focusing on the individual who is experiencing mental ill-heath;

• Have accessible and high-quality mental health services;

• Take an integrated and multi-sectoral approach to mental health;

• Prevent mental illness and promote mental well-being;

• Have strong leadership and good governance;

• Be future‑focused and innovative.

In each dimension, a series of measures of performance were identified or newly collected, to take stock of mental health system performance. At present, OECD countries cannot measure mental health system performance in many of the domains that matter. Of the 23 indicators of the Benchmark only two – life satisfaction, and death by suicide – were available for every OECD country, and there are big gaps in OECD’s countries ability measure performance in key areas such as levels of stigma, outcomes and functional improvement from treatments, service user and carer experiences, and service coverage.

The state of mental health systems: Significant gaps in performance remain

Despite the remaining gaps in data availability, the OECD Mental Health System Performance Benchmark already shows that in all countries, across the six dimensions of the Benchmark, there is scope to strengthen performance:

• OECD governments make person-centred care a priority in mental health strategies, but nearly 20% of people with a mental health condition reported they were not treated with courtesy and respect during a hospital stay. Only eight countries routinely collect information about people’s experiences of and outcomes from mental health care;

• Availability of accessible and high-quality mental health services is improving, but 67% of people who wanted mental health care reported they had difficulties getting it, and people with serious mental health conditions still have a much lower life expectancy than the population average;

• When it comes to delivering an integrated, multi-sectoral approach systematic integration across mental health, education and employment approaches remains an exception, and not the norm. In all countries people with a mental distress were less likely to be employed, and had a lower level of education, than populations without mental distress;

• Promoting good mental health and preventing mental illness is a key part of high performing mental health systems. While the rate of death by suicide is falling, dropping by 21% across OECD countries between 1998 and 2018, during the COVID‑19 crisis the prevalence of anxiety and depression doubled in some countries, with young people especially hard-hit;

• A key part of good mental health system governance and leadership is acknowledgement of the issues. OECD leaders and Ministers have been speaking out about the importance of mental health. However, while the level of spending on mental health care has increased in OECD countries over the past decade, the share of total health spending dedicated to mental health has only increased significantly in Greece;

• Countries are making their mental health systems more innovative and future‑focused using new approaches to mental health support such as apps and telemedicine, but a future‑focused and innovative mental health system also means ensuring a sustainable workforce, and having a strong data infrastructure to track and improve performance. In both these areas countries are falling short: for example, 11 OECD countries have only one or fewer psychologists per 10 000 population, while all countries struggle to collect a complete set of mental health performance indicators.

Some countries are leading the way with policies to tackle the social and economic costs of mental ill-health

Though there are significant mental health system performance gaps in all countries, there are also countries leading the way in implementing policies to tackle the social and economic costs of mental ill-health. Examples of effective policies to strengthen mental health performance can be found across each of the six dimensions of the OECD Benchmark:

• Person-centred care is a policy making priority in Ireland, where the office of Mental Health Engagement and Recovery engages service users in the design delivery and evaluation of services, and Australia and New Zealand have focused on peer-delivered services to improve person-centredness;

• To improve access to services, for specialist mental health services countries have been using waiting time guarantees or targets (for example, in Denmark), backed by targeted increased funding (in the United Kingdom), while evidence from the Czech Republic highlights that outpatient treatment for severe mental health conditions is an effective and cost-effective alternative to inpatient care;

• To strengthen the cross-sectoral and integrated approach to mental health, Australia and the United Kingdom collect information from service users on their employment outcomes, and Denmark stands out for having a range of initiatives to bridge mental health and employment services including “access to the workforce (for somatic and psychiatric patients)” as one of the eight national health care quality goals;

• Children and young people have been a key focus for promoting good mental health and preventing mental illness, with countries such as Finland and Iceland which have been focusing on teaching social-emotional skills in schools, and online programmes to support youth mental health in Australia, Norway, and the Netherlands. Canada has made positive mental health promotion a priority with a dedicated Surveillance Framework;

• Governments and leaders have prioritised mental health as part of their COVID‑19 response plans, and the crisis has galvanised countries to take action: in 2021 Chile – which in 2018 allocated the lowest share of health spending to mental health amongst all OECD countries, at 2.1% of government health spending – announced that the budget for mental health would increase by 310%, and in 2020 Australia doubled entitlement for sessions of psychological therapies. Before the crisis, New Zealand developed the world’s first ‘well-being budget’, England’s anti-stigma campaign (Time to Change) has improved awareness and attitudes around mental health, and in Canada leadership by Indigenous communities in delivering better-adapted mental health services serve as an example of a better way to support diverse population groups;

• In recent years there has been an acceleration of innovative solutions to mental health challenges, including an explosion in apps and digital tools providing mental health support. In England, these tools are being assessed for effectiveness and listed online to help guide consumers, while in 2020 Canada launched a new portal for mental health resources, Wellness Together Canada, which offers no-cost wellness self-assessment and tracking, self-guided courses, apps, and other resources.