Keynote presentation at the EUSPR - European Society for Prevention Research Conference in Tallinn, Estonia 29.09.2022, on cost-effective measures to prevent mental disorders and promote mental health, and on the need for broad cross-sectoral prospective assessment of mental health impact of policy decisions in all sectors of society.

1. 29.9.2022 Kristian Wahlbeck
Cost-effectiveness of prevention in mental
health - towards cross-sectoral impact
assessment
Tallinn 29.9.2022
Kristian Wahlbeck
MIELI Mental Health Finland
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The search for evidence
• Clinicians search for effective preventive interventions
• Health and social service funders search for cost-effective interventions
• Politicians search for overall impact on wellbeing
29.9.2022 Kristian Wahlbeck

3. Prevention of mental ill health is
effective and cost-effective
29.9.2022 Kristian Wahlbeck
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65 studies

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Cost-effectiveness of prevention of mental ill health
• Most studies consistently find that interventions for mental health
promotion and prevention are cost-effective and cost saving
• Childhood interventions tend to be most cost-effective
• The evidence for cost-effectiveness of prevention or promotion in
older adults is inconclusive due to limited number of studies
• Targeted prevention and promotion is likely to be more cost-effective
than universal
29.9.2022 Kristian Wahlbeck

5. Parenting support
“Cost-effectiveness of prevention in mental health – towards cross-sectoral impact assessment” .
Human impact ass
29.9.2022
Cost-effective practice: Parenting support

6. Intergenerational
transmission of
mental health
problems can
be stopped
in adult mental
health care
Risk of mental disorders in the offspring
of parents with mental disorders is reduced by 40% by
preventive interventions
Siegenthaler et al. JAACAP 2012

7. Parenting support enables financial contribution to
society
29.9.2022
Ministry of social affairs and integration, Denmark 2012
Normal life course IY
Conduct disorder
Net
cost/year
(DKR)
Kristian Wahlbeck
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8. School programmes
Cost-effective practice: School-based psychological interventions

9. Targeted CBT-based interventions (screening +
intervention)
Whole-school approach (Anti-bullying
programmes)
Suicide prevention
Cost-effective school interventions

10. Workplace interventions
Cost-effective practice: Work place mental health promotion

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Evidence base for workplace interventions
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• 14 systematic reviews show moderate effectiveness of
workplace interventions
Wagner et al 2016, Int J Occup Envir Med
• Workplace interventions targeting employees are in general
cost-effective
Le at al 2021, PLOS Med
29.9.2022 Kristian Wahlbeck

12. Company performance and workplace wellbeing: indices by country
Source: Eurofound Third European Company Survey 2015
29.9.2022 Kristian Wahlbeck
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Work place mental health promotion
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• Perceived psychological safety
• Social support by peers
• Control over work
• Tolerable workload
• Manager support
• Perceived righteousness and equal treatment
Tan et al 2014 BMC Med, Wagner et al 2016 Int J Occup Envir Med
29.9.2022 Kristian Wahlbeck

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The importance of a wide perspective
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• The studied time horizon is crucial for the economic evaluation
• Cost-effectiveness is context-sensitive
• Many interventions, which from a health perspective are not cost-
effective, may be cost-effective from a societal perspective.

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The case for performing mental wellbeing impact
assessments
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• Mental health is largely shaped by the daily environments in which people
live their lives
• Promoting mental health relies on broad-based actions over multiple sectors
• Mental health impact of policy decisions are often overseen
• Health Impact Assessment (IA) frameworks allow for a structured approach
to evaluating policy actions on different levels
• Several Mental Health/Wellbeing Impact Assessment schemes have been
introduced lately

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Mental
Wellbeing
Impact
Assessment
(Stansfield &
O’Hara)

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Mental wellbeing impact assessment
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• Is a prospective assessment of decision alternatives (a preventative
tool)
• Addresses the social determinants of mental health
• Provides decision-makers with a lens on mental health
• Demonstrates how non-health decisions impact mental health
outcomes
• Involves non-health sectors in mental health promotion and
prevention
• Provides possibilities to address mental health disparities

18. Successful mental health actions build on intersectoral
collaboration
Mental health
impact assessment
guides policymakers
towards mentally
healthy policies
At best, mental
health impact
assessment is a
participatory
dialogue

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Evidence for the effectiveness of prevention of mental ill
health
• Prevention of mental disorders offer good value for money
• Whole-of-government approach is needed for full evaluation of
impact
• Mental wellbeing impact assessment is increasingly used to grasp the
full picture of impact of policy decisions
29.9.2022 Kristian Wahlbeck

20. EU MENTAL HEALTH POLICY PATHWAY
2005
Green Paper for Mental Health -“Improving Mental Health of the population. Towards a
strategy on mental health for the European Union”
2008-2011
The European Pact for Mental Health and Well-being
2011
Adopted Council Conclusions -“The European Pact for Mental Health and Well-being:
results and future actions”
2013
The EU framework on mental health
2013-2016
The Joint Action on Mental Health and Well-being
2015-2018
The EU Compass for Action on Mental Health and Well-being
2020
Council decision on EU Mental Health Strategy
2022
EU Commission initiative for mental health
Kristian Wahlbeck
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.fi
Thank you!
kristian.wahlbeck@mieli.fi
Twitter @mentalblog
LinkedIn wahlbeck
https://mieli.fi/en/ (english)
https://mieli.fi/ru/ (РУССКИЙ)
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