“As a clinician I sometimes go to conferences, where I often hear that the economic costs of mental disorders are very high. But the treatments are not that expensive, certainly not when compared to many general medical treatments. So how come these costs are so high?”
Why the costs are so high
The costs of mental disorders are indeed very high. The main reason why that is the case is that mental disorders are ‘working-age’ problems. Many general medical disorders occur more often in older age, and the chance of getting them is higher as people get older. That is the case, for example, in heart disease, cancer, diabetes and many other conditions. This is different in mental disorders: they affect people during their whole life span, and can be better considered as ‘working-age’ problems.
Much of the costs are, therefore, associated with production losses, meaning that people with mental health conditions cannot work because of their condition (absenteeism) or are less productive when they do go to work (presenteeism). These costs are higher than only the costs of treating the mental health condition (medical costs).
How big are the costs?
It is not possible to give an exact estimate of the costs of mental disorders, because they differ substantially per country, depending on the healthcare system (universal health care or not) and the economic system. Still, a few figures give a sense of the scale:
- A recent study in the US found that the economic costs there were higher than 330 billion dollars in 2019 (Greenberg et al., 2023).
- The WHO estimates that globally 12 billion working days are lost every year to depression and anxiety, at a cost of US$1 trillion per year in lost productivity.
- Another study estimated that the projected global economic burden of depression from 2025 to 2050 will be US$12 trillion (2024 US dollars; Cao et al., 2026).
What about the individual?
These numbers are all about the costs at the population level. For individuals with depression, these numbers can be very different. If treatment is part of the universal health care in a country, individuals often do not have to pay anything, or relatively little, for treatment of mental health problems. If there is no universal health care, or it does not include mental health treatment, the costs for an individual can be substantial.
Do treatments reduce the costs?
Can treatments reduce the costs of mental disorders? In other words: are mental health treatments cost-effective? The answer is: probably yes. One problem with cost-effectiveness studies is that many different methods are used to examine whether treatments are cost-effective. However, most reviews show that psychological treatments are indeed cost-effective.
Mental health care as an investment
If mental health problems are so expensive at the population level and treatments are effective, can mental health care be seen as an investment in the economy of a country? This is indeed probably the case.
In the United Kingdom, the Improving Access to Psychological Therapies (IAPT) program was started with exactly that goal: increasing access to treatments, while the costs would be covered by reducing absenteeism and increasing presenteeism. It is not clear whether that has indeed worked, but it is certain that the health costs of IAPT are paid in large part by these economic benefits.
Developing a mental health care system is beneficial to any country, including low- and middle-income countries. In one modeling study, we found that scaling up mental health treatment for common mental disorders also leads to large economic productivity gains (a net present value of $230 billion for scaled-up depression treatment and $169 billion for anxiety disorders, in 2016).
For every dollar invested, the return on investment was estimated to be 2.3 to 3 dollars in economic benefits. If the value of increased health was also included in the model, every invested dollar can be expected to return 3.3 to 5.7 dollars (Chisholm et al., 2016).
In summary
Yes, the costs of mental health problems are enormous at the level of populations (apart from the personal suffering of patients and their close ones). This is not only because of the costs of treatments, but also because of production losses. Building up systems of mental health care can be seen as an investment in the economy of a country, and can substantially improve the quality of life of those who suffer from these conditions.
Pim Cuijpers is professor emeritus of clinical psychology and scientific director of Metapsy. He has been involved in more than 1,100 scientific studies, mostly on psychological treatments of mental health problems. This is one of a series of evidence summaries in which Prof. Cuijpers tries to answer questions from patients and clinicians, based on what is known in science about treatments. The knowledge is mostly drawn from collective work of the Metapsy collaboration of at least 15 years. Do you have other questions you would like Prof. Cuijpers to discuss? Feel free to contact us.
Literature
- Cao Z, Luo Y, Jiao L, Chen W, Prettner K, Kuhn M, … Chen S. (2026). Global economic burden of depression in 154 countries from 2025 to 2050. Nature Medicine, 1–11.
- Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P, Saxena S. (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry, 3(5), 415–424.
- Clark DM. (2018). Realizing the mass public benefit of evidence-based psychological therapies: the IAPT program. Annual Review of Clinical Psychology, 14, 159–183.
- Greenberg P, Chitnis A, Louie D, Suthoff E, Chen SY, Maitland J, … Kessler RC. (2023). The economic burden of adults with major depressive disorder in the United States (2019). Advances in Therapy, 40(10), 4460–4479.
- Karyotaki E, Tordrup D, Buntrock C, Bertollini R, Cuijpers P. (2017). Economic evidence for the clinical management of major depressive disorder: a systematic review and quality appraisal of economic evaluations alongside randomised controlled trials. Epidemiology and Psychiatric Sciences, 26(5), 501–516.
