ISPOR Central

Rob Abbott, ISPOR CEO and Executive Director


The theme of this issue of Value and Outcomes Spotlight is a timely—and important—one. Mental ill health, which includes our emotional, psychological, and social well-being, is on the rise. Prior to the COVID-19 pandemic, mental health challenges were the leading cause of disability and poor life outcomes for young people in the United States. Between 2009 and 2019, the proportion of high school students reporting persistent feelings of sadness or hopelessness increased by 40%; the share seriously considering suicide increased by 36%; and the share creating a suicide plan increased by 44%. The situation is bad enough that the Surgeon General of the United States issued an advisory to protect youth mental health. For adults, the outlook isn’t significantly better. As Rachel Werner, Executive Director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania puts it:

The percentage of US adults who receive mental health treatment is increasing. There aren’t enough providers to meet existing needs and to ensure equitable access to treatment. Over 75% of US counties don’t have a prescriber and wait times for treatment can range from weeks to months.


The net result of the conditions that Werner describes is a reduced quality of life, loss of productivity, and premature mortality. The situation is even worse for those who are homeless living in shelters, transient, or living with the legacy of adverse childhood experiences.

Alongside the very personal cost of poor mental health, there is a rapidly expanding body of empirical and anecdotal evidence demonstrating the huge economic impacts of mental ill-health. In Canada, it is estimated that these impacts are on the order of $50 billion annually. This is, of course, the thin edge of a much larger wedge when viewed globally.

One of the central questions in strategy—maybe the central question—is understanding what is changing in your operational and competitive environment and how that affects the choices available to you. In the case of mental health, we are facing a perfect storm of systemic challenges that transcend the traditional purview of care providers or patients. I’m thinking here of poverty, discrimination and systemic racism, health inequities, violence, food insecurity, housing, and the impacts of climate change. If we are to forge strategies and policies that work, we need to firstly understand how these seemingly disparate things come together to “lock” people in a cell of mental ill health.

"Alongside the very personal cost of poor mental health, there is a rapidly expanding body of empirical and anecdotal evidence demonstrating the huge economic impacts of mental ill-health."

It should also be acknowledged that enhancing our understanding of how different challenges come together to create a perfect storm for mental health is only the first step. We must also look at gaps in the structures and processes that exist to treat patients. There are, for example, several gaps in the mental health workforce that won’t be closed anytime soon.

On the one hand, simply training new mental health workers to increase supply takes time. Further, the distribution of those workers is not equal; there are large swaths of the United States (and other countries) where the availability of trained mental health workers is severely lacking—or absent. There is also a problem of how healthcare has historically been viewed and delivered, with inadvertent silos separating primary care from mental health care. The list of structural and process gaps goes on and includes insurer and government payment restrictions that limit access to treatment, and data collection practices that underrepresent certain populations that typically have the highest levels of mental ill health.

"In the case of mental health, we are facing a perfect storm of systemic challenges that transcend the traditional purview of care providers or patients."

So, against the rather grim backdrop I’ve described so far, what might health economics and outcomes research (HEOR) contribute to inform the development (or renewal) of mental health policy strategies? It is helpful to note that as a discipline, health economics has helped us to better understand a variety of mental health issues across the lifespan. These include perinatal depression identification-plus-treatment; risk-reduction of mental health problems in childhood and adolescence; scaling up treatment (particularly psychotherapy) for depression; community-based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent care interventions for dementia. These achievements are most properly viewed as a foundation on which new HEOR work can, and should, be done. ISPOR is ready to lead. Health equity, for instance, is something that we take very seriously; it is increasingly woven into the very fabric of all our decisions. I see opportunities for us to help close the gap in our collective understanding of where and how certain vulnerable populations are “left out” or otherwise excluded from data collection practices. I also see ISPOR helping to address payer restrictions that limit access to treatment through our Payer Summits.

"I see opportunities for us to help close the gap in our collective understanding of where and how certain vulnerable populations are “left out” or otherwise excluded from data collection practices."

Meaningful change is not an event, it’s a process. So, it will take some time to address the mental health challenges here in the United States and elsewhere. Still, I draw inspiration from Maya Angelou, who famously wrote: Still, I’ll rise. The journey ahead will be a long one, and it will not follow a straight line. There will be challenges and setbacks, but we must summon the courage to keep going, to rise. Mental health is something that affects all of us; we have skin in this particular game. As advocates for better healthcare, as individuals who have lived with mental ill health—or know someone who has—we know it is in our interest to do more and do better.