Long term economic impact of childhood emotional and behavioural problems

Lead Research Organisation: London School of Economics & Pol Sci
Department Name: Personal Social Services Research Unit

Abstract

This study will evaluate the economic impacts in adulthood of mental health problems experienced by children and young people. Mental health problems are common among children and young people and it is known that they can have long lasting effects into adulthood. These effects have economic consequences, both in the short term (e.g., through the costs of health care and educational support) and into adulthood and across the life-span (e.g. service use in adulthood due to continued difficulties, loss of earnings and unemployment).

There is only limited information on the relationship between early difficulties and economic impacts in adulthood. Existing studies only look at short-term impacts, or focus on specific communities or types of mental disorder.

Data from three British birth cohorts will be used, providing detailed information on people born in 1946, 1958 and 1970. Data have been collected from these groups of people from birth throughout their lives, including information on their mental health, use of mental health services, education, employment and income.

These data will be analysed to understand how mental health problems among children and young people are linked to different outcomes during adulthood.

Our study has four parts:

First, we will analyse the economic impacts up to mid and later adulthood associated with childhood mental health problems, by looking at how childhood difficulties are linked to specific events in adulthood (for example, using services for mental health problems, having been in contact with the criminal justice system, a person's level of income, whether they have received benefits) and work out the costs of these outcomes.

Second, we will investigate whether the effects of having a mental health problem early in life influence various economic impacts over the lifespan. At what ages are costs greatest? How do these cost patterns differ among individuals, for example by gender, ethnicity or socioeconomic group? Do some types of mental health problem have higher costs later in life? We will also look at how changes in educational, health and social care policies have influenced costs.

Third, we plan to understand and assess the potential for the long term economic effects of early intervention for mental health problems and the impact needed for early interventions to be cost saving.

Finally, we plan to use the findings from this research as a basis for more detailed studies in the future. By taking into account the new information this research provides about the relationship between childhood difficulties and their economic impact during mid and later adulthood, future studies can investigate these associations in more detail (for example, types of childhood difficulties, costs associated with these over the life course, causal pathways for these costs and benefits of various mental health interventions).

Planned Impact

This would be the first study to use nationally representative samples to estimate the long-term economic impacts up to mid- and later life of a range of mental health problems experienced by children and young people. Through collaboration with the Centre for Mental Health, this work will reach a large number of commissioners, managers and practitioners working in health, social care and other systems, and across public and other sectors. PSSRU and the Centre for Mental Health have longstanding relationships with many key stakeholders, working with them to help interpret and best utilise research evidence. The proposed study will generate new evidence on the long-term impacts of mental health problems which can be disseminated and used to inform discussion about a number of things, including investments in various interventions. In addition to academic publications, the results of this work will be disseminated through a report written in non-academic language. We will plan a launch event for this report with key stakeholder groups, and also make our findings available on the PSSRU and Centre for Mental Health websites, supported via other social media channels.

A key outcome of this project is that the research will lead to the development of a practicable dataset with estimates of costs attached for a wide range of mental health-related outcomes at different points in the life-course and which can be aggregated over both systems and time. This will facilitate further research by our research team and others on the economic consequences of a range of other risk factors and health behaviours assessed among the cohort participants. Development of the methodology and identification of the costs associated with health service use, education, criminal justice, unemployment, and welfare benefits for each of the cohort members requires a substantial amount of effort, but we believe it will lay the groundwork for additional insightful studies. Training of an early career researcher to develop expertise in this area where there is currently a paucity of researchers will also help to facilitate continuation of work in this important area.

By providing information to guide investment in health, social care and other services, the ultimate aim of this work is to improve the support given to young people experiencing mental health problems. We will also work with third sector organisations such as Young Minds and the Early Intervention Foundation to communicate information that can be useful to help young people, their families and others to understand the implications and empower them to advocate for effective mental health care.

Publications

10 25 50
 
Description The primary aim of the project was to analyse the long-term economic impacts of mental health problems experienced by children and young people (before age 16). We analysed data in British birth cohorts. The following summarises economic impacts in relation to health services used in adulthood and employment earnings. All analyses adjust for gender, maternal education, paternal socioeconomic group, housing tenure and child physical disability.

Impact of mental health problems by children and young people on health service use during adulthood
The following summarises analyses of the association between childhood mental health problems and use of health services in adulthood in the British Cohort Study (1970) and the National Child Development Study (1958). The health services considered were: General Practice (GP) visits, inpatient stays, outpatient visits and where available, accident and emergency (A&E) services.
Emotional problems
- Among those born in 1970, emotional problems in childhood were strongly associated with use of health care services at age 38 and also positively associated with higher costs.
- Among those born in 1970, emotional problems in childhood were positively associated with the costs of health services incurred at age 30.
- Among those born in 1958, emotional problems in childhood were positively associated with health care service use costs at age 34.

Conduct problems
- Among women born in 1970, conduct problems in childhood were strongly associated with use of health care services at age 26 and associated, though less strongly, at age 33.
- Among women born in 1970, conduct problems in childhood were also positively associated with inpatient costs over time. That is, girls who had conduct problems were more likely to have a greater number of inpatient stays in early adulthood as compared to girls not judged to have had conduct problems.
- Among men born in 1970, conduct problems in childhood were strongly associated with use of health services at age 33, and associated, though less strongly, with health service use at age 38.
- Among women born in 1958, conduct problems in childhood was strongly associated with greater use of GP services over time, and associated with use of inpatient services over time.
- Among men born in 1958, those who had conduct problems in childhood were significantly less likely to use health care services at age 34 compared to those who did not have conduct problems in childhood. Among those who did use health care services at age 34; however, costs were higher for those who had conduct problems in childhood.
- Among those born in 1958, conduct problems in childhood were also associated with lower likelihood of using health care services at age 50.
- Among those born in 1958, conduct problems in childhood were positively associated with greater use of GP, inpatient and outpatient services over time in early adulthood. That is, those judged to have conduct problems in childhood had a greater increase in health care service use over time in early adulthood as compared to those who did not have conduct problems.

Hyperactivity problems
- Hyperactivity problems in childhood were also strongly associated with the use of health care services at age 38.
- The severity of behavioural problems in childhood is negatively associated with health care service costs at age 30. That is, more severe problems in childhood is associated with lower health care service use costs at this age.
- Hyperactivity in childhood is positively associated with health care service use costs at age 42.
- Among those born in 1958, hyperactivity in childhood was also associated with greater use of GP services over time.
- Among those born in 1958, hyperactivity in childhood is positively associated with health care service use costs at age 50.
- Hyperactivity in childhood is also associated with greater use of inpatient and outpatient health care services over time.


Impact of mental health problems by children and young people on earnings in adulthood
The following is a summary of the analysis of the association between childhood mental health problems and cumulative earnings from age 16 onwards. Earnings were estimated using the Standard Occupational Classification (SOC) codes for periods in employment or self-employment. Based on SOC codes, the corresponding average wage was matched from data from the Annual Survey of Hours and Earnings (ASHE) for 1999-2017 separately for a) males and females and b) part-time and full-time employment. Wages prior to 1999 were estimated by discounting the 1999 wage by the average annual wage growth for each year . All estimates were inflated to 2016 prices by uprating by 3.5%.
• Individuals with conduct and emotional disorders tended to have lower cumulative earnings in their 20's, 30's and 40's. Those with severe problems had the lowest cumulative earnings.
• Females with mental health problems had lower cumulative earnings compared to males with mental health problems
• Individuals with conduct disorder had lower earnings at all time points and their cumulative earnings tended to decrease at a greater rate than those with emotional problems.
• Those born in 1970 had significantly lower cumulative earnings compared to those born in 1958 (at the same age points)
Exploitation Route We feel that it is important to make our results accessible to people who use mental health services, their families and others, in addition to decision-making stakeholders including commissioners, managers and health care practitioners. Given the tremendous current strain on the healthcare, education, social care and other systems, there is increasing interest in taking the costs and potential benefits of interventions into account when making decisions about short- and long-term investments. We are planning a public event on October 23, 2019 to share and discuss our findings. This will be an opportunity to present our findings to the public and we plan to engage service users and policymakers in particular and to get feedback about how we can best take forward out findings. Following the event, we will also produce a report summarizing our findings in layperson language and we will disseminate this via existing networks of our study collaborators and event attendees.
Sectors Communities and Social Services/Policy,Healthcare

 
Description Project collaborators have made significant efforts to discuss project findings and policy strategies with relevant stakeholders in health, education, and social care sectors. This has include policymakers, academic, service user and carer organisations and third sector organisations. We shared a policy briefing with relevant stakeholders (and updated the briefing based on feedback from participants in our knowledge exchange event) so that the information could be used to share findings with relevant policymakers in a clear consistent way. .
First Year Of Impact 2019
Sector Communities and Social Services/Policy,Education,Healthcare
Impact Types Economic

 
Description Mental health effects on education: Mechanisms, impact and policy guideline
Amount £87,965 (GBP)
Funding ID NIF\R1\181942 
Organisation Academy of Medical Sciences (AMS) 
Sector Charity/Non Profit
Country United Kingdom
Start 03/2019 
End 03/2021
 
Description Interactive knowledge exchange event with policymakers in relation to project findings 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact We held a knowledge exchange event in which we invited 30 high level policymakers, practitioners and representatives from third sector organisations and service user and carer organisations. The event provided an opportunity for us to share project findings and to have an interactive discussion about their implications for policy and public spending with event participants. The second half of the event followed presentation findings and was done in workshop style format in order to discuss the implications of the findings for policies in relation to:
1. mental and physical health
2. early years and education
3. employment/social security?

The end of the workshop focused on identifying opportunities to act on the findings. Following the event we have had several follow-up discussions with workshop participants about how to take the findings forward.
Year(s) Of Engagement Activity 2008,2012