“[We] keep our members out of hospital; help reduce their medication, give structure to member’s day. Through evaluations we have done these are some of the comments we have gathered: "I wouldn't be here if it wasn't for [organisation]"; "It truly has saved my life"; "It's the only place I feel safe"; "It's the only day I leave my house"; "I didn't know I could do the things I get to do here"; "It feels like a big family".”
This was a response given by a mental health charity. A large proportion of Southwark’s charities work with those experiencing mental distress, either directly (specific mental health focused organisations) or indirectly (organisations that may improve mental health as a by-product- for example, by tackling loneliness).
In particular, 45 organisations across Southwark work specifically in the field of mental health or counselling services. Southwark CCG has identified mental health as an issue in Southwark; there is a high prevalence of patients with mental health problems.
Poor mental health in the population has huge socioeconomic costs associated with it, with the economic and social cost estimated to be £105 billion annually. The average cost of service provision for a person suffering from a mental health per year is estimated at £6,617.
The cost associated with mental health patients attending hospital is extremely high. The cost of an individual attending hospital as a mental health outpatient is estimated to be £150 per attendance; the cost of a mental health bed for inpatient specialist services per day is estimated at £459.
Costs increase further if the patient has ongoing care needs. The average cost of a local authority care home for those with mental health problems (per week) is £1070.
People with mental health problems can also have extremely poor physical health outcomes. For example, it has been estimated that people with serious mental illness are at twice the risk of diabetes and 2-3 times the risk of hypertension.
When we take into account the full socio-economic costs of poor mental health, we can start to appreciate the true value of work that mental health charities in the borough do – and what good value for money they are in terms of their preventative power.
“We assist male health including giving online chats and email responses from medical staff. Obviously this cannot be an alternative to visiting a GP or other healthcare but does give necessary advice”
This very brief paragraph gives a great insight into how charities not only save the public sector money, but help to reduce the burden on the health system.
Every query to this charity which results in the individual not visiting a GP saves the public sector £125. More importantly, fewer GP appointments (when they are inappropriate) means less stress and strain on our health professionals – meaning they are able to treat those who need treatment in the best way possible. Southwark GPs are feeling pressure, as demonstrated in a GP Workload Survey conducted in August 2013. 85% of GPs from Southwark felt their workload was unsustainable.
This service also serves to address an opposite issue – those service users who need to see a GP for a genuine reason, but may be disinclined to do so. In the 20-40 age group, women go to see their doctor twice as much as men. Nearly nine in ten men do not like to go to a doctor or pharmacist unless they have a serious problem. Therefore, an online service providing medical advice could provide advice encouraging a young male to visit a GP, which could prevent complications further down the line.
“Over 500 older people were less isolated through the delivery of a range of social and physical activities. Over 800 older people were connected to a range of services to meet needs including income maximisation, occupational therapy, well.”
Loneliness in older people may be particularly problematic in London, which has a higher than average level of social isolation. There are very real socioeconomic costs of loneliness – and, crucially, it can have negative impacts it has on an individual’s health.
It has been estimated that lacking social connections and being lonely is as harmful to health as smoking 15 cigarettes a day. Being lonely increases the risk of high blood pressure, disability, and cognitive decline. According to one study, lonely people have a 64% increased chance of developing clinical dementia, and are more prone to depression and even suicide.
In addition, lonely people are much more likely to visit their GP, use more medication, be at increased risk of falls and go into residential or nursing care earlier than those who are socially connected. They are also more likely to present at accident and emergency.
Using these criteria, we can unpick the potential associated cost to the public sector below:
- A&E attendance per attendance - £117
- Average cost of service provision for adults suffering from depression and/or anxiety disorders, per person per year - £977 (fiscal value) and £4,522 (economic value). Costs are spread across the NHS and the local authority
- Average cost of service provision for people suffering from mental health disorders per person per year (including dementia) - £2,197 (fiscal value) and £4,420 (economic value). Costs are spread across the NHS and the local authority
- GP cost per hour - £125
- Average inpatient costs for hospital admission due to injuries from a fall, people over £60 - £2,825. Costs are to the local CCG
- Residential care for older people – average gross weekly expenditure per person - £370
- Nursing care for older people – average gross weekly expenditure per person £480 fiscal, £183 economic
- Reablement service – average cost per service user - £2,155
Let us imagine a scenario whereby a 75-year-old female becomes isolated because her sole daughter moves away from the area, and she does not have any friends nearby. As she has no-one to talk to and experiences no interaction regularly, she begins to decline cognitively. She also becomes gradually weaker and frailer. One day, the light bulb goes out in the living room. Unable to fix it herself, with no social network to ask and generally confused about the situation, she tries to navigate around her property in the dark. This leads to a fall. She calls an ambulance and is admitted into hospital with a fractured hip. When it comes to discharge, it is decided that she is no longer able to care for herself due to her cognitive decline, and therefore she is admitted into residential care, where she stays for the remaining 10 years of her life. She is means-tested but the local authority comes to the conclusion that she is not in a financial position to make any contributions towards the cost of her care.
This series of event could cost the public sector about £575,000 – and could have potentially been largely avoided, or at least much delayed, had her original isolation been prevented by the intervention of the organisation in the above case study.
That organisation has helped over 500 older people to be less isolated, and connected over 800 older people to services that meet their needs. Without more information, we cannot guess how many of those older people might have ended up unnecessarily in residential care, or who did not develop a mental illness because of the establishment of social network. But on the premise of the cost savings listed that are possible, we can safely assume that any organisation helping to tackle isolation and loneliness is providing astronomical cost savings for the public sector.