Enquiry Overview
The purpose of this dissertation is to assess the impact of mental ill health on the economy with a key focus on the city of London. Mental ill health is the leading cause of disease burden compared to other diseases such as cancer and cardiovascular diseases. In addition, the costs associated with dealing with the condition are high putting a strain on health and social care. The study uses a qualitative and quantitative approach to understand the impact of mental ill health on London’s economy. The enquiry overview section provides the layout of this study and the contents in every chapter.
The first chapter lays down the foundation of the entire dissertation. The background information and rationale of the study gives the information that justifies the need to carry out the study. In addition, the aims and objectives describe what the study aims to achieve. The research question formulated in chapter one gives a direction for the study on what specific question will be answered in the course of the research. Chapter two of this dissertation gives a detailed description of the existing information on the impact of mental ill health on London’s economy. Chapter two provides an appropriate theoretical basis that makes it possible to develop other chapters of the dissertation.
Chapter three describes the research methodology employed in the study. The research paradigm, the research strategy, data collection method and ethical considerations from part of the aspects discussed in the chapter. Chapter four focuses on data analysis. The key focus is on data analysis of the themes discussed in chapter three. As a result, a link is created between literature and findings of the study. Chapter five is the final chapter of the study. The final chapter creates a link between the aims and objectives mentioned in chapter one to the findings of the study. In addition, the chapter provides a way forward on how to deal with mental ill in a way that will minimize costs and minimize the negative impact associated with the condition.
The aim of the researcher was to investigate the impact of mental health on London’s economy and highlight the need for new and improved treatments, diagnose and responses. In addition, recommendations were also made on how mental ill health can be addressed to reduce spending and introduce early intervention for prevention and treatments. These recommendations could benefit the entire society by creating social and economic benefits that contribute to flourishing communities and businesses built upon resilience and lower levels of mental ill health
- The specific objectives of this dissertation include:
- To assess why mental health is a problem in London
- To critically review existing conceptual studies and frameworks related to mental illness and its impact on economy
- To examine the impact of mental ill health on London’s economy
- To identify ways to reduce spending on mental ill health in London.
The key questions that will help to attain the objectives of this research include:
- Why is mental ill health such a problem in London?
- What is the impact of mental ill health on London’s economy?
- How can spending on mental health be reduced in London?
1.4 Background of the study
London has the highest total of compulsory psychiatric admissions and mental health compared to the rest of England (NHS London Clinical Networks, 2014). Simultaneously one million Londoners have an episode of mental illness from depression to Psychotic disorder. Each year an estimated £2.5 billion is spent on health and social care services and £5.5billion of lost working hours due to mental ill-health (Authority 2014). Socioeconomic problems and poverty contribute to poor mental health. London is not an easy place for a person to work in. Business in London expose their employees to situations such as long working hours that leaves some of these employee feeling lonely. According to MITH and VICTOR (2019), loneliness is associated with poor mental health. In addition to long working hours, most of the employees commute for long hours leaving them with little time for a social life. Long working hours especially in high-pressure environments can result in stress that contributes to poor mental health.
According to Authority (2014), among six adults, one is likely to experience poor mental health. The effect of the condition not only affects the individual, it extends to an individual’s social networks. Elliott (2016) explains that women are prone to suffering from mental ill health compared to men especially for populations falling in the low socioeconomic class category. Poverty is mentioned as a risk factors to developing mental ill health, however, it can also be an outcome of suffering from mental ill health. Considering the pressure experienced by a majority of people living in London, it is likely that the pressure to work hard to avoid falling in the poverty line drives some of these employees into depression. Such pressure might make employees fall into depression, experience anxiety or stress. The outcome in most cases is mental ill health. According to DEWA, MCDAID and ETTNER (2007), employees suffering from mental health conditions are more likely to lose their jobs compared to those without mental health conditions. Employees losing their work means a loss of productivity and loss of quality of life. Consequently, the aim of this dissertation was to explore the impact of mental ill health on London’s, economy and alternative ways to respond to mental ill health that will minimize the currents high costs associated with mental ill health.
Mental ill health accounts for a large burden of disease in London. According to Authority (2014), mental ill health presents a larger disease burden compared to cardiovascular diseases and cancer. In addition, the costs associated with dealing with mental health put pressure on the health and social care. The stigma associated with mental ill health makes it difficult for those affected to open up about the condition (Lelliott et al. 2008). Hence, worsening the state of health of those affected. It is important to note that mental ill health is a common occurrence, last longer and have a far worse devastating impact compared to other health conditions. Mental ill health not only affects the individual, it also has social and economic effects. The economy of a country is affected because of the disease.
Authority (2014) explains in the London mental health report that the costs associated with responding to mental ill health is about £7.5 billion in London. The figure is inclusive of the amount spent on treatment of mental ill health, benefits spent on those living with the condition, money allocated to the criminal justice system and education services. Apart from the £7.5 billion, London loses close to £26 billion every year because of the effect of mental ill health on the economy (Authority 2014). The economic impact on London’s economy includes loss of £26 billion, which is inclusive of loss of productivity and reduced quality of life as a result of mental ill health. The high cost associated with mental ill health demonstrate the need to find alternative ways to deal with mental ill health that will reduce the costs associated with the medical condition.
1.6 Scope and limitations of the study
The feasibility of the study was assured through limiting the scope of the research to the fields of health and economics. Mental ill health is a problem that is on the rise and affecting a large proportion of the population. According to McDaid, Knapp and Medieros (2008), mental ill health is the leading cause of disability. Furthermore, the impact of mental ill health extends far beyond the individual. The effects of mental ill health on the economy are evident through the high costs required to treat and manage mental ill health, loss of productivity and reduced quality of life. The state of mental ill health and its effects on London’s economy was used to demonstrate the economic effect of metal ill health. The aim of the discussion is to demonstrate the severity of mental ill health on the economy.
The research utilized secondary sources of information. The information derived from the secondary sources focused on the effects of mental health on the economy. The secondary sources are inclusive of books and academic journals. Furthermore, the information derived from the secondary sources was limited to mental ill health and the economic effects in London or the United Kingdom. The results of the study gives an understanding on the devastating effects of mental ill health to the economy. In addition, it demonstrates the need to find better ways to deal with mental health to minimize the devastating effects of the condition on the economy. The study provides a foundation on the steps that can be taken to minimize the costs associated with mental ill health.
1.7 Summary
The purpose of this dissertation was to expound on the effects of mental ill health on London’s economy. To ensure the aim of this dissertation was achieved, there was need for review of literature relating to the effects of mental ill health on London’s economy and also the possible ways of dealing with mental ill health to help minimize the high costs associated with mental ill health. Furthermore, the dissertation helps to understand the severity of mental ill health in the society using London as the case study.
Chapter 2: Literature Review
This section of the dissertation reviews the existing documents that provide information relating to mental ill health and its impact on London’s economy. Reviewing the available literature relating to mental ill health and its impact on London’s economy helps to strengthen the research together with the secondary data derived during the study. The aims and objectives of this research provides a guideline for writing this chapter. Section 2.2 is the conceptual clarification that provides an in-depth understanding of mental ill health, which is the main concept in this research. Section 2.3 discusses mental health with a focus on how mental ill health is a problem in London. Section 2.4 is a discussion of the effect of mental-ill health on London’s economy. Lastly, section 2.5 is a discussion on alternative ways that will see a reduction in costs associated with mental ill health.
In most instances, mental health is mostly used to refer to mental ill health. The term is associated with clinical illnesses and disorders. However, mental health not only refers to a negative state of stress and anxiety associated with illnesses, it also refers to positive states associated with happiness and a sense of self-worth (Westerhof and Keyes 2010). In most instances, discussions focus on the effect of the negative state of mental health. It is important to note that the positive state of mental health also has an effect on an individual and any other existing social networks. It is important to note that the manifestation of mental health as either positive or negative varies among individuals such that one person’s happiness might be another’s source of stress.
The London mental health report explains that there is no definite cause or symptom that can be used in describing mental ill health (Authority 2014). In most instances the clinical definition of mental ill health are used in research. Hence, this research employs the same strategy. Mental health is categorized as an important economic factor. According to the World Health Organization (2011), mental health is associated with productivity in the economy. A positive state of mental health assures increased productivity while a negative state of mental health, mental ill health, minimizes productivity. Hence, it is vital for the working population to experience positive mental health because mental ill health can have devastating effects on the economy.
KROLL (2015) asserts that the likelihood for a person living in London to experience mental ill health is higher compared to that of a person living outside of the city. Authority (2014) asserts this by stating that London experiences serious mental illnesses than any other part in the UK. Such information regarding London results in more questions considering that London is a city where the population should be able to access improved healthcare, improved work and education opportunities. However, analyzing the challenges that comes with living in such a big city helps to understand that living in such a city exposes one to the risk of developing mental ill health. Some of the risk factors of developing mental ill health facing London’s population include poverty, noise pollution, traffic, social isolation, and noise pollution.
In the United Kingdom, mental ill health is the leading cause of disability with a 22.8% disease burden (Department of Health, 2011). In London, one person in every four people suffers from mental ill health. Development of mental ill health usually begins at an early stage in life. According to Authority (2014), 7.2% of children ranging from the age of 11 to 16 tried to kill or harm themselves at some point. This translates to 38,900 children in London. The report further states that 1.7% of parents in the UK reported that their children aged between 5 to 10 years of age tried to inflict harm or kill themselves at some point in their life. This translates to 10, 400 children.
A common trend among young people, at an average age of 12, associated with mental ill health is inflicting self-harm. According to Authority (2014), 1 in every 15 young people aged between 11 and 25 years in the UK inflict self –harm. In London, this translates to 108,000 young people. The statistics presented demonstrate the negative impact of mental ill health on young people in London. The negative impact on young people results in loss of productivity and quality of life at a very young age. The development of mental ill health from a young age goes further to affect adults in their working age. During the working age, the adults might develop more severe forms of mental ill health such as bipolar disorder and schizophrenia.
The costs associated with mental ill health in London demonstrate the negative impacts of mental ill health on London. The outcomes demonstrate why mental ill health is a problem in London. The large number of young people suffering from mental ill health in London shows that there is a loss of productivity at a very early age in the country. In addition, it contributes to the development of a poor quality of life among those affected. The development of mental ill health at an early age and failure to address the condition contributes to poor quality of life among adults and the older adults. Seeking treatment at an early age can shift the situation and result in an improvement in the quality of life. The costs associated with treatment of mental ill health are usually very high. According to Authority (2014), London spends approximately £7.5 billion every years on mental ill health. The high costs put a strain on the health and social care system. Authority (2014) explains that around £550 million of the social care costs is spent on treatment of mental ill health while a further £960 million is allocated to support those suffering from mental ill health. Despite the financial allocation, the costs Furthermore, the report explains that £26 billion is lost every year because of a reduction in the quality of life and loss of productivity associated with mental ill health.
The education sector is also affected by mental ill health. The number of children diagnosed with mental health disorders is considerably high. 1 in every 10 children experiences a mental health disorder (Authority 2014). This translates to 111,000 children in London. The costs associated with dealing with the psychiatric disorders in the education sector also fall on the government. London’s education system allocates approximately £200 million each year on dealing with psychiatric disorders. Despite this allocation, the psychiatric disorders keep on increasing. Hence, there is need to find a lasting solution that will ensure a reduction in spending on mental ill health.
Mental ill health continues to be a problem in London. The costs related to treatment of mental ill health are considerably high. Furthermore, the costs are expected to rise over the coming years hence more allocations to deal with mental ill health. More allocation to mental ill health might result in disregard to other aspects of healthcare such as physical health (Department of Health 2011). Allocation of a large percentage of London’s revenue to mental ill health means that other projects in the city might lag behind. The situation worsens because mental ill health is severe in London than any other city in the UK. The loss of productivity and poor quality of life associated with the condition might contribute to the city lagging behind.
2.4 Mental Illness and Economy
An analysis of the wider social and economic impacts of mental health on the economy helps in the assessment of the impact of mental ill health on London’s economy. It is important to understand that the effects of mental ill health affect every aspect of an individual’s life such as education, employment, and physical health (McDaid 2011). Hence, an assessment of the effect of mental ill health on London’s entire population helps to give an understanding of the impact of the illness on the entire economy, the population and the infrastructure. Analysis of the market and non-market impacts brings a proper understanding of the severity of mental ill health and a broader understanding of the impact on London’s economy.
Authority (2014) explains that mental ill health results in lost output hence directly affecting London’s economy. A majority of the adults of the working age experiencing mental ill health are unable to deliver in their places of work resulting in loss of jobs. The inability to perform as expected in the workplace is because mental ill health negatively affects performance (Rajgopal 2010. Employees with an underlying mental health condition usually exhibit symptoms such as poor memory, lack of concentration, and impaired attention that hinder productivity (Lelliott et al. 2008). In most cases, employees undergoing mental ill health might continue staying in the workplace but fail to reach the expected productivity level. This is usually referred to as presenteeism. Failure to deliver on the required output results in employment related costs, whereby companies lose money because of the failure of the employees to meet their productivity level. In the long-run, companies will have to relive such employees from their positions resulting in loss of employment. As mentioned earlier in the discussion, young people also experience mental ill health. According to McDaid, Park and Wahlbeck (2019), young people who fail to receive treatment at an early stage are likely to experience poor educational outcomes that might lead to lack of employment, training or further education. Young people lose their opportunity to contribute to the growth of London’s economy, as they are unable to deliver the required output because of the effect of mental ill health.
Mental ill health negatively affects London’s economy as a large share of public expenditure is allocated to meet mental health costs. Considering that mental ill health is the leading cause of disability, the costs associated with treatment and management of the condition are also high (McDaid, Park and Wahlbeck 2019). A large allocation of London’s total revenue to mental health suggests that other development projects within the city will probably lag behind in order to meet the costs associated with mental ill health. However, the costs allocated to mental health are expected to rise considering the increasing cases of mental ill health in London. According to Authority (2014), the total allocations to mental ill health in London ranges from £6 billion to £7 billion. Overall, according to Trautmann, Rehm and Wittchen (2016), the total economic and social costs relating to mental ill health are considerably high. The costs include total loss in output, costs associated with reduction in the quality of life, and the total costs relating to caring for those suffering from mental ill health.
2.5 Reducing Spending on Mental ill health in London
The high costs associated with the treatment and management of mental ill health creates a need for finding alternative options that will minimize the costs incurred as a result of the condition. McDaid, Park and Wahlbeck (2019) acknowledge the high costs associated with mental ill health and propose investment in prevention of mental ill health as a way of reducing the overall costs incurred in currently dealing with mental ill health. Traditionally, governments have failed to allocate adequate resources that will help in the prevention of mental ill health. McDaid, Park and Wahlbeck (2019) explain that an economic evaluation comparing prevention and treatment of mental ill health will demonstrate that prevention is a much better alternative in minimizing costs associated with mental ill health. World Health Organization (2004) had earlier emphasized the need for investing in prevention of mental ill health. In addition, incorporation of mental health promotion with mental health prevention can produce effective results in minimizing mental ill health cases. Case studies show the importance of prevention.
There is a link between mental health promotion and prevention of mental ill health. According to World Health Organization (2004), the outcomes of health promotion and prevention define the difference between the two. The targeted outcome of mental health promotion is to ensure a positive state of mental health, ensuring individual’s psychological well-being and provision of supportive environments to members of the community. As a result, mental health promotion will reduce the incidence of mental illness. Prevention on the other hand focuses on reducing the clinical symptoms associated with mental ill health thereby reducing the number of cases of the condition. Hence, promotion of mental health and prevention of mental ill health are interrelated such that their outcomes are different but end up complementing each other.
According to McDaid, Park and Wahlbeck (2019), economic evidence exists demonstrating the impact of mental ill health in the workplace hence the need to take actions in the workplace that will minimize or prevent occurrence of mental ill health. Some of the negative impacts mentioned include loss of productivity, unemployment and loss of output due to increased absenteeism. Hence, workplaces investing in the overall health of their employees including mental health will significantly reduce the high costs associated with employees experiencing mental ill health. Government offering incentives to workplaces can significantly help businesses to invest in the mental health of their employees hence minimizing the overall costs associated with dealing with mental illness (McDaid, Park and Wahlbeck 2019). In addition, the provision of incentives to the businesses will cost way less compared to the high public expenditure on addressing mental ill health. Addressing the factors that might lead to development of poor mental health in the workplace is important in minimizing costs. Some of the possible interventions in the workplace include provision of stress management programs, improvement of social relationships and task and technical interventions such as lowering the workload.
Considering that London is not an easy city to live in, One of the possible factor that might contribute to mental ill health is stress related to economic insecurity. Government in collaboration with the private sector or non-governmental organizations should take steps to initiate programs that will address economic insecurity among its population (World Health Organization 2004). For example, the provision of credit facilities whose main aim is alleviating poverty will attract even the lowest socio-economic class. As a result, such credit facilities will help in the improvement of psychological state of the population thereby minimizing the chances of development of poor mental health. Furthermore, young people suffering from mental ill health might be at risk of alienation from the society because they might not have the opportunity to access training, education or employment (Authority 2014). Hence, development of innovative and holistic programs might help to cater for such young people and prevent development of poor mental health because of feeling alienated from the society.
This chapter focused on reviewing existing literature relating to mental health and the impact of mental ill health on London’s economy. The chapter gave a clarification on why mental ill health is a problem in London. Furthermore, the literature sources helped to understand the impact of mental ill health on London’s economy and alternative strategies to deal with mental ill health in an aim of reducing spending on the condition.
Chapter 3: Research Methodology
The Key focus of this chapter is to provide an overview of the methodology used to conduct the research. Some of the areas covered under this chapter include the research paradigm, the research approach, the research strategy, the method of data collection and the ethical issues involved in carrying out the research. The final part of this chapter will focus on the strengths and weaknesses of the research.
A research paradigm refers to a model of conducting research that agrees with the community of researchers. The model should have been in practice for quite some time to ensure it fits the research paradigms. The two major forms of research paradigms in existence because of the major approaches to research are positivism and interpretivism (Rehman and Alharthi 2016). The research paradigms provide a researcher with the way forward on the most valid and appropriate research methodology. It is essential to differentiate between positivism and interpretivism before disclosing the research approach of this study.
Positivism gives much importance to empirical hypothesis testing. Empirical hypothesis is also termed as working hypothesis. Positivism is commonly used to define the conceptual framework in scientific or quantitative research (Saunders, Lewis, and Thornhill 2009). It is evident that quantitative research adopts the positivism approach because of its application of the empirical hypothesis testing. Quantitative research employs a probability approach as it uses conducted research. Hence, findings from previous research can be applied in other forms of research. Positivism is applicable in this research as it is possible to measure the effects of mental health on the economy. However, despite the applicability of positivism in scientific research, it poses a challenge in the study of realistic facts for example, it is difficult to apply the positivism paradigm in human behavior.
According to Rehman and Alharthi (2016), the interpretivism paradigm is mostly applicable in qualitative research. In the interpretivism paradigm, it is impossible to apply a probabilistic approach when assessing realistic events for example human behavior. In scientific research, it is possible to control variables, which is not the case in social sciences. It is ineffective to control human behavior in research hence the need to follow up on how human behavior is affected by the various factors in their natural environment. Thus, in this study, it is appropriate to adopt the interpretivism paradigm because it is important to assess behavior change in relation to mental ill health. It is impossible to assign statistical figures when measuring behavior change.
This research employs both the positivism and interpretivism paradigm. The positivism paradigm is applicable in facts and figures (Saunders, Lewis, and Thornhill 2009). The interpretivism paradigm complements the positivism paradigm in this case because it explains the realistic views such as human behavior in relation to mental ill health and the economy.
3.3 Research Approach (Deductive and Inductive).
There are two research approaches that can be differentiated, that is, the deductive and inductive approach. The deductive approach involves formulating a theory, developing a hypothesis, collect data and afterwards analyze data that will either confirm or disregard the theory or hypothesis (Altinay and Paraskevas 2008). A deductive approach is mostly used when carrying out scientific research. Hence, a deductive approach entails analyzing existing data and relevant theories to the area of the current research to test the hypothesis or determine whether theories are true or not (Altinay and Paraskevas 2008). The main shortcoming of the deductive approach is that the validity of the conclusions derived through using the approach are highly dependent on the truth and clarity of the initial inductive studies.
The main difference between an inductive and deductive approach is the order of steps followed in carrying out research. An inductive approach begins by collection of data and research on theories relevant to the topic of the research (Bryman and Bell 2007). Afterwards, the researcher will identify the patterns in data, which will help in formulation of a relevant theory. However, the main limitation that comes from adoption of the inductive approach is that it is difficult to prove the conclusion arrived at through the approach but provides room for other researchers to invalidate the conclusion. This research aims at using the inductive approach to answer the relevant research questions. The inductive approach creates room to study existing literature on the effects of mental ill health in London. The information from existing literature will help in deriving a conclusion on the research topic.
This research employs descriptive research. This type of research is appropriate because it gives a description of the particular phenomenon. In addition, descriptive research gives importance on what is observed hence variables in the study are rarely influenced (Monsen and Van Horn 2007). In relation to the study of the impact of mental ill health on the economy, the focus is on analysis of how mental ill health has had an effect on the economy of London. Variables in the study are influenced because it is a study of events that have already occurred. It is important to note that descriptive research is more of quantitative research whereby statistical information collected helps in the description of the area of the research.
Furthermore, this study adopted the case study in its study strategy. A case study is appropriate for this study because it allows the researcher to focus on a specific subject, in this case it is mental ill health in London. Focus on a specific subject helps to derive observable characteristics and the implications of the case under study (Crowe et al. 2011). Case study is relevant especially when trying to get information from participants affected by the research topic. An added advantage of using a case study in this research is that it helps in management of time and minimize resources for the research especially when there are limited resources for the research.
This research adopts a secondary method of data collection, which is, reviewing existing literature. Thus, secondary data will drive the conclusions of this research. Reviewing existing literature will involve the summary, analysis, and synthesis of existing data that has been organized, compiled and published by others (Daas and Arends-Tóth 2012). The compilation of data from numerous researchers will give a wider view, understanding and different perspectives on the matter at hand. This secondary approach enables the researcher to collate and combine data to answer the questions.
The quantitative and qualitative methodology will be applied to ensure the research provides a comprehensive and complete understanding of the research problem. Quantitative methodology generates numerical data that provides measurement on the area of discussion (Goodwin 2012). Qualitative methodology on the other hand results in narrative description that provides in depth information on the subject of research. Thus, qualitative data complements quantitative data. These data will be collected from websites (NHS England), public libraries, government( London.Gov.Uk) and non-government agencies, academics journals, reports and E-books (Ebsco). Other sources include NHS England, Pubic health England, World Health Organization, Greater London Authority, London.Gov.UK., Department of Education, Home Office, British Journal Of Psychiatry, and Department of health
3.6 Strengths of the methodology
Various strengths are associated with secondary method of collecting data that make it appropriate for this type of research. First, the existing secondary sources provide a vast source of information to the researcher. The wide range of information to the researcher may date from way back in history hence provides the researcher with an opportunity to create a pattern on the subject of research (Daas and Arends-Tóth 2012). Creating a pattern helps in comparison of information. Secondly, past records of information are the surest way of sourcing information from previous years. Third, some of the literature sources are freely available from public documents and official statistics. Secondary research is cost-effective compared to primary data collection, as secondary data is readily available, data gathered has already been approved and filtered
3.7 Weaknesses of the methodology
Despite the strengths of secondary research, there are existing shortcomings to this mode of data collection. The quality of secondary data is highly dependent on effective collection of primary data. There is the possibility of biasness in primary data collection that might hinder the effective use of the data in secondary research (Daas and Arends-Tóth 2012). Some of the secondary data derived might not reflect the current state of affairs mostly because of changing times. Hence, some of the data might be irrelevant, inapplicable or not up to date with the current research topic. The availability of a wide range of secondary data requires the researcher to effectively evaluate the credibility of the documents to ensure their credibility of the information and eliminate any form of biasness.
There are specific ethical considerations that must be adhered to when carrying out secondary research. The existence of a wide range of information require the researcher to cite the relevant sources of the data. Failure to cite individuals who put forward data used in the current research is classified as plagiarism. The second ethical issue is the need for the researcher to protect the identify of respondents used in collection of primary data available in the secondary sources (Tripathy 2013). Revealing the identity of the respondents is likely to cause them distress. One way to ensure privacy of the respondent involved in primary research is ensuring the documents adhere to the terms of de-identification before use in secondary research.
The main aim of this chapter is to give a broad overview of the research methodology. The main method of data collection in relation to achievement of research objectives is put forward. In addition, the chapter gives an elaborate description on why the specific choices of the research paradigm, research approach, research strategy, the method of data collection and its strengths and weaknesses. The ethical issues in secondary research wind up the discussion in chapter three.
Chapter 4: Data Analysis and Findings
4.1 Data Analysis: Content Analysis
This research used content analysis in the interpretation and presentation of data. Content analysis entails identifying relevant patterns, themes or related concepts in secondary sources of information (Vaismoradi, Turunen, and Bondas 2013). This research sought relevant documents giving information on the relationship between mental ill health and London’s economy. Content analysis facilitated the extraction of both qualitative and quantitative data important in this research. Some of the themes of focus in content analysis include the dimensions of mental ill health, reducing spending on mental ill health and the relationship between mental ill health and the economy. Relational analysis of the variables in the research was important to help derive appropriate conclusions.
Content analysis as an approach to data analysis has its advantages. The researcher rarely influences results derived from secondary data. Thus, an unobtrusive data collection method. Conclusions derived from content analysis are highly reliable because of the systematic procedure followed by the researcher (Mayring 2014). Other researchers, proving the reliability of content analysis, can replicate the systematic research procedure. Content analysis is a cost-effective approach because of the minimum expenses associated with the procedure and it does not have any specific place where it can be carried out at, it can be done at any location.
Despite the advantages of content analysis, there are shortcomings associated with the approach. Content analysis can be time-consuming because it takes a lot of time to decode the relevant information from the large volumes of literature material present (Vaismoradi, Turunen, and Bondas 2013). Content analysis is subjective in nature, such that the interpretation of information available in secondary sources depends on the interpretation of the researcher. As a result, there is the possibility of affecting the reliability and validity of the findings. Isolating information from secondary sources disregarding factors such as context is reductive. The researcher might extract information that does not fit the context of the study.
4.2.1 Mental Health: Dimensions
The World Health Organization (WHO), health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Therefore, the fact an increasing number of people suffer from mental ill health is a sign of poor health thus a serious health problem. World Health Organization (2003), affirms the importance of mental health on the overall wellbeing of an individual by stating that physical, mental and social health are closely interrelated such that poor health involving any of the three aspects negatively affects the wellbeing of an individual.
The statistics surrounding mental ill health demonstrate why mental ill health is a problem in London. According to World Health Organization (2003), 450 million people suffer from mental ill health. In addition, among the six causes of years lived with disability, four of the causes relate to mental ill health. They include bipolar disorders, depression, schizophrenia and alcohol-use disorder. World Health Organization (2003) goes further to explain that among four families, at least one of them has a member experiencing mental ill health. The London Mental Health report goes further to explain the seriousness of mental ill health in London.
According to the London Mental Health Report, one in every four people suffers from a mental disorder every year (Authority 2014). In addition, among those diagnosed with amential disorder, a third of them will experience two or more mental disorders. World Health Organization (2003) and Authority (2014) agree that the health and social care costs related to the treatment and management of mental ill health are high. The London Mental Health report reveals that the government spends nearly £7.5 billion each year in the treatment and management of mental ill health in London (Authority 2014). Despite the financial allocation to the treatment and management of mental ill health, World Health Organization (2003) explains that among those suffering from mental health disorders in developed countries, 44% to 70% fail to receive the appropriate treatment for their mental health conditions. London, is a city in a developed nation hence the statistics demonstrate the severity of the problem. Apart from the financial allocation to treatment and management of ill health, there is a further financial loss totaling to £26 billion every year because of the lost productivity and the effect on an individual’s quality of life.
Apart from focusing on mental disorders, other mental health issues in London make mental health a serious concern in the city. According to the London Mental Health report, among all the cities in the United Kingdom (UK), London records the highest proportion of people experiencing high levels of anxiety (Authority 2014). As per the report, nearly half of the individuals living in London experience the feeling of anxiety while almost a third of the population report higher levels of unhappiness. This might explain why KROLL (2015) reports that the likelihood of developing a mental health illness is higher in the city of London compared to the cities in the UK.
4.2.2 Mental Illness and the Economy
The seriousness of mental illness is further reflected in the economy. An analysis of the findings of this research reveal the severity of mental ill health on the economy. As mentioned in the above findings, mental health is part of the overall wellbeing of an individual. Hence, mental illness affects the day-to-day life of an individual and their capacity to perform in the best of their capabilities. Mental illness has had a negative influence on London’s economy. McDaid, Knapp, and Medieros (2008) explains that one of the main negative impacts of mental ill health on the economy is loss of productivity. Loss of productivity entails Authority (2014) holds the same view, the London Mental Health report explains that around 914,300 people who form part of the working population in London are affected by mental health disorders such as depression and anxiety. As a result of the mental health disorders, the potential and productivity levels of employees is affected. The inability of employees to use their full potential to ensure maximum productivity in the workplace has devastating effects on the economy. According to Authority (2014), London loses £1.9 billion every year because of a reduction in productivity among employees while a further £920 million is lost due to employee absenteeism. In general, London industries and businesses lose sum of £10.4 billion every year because of mental ill health.
London is considered a hub of highly talented and productive workforce. The competitive nature among London’s workforce explains why mental ill health is a serious problem. Most of the employees in business and industries are seriously affected by work-related stress that highly contributes to development of mental illness (Black 2008). Some of the aspects of work related stress include the long working hours, work responsibilities, pressure both internal and external to deliver quality work. The increasing death reports among city workers in London raises concern of whether the deaths could be related to stress in the workplace. Thus, the deaths of city workers especially in their prime years is a negative effect on the economy because of loss of productivity and potential that could be of benefit to businesses and industries that strongly contribute to the growth and development of London’s economy.
Apart from the loss of productivity affecting the economy, the London Mental Health Report explains that government allocation of finances to deal with mental ill health also affects the economy because money that would otherwise be meant for development is allocated to deal with mental illness (Authority 2014). The situation worsens because with every passing year, there is a demand for the government to increase its monetary allocation to deal with mental ill health. According to the London Mental Health report, the expenditure related to mental ill health ranges from £6 billion to £7 billion. Some of the costs covered under this amount include treatment of the condition under the health and social care, supporting people living with mental health conditions and allocation to the criminal justice system and education services.
The liability to cater for treatment and management of mental illnesses falls on the government because the most affected population are the vulnerable. Authority (2014) explains that at least one in ten children is affected by mental illness, which translates to 111,000 young people in the city of London. The report further states that the government spends nearly £200million every year in the management of mental health conditions among children in London’s education system. In addition, the government also has to cater for costs in social care. The London Mental Health report explains that forty five percent of children between the ages of 5 and 17 in London experience some form of mental illness while 65,000 older people in London are diagnosed with dementia. Authority (2014) explains that among the social care costs, London boroughs spend approximately £550 million in the treatment of mental health disorders. The boroughs spend £960 million to support old people. The London Mental Health report emphasizes that the amount spend on social care is not enough to cater for mental ill health because £1.2 billion is contributed by carers, unpaid and informal, to help support people experiencing mental health disorders. The statistics presented above demonstrate that the government spends a large proportion of the revenue in dealing with mental ill health yet the amount is not enough. The mental health costs are recurrent which means the government has to include the costs every financial year. The high costs allocated to mental ill health could have been allocated in the development and growth of the economy if mental illnesses could be effectively managed at the early stages.
4.2.3 Reducing Spending on Mental Ill Health
McDaid, Park and Wahlbeck (2019) elaborate that the government spends a large proportion of its revenue in the treatment and management of mental health disorders. The increasing recurrent expenditure catering for mental health. As such, there is need to find alternative methods to reduce government spending on mental ill health. Prevention is an effective strategy in minimizing costs associated with mental ill health. McDaid, Park and Wahlbeck (2019) explain that an economic evaluation comparing prevention and treatment of mental ill health will demonstrate that prevention is a much better alternative in minimizing costs associated with mental ill health. World Health Organization (2004) emphasizes the need for investing in prevention of mental ill health. In addition, incorporation of mental health promotion with mental health prevention can produce effective results in minimizing mental ill health cases.
There is a link between mental health promotion and prevention of mental ill health. According to World Health Organization (2004), the outcomes of health promotion and prevention define the difference between the two. The targeted outcome of mental health promotion is to ensure a positive state of mental health, ensuring individual’s psychological well-being and provision of supportive environments to members of the community. As a result, mental health promotion will reduce the incidence of mental illness. Prevention on the other hand focuses on reducing the clinical symptoms associated with mental ill health thereby reducing the number of cases of the condition. Hence, promotion of mental health and prevention of mental ill health are interrelated such that their outcomes are different but end up complementing each other.
According to McDaid, Park and Wahlbeck (2019), economic evidence exists demonstrating the impact of mental ill health in the workplace hence the need to take actions in the workplace that will minimize or prevent occurrence of mental ill health. Some of the negative impacts mentioned include loss of productivity, unemployment and loss of output due to increased absenteeism. Hence, workplaces investing in the overall health of their employees including mental health will significantly reduce the high costs associated with employees experiencing mental ill health. Government offering incentives to workplaces can significantly help businesses to invest in the mental health of their employees hence minimizing the overall costs associated with dealing with mental illness (McDaid, Park and Wahlbeck 2019). In addition, the provision of incentives to the businesses will cost way less compared to the high public expenditure on addressing mental ill health. Addressing the factors that might lead to development of poor mental health in the workplace is important in minimizing costs. Some of the possible interventions in the workplace include provision of stress management programs, improvement of social relationships and task and technical interventions such as lowering the workload.
London is not an easy city to live in for the working population. One of the possible factor that might contribute to mental ill health is stress related to economic insecurity. In addition, Black (2008) explains that career related stress might result in mental ill health. Government in collaboration with the private sector or non-governmental organizations should take steps to initiate programs that will address economic insecurity among its population (World Health Organization 2004). For example, the provision of credit facilities whose main aim is alleviating poverty will attract even the lowest socio-economic class. As a result, such credit facilities will help in the improvement of psychological state of the population thereby minimizing the chances of development of poor mental health. Furthermore, young people suffering from mental ill health might be at risk of alienation from the society because they might not have the opportunity to access training, education or employment (Authority 2014). Hence, development of innovative and holistic programs might help to cater for such young people and prevent development of poor mental health because of feeling alienated from the society.
Strengthening communication among stakeholders in the health sector is an appropriate strategy in minimizing costs related to mental ill health. Communication is key in the success of any program (HM 2011). In relation to mental ill health, stakeholders working together in implementation of the proposed strategies will ensure their effectiveness in addressing spending on mental ill case. For example, when implementing health promotion of mental health all stakeholders must be involved from the planning stage to ensure achievement of the intended results. Some of the stakeholders include the people, the Department of health, and the Clinical Commissioning Groups (CCGs).
This chapter gives an elaborate explanation of content analysis, which is the method of data analysis used in this research. Moreover, this chapter discusses the themes identified from the various literature content has been put forward, for example, the effect of mental ill health on London’s economy. Furthermore. This chapter has demonstrated the relationship between statistical findings and literature view.
Chapter 5: Conclusion and Recommendations
The main aim of this last chapter of the dissertation is to put forward possible recommendations that can help in improving mental health in London. Furthermore, this chapter will evaluate the results of data analysis in chapter four. Lastly, this chapter will propose further areas of research as a result of gaps identified through this research and questions raised from this research.
5.2 Evaluation of the key findings
The statistics relating to mental ill health mentioned in this research demonstrate that mental ill health is a serious health problem that needs to be addressed considering the devastating effects associated with the associated disorders. The statistics put forward achieved the first objective of this research which is, to assess why mental ill health is a problem in London. The government allocates a large chunk of revenue in the treatment and management of mental ill health. Studies, largely the London Mental Health report has clearly shown that despite the huge financial allocations, it is still not enough to effectively deal with mental ill health (Authority 2014). The most preferable investment the government should make in addressing mental ill health is focusing on prevention of mental ill health and also early diagnosis of cases relating to mental illness.
The figures showing the high financial allocation to mental ill health demonstrate the need to find alternative ways to reduce spending on mental ill health. Some of the proposed ways to reducing spending on mental ill health include health promotion of mental health, prevention of mental ill health, provision of incentives to businesses and collaborative interventions between government and the private sector (World Health Organization 2004). Diversifying interventions is a good strategy because it aims at addressing the causes of mental ill health in different environments that breed causal factors to mental ill health. In addition, it is evident that this strategies aim at preventing the occurrence of mental health disorders or diagnosis of mental illness at the earliest stages therefore providing room for treatment before worsening of the condition. The figures on the number of young people diagnosed with mental health disorders shows why these interventions will help address the needs of young people and prevent loss of productivity and potential of young people at a very young age.
The evidence presented in data analysis shows that the workforce in London is at a much higher risk in developing mental ill health compared to other cities in the UK. Thus, government interventions in dealing with mental ill health should be largely concentrated in London. London’s workforce is prone to experiencing mental health disorders mostly because of work related stress (Black 2008). The evidence that wok related stress can also contribute to the high number of deaths among London’s workforce demonstrates why it is important for workplaces to prioritize mental health of their employees. Failure of organizations to pay attention to the mental health of their employees might further lead to loss in productivity and potential of employees especially with the high risk present for them to develop mental health disorders.
Generally, it is important to note that the conclusions drawn from this research were very enlightening considering the sensitivity of the issue of mental health. The research was limited due to the inability of carrying out primary data collection to get first-hand information from workforce or individuals affected by mental health disorders. The main reason for this limitation is the high cost involved in carrying out primary research and the time intensive nature of primary research. Furthermore, some of the required statistics can only be collected through secondary research, as they require publication from government entities. However, despite the limitation of this study, the results have demonstrated why mental health is a serious subject and how mental illness has affected London’s economy.
The recommendations in this section generally cover the fourth objective of this study, which is, to identify ways to reduce spending on mental ill health in London.
The evidence put forward in the data findings section demonstrates that health promotion is a much better alternative in addressing mental ill health (World Health Organization 2004). Health promotion majorly entails educating people to enlighten them about a specific health issue. Health promotion is necessary to deal with the stigma surrounding mental health disorders. Dealing with the stigma and letting people know that experiencing a mental health disorder is nothing to be ashamed of will encourage people to come out openly when suffering from any disorder. Early diagnosis of the condition is better and cheaper alternative compared to management of the condition when things get out of hand. In addition, health promotion can individuals to identify alternative ways to deals with stress resulting from pressure such as in the workplace. Such a strategy will also help to minimize the number of cases related to mental health disorders.
5.3.2 Children and Young People
The London Mental Health report clearly explained that onset of mental health disorders usually commence at a young age. The statistics show that mental ill health is a severe problem among children and young people. Therefore, it is important to focus and create friendly services to children and young people that will help in early diagnosis of the mental health condition (HM 2011). It is possible that there are children and young people who might progress to their adulthood without receiving any treatment of their mental health disorder. In such a case, the outcome is very devastating because during adulthood such children might develop a severe form of the condition. However, if attention shifts to focusing mental health services to children and young people, it will be easier to diagnose, treat, and provide those affected with the necessary skills to move forward. Overall, it will help to minimize the burden of mental illness especially among young people.
5.3.2 Improvement in Service Delivery
Apart from focusing on health care settings to provide support to those affected by mental health disorders, priority can be shifted to incorporate technology in offering mental health services. The existence of new and emerging technologies puts a challenge on the health and social care sector to make use of them in increasing efficiency and ensuring effectiveness in service delivery (HM 2011). E-mental health services can help to ensure a large number of people are targeted and receive the appropriate mental healthcare. The e-mental health services makes it possible for people who are not comfortable in healthcare settings to receive treatment. In the scenario such as that of London’s workforce, it is possible for them to seek e-mental health services without interfering with their work schedule. Other technologies that can be used in service delivery include skype and videoconferencing.
5.4 Further Research Directions
This research focused mainly on the impact of mental health on the economy thereby leaving out other areas affected by mental ill health such as the health and education sector. The method of data collection in this research is purely reviewing existing literature. Alternative research may opt to carry out primary research to obtain primary data. The expensive nature of primary research and time constraint largely contributed to the option of conducting a secondary research, which entails reviewing existing literature as a form of data collection.
In conclusion, it is evident that mental ill health is a serious problem in London that has contributed to devastating effects on the economy. The working population in London is at a higher risk of developing mental ill health compared to a working population in other cities in the UK. The financial allocation to deal with mental ill health are significantly high yet unable to appropriately meet the expenses related to mental ill health. The government is required to meet the costs associated with mental ill health because the condition mostly affects the vulnerable. The vulnerable include older people and children and young people.
The evidence put forward in this research shows the large amounts of revenue allocated to the treatment and management of ill health. Considering this is a recurrent expenditure, it needs to be catered for each year. With each passing year there is a demand for a higher financial allocation than the previous years. Hence, the need to find ways to help government to minimize spending on mental ill health. Some of the proposed alternatives include health promotion and prevention of mental ill health, improving in mode of service delivery through adoption of e-mental health services and offering incentives to business to motivate them to pay attention to the mental health of their employees.
This is the final chapter of the research. It provides an evaluation of the key findings of the research in relation to the research objectives. An evaluation of the findings creates room to put forward some of the recommendations that will help in dealing with mental ill health thereby promoting mental health. The chapter comes to a close by providing directions for further research and the conclusion for the research.
