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Family and Group Conferencing (FGC) is a strengths-based approach to social work, originating from New Zealand and now used internationally. Previous research on FGC has focused largely on the context of children's services but, FGC also aligns with the principle of the Care Act in England to prevent, reduce or delay the need for long-term (and potentially costly) adult care services. Limited previous research has tended to explore potential cost savings associated with FGC, without accounting for the cost of the intervention itself, risking biased results. This paper aims to identify resource use and associated monetary costs associated with FGC services in English adult social care and mental health settings. Framework development was informed by previously published work establishing programme theory for FGC, extended by expert opinion and published sources of monetary costs. The framework used scenario-based analysis and a bottom-up costing approach, with sensitivity analysis. Estimated costs of conducting a standard full FGC (excluding referral) range from £1,455 to £2,043 (adjusted from 2022-2023-2025 prices) from a local authority and National Health Service (NHS) perspective. Costs can vary depending on the involvement of an advocate or interpreter, network size and the complexity of issues being addressed. We report overall costs with and without resource use specifically related to referral. Higher staff costs account for slightly higher intervention costs in an NHS mental health setting, compared to adult social care settings. Reallocating scarce public resources with the intention of preventing, reducing or delaying use of costly future care must be evidence-based as pressures build to meet acute needs. Accurate per-case costing of FGC is a necessary preliminary step towards exploring the cost-effectiveness of FGC. A full economic evaluation will account for costs, outcomes, and alternative options (uses of limited resources).

Background Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014–19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through ‘managed transition’, ethics of transitioning and the training of health care professionals. Methods Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians. Discussion Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers. Trial registration “MILESTONE study” registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.

Background In Sweden, adolescents (10-19-year-olds) increasingly face problems related to their mental health and well-being, driving the rise in rates of mental ill-health (e.g., anxiety, depression, suicidal ideation and self-harm), and care-seeking for psychiatric conditions. Although awareness about adolescent mental health and well-being (AMH) has grown in recent years, this has not translated into effective financing and youth-centered collective action to change the trajectory. This study investigates the barriers to financing and action for AMH in Sweden, drawing lessons for global learning. Methods This study triangulates data from interviews, focus group discussions (FGDs), consultation and document review. The interviews and the consultation included stakeholders who have experience with and knowledge of AMH, e.g., government, civil society and funders. The FGDs included youth representatives who are mental health advocates, some with lived experience of mental ill-health. We collected the qualitative data between February 2022 and October 2023, analyzing the data using a political science framework and thematic analysis. Results The themes that this study identifies highlight the barriers to effective financing and youth-centered collective action: (1) the limited data and evidence related to AMH; (2) the divergent definitions of and ways of framing AMH; (3) the growing but fragmented AMH stakeholder landscape; and (4) the weak multidisciplinary and multisector collaboration for AMH. Conclusions Transformational change is needed to improve AMH outcomes through effective financing across sectors in support of youth-centred collective action. Identified barriers may be overcome by: researchers focusing on advancing data and evidence, especially on what works in AMH prevention and promotion; stakeholders, especially advocates of AMH, deliberating and agreeing on a broadened definition and framing of AMH, led by youth and using a positive narrative; decision-makers, funders and researchers strengthening leadership, accountability and adolescent engagement for AMH, and enhancing multidisciplinary and multisector collaboration for AMH, backed up by well-coordinated, youth-centered health and social services, learning from good practices within and outside of Sweden.

A small proportion of health care users, called high-cost patients, account for a disproportionately large share of health care costs. Most literature on these patients has focused on the entire population. However, high-cost patients whose use of mental health care services is substantial are likely to differ from other members of the population. We defined a mental health high-cost patient as someone for whom mental health-related services accounted for at least 50 percent of total health care costs. We examined these patients' health care utilization and costs in Ontario, Canada. We found that their average cost for health care, in 2012 Canadian dollars, was $31,611. In contrast, the cost was $23,681 for other high-cost patients. Mental health high-cost patients were younger, lived in poorer neighborhoods, and had different health care utilization patterns, compared to other high-cost patients. These findings should be considered when implementing policies or interventions to address quality of care for mental health patients so as to ensure that mental health high-cost patients receive appropriate care in a cost-effective manner. Furthermore, efforts to manage mental health patients' health care use should address their complex profile through integrated multidisciplinary health care delivery.

Resources for mental health include policy and infrastructure within countries, mental health services, community resources, human resources, and funding. We discuss here the general availability of these resources, especially in low-income and middle-income countries. Government spending on mental health in most of the relevant countries is far lower than is needed, based on the proportionate burden of mental disorders and the availability of cost-effective and affordable interventions. The poorest countries spend the lowest percentages of their overall health budgets on mental health. Most care is now institutionally based, and the transition to community care would require additional funds that have not been made available in most countries. Human resources available for mental health care in most low-income and middle-income countries are very limited, and shortages are likely to persist. Not only are resources for mental health scarce, they are also inequitably distributed—between countries, between regions, and within communities. Populations with high rates of socioeconomic deprivation have the highest need for mental health care, but the lowest access to it. Stigma about mental disorders also constrains use of available resources. People with mental illnesses are also vulnerable to abuse of their human rights. Inefficiencies in the use of available resources for mental health care include allocative and technical inefficiencies in financing mechanisms and interventions, and an overconcentration of resources in large institutions. Scarcity of available resources, inequities in their distribution, and inefficiencies in their use pose the three main obstacles to better mental health, especially in low-income and middle-income countries.

Background Global mental health is a growing field intricately connected to broader health, violence and economic issues. Despite the high prevalence and cost of mental health disorders, an estimated 75 % of those with need in lower resource settings do not receive intervention. Most studies to date have examined the effectiveness of single-disorder mental health treatments – an approach that may be a significant challenge to scale-up and sustainability in lower resource settings. Main body This paper presents a brief overview of the scientific progress in global mental health, and suggests consideration of an internal stepped care delivery approach. An internal stepped care model is one idea of a delivery system, utilizing a common elements approach, where the same provider could navigate between different elements based on severity and type of problems of the client. It is distinct from traditional stepped care models in that clients remain with the same provider, rather than relying on referral systems. Conclusion An internal stepped care delivery system based on a simplified common elements approach could be more efficient, scalable, sustainable, and reduce the loss of clients to referrals in lower resource settings.

Mental-health disorders are the leading causes of disability worldwide. Nearly 30% of people around the world experience a mood, anxiety or substance-use disorder in their lifetime1. The resources required to address these conditions are inadequate, unequally distributed, inefficiently used and static2. The widespread incarceration of people with mental-health disorders persists.

Background Effective mental health interventions may reduce the impact that mental health problems have on young people’s well-being. Nevertheless, little is known about the cost effectiveness of such interventions for children and adolescents. Objectives The objectives of this systematic review were to summarize and assess recent health economic evaluations of universal mental health interventions for children and adolescents aged 6–18 years. Methods Four electronic databases were searched for relevant health economic studies, using a pre-developed search algorithm. Full health economic evaluations evaluating the cost effectiveness of universal mental health interventions were included, as well as evaluations of anti-bullying and suicide prevention interventions that used a universal approach. Studies on the prevention of substance abuse and those published before 2013 fell outside the scope of this review. Study results were summarised in evidence tables, and each study was subject to a systematic quality appraisal. Results Nine studies were included in the review; in six, the economic evaluation was conducted alongside a clinical trial. All studies except one were carried out in the European Union, and all but one evaluated school-based interventions. All evaluated interventions led to positive incremental costs compared to their comparators and most were associated with small increases in quality-adjusted life-years. Almost half of the studies evaluated the cost effectiveness of cognitive behavioural therapy-based interventions aimed at the prevention of depression or anxiety, with mixed results. Cost-effectiveness estimates for a parenting programme, a school-based social and emotional well-being programme and anti-bullying interventions were promising, though the latter were only evaluated for the Swedish context. Drivers of cost effectiveness were implementation costs; intervention effectiveness, delivery mode and duration; baseline prevalence; and the perspective of the evaluation. The overall study quality was reasonable, though most studies only assessed short-term costs and effects. Conclusion Few studies were found, which limits the possibility of drawing strong conclusions about cost effectiveness. There is some evidence based on decision-analytic modelling that anti-bullying interventions represent value for money. Generally, there is a lack of studies that take into account long-term costs and effects. Systematic Review Registration Number CRD42019115882.

Background The objective of this international comparative study is to describe and compare the mental health policies in seven countries of Eastern Europe that share their common communist history: Bulgaria, the Czech Republic, Hungary, Moldova, Poland, Romania, and Slovakia. Methods The health policy questionnaire was developed and the country-specific information was gathered by local experts. The questionnaire includes both qualitative and quantitative information on various aspects of mental health policy: (1) basic country information (demography, health, and economic indicators), (2) health care financing, (3) mental health services (capacities and utilisation, ownership), (4) health service purchasing (purchasing organisations, contracting, reimbursement of services), and (5) mental health policy (policy documents, legislation, civic society). Results The social and economic transition in the 1990s initiated the process of new mental health policy formulation, adoption of mental health legislation stressing human rights of patients, and a strong call for a pragmatic balance of community and hospital services. In contrast to the development in the Western Europe, the civic society was suppressed and NGOs and similar organizations were practically non-existent or under governmental control. Mental health services are financed from the public health insurance as any other health services. There is no separate budget for mental health. We can observe that the know-how about modern mental health care and about direction of needed reforms is available in documents, policies and programmes. However, this does not mean real implementation. Conclusions The burden of totalitarian history still influences many areas of social and economic life, which also has to be taken into account in mental health policy. We may observe that after twenty years of health reforms and reforms of health reforms, the transition of the mental health systems still continues. In spite of many reform efforts in the past, a balance of community and hospital mental health services has not been achieved in this part of the world yet.