The burden of mental illness is substantial, affecting an estimated one in five people among the population of OECD countries at any given time, and one in two across the life course (see indicator “Mental health” in Chapter 3). The total cost of mental ill health is estimated at between 3.5% and 4% of GDP in OECD countries (OECD, 2018[1]). High-quality, timely care has the potential to improve outcomes and may help reduce suicide and excess mortality for individuals with mental disorders.
High-quality care for mental disorders in inpatient settings is vital, and inpatient suicide is a “never” event, which should be closely monitored as an indication of how well inpatient settings are able to keep patients safe from harm. Most countries report inpatient suicide rates below 10 per 10 000 patients, but Denmark is an exception, with rates of over 10 (Figure 6.24). Steps to prevent inpatient suicide include identification and removal of likely opportunities for self-harm, risk assessment of patients, monitoring and appropriate treatment plans. While inpatient suicide should be considered a never event, some practices that reduce risk of inpatient suicide – such as use of restraints – may impede high-quality care.
Suicide rates after hospital discharge can indicate the quality of care in the community, as well as co-ordination between inpatient and community settings. Across OECD countries, suicide rates among patients who had been hospitalised in the previous year was as low as 10 per 10 000 patients in Iceland and the United Kingdom but higher than 50 per 10 000 in the Netherlands, Slovenia and Lithuania (Figure 6.25). Patients with a psychiatric illness are particularly at risk immediately following discharge from hospital, but it is known that suicide in the high-risk days following discharge can be reduced by good discharge planning and follow-up, and enhanced levels of care immediately following discharge.
Individuals with a psychiatric illness have a higher mortality rate than the general population. An “excess mortality” value that is greater than one implies that people with mental disorders face a higher risk of death than the rest of the population. Figure 6.26 shows the excess mortality for schizophrenia and bipolar disorder, which is above two in most countries. In order to reduce their high mortality, a multifaceted approach is needed for people with mental disorders, including primary care prevention of physical ill health, better integration of physical and mental health care, behavioural interventions and changing professional attitudes (OECD, 2014[2]).
Patient experiences can also shed light on the quality of care provided to individuals diagnosed with a mental problem. On average across OECD countries, patients diagnosed with a mental health problem are less likely to report that they were treated with courtesy and respect by doctors and nurses during hospitalisation than hospitalised patients never diagnosed with a mental health problem (Figure 6.27). In addition, in several countries including Australia, Sweden and France, people diagnosed with a mental health problem are more likely to have received conflicting information from different health care professionals (see Chapter 2). This suggests that there is a room to improve the quality of care for people with mental health problems.
