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Mental Health Economics, Mental Health Policies, and Human Rights 

Mental Health Economics, Mental Health Policies, and Human Rights
Chapter:
Mental Health Economics, Mental Health Policies, and Human Rights
Author(s):

Roshni Mangalore

, Martin Knapp

, and David McDaid

DOI:
10.1093/med/9780199213962.003.0009
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date: 14 October 2019

Roshni Mangalore, Martin Knapp, and David McDaid contemplate mental health economics, mental health policies, and human rights. How do states and the international community achieve positive mental health outcomes, given their human rights duties and the limits of available resources? Noting that mental health problems and mental health policies and programmes (or lack thereof) can violate human rights and diminish capabilities, they propose introducing fundamental freedoms and human rights into the analysis of economic processes. They adopt the notion of core capabilities, the empirical application of which they discuss in examining individual entitlements, modelling achievement for different groups regarding prevention and interventions, and freedom of choice and opportunity freedom. They introduce the notion of needs, as the basic entity linking human rights, capabilities, resource allocation, and equity in mental health. Further analysing need, especially of the least favoured or worst off, they ask whether applying utilitarian principles of cost-effectiveness in allocating mental health care resources results in denial of human rights (e.g. rationing access to interventions). Resource efficiency, where only economic needs that produce net benefits are met, or where health is regarded as a market commodity, is contrasted with equity approaches. These may sacrifice efficiency gains to focus resources on those socially marginalized and/or suffering severe mental illness, and may include normative need for services, providing good health and equal opportunity for quality living. The authors also consider resource insufficiency (e.g. budgetary allocations, pharmaceuticals), barriers to resource sufficiency (resource inappropriateness, attitudes, financing mechanisms), recognizing value judgments (e.g. re cost-effectiveness) and the importance of economic evaluation in rationing.

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