Every month someone has to wait for specialized mental health care reduces the chance of finding work. Even years after treatment, people who have had to wait a long time find it more difficult to find a job. And that costs society a lot of money, according to Wednesday economists magazine ESB published research by Roger Prudon, econometrician and PhD candidate in the field of labor market and health care at VU University Amsterdam.
Waiting for the end of 2022 84,000 people in the Netherlands to a registration interview or treatment in mental health care (ggz). Half of them wait longer than the standard set for this; fourteen weeks for basic mental health care. This is partly due to budget cuts, a shortage of psychologists and psychiatrists and the growing demand for mental health care.
Little is known about the effects of mental health care waiting lists on individuals awaiting treatment in the Netherlands. International research shows that mental problems have a major impact on the chance to work.
Prudon investigated whether delaying treatment in mental health care negatively affects the chance of finding work. It turns out that with every additional month on the waiting list, the chance of finding a job decreases by 2 percentage points. “If we were to reduce waiting times by a month, some of the people who are now unemployed could still find work.”
depression
Prudon based his research on figures from Statistics Netherlands (until 2019) about all treatments in specialized mental health care that are reimbursed by basic insurance. He also analyzed CBS figures on the use of various benefits.
The fact that every month of extra mental health care waiting time reduces the chance of finding a job, according to Prudon, may partly be related to further deterioration of mental health during that period. “During the waiting period, for example, depression can increase in someone with depression.” The distance to the labor market increases during that period. “An extra month of waiting for treatment can mean that someone is sick at home for a month longer, making it more difficult to return to work.”
The negative effects of the waiting times appear to be long-lasting. Eight years after registering with a mental health care provider, the waiting time still has a ‘substantial effect’ on the likelihood of going to work. “People who are unable to work for a long time find it difficult to get out of that situation,” says Prudon. “There is a gap in the resume, and it is often harder to get a job as you get older.”
The adverse effects are greatest for people with a migration background or a lower level of education – groups that usually already have a weaker position on the labor market. “They more often have work with temporary contracts, so that they lose their job sooner if they have mental complaints.”
In addition, these groups have to wait an average of a week longer for treatment, says Prudon. “Language barriers may make them less able to explain their problems to the healthcare provider. That makes it more difficult to find suitable mental health treatment, for example.”
Due to the long waiting times, according to Prudon’s calculations, the use of mental health care will increase by 10 percent. “I looked at the number of treatment minutes; if people have to wait longer, they will eventually need more treatment.” Long waiting lists therefore cost society money and have a negative effect on public health.
Shorter waiting times would save society a lot of money anyway, argues Prudon. The researcher calculated that shortening the waiting time by one month would prevent job losses for about 1,600 people and ultimately save 300 million euros. He assumes that an unemployed person costs 24,000 euros per year – calculated by a financial journalism program The Court of Auditors – and that the effects of waiting one month less last for eight years.
More psychologists
A month’s shorter waiting time would then require a hundred extra full-time psychologists or psychiatrists, which also costs money. But according to Prudon, those wage costs are ‘only’ about 10 million euros.
The cabinet and care providers have been trying for a long time to shorten waiting times in mental health care. For example, they are trying to improve cooperation between, for example, general practitioners, mental health care providers and municipalities, and to create more training places for mental health psychologists, among others. But the demand for spiritual help and for training places is still greater than the supply. You also don’t find extra psychologists just like that; especially to mental health psychologists according to knowledge institute Nivel a big deficit. The training programs lack the capacity to train sufficient extra staff.
Prudon hopes that his research will contribute to the discussion about solutions. “The price tag can play a role in the choices made by policymakers. Health care is often seen as a cost item, rather than something that could be cost effective. From a purely economic point of view, it pays to do something about this.”
For example, by creating more training places. That is not a short-term solution, says Prudon, “but we may still have this problem in ten years’ time”.
Prudon is an econometrician and in his studies ‘only looks at the numbers’. But he also thinks it’s important to convey that this research is about more than numbers. “Everyone knows people who end up in mental health care, including me. I’ve seen people put on long waiting lists and might have been better off getting treatment sooner. I cannot help those people, but in this way I may be able to contribute to the system taking care of them a little better.”
A version of this article also appeared in the August 21, 2023 newspaper.