This paper applies some simple analytical tools from the economists' toolbox to shed some light on a sleeper issue in Australia's mental health sector.The problem is that there are large numbers of people with no diagnosed mental health condition who consume mental health services.Simultaneously, there are large numbers of people who have very serious mental health problems who receive no mental health services.This untreated group is often referred to as those with 'unmet need', a much-heard term.We refer to the first group as people with 'met non-need', a term hardly ever heard.Although the solution to the unmet-need problem is the oft-heard call for increased government expenditure, no attention is directed to the wasted expenditure associated with the 'met non-need' group: the met non-need issue is 'the elephant in the room'.We point to an alternative policy response; that is, a reallocation of resources from the met non-need group to the unmet need group.To achieve this, we direct focus upon a structural reform in the processes of supplying mental health services.

Purpose– The purpose of this paper is to provide an exposition of the concepts relevant to measuring the economic effect of premature mortality and the conception of how the social loss from premature mortality can be incorporated into social welfare measurement. None of the conventional welfare measures currently pick up this welfare signal.Design/methodology/approach– Various concepts are examined in the conventional and “new” literatures of welfare measurement. Six Venn diagrams show how various concepts “fit together”.Findings– This paper outlines a framework for measuring the economic effect of premature mortality in a conceptually appropriate way. Thus the paper shows how the welfare loss associated with premature mortality can be incorporated into social welfare measurement.Research limitations/implications– Accurate premature mortality measurement is difficult but this data problem hardly limits this exercise. Sensitivity analyses can alleviate this measurement problem.Practical implications– The main practical implication is that empirical applications are feasible. Time series data can be analysed from this conceptual framework to determine whether the problem of the social loss from premature mortality is improving through time, or worsening.Social implications– Knowing the size of the welfare impact of premature mortality is useful not only on policy fronts concerning premature mortality prevention.Originality/value– “New welfare measurement” has not yet been applied to the notion of the social loss from premature mortality.

PurposeGovernment policy can alleviate inequities in living standards. Disabled people often qualify for government assistance which is one way that their living standard can improve, although arbitrary systems for distributing assistance are not likely to serve equity objectives. The purpose of this paper is to indicate the key variables to which government should direct attention, in order to alleviate both horizontal and vertical inequity in grants to disabled people.Design/methodology/approachThere is no literature, either theoretical or empirical, that specifically addresses this problem. This paper invokes important economic concepts associated with the nineteenth century English philosopher/economist, John Stuart Mill, as well as the 1998 Nobel Laureate in Economics, Amartya Sen. Mill's general conception of how government should behave in treating citizens was elaborated subsequently in the public finance literature on principles of taxation. These notions are about “the equal treatment of equals” and “the unequal treatment of unequals”. Sen's recent discussion of the “conversion handicap” from his general framework of capabilities is highly relevant to the question addressed here.FindingsThese concepts, applied with some analytical tools of algebra and geometry, show that Mill's principles can combine with Sen's into a relevant conceptual framework. The central principles and concepts for policy formation on the standard of living for disabled people are not random; they can be specified with clarity.Originality/valueThis paper contributes the relevant conceptual “yardsticks” by which policy for distributing assistance to disabled people can be evaluated. Steps, towards devising better approaches to the distribution of assistance to disabled people can now be taken.

This article quantifies and describes some key dimensions of the mental health sector in Australia since 1992-93. The article considers three broad perspectives on the economic structure of the sector. Our first set of descriptions is of this sector's size. We measure expenditures and sources of funding in absolute and relative terms. Second, we examine expenditures on specialized mental health services. Here, we examine the expenditures allocated to the nationally defined set of specialized services, consisting of stand-alone and co-located hospital services, community mental health services, residential services, non-government organizations, and so on. Finally, we undertake a spatial perspective on our quantification exercise. Using population-adjusted measures of service provision data, we calculate the coefficient of variation for the provision of specialized mental health services across the regions of Australia, and determine whether temporal conver-gence or divergence has occured across the regions in the provision of specialized mental health services. Although the Australian mental health sector may appear to be a jigsaw with many pieces, broad overviews, such as this article, help clarify its dimensions.

Evidence of poor correspondence between resources and "need'' in mental health sectors is accumulating. This non-correspondence relates to the tendency for some people with mental disorders not to receive services and some people without mental disorders to use services subsidised under Medicare. Time-series Australian data are examined here and an appropriate approach is applied to measure the correspondence of Australian Bureau of Statistics (ABS) epidemiological surveys of mental disorders and the enumeration of consumers of mental health services under Medicare. The extent of this "structural imbalance'' is determined to be extensive. This result reflects a sector beset with incomplete information. Diagnostic efficacy, and funding efficacious processes, is vital economically for the allocation of scarce mental health resources, not just clinically for efficacious therapy. Relevant policy is yet to be formulated.

PurposeMultiple connotations and conceptions of health need are currently in use. The purpose of this paper is to specify some important distinctions regarding this confusing multiplicity in a taxonomic fashion relevant to the economic problems that arise in addressing health need. Classification is possible with the relevant concepts in conventional economic theory. The classification applies wherever economic considerations bear upon health need.Design/methodology/approachInitially, some seminal economic ideas about need are presented from Marshall, Pauly, Banfield, Jevons, Deaton and Meullbauer, and Georgescu‐Roegen. Recent discussions of basic needs by Sen and Nussbaum concerning “capabilities” and human flourishing are also considered. Ruger's subsequent developments of these concepts specifically for health are noted. The paper then specifies and classifies the current economic connotations of “health need” by applying positive economic analysis and the framework of economic theory. In particular, the conventional theories of consumer demand and production supply are useful. Geometric tools of analysis along with illustrations from the health sector specify various distinctions and classifications.FindingsThe uses of the generic term “need” relate to quite different economic problems. The findings show how diverse interpretations of need can be specified.Originality/valueDistinctions over health need are important since, in many Western countries, need is one of the “pillars” of the Welfare State. Effective policy requires sound conceptions and measurements of need. Given the relevance of economics for approaching competing resource uses in the face of health need, measurement of need is improved with taxonomy, and confusion reduced.

by Damian Thompson, London, Atlantic Books, 2008, x + 196 pp., ISBN 978 1 84354 6764 Thompson defines the subject matter of this book, ‘counterknowledge’, as misinformation packaged to look like fa...

Economic studies of innovation are relevant to the mental health sector, not just for innovations in more conventional industries, such as telecommunications. We present an economic examination of the impact of an innovation in the mental health sector. The innovation examined here was first adopted in 1980 with the publication of a new edition of the nosology (or classification) for the diagnosis of mental illnesses and disorders, which is known familiarly as the DSM‐III . In our analysis, we incorporate the impact of that innovation, and another major force relevant to psychiatric diagnosis during that time period, i.e. a trend in the West towards the medicalisation of normal sorrows. This is now a documented phenomenon. By using conventional price–quantity space and focussing attention on the quantity outcome, we are able to consider the impact of these concurrent forces on the false positive rate in the diagnosis of mental illnesses in the West and on efficacious diagnostic practice in this sector. Diagnostic efficacy is relevant to treatment, but it is relevant also to resource allocation in the mental health sector. Our analysis highlights the vital place of innovation in diagnostic practices, and the funding of this, in the mental health sector.

Nearly two thousand Australians take their own lives every year. Suicide impacts individuals, the community and society on a broad level. While there are various suicide prevention activities, information about their availability and effectiveness is limited. The aim of this presentation is to provide comprehensive information about suicide prevention programs/services, currently operating in Queensland. Method: Organisations, relevant to mental health, were asked to participate by completing an on-line survey, which collected data on their suicide preventive program/service. Relevant variables include the aims/objectives of identified programs/services, the type of intervention, target populations and locations, and issues related to the evaluation. Outcomes: A summary of this information will later be published on a web-based register of current suicide prevention programs/services in Queensland (with links to relevant websites). This will facilitate better access to information for communities as well as mental health organisations when developing new content related to suicide prevention. This presentation will contribute to increased practical and applied knowledge to a theoretical field through the identification of how national suicide prevention guidelines, policies and plans of action are implemented at the community level, and the extent to which they respond to client and local need.

Objective: To report on economic studies of Australian mental health issues. Conclusion: Although the international literature on the economics of mental health issues is increasing, and although many Australian studies exist on one comorbid condition of mental illness, namely substance abuse, there are very few empirical studies by economists of Australia's mental health issues.

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