THE LAW COMMISSION

The Law Commission, when considering the plight of those with mental health problems in the course of their review of community care law

The Law Commission, when considering the plight of those with mental health problems in the course of their review of community care law

Introduction

Mental health disorders are a growing major global health problem affecting the health and productivity of millions of individuals. The most common mental health disorder, depression, is a major health problem around the world with a lifetime prevalence ranging from 2 percent to 15 percent (Murray and Lopez, 1996). Depression accounted for 4.4 percent of disability-adjusted life years (DALYs) in 2000, which was the fourth leading cause of disease burden. In 2020 depressive disorders are projected to be the second leading global cause of disease burden after heart disease (Murray and Lopez, 1996). The WHO World Health Survey cross-sectional study of 245,404 adults aged 18 years and older in 60 countries reported the overall one-year prevalence for ICD-10 depressive episode alone was 3.2 percent. That compares with other medical conditions such as 4.5 percent for angina pectoris, 4.1 percent for arthritis, 3.3 percent for asthma, and 2.0 percent for diabetes mellitus (Moussavi et al., 2007).

The reported prevalence of depressive disorders varies between countries. For example, major depression affects 6.6 percent of the adult US population in any one year, while depressive disorders in Americans have a lifetime prevalence estimated at 16 percent (Kessler et al., 2003). In contrast, a Canadian population-based survey found that 4.6 percent of adults met the criteria for major depressive episodes (Blackmore et al., 2007), while 4 percent of employed adults had a depressive episode in the previous year (Gilmour and Patten, 2007). But depression is not just a problem affecting North America. A study in The Netherlands found that 4.8 percent of working adults had major depressive disorder (Laitinen-Krispijn and Bijl, 2000) while in Australia, the one-month prevalence of depression was found to be 2.2 percent (Lim et al., 2000). A review of prevalence studies of mental health conditions found that depression and simple phobias were the most prevalent disorders in working populations around the world (Sanderson and Andrews, 2006). See Table I for a list of the prevalence rates of mental health conditions among working adults in various countries.

Depressive disorders are associated with increased morbidity and mortality. For the employer, these conditions result in increases in disability (Murray and Lopez, 1996; Michaud et al., 2001) as well as several workplace outcomes such as absenteeism, lost on-the-job productivity (known as presenteeism), and increased health care costs (US Department of Health and Human Services, 1999) The economic costs posed by depression are estimated in the tens of billions of dollars, due largely to on-the-job productivity losses (Greenberg et al., 1996; Kessler and Frank, 1997). Research indicates that depressive disorders for many employers may be one of the most costly of all health conditions (Burton et al., 1999; Druss et al., 2001; Kessler et ...