The burden of mental illness is substantial, affecting one‑in-two people at some point in their lives (see section on “Mental Health” in Chapter 3). Since the pandemic, the prevalence of severe mental illnesses has risen and remains above pre‑pandemic levels in most OECD countries. The economic costs of mental health disorders are estimated to be over 4.2% of gross domestic product, covering direct treatment costs and indirect costs from lower employment and reduced productivity (OECD, 2021[1]). High-quality, timely care can improve outcomes and reduce suicide and excess mortality for people with mental health disorders.
Rates of death by suicide after hospital discharge can indicate the quality of care in the community following hospitalisation, and co‑ordination between inpatient and community settings. Across OECD countries, suicide rates among patients who had been hospitalised in the previous year ranged from 1.4 per 1 000 patients in the United Kingdom to 6.9 per 1 000 patients in Korea in 2023 (Figure 6.29). Differences in suicide rates may also reflect differences in access to mental health care and the severity of conditions treated in inpatient settings, as hospital discharges vary widely across countries. Between 2013 and 2023, suicides after hospital discharge increased in Chile, Czechia, the Slovak Republic, Slovenia and Korea; but decreased in Finland, Denmark, Latvia, Canada, Lithuania, Sweden, Israel and Iceland. In Finland, suicide prevention has been a policy priority, as part of its National Mental Health Strategy and Suicide Prevention Agenda, which aims to increase resources for mental health services in primary care and to strengthen co‑ordination between primary care and specialised care (OECD/European Observatory on Health Systems and Policies, 2023[2]).
An “excess mortality” value greater than one implies that people with mental health disorders face a higher risk of death than the rest of the population. Figure 6.30 shows that across OECD countries, mortality rates are over four times higher for people with schizophrenia and over twice as high for people with bipolar disorder, compared to the general population. In 2023, excess mortality ranged from 2.1 in Lithuania to 6.5 in Norway for people with schizophrenia, and from 1.4 in Lithuania to 4.3 in Korea for people with bipolar disorder. Over the past decade, excess mortality among people with severe mental illness has risen in most countries, except for bipolar disorder in Sweden and schizophrenia in Chile. One study found that increases in excess mortality among people with schizophrenia during the pandemic were driven by fewer admissions for somatic diseases and reduced access to and effectiveness of non-COVID acute care for people with schizophrenia compared to patients without severe mental disorders (Boyer et al., 2022[3]).
Patient-reported experience measures (PREMs) help to capture the quality of care provided to individuals living with mental health conditions. These metrics are increasingly used in mental health care to understand people’s experience of health services and provision of people‑centred care (de Bienassis et al., 2022[4]). Figure 6.31 shows whether service users felt as involved in treatment decisions as they wanted, both in inpatient mental health settings and among those using community services. The share of inpatient mental health service users reporting that they felt involved in their treatment decisions ranged from 50% in Japan to 83% in Türkiye. In community mental health settings, the lowest share was in Japan (75%), and the highest shares were in Türkiye (96%) and Portugal (89%).
