Expenditure by the National Health Service in England and Wales on patients suffering mental disorders currently exceeds £130m. a year, about one-eighth of the total health services' expenditure. This large amount spent on mental disorder is only one side of the picture. The cost of treating diseases must be set against the cost of not treating them. More effective and expensive medical procedures may in fact reduce the total costs of sickness. The total cost of sickness comprises not only the direct costs of medical care, but also the indirect costs of incapacity borne by the patient and his kin.
This paper estimates and discusses the expenditure by the health and welfare services on mental disorders, in relation to trends in patient care. Through changes in policy and advances in therapeutics the pattern of care has altered, allowing the psychiatric services to be used by a greater number of patients. This trend has raised the amount spent on mental disorders. The benefits the community receives from this greater expenditure are, however, not capable of being measured precisely. Far more needs to be known about the impact of the changed pattern of care on the current life of the mentally disordered and their kin and on the prognosis of the diseases. The extended scope of the services is bringing psychiatric care for the mentally ill to more people at a far earlier stage than previously. The closer integration between the psychiatric services and the community may possibly alter the outlook for mental illness. In this case the full benefits may not be realised until several decades have passed. The foundations of mental health are laid early in life, and so the improvement from greater understanding and more effective medical care takes only one step forward with each generation.