An international perspective on worker mental health problems: who bears the burden and how are costs addressed?
OBJECTIVE
To discuss the burden of poor mental health in workers, who currently bears it, and how the associated rising costs are being addressed, from an international perspective.


METHODS
We identify the stakeholder groups and the costs they incur as a result of problems related to mental health in 6 different domains. In addition, we offer examples of programs, services, and strategies being used to either decrease costs or enhance benefits.


RESULTS
Mental illness is associated with a wide range of costs distributed across multiple stakeholders including government, employers, workers and their families, and the health care system. The costs incurred by the groups are interrelated; an attempt to decrease the burden for one group of stakeholders will inevitably affect other stakeholders. Thus the answer to the question of who bears the costs of poor mental health is "everyone."


CONCLUSIONS
Everyone could benefit from investment in improved mental health in the workplace. However, because the benefits associated with improved worker mental health are often distributed among several stakeholders, the incentives for any single stakeholder to pay for additional services for workers may be diluted. As a consequence, no one invests. Nevertheless, there is a role for all stakeholders, just as there are potential benefits for all. Along with government, employers, employees, and the health care system must invest in promoting good workplace health.
Dewa
Carolyn S
CS
Centre for Addition and Mental Health, Department of Psychiatry, University of Toronto, Ontario. carolyn_dewa@camh.net
McDaid
David
D
Ettner
Susan L
SL
D000041:Absenteeism; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D017598:Efficiency, Organizational; D006801:Humans; D007391:International Cooperation; D001523:Mental Disorders / Q000191:economics* / Q000523:psychology*; D014478:Unemployment / Q000706:statistics & numerical data; D017132:Workplace / Q000523:psychology* / Q000706:statistics & numerical data*