MIND-ECON: The longer term, average & distributional effects of mental health interventions & the causal impact of mental illness on economic outcomes

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South Africa has a high burden of mental illness, with around a third of adults suffering from a mental disorder at some point in their life. Around three-quarters of people with mental disorders such as depression, anxiety and alcohol use never access mental health treatment. Untreated mental illness is the third largest contributor to the national burden of disease. Mental illness also contributes to the national burden of disease associated with chronic communicable diseases (such as HIV) and non-communicable diseases, such as diabetes. Including mental health care as part of chronic disease care in primary care clinics is seen as a way to improve access to mental health treatment, as well as improve chronic disease outcomes.A trial, called MIND, is currently being run in the Western Cape looking at different ways of providing brief mental health counselling in primary care services for patients with depression or alcohol use disorders who also suffer from diabetes or HIV. The aim of MIND is to examine the most effective and cost-effective way to provide mental health counselling services through community health workers. The MIND trial will collect information on patients' mental health at three points in time to look at whether there are changes in patients' level of depression and hazardous/harmful alcohol use as a result of the counselling.We are proposing to build on the MIND trial in the MIND-ECON study. We will analyse existing data from the MIND trial and collect additional information from patients at a further time point (2 years), so that we can examine the long-term effects of the counselling intervention. We will also examine whether the counselling had different effects on patients' depression or alcohol disorder, depending on their socio-economic status. We will measure socio-economic status by creating an index based on household characteristics (e.g. the type of house the patient lives in, type of toilet, their source of drinking water and energy for cooking) and asset ownership (e.g. whether they own a fridge, stove, TV, etc.). We will also look at the impact of changes in mental health on an individual's employment, productivity, and other economic outcomes such as out-of-pocket payments. In addition to patient economic outcomes, we will further capture information from other members of the household so that we can learn what impact patients' mental illness has on the family and those who care for them and what coping strategies are used to deal with the burden of mental illness.Very little is known about the long-term impact of psychological counselling on mental health in this context and even less is known about the impact of mental health on economic outcomes or on the caregiving burden. MIND-ECON will provide valuable information on the relationship between mental health and economic outcomes, as well as how mental health outcomes from the counselling may be affected by socio-economic status. MIND-ECON will be an efficient way to collect further much needed data since it builds on an existing study. Issues that are sometimes risky in trials, such as whether the study can recruit enough patients, are already in place. We will seek the needed additional ethical approvals to collect information from the patients and the members of their household.We will use state-of-the art methods to analyse these data and will draw on a range of expertise in this UK-SA collaboration, which will also support capacity development. We will use MIND's existing stakeholder advisory group consisting of policymakers, staff from the HIV and diabetes clinics, and mental health patient groups to help us ensure that our findings can feed directly into changing policy and practice and have a large impact. We will ensure our results are widely publicised to various audiences and through different media. We will seek to influence policy in South Africa and globally on improving access to mental health care.