Over recent years, concepts of economic efficiency, social justice, and individual liberty have gained a lot of attention in mental health care. Economic efficiency demands optimal allocation of resources to ensure that target individuals and entities benefit equitably. Economic efficiency acts as a parameter that measures whether resources used in a given undertaking achieved the best-expected outcome at the least cost. In healthcare, the best results may be measured in terms of lives saved, life years gained, and quality of life attained after care (Palmers & Torgerson, 1999).Stated in another way, economic efficiency is the state where stakeholders in health care make choices that reap maximum benefits from resources committed to the health sector.
Mental health is among the leading drivers of medical expenditures in the United States (Emanuel, 2015). This is the case despite the availability of substantial resources allocated to mental health care in the country in terms of human capital, financial resources, and hospital equipment. As such, the system can be termed as economically inefficient as research conducted by Emanuel (2015) show that the mental health care system stands to gain significantly in terms of cost reduction if services focus on tertiary prevention -interventions that seek to prevent exacerbation of the psychological condition of patients. As Moradi-Lakeh, Yaghoubi, Hajebi, Malakouti, and Vasfi (2017) find, aftercare services such as telephone follow-ups, home visits and education and training of caregivers is a cost-effective way of offering services to mentally ill patients. To this end, Emanuel (2015) notes that mentally ill patients use the health care system because it provides them attention and social interactions, services which can be offered outside the hospital settings. If well-effected, such approaches can reduce costs incurred per patient in mental health care.
Mental conditions of patients worsen because attention they get from physicians is not adequate to enough to avert episodes from recurring. This is because mental illnesses are better handled through social interactions and adherence to medication (Emanuel, 2015; Johnstone, 2001). For instance, if the cost of an aftercare services program is smaller than what is incurred during hospitalizations and health outcomes are equal or better, then economic efficiency obtains. In this context, economic efficiency is realized when admissions are kept at the kept minimum while maximizing the value of out-of-hospital care. Such parameter may act as a measure of economic efficiency in mental health care. As Palmers and Torgerson (1999) noted, economic efficiency can be determined by evaluating the final health outcomes of medical interventions.
Social justice may be realized in settings where there is economic efficiency. From a general viewpoint, social justice is a scenario in which the various human needs such as housing, healthcare, and employment have been addressed adequately. In a society where the mentioned needs are provided on an equitable basis, such society can be termed as just to its people (Rudnick et al., 2014).Some scholars have argued that social justice entails providing equal opportunities for all people to pursue happiness and self-fulfillment without any hindrance (Johnstone, 2001; Draine, 2013).In other words, social justice is equity in the allocation of resources that make everyone assume individual responsibility for their own good and that of society.
In mental health, social justice revolves around access to quality healthcare. A just system does not discriminate people based on their mental conditions (Emanuel, 2015). As studies have shown, mentally ill patients are discriminated against in the provision of care, stigmatized by society for their perceived security threat to normal people,' and socially excluded from other populations in participative citizenship (Draine, 2013; Peay, 2009; Johnstone, 2001).As such, a socially just society does not subject mentally ill patients to dehumanizing conditions. Rather, it accords these people with the entitlements such as happiness, social attention, and participative citizenship which are available to normal people in that society.
Attainment of social justice in mental health can be demonstrated by the improved health outcomes resulting from the efficient allocation of resources. As suggested by Emanuel (2015), evaluating the level to which mental health has been standardized with primary care practice can provide vital information for measuring the social justness of a health care system. Obtaining feedback from patients can also be an effective way of measuring social justice. As demonstrated by the study conducted by Rudnick et al., (2014), patients can provide an assessment of the justness of a society by giving accounts on how they perceive medical interventions accorded to them by normal people in said society.
Individual liberty connotes the freedom to do as one chooses as well as enjoy what other members of society enjoy. Individual liberties cannot be achieved where social justice is absent. This is because such absence denies people the chance to make choices on what is best for them in areas such as good housing, high-quality health care(Draine, 2013; Johnstone, 2001).In context, mental illness undermines individuals ability to participate fully in the building of society(Ventriglio & Bhugra, 2015).It is a life characterized by an intense individual struggle to regain a shared human identity(Johnstone, 2001).Struggles, disablements, and discriminative treatment from normal people all put limitations to individual liberty. Assessment of individual perceptions of constraints on liberty can also be an effective tool for measuring the level individual liberty.
Mental health and physical health vary worldwide. This variation results from differences in funding and resources available to the relevant health care systems. Equally, the extent of individual liberty, social justice, and economic efficiency may vary depending on the amount of resources allocated for such causes (Ventriglio & Bhugra, 2015). Hence, the definition of economic efficiency, social justice, and individual liberty may vary in different cultures and jurisdictions.
References
Draine, J. (2013). Mental health, mental illnesses, poverty, justice, and social justice. American Journal of Psychiatric Rehabilitation, 16(2), 87-90. doi:10.1080/15487768.2013.789684
Emanuel, E. J. (2015). Where are the health care cost savings? JAMA, 307(1), 39. doi:10.1001/jama.2011.1927
Johnstone, M. (2001). Stigma, social justice and the rights of the mentally ill: Challenging the status quo. Australian and New Zealand Journal of Mental Health Nursing, 10(4), 200-209. doi:10.1046/j.1440-0979.2001.00212.x
Moradi-Lakeh, M., Yaghoubi, M., Hajebi, A., Malakouti, S. K., & Vasfi, M. G. (2017). Cost-effectiveness of aftercare services for people with severe mental disorders: an analysis parallel to a randomized controlled clinical trial in Iran. Health & Social Care in the Community, 25(3), 1151-1159. doi:10.1111/hsc.12416
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Rudnick, A., Montgomery, P., Coatsworth-Puspoky, R., Cohen, B., Forchuk, C., Lahey, P., Schofield, R. (2014). Perspectives of social justice among people living with mental illness and poverty: a qualitative study. Journal of Poverty and Social Justice, 22(2), 147-157. doi:10.1332/175982714x14007697173759
Ventriglio, A., & Bhugra, D. (2015). Social justice for the mentally ill. International Journal of Social Psychiatry, 61(3), 213-214. doi:10.1177/0020764015579824.
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