Mental health problems impose a significant burden on people. They experience lower levels of wellbeing, reach lower levels in their education and are more likely to become unemployed. This personal burden translates into a substantial and growing economic cost to society. In 2010, the worldwide cost associated with mental health problems was estimated at US$2.5 trillion (5% of world GDP), and this is predicted to grow to US$6 trillion by 2030. Given the substantial cost, adequate treatment could greatly benefit society. Unfortunately, many countries struggle with providing sufficient mental healthcare, resulting in long waitlists. In England, almost four million people received mental healthcare through the National Health Service (NHS) in 2024. However, approximately one million are currently on the waitlist due to limited treatment capacity. The UK government has made it one of its priorities to reduce these waitlists. Prime Minister Keir Starmer announced in May 2024 that “the first steps of my Labour government will be to cut NHS waiting lists”. Despite this high prioritisation, evidence on the actual impact of waiting for mental healthcare on individuals is lacking. Insight into this is crucial in determining where, for whom, and how to effectively reduce the burden of waitlists given that NHS funds for interventions are limited. My study sheds light on these impacts, showing strong deteriorations in patient labour market outcomes as a result of waiting times, especially among those with a lower educational attainment and/or a migration background. MEASURING WAITING TIMES The first step in determining the impact of waitlists is measuring how long people actually wait for mental healthcare. Data in the UK is scarce, however. The NHS publishes average waitlist for the NHS Talking therapies, Children and Young People with Eating Disorders, and Early Intervention in Psychosis programmes, but information on all other mental healthcare is not available. Given this lack of data, I turned to mental healthcare in the Netherlands. The UK and the Netherlands share many similarities in terms of their healthcare and social assistance systems, and both struggle with mental health provision waitlists. The Dutch context is therefore ideal for studying the impact of waiting times, as detailed individual level data is available on all mental healthcare treatments. This data can be linked with a wide range of labour market measures, making it possible to examine the impacts of waiting times on both healthcare utilisation and employment outcomes. Before turning to waiting times, it is important to have an idea of what happens to people around the moment they seek care. Mental health is a broad concept and ranges from mild depressive symptoms to severe personality disorders. To illustrate the severity of mental health problems of individuals on the waiting list, Figure 1 shows the percentage of patients with a job relative to the moment they first seek care. In the years prior to seeking care, approximately six-in-10 are employed, and this drops to five-in-10 in the years after seeking care. One-in-10 thus lose their job around the moment they enter the waitlist. The drop in employment illustrates that there is 12 | 66 64 62 60 58 56 54 -72-48-24 0 24 48 72 96 PERCENTAGE EMPLOYED MONTHS BEFORE AND AFTER SEEKING CARE Figure 1
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