scope for labour market improvements through treatment and thus also for negative labour market impacts due to waiting times. THE IMPACT OF WAITING The actual duration people must wait for care is not random. A key driver is the severity of their mental health problems. If they are severe, individuals are likely to be given urgency, and treatment will commence as soon as possible. This means that to estimate the impact of waiting times, we cannot simply compare people with short and long delays, as such a comparison would not take severity into account. In my study, I therefore exploit differences in average local waiting times. The intuition behind this is that individuals can be ‘lucky’ and seek care when the mental healthcare system in their municipality is not congested, resulting in a relatively short waiting time. I can compare these individuals to others who are ‘unlucky’ and seek care when the system is very congested. These lucky and unlucky individuals are similar in the severity of their condition but face a different waiting time. I computed average monthly waiting times across the Netherlands between 2012 and 2019 and compared the healthcare utilisation and employment outcomes for patients. I found that a one-month increase in waiting time increases the total amount of care patients receive by approximately 10 percent in the first five years. This increased utilisation of care could indicate that the mental health of patients deteriorates while they are waiting, or that care becomes less effective as patients wait longer. This implies that if we could reduce waiting times for mental healthcare, the total amount of care needed would reduce as well, and treatment capacity could be shifted to other individuals seeking care – further reducing the waitlist. Alongside this healthcare impact, the labour market status of patients also deteriorates as they wait for care. For every one-month increase in waiting time, approximately two percentage points of all patients lose their job. Most flow into the disability insurance system or into social assistance. These negative consequences are very persistent, as the vast majority of those who have lost their job due to the waiting times are still unemployed eight years after the start of treatment. AN UNEQUAL BURDEN The negative impact of waiting times is not equal for all subgroups of the population. Firstly, there are differences in how long people wait before receiving care. Prior research has shown that disadvantaged groups such as those with a migration background are less likely to use mental healthcare. However, my study shows that even among those who do seek care, individuals with a migration background or lower educational attainment must wait one more week on average. This is even true when comparing them to individuals seeking care at the same healthcare provider and with the same diagnosis. Secondly, there are also differences in the impact of having to wait an additional month. Perhaps unsurprisingly, the negative consequences are largest for those with more severe mental healthcare problems seeking care from psychiatrists, and smallest for those with mild problems seeking care from psychologists. More surprisingly, individuals with a migration background or lower educational attainment also experience larger negative impacts of having to wait one additional month. This implies that the burden of waitlists is particularly large for already disadvantaged groups. CONCERTED EFFORTS The most straightforward way of reducing the negative impact of waitlists for mental healthcare is to reduce the average waiting times by providing more care. While providing more care can be costly, I used a back-of-the-envelope calculation to show that in the Netherlands a one-month reduction in the average waiting time would save more than €300 million in unemployment-related costs each year. This saving strongly outweighs the labour cost of training and hiring the healthcare workers required to achieve the reduction in waiting times. Alongside work to reduce the average waitlist, additional efforts should be undertaken to support those most affected: individuals with a migration background or lower educational attainment, and those suffering from the most severe mental health issues. FIFTY FOUR DEGREES | 13 Dr Roger Prudon is a Lecturer in the Department of Economics. His research focuses on the interplay between mental health, disability and employment. The paper Is delayed mental health treatment detrimental for employment? by Dr Roger Prudon, is forthcoming in The Review of Economics and Statistics. r.prudon@lancaster.ac.uk
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