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The Economic Cost of Covid's Mental Health Crisis · Trumponomics

• 0:08
  Speaker 1: Hello, and welcome to Stephanomics, the podcast that brings the
• 0:11
  Speaker 1: global economy to you. What makes us happy? Well, not
• 0:16
  Speaker 1: living through a pandemic in January would be a start
• 0:19
  Speaker 1: in large parts of Europe. In the US, the midwinter
• 0:21
  Speaker 1: this year is feeling particularly bleak. But a lot of
• 0:25
  Speaker 1: the time we're wrong about what makes us happy, and
• 0:27
  Speaker 1: that's encouraged governments to get it wrong as well. They
• 0:30
  Speaker 1: focus on growing GDP, making the economy larger, but we
• 0:34
  Speaker 1: would all be genuinely better off if they focused on
• 0:37
  Speaker 1: what makes us happy instead. When the respected British economist
• 0:41
  Speaker 1: Richard Layard started saying things like this in the early
• 0:44
  Speaker 1: two thousands, it was considered rather odd. But these days
• 0:48
  Speaker 1: policymakers around the world take mental health seriously enough to
• 0:52
  Speaker 1: worry quite a lot about the psychological scarring that may
• 0:56
  Speaker 1: be caused by the pandemic and how that could worsen
• 0:59
  Speaker 1: the hit to theonomy. In a few minutes, you can
• 1:02
  Speaker 1: hear Layout himself explain how governments could really build that
• 1:06
  Speaker 1: better and build back happier. But first he our France
• 1:10
  Speaker 1: economy reporter William Horrobin on the mental health legacy of
• 1:13
  Speaker 1: COVID nineteen sefe I've been a psychologist for ten years
• 1:26
  Speaker 1: and I've never seen this kind of thing. We had
• 1:29
  Speaker 1: no idea where this could lead to. Man is by
• 1:31
  Speaker 1: nature relatively strong at picking himself up. And this is
• 1:35
  Speaker 1: what happened with the first lockdown. It was really rebounded
• 1:38
  Speaker 1: this way, this is happening to us, but it doesn't matter.
• 1:41
  Speaker 1: We'll get there start again. But the second blow was
• 1:45
  Speaker 1: the Kudo Graphs. Indica staffed the piece of hotline in France,
• 1:54
  Speaker 1: providing psychological support for entrepreneurs in distress. Since France entered
• 1:59
  Speaker 1: a second up down in November, some of her six
• 2:02
  Speaker 1: hour shifts have become relentless. As soon as she hangs up,
• 2:06
  Speaker 1: the phone rings again, and the distress and despair of
• 2:09
  Speaker 1: French business leaders is intensifying. Selene Luca is on just
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  Speaker 1: one of the front lines of a mental health crisis
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  Speaker 1: that is emerging across the globe in the COVID nineteen pandemic.
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  Speaker 1: There are multiple causes, the threat of the bankruptcy for
• 2:24
  Speaker 1: business owners and rising unemployment for workers, not to mention
• 2:28
  Speaker 1: the psychological strain for vast numbers of people from being
• 2:31
  Speaker 1: confined to their homes. From an economic view, researchers have
• 2:36
  Speaker 1: been looking at mental health at least since the nineties,
• 2:39
  Speaker 1: when studies established a link between an increase in suicide
• 2:43
  Speaker 1: rates and the economic slump following the Wall Street crash.
• 2:48
  Speaker 1: In recent times, the focus has been on a more
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  Speaker 1: complex into play. Mental ill health is both a symptom
• 2:55
  Speaker 1: of economic malais and a cause, and that this is
• 3:00
  Speaker 1: the question of what kind of legacy the pandemic will
• 3:03
  Speaker 1: leave behind. Christopher Prints, a labor analyst at the o
• 3:08
  Speaker 1: e c D, has spent a decade grappling with the
• 3:11
  Speaker 1: links between mental health, employment, and the economy. His research
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  Speaker 1: suggests that poor mental health cost developed economies are staggering
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  Speaker 1: four percent of GDP in any given year. For the US,
• 3:25
  Speaker 1: that's more than eight hundred billion dollars. Basically, there's two
• 3:28
  Speaker 1: main reasons. One is the very high prevalence of mental
• 3:31
  Speaker 1: health problems in the population, so with as we know
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  Speaker 1: from all kinds of statistics, is about one in five
• 3:38
  Speaker 1: of the population at any point in time, So the
• 3:41
  Speaker 1: sheer number creates high cost. And the second factor is
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  Speaker 1: that those who have mental health conditions, they do face
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  Speaker 1: challenges in terms of the education outcomes, in terms of
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  Speaker 1: the employment outcomes, so that there's These two things together
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  Speaker 1: explain the high cost. Right, So, we have a lot
• 3:57
  Speaker 1: of people and everyone who has issues is at high
• 4:01
  Speaker 1: risk of having experience really poorer educational employment outcomes, which
• 4:08
  Speaker 1: cost the economy a lot. Part of the cost is
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  Speaker 1: accounted for by measuring direct government spending on care and
• 4:13
  Speaker 1: support for people not working for mental health reasons, but
• 4:17
  Speaker 1: to get closer to the full cost requires more complex
• 4:20
  Speaker 1: estimates of lost productivity in the workplace and lost tax revenues.
• 4:24
  Speaker 1: Might be simple to add up costs of sick leave,
• 4:27
  Speaker 1: but not under performance or the impact of what is
• 4:30
  Speaker 1: known as present tears and that unproductive time you spend
• 4:33
  Speaker 1: in an office, or how coworkers are affected by the
• 4:36
  Speaker 1: problems of others. These four percent that we have estimated
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  Speaker 1: is still a very very lower boundary of any real,
• 4:45
  Speaker 1: real cost to the economy. How could the COVID pandemic
• 4:49
  Speaker 1: change this equation for workers, entrepreneurs and governments in the
• 4:53
  Speaker 1: long run. According to researcher Michel de Beaux, a doctor
• 4:58
  Speaker 1: who led a French study on suicidal ports last year,
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  Speaker 1: there are indications that the mental health crisis will have
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  Speaker 1: a long tail. His survey, for example, showed more people
• 5:08
  Speaker 1: reported considering suicide when restrictions were lifted than when they
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  Speaker 1: were first but in place. There may be a silver
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  Speaker 1: lining to the crisis. As mental health takes a more
• 5:21
  Speaker 1: central place in debate, it could spare governments to review
• 5:24
  Speaker 1: policies in a way that helps both mental health and
• 5:27
  Speaker 1: the economy. In that respect, the o c LE has
• 5:31
  Speaker 1: three main recommendations. Improved training, a frontline workers, intervened sooner
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  Speaker 1: to help people, and crucially integrate mental health into all
• 5:41
  Speaker 1: policy areas class secrecy. What I fear is that if
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  Speaker 1: we're not able to provide a response to this distress,
• 5:51
  Speaker 1: to this depression, rather than finding a population that is
• 5:55
  Speaker 1: able to rebound in the spring, we will still be
• 5:59
  Speaker 1: in a state of dress at that moment. That's why
• 6:03
  Speaker 1: it's an issue today. It's an issue for the well
• 6:05
  Speaker 1: being of tomas. The vaccine for the coronavirus being rolled
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  Speaker 1: out in many countries. Attention is turning to managing infections
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  Speaker 1: over the next few months and then the hope for
• 6:22
  Speaker 1: economic recovery, but for long term prosperity, underlying psychological effects
• 6:28
  Speaker 1: of this pandemic may prove just as important. Sadly, I
• 6:34
  Speaker 1: think we will have pretty significant consequences ahead of us
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  Speaker 1: in terms of mental health. I think we've not got
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  Speaker 1: past the worst. I think that it's still to come. Well,
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  Speaker 1: I'm I'm joined now by Lord Richard Layard, Professor and
• 6:54
  Speaker 1: founder and director of the Center for Economic Performance at
• 6:57
  Speaker 1: the London School of Economics. I think it's fair to
• 7:00
  Speaker 1: say he was one of the first economists to start
• 7:03
  Speaker 1: working on happiness, years before it was fashionable, and he
• 7:07
  Speaker 1: spent the past few years researching mental health, trying to
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  Speaker 1: persuade policymakers to take it seriously as an economic issue
• 7:14
  Speaker 1: as well as a human and a social one. In fact,
• 7:17
  Speaker 1: he's just published a book, another book, Can We Be
• 7:20
  Speaker 1: Happier Ethics and Evidence. Richard, thank you very much for
• 7:24
  Speaker 1: coming on Stephanomics, just to think about COVID first, and
• 7:30
  Speaker 1: then I know we also, I'm very keen to talk
• 7:33
  Speaker 1: about sort of broader issues around this, but you know,
• 7:36
  Speaker 1: we heard there some of the concern about the mental
• 7:39
  Speaker 1: health implications of COVID. You know, we've had a massive recession.
• 7:43
  Speaker 1: Recessinge always make people unhappier by and large, but the
• 7:48
  Speaker 1: added impact on mental health of fear of COVID, the
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  Speaker 1: social isolation of those in lockdown. You know, there are
• 7:54
  Speaker 1: now a lot of policymakers worried about this. You know,
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  Speaker 1: how do you view uh, the mental health impact of COVID. Well,
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  Speaker 1: there's very good evidence that mental health has deteriorated during
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  Speaker 1: the lockdown, and it's particularly affected people who were already
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  Speaker 1: more likely to have poor mental health, which means young people,
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  Speaker 1: women and poor people. So it's a dis equalizing effect
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  Speaker 1: as well as a bad thing all around. But I
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  Speaker 1: think the thing which I feel strongest about is that, um,
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  Speaker 1: the situation for mentally old people has been very, very
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  Speaker 1: bad from before COVID. Basically, in this world, if you're
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  Speaker 1: physically sick, you get treated, and if you're mentally sick,
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  Speaker 1: you don't get treated. UM in most countries, if you
• 8:49
  Speaker 1: look at the surveys that will been done with people
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  Speaker 1: in households where you then diagnose whether they have a
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  Speaker 1: mental health condition or not, you find that under a
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  Speaker 1: third heard of the people with a mental health condition
• 9:03
  Speaker 1: are receiving any treatment or have recently received any I mean,
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  Speaker 1: we would think this was outrageous if it was the
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  Speaker 1: case for any equally serious physical condition, and these are
• 9:14
  Speaker 1: serious conditions. I mean, depression is a more disabling condition
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  Speaker 1: than asthma, arthritis, um angina, many other characteristic physical illnesses
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  Speaker 1: um and of course it causes a massive economic cost
• 9:31
  Speaker 1: in terms of people being either out of work altogether
• 9:35
  Speaker 1: or absenteerism or present he is um um and yet
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  Speaker 1: the treatment rates are as low as I said, So
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  Speaker 1: I think that we have to take advantage of COVID
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  Speaker 1: and the alarm which has caused other mental health to
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  Speaker 1: really address this problem. This is a great moment to
• 9:57
  Speaker 1: do it. I should say to listeners outside Britain that
• 10:02
  Speaker 1: we have managed actually to get the British government to
• 10:05
  Speaker 1: address this problem more seriously than most other governments over
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  Speaker 1: the last ten or twelve years, and we have created
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  Speaker 1: a completely new service for evidence based psychological therapy within
• 10:17
  Speaker 1: our National Health Service, which is now treating nearly two
• 10:21
  Speaker 1: thirds of a million people each year with good recovery
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  Speaker 1: rates um as of the same sort of levels would
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  Speaker 1: expect from trials, which means over so it can be done.
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  Speaker 1: But even the British program is behind schedule at the
• 10:37
  Speaker 1: moment was before COVID. So it is extraordinary how difficult
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  Speaker 1: it is to get policymakers to take this seriously. In
• 10:47
  Speaker 1: spite of the massive suffering. Obviously human suffering the most
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  Speaker 1: serious aspect of it, but also the big impact not
• 10:55
  Speaker 1: only on the simple economics that I mentioned, but also
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  Speaker 1: a very big impact on physical health. I mean, one
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  Speaker 1: of the reasons mental health it causes so much absenteerisum
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  Speaker 1: and so on, is that it also deteriorates the person's
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  Speaker 1: physical health, and therefore the amount of physical healthcare which
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  Speaker 1: a person gets with a given physical illness is more
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  Speaker 1: if they're mentally ill. That's another huge burden on our economy.
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  Speaker 1: So there are all these reasons why we should be
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  Speaker 1: taking mental health a lot more seriously, and let's hope
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  Speaker 1: that the COVID experience makes people do it well. You
• 11:36
  Speaker 1: mentioned there that you have had some success getting the
• 11:39
  Speaker 1: UK to focus on it, but I wonder how successful
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  Speaker 1: we've been integrating into our thinking about other policies, because
• 11:48
  Speaker 1: there's still a tendency to sort of put it in
• 11:50
  Speaker 1: a different box. And it might even be a risk
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  Speaker 1: after COVID that there's less money going into that because
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  Speaker 1: of other things that are perceived to be more central
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  Speaker 1: to economic policy. So how do we address that that
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  Speaker 1: it's treated in isolation from other economic policies and other
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  Speaker 1: social policies. Well, obviously, as a people like to say
• 12:10
  Speaker 1: prevention is better than than cure. My feeling is that
• 12:15
  Speaker 1: we know a certain amount about prevention and the most
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  Speaker 1: obvious area um is the school system, which is a
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  Speaker 1: tremendous lever we have to improve the mental health of
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  Speaker 1: the whole population. And remarkably we found in studies which
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  Speaker 1: we've done, including the famous so called ALSPAC data base
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  Speaker 1: from Bristol, we found that schools have as much an
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  Speaker 1: effect on the mental health of children as parents. And
• 12:48
  Speaker 1: now this is a very very important They just are
• 12:51
  Speaker 1: having that effect and this shows you know, if if
• 12:57
  Speaker 1: they as it were, can have such a big differential effect,
• 13:02
  Speaker 1: and we should exploit it to make sure that they
• 13:05
  Speaker 1: are doing The worst schools are doing as well or
• 13:09
  Speaker 1: better than the best schools. And I think that there's
• 13:12
  Speaker 1: very good evidence based programs for teaching good mental health
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  Speaker 1: habits which could be used right throughout the school curriculum.
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  Speaker 1: I've been involved in developing one called Healthy Minds, which
• 13:28
  Speaker 1: had very good effects in a proper trial, which was
• 13:31
  Speaker 1: a four year curriculum for secondary school pupils. But we
• 13:38
  Speaker 1: really should be getting schools to take the whelming of
• 13:41
  Speaker 1: the children as one of their main objectives equal I
• 13:46
  Speaker 1: would say, to the academic development of the children. And
• 13:51
  Speaker 1: this will probably only happen given that we are now
• 13:54
  Speaker 1: in an age of measurement. If we measure the well
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  Speaker 1: being of the children so remarkably. Our Prime Minister the
• 14:03
  Speaker 1: reason may promised at one point to organize the measurement
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  Speaker 1: of well being and of children in schools, so that
• 14:10
  Speaker 1: each school would know whether it's children were as it
• 14:14
  Speaker 1: were moving from year to year upwards, relative to their
• 14:20
  Speaker 1: cohort in the country as a whole or not. Absolutely
• 14:24
  Speaker 1: nothing has happened about it. Uh, some excellent people are
• 14:29
  Speaker 1: trying to get a pilot going in Manchester. But this,
• 14:34
  Speaker 1: I think, you know, across Europe, this should be one
• 14:38
  Speaker 1: of the the key steps in what I think of
• 14:42
  Speaker 1: as the well being movement. I mean I think of
• 14:45
  Speaker 1: myself as part of a well being movement to try
• 14:48
  Speaker 1: and shift the priorities of the society to ultimately the
• 14:53
  Speaker 1: well being of the population, both the child population and
• 14:57
  Speaker 1: the adult population. And there are a whole series of
• 15:02
  Speaker 1: building blocks and doing that. But I think it's also
• 15:05
  Speaker 1: incredibly important we just changed the overall objectives which are
• 15:09
  Speaker 1: policy makers have in mind. I mean, what they think
• 15:14
  Speaker 1: matters to people. It's just not borne out by the evidence.
• 15:18
  Speaker 1: I mean, if you look at the evidence in many
• 15:20
  Speaker 1: different ways. You can look at the evidence of what's
• 15:23
  Speaker 1: important to people, and people have now been discovering it
• 15:25
  Speaker 1: in COVID of course. Well, here are the different ways
• 15:29
  Speaker 1: you can examine this. You can simply measure how happy
• 15:32
  Speaker 1: people are. Um. And then you get all the kinds
• 15:36
  Speaker 1: of other information about their situation in life and see
• 15:40
  Speaker 1: which bits of their situation best explain how happy they are.
• 15:44
  Speaker 1: That's one approach. Another approach is to ask them what
• 15:47
  Speaker 1: do they worry about from day to day. You get
• 15:51
  Speaker 1: the same answers. The same answers are always this. So
• 15:55
  Speaker 1: the top worry that people have is health and and
• 15:59
  Speaker 1: then and that includes the mental health their own, their
• 16:02
  Speaker 1: parents mental health, their children's mental health. Then physical health
• 16:08
  Speaker 1: that is for most people only worry in the last
• 16:12
  Speaker 1: two or three decades of life. UM. Then the next
• 16:18
  Speaker 1: things that people worry about our relationships. And we know
• 16:22
  Speaker 1: it ourselves, We're honest with ourselves. We know that these
• 16:25
  Speaker 1: are the things we worry about. Our close personal relationships
• 16:28
  Speaker 1: in the family, our relationships at work, and maybe other
• 16:31
  Speaker 1: dimensions of work are also important, whether it might mind
• 16:35
  Speaker 1: bending lye boring or whatever, and then community. Only after
• 16:40
  Speaker 1: that comes income. And yet our politicians absolutely assume that
• 16:46
  Speaker 1: the number one concerned that people have is their income.
• 16:55
  Speaker 1: But one of the reasons that governments do that is
• 16:57
  Speaker 1: that the people vaiting for them also think money may
• 17:00
  Speaker 1: them happy. I think that is part of the disconnected.
• 17:02
  Speaker 1: It's not just politicians. And Daniel Carnovan Madems are famous
• 17:07
  Speaker 1: by many insights, one of which was that people, of
• 17:10
  Speaker 1: course misfecast the importance of getting more income or a
• 17:15
  Speaker 1: bigger house. But I come back though to the survey
• 17:19
  Speaker 1: which I was slightly involved with, the survey done by
• 17:22
  Speaker 1: Sainsbury's Grosser as it was, but it was a survey
• 17:25
  Speaker 1: of the whole population, and it shows that the the
• 17:30
  Speaker 1: when people are asked to rank money and debt against
• 17:33
  Speaker 1: all the other things that I've talked about, it comes six.
• 17:37
  Speaker 1: So and I'll tell you what I think. The reason
• 17:41
  Speaker 1: is that politicians think like this is that they don't
• 17:45
  Speaker 1: think that people think that these other worries that they
• 17:52
  Speaker 1: have are things that the state can in any way
• 17:56
  Speaker 1: help them with. So it's a fairly recent things for
• 18:01
  Speaker 1: people really to think that the states can do too
• 18:04
  Speaker 1: much about income. But it's now firmly in people's minds
• 18:08
  Speaker 1: that the state is responsible to a degree for people's incomes,
• 18:12
  Speaker 1: for their education, and I suppose now we would say
• 18:16
  Speaker 1: for their physical health. But given that we now have
• 18:21
  Speaker 1: good evidence based ways in which we can help people
• 18:24
  Speaker 1: with these personal problems, their mental health, addictions, domestic violence,
• 18:31
  Speaker 1: all these issues which are now becoming coming up into
• 18:35
  Speaker 1: the public arena, partly because people are beginning to realize
• 18:38
  Speaker 1: that the state can offer support. It's not a matter
• 18:41
  Speaker 1: of forcing people to be happier, offering them support when
• 18:45
  Speaker 1: they're struggling. Um that this is going to be undoubtedly,
• 18:49
  Speaker 1: in my view, the great, great area of development of
• 18:53
  Speaker 1: state activity. It's not very expensive, it saves a lot
• 18:57
  Speaker 1: of money, it will save a lot of money on prisons,
• 19:00
  Speaker 1: littles over a lot of money on physical illness and
• 19:03
  Speaker 1: so on. But we are going to be seeing the
• 19:07
  Speaker 1: big development over the next decades of support for families,
• 19:13
  Speaker 1: for children, for loneliness and old age. All these things
• 19:17
  Speaker 1: are going to become within the ambit of things which
• 19:21
  Speaker 1: which the state and the population expect the state to provide.
• 19:27
  Speaker 1: And I think if we had this conversation ten years ago,
• 19:29
  Speaker 1: and certainly when you first started writing Richard about happiness,
• 19:33
  Speaker 1: you were very much on the fringes not of economics
• 19:36
  Speaker 1: as an economists, but in thinking about that um and
• 19:40
  Speaker 1: now it's very much what you're saying is tapping into
• 19:44
  Speaker 1: a vein that's very mainstream, the idea that economic growth
• 19:48
  Speaker 1: is not the solution to everything, that the quality of
• 19:51
  Speaker 1: our lives and of economic growth matters as much as
• 19:55
  Speaker 1: the quantity um. But if so, if we were, if
• 19:58
  Speaker 1: you're sitting in government across Europe or in the US
• 20:03
  Speaker 1: incoming President Biden, thinking how do I really incorporate this
• 20:09
  Speaker 1: in policy and as part of my building back better?
• 20:13
  Speaker 1: As everyone talks about if you're going to build back
• 20:15
  Speaker 1: better in this direction, briefly, what what's the big what
• 20:21
  Speaker 1: are the pieces of that? The first thing actually is
• 20:23
  Speaker 1: the methodology. I mean, when people go to the finance
• 20:28
  Speaker 1: minister and asking for money, I want them to be
• 20:32
  Speaker 1: justifying their request by saying, well, this is the effect
• 20:35
  Speaker 1: it would have on well being, and this is cost
• 20:38
  Speaker 1: effective way of improving well being because it would be
• 20:41
  Speaker 1: a big effect per per per unit of cost in
• 20:47
  Speaker 1: terms of improved well being, better bang for the buck
• 20:51
  Speaker 1: and the bug should be thought of as money, and
• 20:54
  Speaker 1: the bang should be thought of as well being. Um
• 20:57
  Speaker 1: So I wanted that change in mindset in procedures in
• 21:01
  Speaker 1: the operation of government, and we've been trying to educate
• 21:05
  Speaker 1: the British Civil Service to a degree successfully and how
• 21:10
  Speaker 1: to do this because there is now this massive evidence
• 21:12
  Speaker 1: available on what the effects on molding are of all
• 21:17
  Speaker 1: the different things that you might do and that happen
• 21:21
  Speaker 1: in life. So we need to be using that that evidence.
• 21:25
  Speaker 1: That's that's number one. But then if you say what
• 21:28
  Speaker 1: priorities would come out if we did that, then I
• 21:31
  Speaker 1: think we're going to see that they're very different. Um
• 21:37
  Speaker 1: The idea that you build back better by building a
• 21:39
  Speaker 1: lot of physical structures, rose railways, lots of new new
• 21:44
  Speaker 1: new physical buildings and so on is much much less
• 21:49
  Speaker 1: cost effective than rebuilding proper services for children, proper services
• 21:57
  Speaker 1: for families, that proper health service and obviously proper social care,
• 22:01
  Speaker 1: proper support for old people in the conditions of extreme loadedness.
• 22:08
  Speaker 1: All all the problems that people actually spend most of
• 22:12
  Speaker 1: their time worrying about are things which the state can
• 22:15
  Speaker 1: with small amounts of money, make a massive difference too.
• 22:19
  Speaker 1: And I think we need I would call it the
• 22:21
  Speaker 1: social infrastructure. We need to be building the social infrastructure,
• 22:25
  Speaker 1: rather than focus on thinking the physical infrastructure and either
• 22:29
  Speaker 1: ways to produce overall the better society or to level up.
• 22:32
  Speaker 1: We should be leveling up through the social mainly through
• 22:35
  Speaker 1: the social services. Well, it's an uplifting note to end
• 22:39
  Speaker 1: on Richard lay Lord Ler, thank you very much, my pleasure.
• 22:49
  Speaker 1: Thanks for listening to Stephanomics. We'll be back next week
• 22:51
  Speaker 1: with more on all things economic. Remember you can always
• 22:54
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• 22:57
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• 23:00
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• 23:05
  Speaker 1: This episode was produced, as ever by Magnus Hendrickson, with
• 23:08
  Speaker 1: special thanks to Professor Richard Layoard, William Horrabin, Anya Noosbaum,
• 23:13
  Speaker 1: and Gaspar subag Lucy Meekin is the executive producer of
• 23:16
  Speaker 1: Stephanomics and the head of Bloomberg podcast is Francesca Levi.