MHCC Life Economic Impact Scenarios FINAL ENG 0

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Life and Economic Impact of Hypothetical

Intervention Scenarios on Major Mental Illness in Canada: 2011 to 2041

August 2012

Prepared on Behalf of the Mental Health Commission of Canada by:

North York Corporate Centre 4576 Yonge Street, Suite 400

Toronto, ON M2N 6N4 Tel: (416) 782-7475 Fax: (416) 309-2336 www.riskanalytica.com

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Page | 2 This report was prepared by RiskAnalytica on behalf of the Mental Health Commission of Canada.

The RiskAnalytica team members who contributed to this report are: Paul Smetanin, Carla Briante, David Stiff, and Minhal Khan. The assumptions and calculations underlying RiskAnalytica’s Life at Risk simulation platform were prepared by RiskAnalytica as part of this study. The use and interpretation of the methodologies, data, assumptions and simulation outcomes is entirely that of the authors.

Suggested Citation

Smetanin, P., Stiff, D., Briante, C., and Khan, M. Life and Economic Impact of Hypothetical Intervention Scenarios on Major Mental Illness in Canada: 2011 to 2041. RiskAnalytica, on behalf of the Mental Health Commission of Canada 2012.

©Mental Health Commission of Canada, 2012

Acknowledgements

This collaboration was coordinated and funded by the Mental Health Commission of Canada. The research was made possible through a financial contribution from Health Canada to the Mental Health Commission of Canada. RiskAnalytica would like to acknowledge the contributions, comments and input from the staff and project team at the Mental Health Commission of Canada:

Scott Dudgeon, Project Manager; Seniors Advisory Committee

Mike de Gagne, Chair First Nations, Inuit and Métis Advisory Committee

Dr. Elliot Goldner, Chair Science Advisory Committee

Dr. David Goldbloom, Vice-Chair Steve Lurie, Chair Service Systems Advisory

Committee

Sapna Mahajan, Chief Integration Officer Michelle McLean, Vice President, Public Affairs Phil Upshall, Advisor, Stakeholder Relations Nancy Reynolds, Child and Youth Advisory

Committee

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Page | 3 EXECUTIVE SUMMARY

INTRODUCTION AND SCOPE

Mental illness is a behavioural or psychological syndrome that significantly interferes with an individual’s thought processing abilities, social abilities, emotions and behaviour (Mental Disorders, WHO). Our previous study¹ estimated that 1 in 5 Canadians are affected annually by mood disorders, anxiety disorders, schizophrenia, attention deficit/hyperactive disorders (ADHD), conduct disorders, oppositional defiant disorders (ODD), substance use disorders or dementia. Not only does mental illness impact individuals but it also places a significant impact on families, communities and the health care system.

Study Objective

The purpose of this study was to investigate the high level impacts of hypothetical intervention scenarios on the baseline burden in our previous analysis, across four target areas.. When compared to the baseline outcomes, the hypothetical scenarios demonstrate the potential impact on 12-month prevalence and economic outcomes (direct health care costs and indirect wage-based productivity cost) for all major mental illness in Canada over the simulated time frame. It is important to note that the intervention scenarios were hypothetical in nature and did not include any specific evidence-based mental health interventions. Furthermore, it is important to note that the feasibility of these impacts may be dependent upon the mental illness itself, where some benefits may be more feasible or realistic for certain mental illnesses than for others.

A total of five intervention scenarios (spanning four target areas) were identified by the Mental Health Commission of Canada and evaluated within the Life at Risk platform. These included:

All-Cause Incidence:

o A reduction in the overall all-cause incidence by 10%;

Prior Mental Illness in Childhood or Adolescence:

o A reduction in the risks associated with prior mental illness in childhood or adolescence by 10%;

Remission Rates:

1 Smetanin et al. (2011)

2 For this analysis it was assumed that increasing the remission rates had no impact on cognitive impairment including

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Page | 4 o An increase in remission rates by 10 %, thereby reducing the effects associated with

mental illness²; Economic Disability:

o A reduction in workplace disability by 10% which affects productivity in the labour force but not the prevalence or direct costs of mental illness;

The Combined Impact of All of the Above:

o The impact of all of the above interventions applied simultaneously within the Life at Risk platform.

INTERVENTION SCENARIO: MODEL RESULTS

Comparisons of the baseline impact of mental illness in our previous study to the proposed hypothetical interventions were assessed to determine the high-level impact of the interventions relative to the baseline results across each of the four intervention target areas. The results demonstrate the potential benefits of each hypothetical intervention and do not include specific mental health interventions that would illustrate how these targets could be met. In addition, the feasibility of each scenario may be dependent upon the type of mental illness. Therefore the results should be viewed as a general quantification that demonstrates the potential benefits of the hypothetical scenarios. All economic results below are reported in annual future value terms and 2011 cumulative present value terms.

Prevalence Impacts

Figure 1 Estimated Number of People with Any Mental Illness (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios.

2 For this analysis it was assumed that increasing the remission rates had no impact on cognitive impairment including dementia.

6,500,000 7,000,000 7,500,000 8,000,000 8,500,000 9,000,000

2011 2016 2021 2026 2031 2036 2041

Number of Canadians

Estimated Number of People with Any* Mental Illness (12-Month Prevalence)

Base Case Remission Incidence Child/Adol RR Combined Any* is Mood, Anxiety, Schizophrenia, SUD, ADHD, ODD, CD, Dementia

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Page | 5 Relative to the baseline model, the short-term (2011-2021) impacts are expected to yield the following results:

By increasing remission by 10%, over 183,900 fewer Canadians will be living with the effects associated with major mental illness by 2021 (a 0.5% reduction in 12-month prevalence relative to the baseline model)³;

By reducing all cause incidence by 10%, over 289,860 fewer Canadians will be living with a major mental illness by 2021 (a 0.8% reduction in 12-month prevalence relative to the baseline model)⁴;

By reducing the relative risk of incidence of mental illness due to a prior mental illness in childhood or adolescence, over 22,100 fewer Canadians will be living with a major mental illness by 2021 (a 0.1% reduction in 12-month prevalence relative to the baseline model); and

The combination of each of the above scenarios results in over 488,120 fewer Canadians living with a major mental illness by 2021 (a 1.3% reduction in 12-month prevalence relative to the baseline model).

Relative to the baseline model, the long-term (2011-2041) impacts are expected to yield the following results:

By increasing remission by 10%, over 367,220 fewer Canadians will be living with the effects associated with major mental illness by 2041 (a 0.9% reduction in 12-month prevalence relative to the baseline model);

By reducing all cause incidence by 10%, over 597,440 fewer Canadians will be living with a major mental illness by 2041 (a 1.4% reduction in 12-month prevalence relative to the baseline model);

3 It is important to note that increasing the remission rates was assumed to have no impact on cognitive impairment including dementia.

4 It is important to note that increasing remission rates was assumed to have no impact on cognitive impairment including dementia.

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Page | 6 By reducing the relative risk associated with a prior mental illness in childhood or adolescence, over 40,160 fewer Canadians will be living with a major mental illness by 2041 (a 0.1% reduction in 12-month prevalence relative to the baseline model); and

The combination of each of the above scenarios results in over 981,280 fewer Canadians living with a major mental illness by 2041 (a 2.3% reduction in 12-month prevalence relative to the baseline model).

Total Direct Economic Impacts

Figure 2 Estimated Reduction in Total Direct Mental Health Costs for Any* Disorder Including Dementia in Annual Future Value Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios.

$-

$5,000.0

$10,000.0

$15,000.0

$20,000.0

$25,000.0

$30,000.0

Increase Remission Reduce Incidence Reduce Relative Risk

Combined Intervention

Future Value ($ Millions)

Scenario

Estimated Reduction in Total Direct Mental Health Costs for Any*

Disorder Including Dementia in Annual Future Value Terms

2011 2021 2031 2041

Any* is Mood, Anxiety, Schizophrenia, SUD, ADHD, ODD, CD, Dementia

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Page | 7 The table below outlines the expected short-term and long-term direct health care cost savings⁵ attributable to major mental illnesses for each scenario in future value and cumulative 2011 present value terms.

Table 1 Direct Health Care Cost Savings Attributable to Any Mental Illness for each Hypothetical Scenario

Impact 10% Increase in Remission Rate

10% Reduction in All- Cause Incidence

10% Reduction in Relative Risk Associated with Prior Youth Illness

Combination of All Scenarios

Short-Term (2011-2021) Future Value Terms

Over $1.0 billion dollars are expected to be saved annually by 2021

Over $129.5 million dollars are expected to be saved annually by 2021

Over $5.2 billion in annual direct health care cost savings by 2021

Long-Term (2011-2041) Future Value Terms

Over $583.0 million dollars are expected to be saved annually by 2041

Over $28.0 billion in annual direct health care cost savings by 2041

Short-Term (2011-2021) Cumulative 2011 Present Value Terms

Present value of cumulative short-term savings of over $4.6 billion dollars

Present value of cumulative short-term savings of over

$562.4 million dollars

Long-Term (2011-2041) Cumulative 2011 Present Value Terms

Present value of cumulative long-term savings of over $35.2 billion dollars

Present value of cumulative long-term savings of over

$4.0 billion dollars

5 Note that direct costs include costs to the health care system such as hospitalizations, physician visits, medication, care and support staff. The costs do not include costs to the justice system, social service and education systems, costs for child and youth services, informal care giving costs or costs attributable to losses in health related quality of life.

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Page | 8 Total Indirect Economic Impacts

Figure 3 Estimated Total Indirect Economic Benefit for All* Disorders Annual Future Value Terms for each of the Hypothetical Intervention Scenarios.

The table below outlines the expected short-term and long-term wage-based productivity benefits (the indirect economic benefits driven by improved productivity in the labour force measured by the total wages paid in the economy) for each scenario in future value and cumulative 2011 present value terms.

$-

$1,000.0

$2,000.0

$3,000.0

$4,000.0

$5,000.0

$6,000.0

$7,000.0

$8,000.0

$9,000.0

$10,000.0

Reduced Disability

Increase Remission

Reduce Incidence

Reduce Relative Risk

Combined Intervention

Future Value ($ Millions)

Estimated Total Indirect Economic Benefit for All* Disorders Including Dementia in Annual Future Value Terms

2011 2021 2031 2041

All* is Mood, Anxiety, Schizophrenia, SUD, ADHD, ODD, CD, Dementia

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Table 2 Wage-Based Productivity Benefits for each Hypothetical Scenario Impact 10% Increase in

Remission Rate

10% Reduction in All-Cause Incidence

10% Reduction in Relative Risk Associated with Prior Youth Illness

10% Reduction in Economic Disability

Combination of All Scenarios Short-Term

(2011-2021) Future Value Terms

Over $88.6 million in indirect economic benefits annually by 2021

Over $2.3 billion dollars in indirect economic benefits annually by 2021

Over $2.5 billion dollars in indirect economic benefits annually by 2021 Long-Term

(2011-2041) Future Value Terms

Over $205.0 million dollars in indirect economic benefits annually by 2041

Over $9.6 billion dollars in indirect economic benefits annually by 2041 Short-Term

(2011-2021) Cumulative 2011 Present Value Terms

Cumulatively over $83.3 million dollars in indirect economic benefits are expected

Cumulatively over

$1.0 billion dollars in indirect economic benefits are expected

Cumulatively over $141.1 million dollars in indirect economic benefits are expected

Cumulatively over $19.2 billion dollars in indirect economic benefits are expected

Cumulatively over $20.1 billion dollars in indirect economic benefits are expected Long-Term

(2011-2041) Cumulative 2011 Present Value Terms

Cumulatively over

$8.6 billion dollars in indirect economic benefits are expected

CONCLUSIONS

Compared to the baseline outcomes in our previous study, the hypothetical scenarios demonstrate a significant reduction in 12-month prevalence, direct health care costs and indirect wage-based productivity costs of major mental illnesses. With relatively small changes in each of the target areas, significant life and economic benefits can be achieved over time. As a result of the relatively high baseline prevalence for all mental illnesses across all age-groups the greatest benefits are shown in the long-term. This is due to interventions that directly change the prevalence and their incremental impacts over the simulation timeframe, which cumulatively add to a significant reduction in the long- term.

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Page | 10 Over the next 30 years, the combination of each of the target scenarios is expected to decrease the 12- month prevalence of major mental illnesses by 2.3%, reducing the number of people living with a mental illness in 2041 from 8.9 million to 7.9 million. This decrease in prevalence is expected to significantly reduce the cumulative direct health care costs by over $179.3 billion dollars within the next 30 years.

The combined scenarios are also expected to significantly reduce the cumulative present-value wage- based productivity costs by over $76.1 billion over the next 30 years.

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Page | 11 STRUCTURE OF THE REPORT

This report is divided into four Sections:

Section 1 provides details on the background, purpose and objectives of the study; as well as a general overview of the scenario models and assumptions.

Section 2 summarizes the impacts of the hypothetical intervention scenarios; and Section 3 summarizes the key findings and conclusions.

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Page | 12 TABLE OF CONTENTS

Executive Summary ... 3

Introduction and Scope ... 3

Intervention Scenario: Model Results ... 4

Conclusions ... 9

Structure of the Report ... 11

List of Figures ... 14

List of Tables ... 16

1 Introduction and Background... 22

1.1 Overview of Engagement Scope ... 22

1.2 Overview of Scenarios ... 23

2 Scenario Analysis of Mental Illness Interventions ... 28

2.1 LIfe Impacts of Scenarios ... 28

2.1.1 Any Mental Illness ... 29

2.1.2 ADHD ... 34

2.1.3 ODD ... 39

2.1.4 Conduct Disorders ... 44

2.1.5 Mood and Anxiety Disorders ... 49

2.1.6 Schizophrenia ... 54

2.1.7 Substance Use Disorders ... 59

2.1.8 Cognitive Impairment Including Dementia ... 64

2.2 Economic Impacts of Scenarios ... 68

3 Conclusions ... 75

3.1 General Conclusions and Implications ... 75

Bibliography ... 77

A Detailed LIfe at Risk Methodology ... 78

B Detailed Results ... 79

B.1.1 Any Mental Illness ... 79

B.1.2 ADHD ... 88

B.1.3 ODD ... 97

B.1.4 Conduct Disorder ... 106

B.1.5 Mood and Anxiety Disorders ... 115

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B.1.6 Schizophrenia ... 124

B.1.7 Substance Use Disorders ... 133

B.1.8 Dementia Including Cognitive Impairment ... 142

B.1.9 Direct Costs Excluding Dementia ... 151

B.1.10 Direct Costs For Dementia Including Cognitive Impairment ... 154

B.1.11 Total Direct Costs ... 157

B.1.12 Indirect Costs ... 161

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Page | 14 LIST OF FIGURES

Figure 1 Estimated Number of People with Any Mental Illness (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios... 4 Figure 2 Estimated Reduction in Total Direct Mental Health Costs for Any* Disorder Including Dementia in Annual Future Value Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 6 Figure 3 Estimated Total Indirect Economic Benefit for All* Disorders Annual Future Value Terms for each of the Hypothetical Intervention Scenarios. ... 8 Figure 4 Estimated Number of People with Any Mental Illness (12-Month Prevalence) for the Baseline Model and Each of the Hypothetical Intervention Scenarios... 29 Figure 5 Estimated Reduction in Number of People with Any Mental Illness (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 30 Figure 6 Estimated Reduction in 12-Month Prevalence of Any Mental Illness for Each of the Hypothetical Intervention Scenarios. ... 31 Figure 7 Estimated Number of People with ADHD (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 34 Figure 8 Estimated Reduction in Number of People with ADHD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 35 Figure 9 Estimated Reduction in 12-Month Prevalence of ADHD for Each of the Hypothetical Intervention Scenarios. ... 36 Figure 10 Estimated Number of People with ODD (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 39 Figure 11 Estimated Reduction in Number of People with ODD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 40 Figure 12 Estimated Reduction in 12-Month Prevalence of ODD for Each of the Hypothetical Intervention Scenarios. ... 41 Figure 13 Estimated Number of People with Conduct Disorder (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios... 44 Figure 14 Estimated Reduction in Number of People with Conduct Disorder (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 45 Figure 15 Estimated Reduction in 12-Month Prevalence of Conduct Disorder for Each of the Hypothetical Intervention Scenarios. ... 46 Figure 16 Estimated Number of People with Mood or Anxiety Disorders (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 49 Figure 17 Estimated Reduction in Number of People with Mood or Anxiety Disorders (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 50

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Page | 15 Figure 18 Estimated Reduction in 12-Month Prevalence of Mood or Anxiety Disorders for Each of the

Hypothetical Intervention Scenarios. ... 51 Figure 19 Estimated Number of People with Schizophrenia (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios... 54 Figure 20 Estimated Reduction in Number of People with Schizophrenia (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 55 Figure 21 Estimated Reduction in 12-Month Prevalence of Schizophrenia for Each of the Hypothetical Intervention Scenarios. ... 56 Figure 22 Estimated Number of People with SUD (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 59 Figure 23 Estimated Reduction in Number of People with SUD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 60 Figure 24 Estimated Reduction in 12-Month Prevalence of SUD for Each of the Hypothetical Intervention Scenarios. ... 61 Figure 25 Estimated Number of People with Dementia* for the Baseline Model, and All Cause Incidence Reduction Scenario. ... 64 Figure 26 Estimated Reduction in Number of People with Dementia* for All Cause Incidence Reduction Scenario. ... 65 Figure 27 Estimated Reduction in Prevalence of Dementia* for All Cause Incidence Reduction Scenario.

... 66 Figure 28 Estimated Reduction in the Total Direct Mental Health Costs for Any* Disorder Including Dementia in Annual Future Value Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 69 Figure 29 Estimated Total Indirect Economic Benefit for All* Disorders Annual Future Value Terms for each of the Hypothetical Intervention Scenarios. ... 71 Figure 30 Estimated Total Direct Mental Health Costs for Any* Disorder Excluding Dementia in Annual Future Value Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 151 Figure 31 Estimated Reduction in the Total Direct Mental Health Costs for Any* Disorder Excluding Dementia in Annual Future Value Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 151 Figure 32 Estimated Total Direct Mental Health Costs for Dementia Including Cognitive Impairment in Annual Future Value Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 154 Figure 33 Estimated Reduction in the Total Direct Mental Health Costs for Dementia Including Cognitive Impairment in Annual Future Value Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 154

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Page | 16 LIST OF TABLES

Table 1 Direct Health Care Cost Savings Attributable to Any Mental Illness for each Hypothetical

Scenario ... 7

Table 2 Wage-Based Productivity Benefits for each Hypothetical Scenario ... 9

Table 3 Baseline Model: Relative Risk of Adolescent Mental Illness Given Prior Childhood Illness ... 25

Table 4 Baseline Model: Relative Risk of Adult Mental Illness Given Prior Adolescent Illness ... 25

Table 5 Scenario Model: Relative Risk of Adolescent Mental Illness Given Prior Childhood Illness .... 26

Table 6 Scenario Model: Relative Risk of Adult Mental Illness Given Prior Adolescent Illness ... 26

Table 7 Estimated Baseline and Reduction in Number of People with Any Mental Illness (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. .. 33

Table 8 Estimated Baseline and Reduction in 12-Month Crude Prevalence of People with Any Mental Illness for Each of the Hypothetical Intervention Scenarios. ... 33

Table 9 Estimated Baseline and Reduction in Number of People Aged 9 to 19 Years with ADHD (12- month prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 38

Table 10 Estimated Baseline and Reduction in 12-Month Crude Prevalence of People Aged 9 to 19 Years with ADHD for Each of the Hypothetical Intervention Scenarios. ... 38

Table 11 Estimated Baseline and Reduction in Number of People Aged 9 to 19 Years with ODD (12- Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 42

Table 12 Estimated Baseline and Reduction in 12-Month Crude Prevalence of People Aged 9 to 19 Years with ODD for Each of the Hypothetical Intervention Scenarios. ... 43

Table 13 Estimated Baseline and Reduction in Number of People Aged 9 to 19 Years with Conduct Disorder (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 48

Table 14 Estimated Baseline and Reduction in 12-Month Crude Prevalence of People Aged 9 to 19 Years with Conduct Disorder for Each of the Hypothetical Intervention Scenarios. ... 48

Table 15 Estimated Baseline and Reduction in Number of People with Mood or Anxiety Disorders (12- Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 53

Table 16 Estimated Baseline and Reduction in 12-Month Crude Prevalence of People with Mood or Anxiety Disorders for Each of the Hypothetical Intervention Scenarios. ... 53

Table 17 Estimated Baseline and Reduction in Number of People with Schizophrenia (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. .. 57

Table 18 Estimated Baseline and Reduction in 12-Month Crude Prevalence of People with Schizophrenia for Each of the Hypothetical Intervention Scenarios. ... 58

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Page | 17 Table 19 Estimated Baseline and Reduction in Number of People with SUD (12-Month Prevalence) for

the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 62 Table 20 Estimated Baseline and Reduction in 12-Month Crude Prevalence of People with SUD for Each of the Hypothetical Intervention Scenarios. ... 63 Table 21 Estimated Baseline and Reduction in Number of People with Dementia* (Prevalence) for the Baseline Model, and All Cause Incidence Reduction Scenario ... 67 Table 22 Estimated Baseline and Reduction in Crude Prevalence of People with Dementia* for All Cause Incidence Reduction Scenario ... 67 Table 23 Estimated Reduction in Total Direct Mental Health Costs for Any* Disorder Including Dementia in Annual Future Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 69 Table 24 Estimated Reduction in Total Direct Mental Health Costs for Any* Disorder Including Dementia in Cumulative Present Value Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 70 Table 25 Estimated Total Indirect Economic Benefits for Any* Disorder Including Dementia in Annual Future Value Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 72 Table 26 Estimated Total Indirect Economic Benefits for Any* Disorder Including Dementia in Cumulative Present Value Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 74 Table 27 Estimated Number of Males with Any Mental Illness (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios... 79 Table 28 Estimated Number of Females with Any Mental Illness (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 80 Table 29 Estimated Number of People with Any Mental Illness (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios... 81 Table 30 Estimated Reduction in Number of Males with Any Mental Illness (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 82 Table 31 Estimated Reduction in Number of Females with Any Mental Illness (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 83 Table 32 Estimated Reduction in Number of People with Any Mental Illness (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 84 Table 33 Estimated Reduction in 12-Month Prevalence of Any Mental Illness in Males for Each of the Hypothetical Intervention Scenarios. ... 85 Table 34 Estimated Reduction in 12-Month Prevalence of Any Mental Illness in Females for Each of the Hypothetical Intervention Scenarios. ... 86 Table 35 Estimated Reduction in 12-Month Prevalence of Any Mental Illness in People for Each of the Hypothetical Intervention Scenarios. ... 87

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Page | 18 Table 36 Estimated Number of Males Aged 9 to 19 Years with ADHD (12-Month Prevalence) for the

Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 88 Table 37 Estimated Number of Females Aged 9 to 19 Years with ADHD (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 89 Table 38 Estimated Number of People Aged 9 to 19 Years with ADHD (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 90 Table 39 Estimated Reduction in Number of Males Aged 9 to 19 Years with ADHD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 91 Table 40 Estimated Reduction in Number of Females Aged 9 to 19 Years with ADHD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 92 Table 41 Estimated Reduction in Number of People Aged 9 to 19 Years with ADHD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 93 Table 42 Estimated Reduction in 12-Month Prevalence of ADHD in Males Aged 9 to 19 Years for Each of the Hypothetical Intervention Scenarios. ... 94 Table 43 Estimated Reduction in 12-Month Prevalence of ADHD in Females Aged 9 to 19 Years for Each of the Hypothetical Intervention Scenarios. ... 95 Table 44 Estimated Reduction in 12-Month Prevalence of ADHD in People Aged 9 to 19 Years for Each of the Hypothetical Intervention Scenarios. ... 96 Table 45 Estimated Number of Males Aged 9 to 19 Years with ODD (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 97 Table 46 Estimated Number of Females Aged 9 to 19 Years with ODD (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 98 Table 47 Estimated Number of People Aged 9 to 19 Years with ODD (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 99 Table 48 Estimated Reduction in Number of Males Aged 9 to 19 Years with ODD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 100 Table 49 Estimated Reduction in Number of Females Aged 9 to 19 Years with ODD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 101 Table 50 Estimated Reduction in Number of People Aged 9 to 19 Years with ODD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 102 Table 51 Estimated Reduction in 12-Month Prevalence of ODD in Males Aged 9 to 19 Years for Each of the Hypothetical Intervention Scenarios. ... 103 Table 52 Estimated Reduction in 12-Month Prevalence of ODD in Females Aged 9 to 19 Years for Each of the Hypothetical Intervention Scenarios. ... 104 Table 53 Estimated Reduction in 12-Month Prevalence of ODD in People Aged 9 to 19 Years for Each of the Hypothetical Intervention Scenarios. ... 105 Table 54 Estimated Number of Males Aged 9 to 19 Years with Conduct Disorder (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. 106

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Page | 19 Table 55 Estimated Number of Females Aged 9 to 19 Years with Conduct Disorder (12-Month

Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. 107 Table 56 Estimated Number of People Aged 9 to 19 Years with Conduct Disorder (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. 108 Table 57 Estimated Reduction in Number of Males Aged 9 to 19 Years with Conduct Disorder (12-

Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 109 Table 58 Estimated Reduction in Number of Females Aged 9 to 19 Years with Conduct Disorder (12-

Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 110 Table 59 Estimated Reduction in Number of People Aged 9 to 19 Years with Conduct Disorder (12-

Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 111 Table 60 Estimated Reduction in 12-Month Prevalence of Conduct Disorder in Males Aged 9 to 19 Years for Each of the Hypothetical Intervention Scenarios. ... 112 Table 61 Estimated Reduction in 12-Month Prevalence of Conduct Disorder in Females Aged 9 to 19 Years for Each of the Hypothetical Intervention Scenarios. ... 113 Table 62 Estimated Reduction in 12-Month Prevalence of Conduct Disorder in People Aged 9 to 19 Years for Each of the Hypothetical Intervention Scenarios. ... 114 Table 63 Estimated Number of Males with Mood or Anxiety Disorders (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 115 Table 64 Estimated Number of Females with Mood or Anxiety Disorders (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 116 Table 65 Estimated Number of People with Mood or Anxiety Disorders (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 117 Table 66 Estimated Reduction in Number of Males with Mood or Anxiety Disorders (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 118 Table 67 Estimated Reduction in Number of Females with Mood or Anxiety Disorders (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 119 Table 68 Estimated Reduction in Number of People with Mood or Anxiety Disorders (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 120 Table 69 Estimated Reduction in 12-Month Prevalence of Mood or Anxiety Disorders in Males for Each of the Hypothetical Intervention Scenarios. ... 121 Table 70 Estimated Reduction in 12-Month Prevalence of Mood or Anxiety Disorders in Females for Each of the Hypothetical Intervention Scenarios. ... 122 Table 71 Estimated Reduction in 12-Month Prevalence of Mood or Anxiety Disorders in People for Each of the Hypothetical Intervention Scenarios. ... 123 Table 72 Estimated Number of Males with Schizophrenia (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios... 124 Table 73 Estimated Number of Females with Schizophrenia (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios... 125

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Page | 20 Table 74 Estimated Number of People with Schizophrenia (12-Month Prevalence) for the Baseline

Model, and Each of the Hypothetical Intervention Scenarios... 126 Table 75 Estimated Reduction in Number of Males with Schizophrenia (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 127 Table 76 Estimated Reduction in Number of Females with Schizophrenia (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 128 Table 77 Estimated Reduction in Number of People with Schizophrenia (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 129 Table 78 Estimated Reduction in 12-Month Prevalence of Schizophrenia in Males for Each of the Hypothetical Intervention Scenarios. ... 130 Table 79 Estimated Reduction in 12-Month Prevalence of Schizophrenia in Females for Each of the Hypothetical Intervention Scenarios. ... 131 Table 80 Estimated Reduction in 12-Month Prevalence of Schizophrenia in People for Each of the Hypothetical Intervention Scenarios. ... 132 Table 81 Estimated Number of Males with SUD (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 133 Table 82 Estimated Number of Females with SUD (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 134 Table 83 Estimated Number of People with SUD (12-Month Prevalence) for the Baseline Model, and Each of the Hypothetical Intervention Scenarios. ... 135 Table 84 Estimated Reduction in Number of Males with SUD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 136 Table 85 Estimated Reduction in Number of Females with SUD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 137 Table 86 Estimated Reduction in Number of People with SUD (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios. ... 138 Table 87 Estimated Reduction in 12-Month Prevalence of SUD in Males for Each of the Hypothetical Intervention Scenarios. ... 139 Table 88 Estimated Reduction in 12-Month Prevalence of SUD in Females for Each of the Hypothetical Intervention Scenarios. ... 140 Table 89 Estimated Reduction in 12-Month Prevalence of SUD in People for Each of the Hypothetical Intervention Scenarios. ... 141 Table 90 Estimated Number of Males with Dementia* (Prevalence) for the Baseline Model, and the Incidence Reduction Scenario. ... 142 Table 91 Estimated Number of Females with Dementia* (Prevalence) for the Baseline Model, and the Incidence Reduction Scenario. ... 143 Table 92 Estimated Number of People with Dementia* (Prevalence) for the Baseline Model, and the Incidence Reduction Scenario. ... 144

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Page | 21 Table 93 Estimated Reduction in Number of Males with Dementia* (Prevalence) for the Incidence

Reduction Scenario. ... 145 Table 94 Estimated Reduction in Number of Females with Dementia* (Prevalence) for the Incidence Reduction Scenario. ... 146 Table 95 Estimated Reduction in Number of People with Dementia* (Prevalence) for the Incidence Reduction Scenario. ... 147 Table 96 Estimated Reduction in Prevalence of Dementia* in Males for the Incidence Reduction Scenario. ... 148 Table 97 Estimated Reduction in Prevalence of Dementia* in Females for the Incidence Reduction Scenario. ... 148 Table 98 Estimated Reduction in Prevalence of Dementia* in People for the Incidence Reduction Scenario. ... 150 Table 99 Estimated Total Direct Costs for Any* Mental Illnesses Excluding Dementia* in Canada in Future Value Terms (in $ Millions). ... 152 Table 100 Estimated Reduction in the Total Direct Costs for Any* Mental Illnesses Excluding Dementia*

in Canada in Future Value Terms (in $ Millions). ... 153 Table 101 Estimated Total Direct Mental Health Costs for Dementia Including Cognitive Impairment in Canada in Future Value Terms for the Baseline Model, and Each of the Hypothetical Intervention Scenarios (in $ Millions). ... 155 Table 102 Estimated Reduction in Total Direct Mental Health Costs for Dementia Including Cognitive Impairment in Canada in Future Value Terms for the Each of the Hypothetical Intervention Scenarios (in $ Millions). ... 156 Table 103 Estimated Total Direct Costs for Any* Mental Illnesses Including Dementia* in Canada in Future Value Terms (in $ Millions). ... 157 Table 104 Estimated Reduction in the Total Direct Costs for Any* Mental Illnesses Including Dementia*

in Canada in Future Value Terms (in $ Millions). ... 158 Table 105 Estimated Total Direct Costs for Any* Mental Illnesses Including Dementia* in Canada in Cumulative Present Value Terms (in $ Millions)... 159 Table 106 Estimated Reduction in the Total Direct Costs for Any* Mental Illnesses Including Dementia*

in Canada in Cumulative Present Value Terms (in $ Millions). ... 160 Table 107 Estimated Total Indirect Economic Benefits for Any* Mental Illnesses Including Dementia* in Canada in Annual Future Value Terms (in $ Millions). ... 161 Table 108 Estimated Total Indirect Economic Benefits for Any* Mental Illnesses Including Dementia* in Canada in Cumulative Present Value Terms (in $ Millions). ... 162

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Page | 22 1 INTRODUCTION AND BACKGROUND

1.1 OVERVIEW OF ENGAGEMENT SCOPE

Purpose and Objectives

In our previous analysis (Smetanin et al. 2011), we developed a base model that was used to estimate the current and future impact of mental illness in Canada beginning in 2011 and annually over the next three decades. The mental illnesses included in this model were mood disorders, anxiety disorders, schizophrenia, substance use disorders (SUDs), attention deficit/hyperactive disorders (ADHD), conduct disorders, oppositional defiant disorder (ODD) and cognitive impairment including dementia. Our Life at Risk platform was used to simulate incidence, prevalence and mortality for the total population in Canada over the age of 9, and project these measures over a 30 year time horizon. Assuming steady- state prevalence, and no changes in treatment or health care utilization, these measures were linked to current estimates of health service use and workplace productivity to forecast the economic impact of mental illness now and in the future.

The purpose of this analysis was to investigate the high level impact of hypothetical mental health intervention scenarios within the simulation platform on the baseline burden in Smetanin et al. (2011) When compared to the baseline outcomes, the scenario impacts demonstrate how each hypothetical intervention could affect the prevalence and economic costs (direct health care costs and indirect wage- based productivity cost) of major mental illness in Canada over the simulated time frame.

A total of five intervention scenarios were identified by the Mental Health Commission of Canada (MHCC) and evaluated within the Life at Risk platform. Each of the scenarios evaluated the impact of making a 10% improvement across each of the following target areas:

All-Cause Incidence:

o A reduction in the overall all-cause incidence by 10%

Prior Mental Illness in Childhood or Adolescence:

o A reduction in the risks associated with prior mental illness in childhood or adolescence by 10%

Remission Rates:

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Page | 23 o An increase in remission rates by 10 %, thereby reducing the negative effects associated

with mental illness⁶ Economic Disability:

o A reduction in workplace disability by 10% which affects productivity in the labour force but not the prevalence or direct costs of mental illness

The Combined Impact of Each of the Above:

o The impact of all of the above interventions applied simultaneously within the Life at Risk platform

Out of Scope to the Current Analysis

Although the potential benefits of each hypothetical intervention were quantified, the analysis did not include specific mental health interventions supported by evidence to illustrate how these targets could be met. That is, the interventions presented in this report are hypothetical in nature and show the possible reductions in prevalence of mental illness and the direct and indirect costs that could be met if 10% improvements across each target area could be achieved. The results can be viewed as a general quantification of the potential impacts across each of the four target areas; however, the actual intervention programs that could be implemented to meet these targets were excluded from this analysis.

1.2 OVERVIEW OF SCENARIOS

The following section provides further details on each of the hypothetical interventions tested in the model including key assumptions. Each of the scenarios described below were simulated and compared to the baseline model over a thirty year time frame, from 2011 to 2041. For more information on the baseline model please refer to Smetanin et al. (2011).

All-Cause Incidence

The all-cause incidence scenario examined the impact of reducing the overall all cause incidence of mental illness across each of the major mental illnesses in Canada including mood disorders, anxiety disorders, schizophrenia, SUD, dementia, CD, ODD and ADHD. The annual incidence rate of each illness was reduced by 10% to examine the impact on 12-month prevalence, total direct and indirect costs

6 Note that for this analysis it was assumed that an increase in remission rates had no impact on cognitive impairment including dementia.

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Page | 24 relative to the baseline model. It is important to note that all other model parameters remained unchanged from the baseline and that existing prevalent cases were not altered. It was only the incidence rate of new cases that was adjusted.

Prior Mental Illness in Childhood or Adolescence

This risk reduction scenario examined the impact of reducing the risks associated with prior mental illness in childhood and adolescence for all major mental illnesses in Canada. This hypothetical intervention assessed the impact of decreasing the relative risks associated with a prior mental illness in youth by 10% on 12-month prevalence⁷, total direct and indirect costs against the baseline model. This scenario included two parts:

1. A 10% reduction in the risks associated with incidence of any adolescent mental illness given a childhood mental illness; and

2. A 10% reduction in the risks associated with any adult mental illness given an adolescent mental illness.

As in the incidence reduction scenario, the existing prevalent cases were not altered at the time of the intervention. The relative risks of an adolescent mental illness given prior childhood illness from our baseline model are shown in Table 3.

7 Note that it is the excess risk above one that is reduced by 10%, not the total value of the relative risk factor.

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Page | 25

Table 3 Baseline Model: Relative Risk of Adolescent Mental Illness Given Prior Childhood Illness

The relative risks of an adult mental illness given prior adolescent illness from our baseline model are shown in Table 4.

Table 4 Baseline Model: Relative Risk of Adult Mental Illness Given Prior Adolescent Illness

Table 5 and Table 6 provide the 10% reduction in the relative risk estimates associated with the incidence of any adolescent mental illness given a childhood mental illness and the risk of any adult mental illness given an adolescent mental illness, respectively.

Prior Childhood

Illness ADHD Anxiety

Conduct Disorders

Mood

Disorders ODD SUD

ADHD - 1.66 1.89 1.99 4.99 2.88

Anxiety 4.14 - 2.22 2.93 2.47 1.34

Conduct Disorders 6.54 1.09 - 1.23 3.50 3.38

Mood Disorders 4.28 3.33 3.31 - 4.09 2.45

ODD 4.06 2.33 3.18 2.30 - 3.09

ADHD - 1.60 1.92 1.92 4.98 3.17

Anxiety 5.10 - 2.27 2.78 2.50 1.37

Mood Disorders 5.39 3.00 3.45 - 4.17 2.71

ODD 5.01 2.17 3.30 2.20 - 3.54

Adolescent Illness

Male

Female

Prior Adolescent

Illness Anxiety

Mood

Disorders SUD Anxiety

Mood

Disorders SUD

ADHD 2.21 1.23 2.23 2.00 1.22 2.52

Anxiety - 2.43 1.04 - 2.33 1.05

Conduct Disorders 1.78 1.74 2.81 1.67 1.69 3.46

Mood Disorders 3.05 - 1.38 2.70 - 1.44

ODD 2.74 2.08 1.84 2.40 1.99 2.03

SUD 2.59 1.88 - 2.31 1.81 -

Adult Illness - Male Adult Illness - Female

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Page | 26

Table 5 Scenario Model: Relative Risk of Adolescent Mental Illness Given Prior Childhood Illness

Table 6 Scenario Model: Relative Risk of Adult Mental Illness Given Prior Adolescent Illness

Remission Rates

The remission rate scenario examined the potential impact of increasing remission rates for all major mental illnesses in Canada by 10% over the baseline model, on 12-month prevalence, total direct and indirect costs. It is important to note that the model assumed no remission rates for those with cognitive impairment including dementia. It is also important to note that increasing remission rates do necessarily reduce the number of people living with mental illness but rather reduces the effects associated with mental illness, improving overall health and the costs associated with treatment of mental illness.

Prior Childhood

Illness ADHD Anxiety

Conduct Disorders

Mood

Disorders ODD SUD

ADHD - 1.59 1.80 1.89 4.59 2.69

Anxiety 3.83 - 2.10 2.74 2.33 1.31

Mood Disorders 3.95 3.09 3.08 - 3.78 2.31

ODD 3.75 2.20 2.96 2.17 - 2.88

ADHD - 1.54 1.82 1.82 4.58 2.96

Anxiety 4.69 - 2.14 2.60 2.35 1.34

Mood Disorders 4.95 2.80 3.21 - 3.85 2.54

ODD 4.61 2.06 3.07 2.08 - 3.29

Adolescent Illness

Male

Female

Prior Adolescent

Illness Anxiety

Mood

Disorders SUD Anxiety

Mood

Disorders SUD

ADHD 2.09 1.21 2.11 1.90 1.19 2.37

Anxiety - 2.29 1.04 - 2.20 1.04

Conduct Disorders 1.70 1.67 2.63 1.60 1.62 3.21

Mood Disorders 2.84 - 1.34 2.53 - 1.39

ODD 2.56 1.98 1.75 2.26 1.89 1.92

SUD 2.43 1.79 - 2.18 1.73 -

Adult Illness - Male Adult Illness - Female

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Page | 27 Economic Disability

Economic disability is a measure of how an illness affects productivity in the labour force. The economic disability scenario examined the impact of decreasing the economic disability associated with (or equivalently improving the productivity of people with) all major mental illnesses in Canada by 10% over the baseline on the total indirect economic costs. This hypothetical scenario did not directly alter the prevalence of illness in the labour force or the direct costs associated with mental illness, but assumed that people with mental illness would be 10% more productive in the labour force than in the base model.

The Combined Impact of All of the Above

The final scenario examined a combination of all of four scenarios for all major mental illness in Canada.

That is, it evaluated the combined impact of:

Decreasing the all-cause incidence of mental illness by 10%;

Increasing the remission rates by 10%;

Decreasing the relative risks associated with prior mental illness in childhood or adolescence by 10%; and

Decreasing the workplace disability associated with mental illness by 10%.

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Page | 28 2 SCENARIO ANALYSIS OF MENTAL ILLNESS INTERVENTIONS

The impacts of the proposed intervention scenarios were compared to the base model results to derive the value proposition of the interventions. The following section summarizes the value proposition of each scenario over the simulation period. It is important to note that since these interventions represent hypothetical scenarios, the actual intervention programs and the costs associated with program implementation and human resource requirements were not taken into account. In addition, the hypothetical interventions may have additional benefits not taken into consideration within this analysis. These additional benefits may include, but are not limited to, improvements in activities of daily living, quality of life and comorbid health conditions, as well as benefits associated with burden placed on formal and informal caregivers. Note that the economic disability reduction scenario does not affect the incidence or prevalence of mental illness. It only affects productivity in the labour force. There results of the economic disability scenario are limited to Section 2.2.

2.1 LIFE IMPACTS OF SCENARIOS

In this section the impact of each scenario on the 12-month prevalence from 2011 to 2041 is presented for each of the mental illnesses included in the model. For detailed annual results, please refer to Appendix B.

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Page | 29 2.1.1 ANY MENTAL ILLNESS

Figure 4 Estimated Number of People with Any Mental Illness (12-Month Prevalence) for the Baseline Model and Each of the Hypothetical Intervention Scenarios.

Figure 4 compares the estimated number of Canadians with any mental illness at baseline to each of the hypothetical scenarios over a 30-year simulation period. For both males and females, reducing the all cause incidence rates by 10% produces the largest reduction on the number of people living with any mental illness. The interventions affect the health state of the population through altered incidence and remission rates. The prevalence was not altered directly. As a result, the benefits of the interventions grow over time. For example, when incidence rates are reduced, those currently with a mental illness will continue with that illness until remission or death. However, over time fewer people are becoming ill than would have without the intervention resulting in a reduction in prevalence which grows over time. The estimated reduction in these numbers is shown in Figure 5. The reduction in prevalence as a percentage of the population is shown in Figure 6. Note that this is the absolute prevalence in the population, not the relative reduction in the number of people with any illness. Since the simulation

6,500,000 7,000,000 7,500,000 8,000,000 8,500,000 9,000,000

2011 2016 2021 2026 2031 2036 2041

Number of Canadians

Estimated Number of People with Any* Mental Illness (12-Month Prevalence)

Base Case Remission Incidence Child/Adol RR Combined Any* is Mood, Anxiety, Schizophrenia, SUD, ADHD, ODD, CD, Dementia 3,000,000

3,200,000 3,400,000 3,600,000 3,800,000 4,000,000 4,200,000 4,400,000 4,600,000 4,800,000 5,000,000

2011 2016 2021 2026 2031 2036 2041

Number of Canadians

Estimated Number of People with Any* Mental Illness (12- Month Prevalence)- Male

Base Case Remission Incidence RR Combined

3,000,000 3,200,000 3,400,000 3,600,000 3,800,000 4,000,000 4,200,000 4,400,000 4,600,000 4,800,000 5,000,000

2011 2016 2021 2026 2031 2036 2041

Number of Canadians

Estimated Number of People with Any* Mental Illness (12- Month Prevalence)- Female

Base Case Remission Incidence RR Combined

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Page | 30 time-frame is 30 years, a significant number of people with mental illness prior to the intervention remain alive in the model limiting the reduction in prevalence to 2.3% when all interventions are combined.

Figure 5 Estimated Reduction in Number of People with Any Mental Illness (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios.

- 200,000 400,000 600,000 800,000 1,000,000 1,200,000

2011 2016 2021 2026 2031 2036 2041

Reduction in Number of Canadians

Estimated Reduction in Number of People with Any* Mental Illness (12-Month Prevalence) for Each of the Hypothetical Intervention Scenarios

Remission Incidence Child/Adol RR Combined Any* is Mood, Anxiety, Schizophrenia, SUD, ADHD, ODD, CD, Dementia -

100,000 200,000 300,000 400,000 500,000 600,000

2011 2016 2021 2026 2031 2036 2041

Estimated Reduction in Number of People with Any* Mental Illness (12-Month Prevalence) for Each of the Hypothetical

Intervention Scenarios- Male

Remission Incidence RR Combined

- 100,000 200,000 300,000 400,000 500,000 600,000

2011 2016 2021 2026 2031 2036 2041

Estimated Reduction in Number of People with Any* Mental Illness (12-Month Prevalence) for Each of the Hypothetical

Intervention Scenarios- Female

Remission Incidence RR Combined