Health-Related Quality of Life in Schizophrenia: Health Policy and Resource Allocation

  • Frank HollowayEmail author
  • Jerome Carson


This chapter investigates the impact of the quality of life (QoL) construct on mental health policy and resource allocation, with a focus on the care and treatment of people with a diagnosis of schizophrenia or other functional psychoses. We review the many approaches that have been taken towards QoL and the impact of schizophrenia on the individual, family and society. The role of QoL in public policy in general and in particular the salience of specific measures of health-related quality of life (HRQoL) is discussed. A brief analysis of recent mental health policy documents from seven Anglophone documents is presented – from which it is concluded that QoL is losing out to the rhetoric of ‘recovery’. We end with a discussion of the real-world drivers for resource allocation and the often tenuous link between policy and practice.


Life Satisfaction Gross Domestic Product Severe Mental Illness Mental Health Policy Mental Health Spending 
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  1. Andrews A, Knapp M, McCrone P, Parsonage M, Trachtenberg M. Effective interventions in schizophrenia the economic case: a report prepared for the Schizophrenia Commission. London: Rethink Mental Illness; 2012.Google Scholar
  2. Appleby L. Mental health ten years on: progress on mental health care reform. London: Department of Health; 2007.Google Scholar
  3. Bache I. Measuring quality of life for public policy: an idea whose time has come? Agenda-setting dynamics in the European Union. J Eur Public Policy. 2013;20(1):21–38.CrossRefGoogle Scholar
  4. Bowling A. Measuring health: a review of quality of life and measurement scales. Milton Keynes: Oxford University Press; 2002.Google Scholar
  5. Brazier J. Is the EQ-5D fit for purpose in mental health? Br J Psychiatry. 2010;197:348–9. doi: 10.1192/bjp.bp.110.082453.CrossRefPubMedGoogle Scholar
  6. Brazier J, Connell J, Papaioannou D, Mukuria C, Mulhern B, Peasgood T, et al. A systematic review, psychometric analysis and qualitative assessment of generic preference-based measures of health in mental health populations and the estimation of mapping functions from widely used specific measures. Health Technol Assess. 2014;18(34):vii–viii, xiii–xxv, 1–188.CrossRefGoogle Scholar
  7. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37(1):53–72.CrossRefPubMedGoogle Scholar
  8. Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar A; on behalf of the Grand Challenges in Global Mental Health Scientific Advisory Board and Executive Committee. Grand challenges in global mental health. Nature. 2011;474(7354):27–30. PMID 21734685.Google Scholar
  9. Commonwealth of Australia. Fourth national mental health plan. An agenda for collaborative government action in mental health 2009-2014. Canberra: Commonwealth of Australia; 2009.Google Scholar
  10. Department of Health. Healthy lives, healthy people: our strategy for public health in England. London: Department of Health; 2010.Google Scholar
  11. Department of Health. Closing the gap: priorities for essential change in mental health. London: Department of Health; 2014a.Google Scholar
  12. Department of Health. The NHS outcomes framework 2015/16. London: Department of Health; 2014b.Google Scholar
  13. Department of Health. Wellbeing. Why it matters to health policy. 2014c. Accessed 28 July 2015.
  14. Department of Health and Children. A Vision for change. Report of the Expert Working group on mental health policy. Dublin: Department of Health and Children; 2006.Google Scholar
  15. Dolan P, Metcalfe R. Measuring subjective wellbeing: recommendations on measures for use by national governments. J Soc Policy. 2012;41(02):409–27. doi: 10.1017/S0047279411000833.CrossRefGoogle Scholar
  16. Dolan P, Layard R, Metcalfe R. Measuring subjective well-being for public policy. Newport: Office for National Statistics; 2011.Google Scholar
  17. Grasso M, Canova L. An assessment of the quality of life in the European Union based on the social indicators approach. Soc Indic Res. 2007. doi: 10.1007/s11205-007-9158-7.Google Scholar
  18. HM Treasury. The green book. Appraisal and evaluation in central government. London: The Stationery Office; 2011. Accessed 14 Nov 2015.
  19. Hogan M. Transforming mental health care: realities, priorities and prospects. Psychiatr Clin N Am. 2008;31:1–9.CrossRefGoogle Scholar
  20. Holloway F, Carson J. Quality of life in severe mental illness. Int Rev Psychiatry. 2002;14:175e184.CrossRefGoogle Scholar
  21. Joint Commissioning Panel for Mental Health. Guidance for commissioning public mental health services. 2013. Accessed 14 Nov 2015
  22. Knapp M, Mangalore R, Simon J. The global costs of schizophrenia. Schizophr Bull. 2004;30:279–93.CrossRefPubMedGoogle Scholar
  23. Layard R. Happiness. Lessons from a new science. London: Allen Lane; 2005.Google Scholar
  24. Layard R, Clark DM. Thrive: the power of evidence-based psychological therapies. London: Penguin; 2014.Google Scholar
  25. Lehman AF. A quality of life interview for the chronically mentally ill. Eval Program Plann. 1988;11(1):51e62.CrossRefGoogle Scholar
  26. Marcheschi E, Laike T, Brunt D, Hansson L, Johansson M. Quality of life and place attachment among people with severe mental illness. J Environ Psychol. 2015;41:145–54.Google Scholar
  27. Medeiros H, McDaid D, Knapp M (2008) Shifting care from hospital to the community in Europe: economic challenges and opportunities. MHEEN II policy briefing 4. pdf Accessed 3/03/16.
  28. Mental Health Commission of Canada. Changing directions, changing lives: the mental health strategy for Canada. Calgary: Mental Health Commission of Canada; 2012.Google Scholar
  29. Mental Health Strategies (2013) 2011/12 National Survey of Investment in Adult Mental Health Services.
  30. Ministry of Health. The mental health and addictions service development plan 2012-2017. Wellington: Ministry of Health; 2012.Google Scholar
  31. National Collaborating Centre for Mental Health. Psychosis and schizophrenia in adults. The NICE guideline on treatment management. Leicester: British Psychological Association; 2014. Accessed 8 Aug 2015.
  32. National Institute for Health and Care Excellence. Guide to the methods of technology appraisal. 2013. Accessed 28 July 2015.
  33. New Freedom Commission on Mental Health. Achieving the promise: transforming mental health care in America. Final report. Rockville: Department of Health and Human Services; 2003. DHHS pub no SMA-03-3832.Google Scholar
  34. O’Donnell G, Deaton A, Gurand M, Halpern D, Layard R. Wellbeing and policy. London: Legatum Institute; 2014.Google Scholar
  35. Office for National Statistics. Measuring national wellbeing. 2015. Accessed 28 July 2015.
  36. Roberts G, Wolfson P. The rediscovery of recovery: open to all? Adv Psychiatr Treat. 2004;10:37–49.CrossRefGoogle Scholar
  37. Saarni SI, Viertio S, Perala J, Koskinen S, Lonnqvist J, Suvisaari J. Quality of life of people with schizophrenia, bipolar disorder and other psychotic disorders. Br J Psychiatry. 2010;197:386–94.CrossRefPubMedGoogle Scholar
  38. Sen AK. Capability and wellbeing. In: Nussbaum MC, Sen AK, editors. The quality of life. New York: Oxford Clarendon Press; 1993. p. 30–53.CrossRefGoogle Scholar
  39. Stiglitz JE, Sen A, Fitoussii J-P. Report by the commission on the measurement of economic performance and social progress. 2009. Accessed 14 Nov 2015.
  40. The Kings Fund. Has the government delivered a new era for public health? The Kings Fund verdict. 2015. Posted April 15 2015. Accessed 31 July 2015.
  41. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473–83.CrossRefPubMedGoogle Scholar
  42. Wittchen HU, Jacobi F, Rehm J, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2010;21:655–79.CrossRefGoogle Scholar
  43. World Health Organization. The global burden of disease: 2004. Geneva: Update World Health Organisation; 2008.Google Scholar
  44. World Health Organization. Improving health systems and services for mental health. Geneva: World Health Organization; 2009.Google Scholar
  45. World Health Organization. Mental health atlas 2014. Geneva: World Health Organization; 2015.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.South London and Maudsley NHS Foundation TrustBeckenhamUK
  2. 2.Maudsley HospitalDenmark Hill, LondonUK
  3. 3.School of Education and PsychologyUniversity of BoltonBoltonUK

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