Abstract
AIMS: A rise in mental illness has inspired the UK government to increase mental health service funding by £2.3 billion/year, deepening the need for robust evidence on how to best allocate mental health resources. The STAR methodology was co-developed by the London School of Economics and the Health Economics Unit to help commissioners allocate resources by combining a value-for-money analysis with stakeholder engagement. The aim of this research was to evaluate the potential benefit of implementing the STAR methodology in the allocation of mental health resources. METHODS: The barriers and facilitators to commissioning cost-effective mental health services were systematically reviewed. The potential for STAR to overcome these barriers and promote these facilitators was then evaluated by analysing its socio-technical components and assessing its real-world implementation in the COPD pathways of five ICSs. RESULTS: Fragmentation and cross-sectoral responsibility for the funding and delivery of services can hinder multi-sector buy-in. STAR has overcome this barrier in the COPD pathways of five ICSs by pooling their budgets and building partnerships across sectors through decision conferencing that has facilitated shared priority setting. Lacking community involvement impedes local stakeholders from embracing change. By championing local stakeholders, STAR's ‘socio’ component involves front-line workers in funding decisions and fosters a sense of ownership over service adjustments. The value placed on each outcome varies between sectors, often resulting in conflicting incentives. By considering each sector's interests, STAR enables a consensus on which outcomes to optimise for. Furthermore, STAR's ‘technical’ components strengthen the objective value-for-money evaluations of the interventions that contribute to each outcome. When modelling the health gain and cost of COPD interventions, STAR discovered that CBT offers a relatively high return on investment, despite often being overlooked as a core intervention for COPD. STAR's economic evaluations are communicated in easily interpretable ways to facilitate a shared understanding on which resources are most worth funding. CONCLUSION: Resource allocation decisions are fuelled by the quality of evidence supporting them. Compared with physical health services, mental health services lack evidence that reflects the qualitative and quantitative nature of their outcomes. In particular, services that rely mostly on subjective reports, such as psychotherapy, lack objective value-for-money evaluations, resulting in a hesitancy for funding. By measuring the health gain and cost of each mental health intervention in a systematic, transparent and objective way, STAR enables commissioners to improve the allocative efficiency of mental health resources, thus improving population mental health without increasing cost.