According to international publications the burden of mental diseases is considered to be significant and rising.

Scope of analysis is to present 1) patient numbers and 2) direct mental health costs from the database of the National Health Insurance Fund Hungary for patients with F00-F99 ICD code between 2015-2019.

An Oracle database was created with direct mental care costs for each patient in a given year with a three-digit ICD code and type of care (primary, specialist, prescribing) and handled via sql queries. Data on capacity and performance came from the NHIF and NSO website for 2008-2019 and were handled via Microsoft Excel.

Mental problems affected 3 million people (more than 30% of the population) in a five year period, though patient numbers are continuously declining. Almost half of the patients only visit a general practitioner and don’t get a prescription. There is also a drop in proportional mental spending which has fallen from 5,03% to 4,02%. This tendency is accordance with international findings. There is a dramatic fall of inpatient cases and a growing number of outpatient interventions, though we see a move from individual therapy sessions to group interventions and a decline in specialist psychotherapy sessions. We can see a shift towards more young patients both in inpatient and outpatient setting.

The analysis raises the question whether declining patient numbers and shrinking proportional spending are due to smaller provider capacities and unmet need or a mentally healthier population.

No significant relationships.

Information on individual mental healthcare costs and utilization patterns in Italy is scant. We analysed the use and the annual costs of community mental health services (MHS) in an Italian local health authority (LHA). Our aims are to compare the characteristics of patients in the top decile of costs with those of the remaining 90%, and to investigate the demographic and clinical determinants of costs.

This retrospective study is based on administrative data of adult patients with at least one contact with MHS in 2013. Costs of services were estimated using a microcosting method. We defined as high cost (HC) those patients whose community mental health services costs place them in the top decile of the cost distribution. The predictors of costs were investigated using multiple linear regression.

The overall costs borne for 7601 patients were 17 million €, with HC accounting for 87% of costs and 73% of services. Compared with the rest of the patients, HC were younger, more likely to be male, to have a diagnosis of psychosis, and longer and more intensive MHS utilization. In multiple linear regression, younger age, longer duration of contact with MHS, psychosis, bipolar disorder, personality disorder, depression, dementia and Italian citizenship accounted for 20.7% of cost variance.

Direct mental health costs are concentrated among a small fraction of patients who receive intensive socio-rehabilitation in community services. One limitation includes the unavailability of hospital costs. Our methodology is replicable and useful for national and cross-national benchmarking.