Beyond health: a systematic review of cross-sector economic implications of school-based mental health programmes in Europe

Objective To assess the economic evidence on school-based prevention and mental health promotion interventions, focusing on costs and outcomes across key societal sectors, including healthcare, education, social care, criminal justice, as well as in productivity and individual expenses. Design A systematic review with narrative synthesis was conducted following the Synthesis Without Meta-analysis approach, including an assessment of monetised outcomes across all sectors and an additional analysis of non-monetised outcomes in the education sector. Study quality was appraised using Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Consensus Health Economic Criteria (CHEC). Data sources Medline, Embase, PsycINFO, Econlit, ERIC and Scopus. Eligibility criteria for selecting studies Economic evaluations of school-based prevention or mental health promotion interventions for children or adolescents in Europe that report outcomes across healthcare and other societal sectors. Results 20 studies were included, comprising different types of economic evaluations as well as trial-based and model-based evaluations. Based on the primary analyses reported in the studies, which consider costs and benefits across multiple societal sectors, most evaluations suggested favourable economic outcomes. Benefits exceeded costs in four out of five (80%) cost–benefit analyses (average cost–benefit ratio of 5.14). Half of the cost-effectiveness analyses found that interventions were more effective but also more costly than the comparator while two interventions were both more effective and less costly. In cost–utility analyses, 9 out of 10 (90%) fell below commonly used thresholds for good value for money. Reported outcomes covered healthcare, education, social care, criminal justice sectors, as well as productivity and individual expenses. Pronounced cost savings from included interventions were observed in productivity and healthcare, with improvements also observed in non-monetised education outcomes. Study quality was mixed. Conclusions School-based mental health interventions yield cross-sectoral economic benefits and, in many cases, societal returns on investment, in both the short and longer term, by influencing key determinants of health and well-being across multiple sectors.