Early action on mental health matters
Posted on Wednesday 19 November 2025
Rowena Jacobs, Professor of Health Economics and Deputy Head of Department for CHE, was recently interviewed by Expresso, one of Portugal’s leading newspapers.
The conversation explored why mental health must be understood not just as a clinical issue, but as a core economic priority for governments, employers, and societies.
“Mental health differs from physical health in one essential point,” she explained. “Physical illnesses tend to affect mainly people at older ages, whereas mental health problems arise earlier, particularly during working age. That changes everything from an economic point of view.”
With mental illnesses often beginning in adolescence, the financial implications are vast. Lost productivity, reduced tax revenue, increased healthcare costs, and poorer long-term outcomes contribute to an estimated 4% of European GDP, amounting to around €600 billion.
Professor Jacobs emphasised that the burden of these costs is unevenly distributed. “About 60% falls on individuals and families, 30% on companies and employers and only 10% on the State,” she said. “This shows how crucial it is to invest in prevention and early intervention.”
What works
When asked about the most effective approaches, Professor Jacobs highlighted interventions with a strong evidence behind them. Cognitive Behavioural Therapy (CBT) remains one of the most cost-effective treatments for depression and anxiety. She also pointed to behavioural activation which can be as effective as full CBT but is delivered by less specialised teams; making it particularly promising for expanding access.
For severe mental illness, she underscored the success of early intervention teams and programmes like Assertive Community Treatment along with Individual Placement and Support (IPS), which helps people return to employment.
Digital mental-health tools are often promoted as scalable alternatives, but Professor Jacobs urged caution. “There is still no solid evidence base that these solutions are cost-effective in the long term,” she explained. The evidence suggests that they may be advantageous compared with “not treating”, but there are no data yet that confirm their effectiveness compared with in-person therapy, medication or a combination of both. While potentially helpful, “many of these applications still lack verification, supervision or regulation,” raising concerns about safety and equity.
Improving care: insights for Portugal
Portugal’s high rates of antidepressant use, Professor Jacobs suggested, signal a lack of accessible alternatives. Drawing on the UK system, she highlighted the NHS Talking Therapies programme as an example of a national, evidence-based service that provides free psychological treatment that has shown long-term positive outcomes:
“[The programme] has showed very positive results: improvements in mental health, greater employability and increased earnings, with effects that last up to seven years after treatment, without additional costs.”
She also stressed the importance of stable, long-term funding. Reliance on temporary funds, such as Portugal’s Recovery and Resilience Plan, risks incentivising short-term solutions rather than sustained workforce investment.
Finally, Professor Jacobs highlighted financial, structural, and cultural barriers that continue to prevent people from accessing care. Stigma remains a significant obstacle: “Many people avoid seeking help for fear of being labelled or discriminated against”. Long waiting times, provider shortages, geographical inequality, and the need for culturally competent services also contribute to persistent treatment gaps.
Looking Ahead
This week, Professor Jacobs will continue these conversations with policymakers, delivering a follow-up talk to the National Coordination for Mental Health Policy at the Portuguese Ministry of Health.
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