Is higher-quality secondary mental healthcare more costly? A systematic review

Mental health disorders impose a substantial disease and economic burden to global health systems. Although expenditure on mental healthcare comprises a relatively small part of overall healthcare budgets, it tends to be concentrated in the secondary mental healthcare sector. This review examines whether higher-quality secondary mental healthcare is associated with increased costs, and explores the processes underlying this relationship.

A two-phase structural search strategy was applied. The initial search was conducted in MEDLINE, Embase, PsycINFO, and EconLit in September 2023, following a supplementary search using PubMed citation tracking and Similar Articles functions in March 2026. Risk of bias was assessed using the ROBINS-I for intervention studies and the ROBINS-E for exposure studies. The review followed PRISMA 2020 guidelines.

Nine studies were included, all rated to be at moderate to very high risk of bias. The overall evidence suggests that higher quality care does not necessarily entail higher costs. Interventions and care models emphasising timely access, continued outpatient service delivery were associated with improved quality indicators and stable or reduced costs. Confounding was the dominant source of bias across all studies.

Higher-quality secondary mental healthcare may be achievable without increased expenditure, potentially through investment in timely accessible and continued care models. However, the evidence base remains limited and largely observational. Strengthening linked administrative data infrastructure and applying robust causal methods will be essential to inform policy design and service delivery.