Economics and ethics in mental health care: traditions and trade-offs

Both economic and ethical perspectives are exerting increasing influence on all levels of mental health practice and policy; yet there is little discussion how these two different perspectives are integrated and reconciled. In this article, we outline four key principles of health care economics and ethics, and then focus on the particular considerations and trade offs that are raised by these principles at three levels of mental health decision making: government and society; purchasers and providers; and users and carers. We conclude by highlighting the need to move towards a more open, accountable and evidence-based mental health system.