Deteriorating mental health among healthcare professionals is a long-documented concern, and the incidence continues to rise despite the growing number of reports and preventive measures. This observation raises a fundamental question: why are current institutional measures failing to reverse this trend?

As a health economist in the French public hospital sector for the past fifteen years, I have seen the increased workload borne by frontline staff. This phenomenon cannot be solved by internal management changes alone, but requires the convergence of severalmacroeconomic and demographic factors:

• The epidemiological transition: The shift toward chronic conditions requires long-term care, transforming the very nature of healthcare delivery;
• The demographic challenge: The aging population generates a demand for care exceeding current capacity;
• Technological progress: While innovations improve the quality of care, they also drive up costs and require greater expertise and technical skills, putting further time pressures on teams, not to mention the ever-growing administrative burden of managing patient records.

It would be an over simplification to blame disengaged authorities or hiring freezes. Indeed, healthcare facilities demonstrate genuine growth in staffing levels. However, there isa temporal and quantitative mismatch: the increase in personnel, while real, remains inadequate for the exponential increase in healthcare needs.

Public hospitals in France, and in other European countries, are seeing their budgets stretched to the limits. Although staff costs represent the largest single expense, budget flexibility is constrained by rising operating costs and technological investments. Years of extreme optimization have now reached critical limits: adjustments can no longer be made without jeopardizing workers.

What can we do?

Faced with what is proving to be amajor challenge to healthcare system sustainability, what solutions should we prioritize? We have moved beyond merely allocating more resources, and must now rethink resource allocation based on detailed and rigorous data concerning the economic assessment of the real consequences (social, clinical, and economic) of deteriorating healthcare workers' mental health.

This is precisely the ambition of the economic objective of the European Apollo2028 project. By employing a rigorous methodology, our mission is to equip decision-makers and stakeholders with decision-making tools capable of radically transforming how we use our budgets.

Our aim is to demonstrate that, while aprevention policy represents an initial investment, it cannot be equated with anet cost. Indeed, the cost of mental health deterioration already exists. Until now, this cost has been primarily understood through a broad macroeconomic lens; our project aims to assess it on a "microscopic" and operational scale. This financial and human burden is currently borne by society, the healthcare system, and professionals themselves.

Ultimately, the goal is to transform this imposed cost into a purposeful investment. By revealing these hidden expenses, we aim to encourage a reallocation of resources towards measurable improvements in working conditions and reduced burnout.

Our objective is thus twofold: to safeguard population health while protecting the health of the professionals who form the backbone of the healthcare system. We must move beyond reactive crisis management and build a systemic strategy - the only approach that can providel ong-term protection for those who care for us.

Hidden risks: A major statistical gap

One of the major obstacles to an effective institutional response lies in the lack of precise probabilistic data on all the consequences of impaired mental health.While the literature clearly identifies the symptoms of burnout, we sorely lack quantitative measures of the probability of each specific consequence occurring. This lack of information prevents us from accurately modeling the progression from emotional exhaustion to action, whether manifesting in disengagement from work, medical errors, serious physical deterioration, or other outcomes.

This lackof probability data makes it virtually impossible to produce realistic cost estimates. The economic studies available to date suffer from two major limitations: they focus either on isolated impacts (such as absenteeism) or on national macroeconomic aggregates. These aggregate figures, while alarming, are too disconnected from realities on the ground and are insufficient to guide managerial or budgetary decisions at the operational level. Without a detailed understanding of the causal chain, decision-makers are left ill-equipped to allocate resources.

The cost of inaction: a hidden burden

It is essential to overturn the conventional budgetary paradigm: failing to invest in the mental health of healthcare workers does nothing to reduce costs. In reality, the costs are already present, but hidden. The silent deterioration of human capital generates additional costs related to presenteism, declining quality of care, and constant staff turnover. These hidden costs often prove far greater than the investments required for robust prevention policies. Making these costs visible is a key aim of the Apollo2028 project.

A hybrid methodological framework to support decision-making

To address these empirical gaps, the economic component of the Apollo2028 project employs a multidimensional research framework. Our approach is based on the synergy of three methodological pillars:

1.    Synthesisof high-level evidence: We conducted an umbrella review to map the full range of consequences related to impaired mental health. In parallel, a large-scalemeta-analysis, integrating data from international and national surveys, allowed us to quantify the various pathological states of impaired mental health (anxiety, depression, burnout, PTSD, sleep disorders, stress, etc.).

2.    Arbitration using the Delphi method: Due to the lack of conclusive data in the literature regarding the probabilities of occurrence of consequences, we drew on expert knowledge. This iterative process allows us to gather, compare, and synthesize expert opinions on the psychological, physical, social, and professional repercussions.

3.    Harnessing tacit knowledge: By converting clinicalfield expertise into quantifiable, economically valuable, and actionable data,we lay the groundwork for precision economic modeling. This level of analytical precision is essential for guiding health policies toward long-term prevention strategies.

The robustness of our future results relies on the creation of a panel of international experts from seven countries (Italy, Lithuania, Ireland, Sweden, Finland, France, and the United States). To ensure a holistic view of the healthcare journey for healthcare professionals, we have brought together a diverse range of medical specialties: psychiatrists, occupational physicians, general practitioners, and psychologists.

Each of these professionals contributes critical expertise on the care of healthcare professionals experiencing burnout, thus grounding our economic model in a concrete and shared clinical reality.

This evaluationwill provide a first-of-its-kind measure of the societal cost of healthcare worker burnout. Our goal is to turn these figures into a decision-making tool for stakeholders, in order to initiate a strategic and efficient real location of budget resources.

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