Investing to save in a time of austerity
A report published by the World Health Organisation acknowledged that the economic crisis is expected to produce secondary mental health effects. Under such circumstances demand for services, including psychological therapies, is likely to grow.
The challenge in the current climate is to make the case for meeting this demand, when there are many competing priorities for limited resources. One area in which this has been possible is around the link between mental health and employment prospects.
Studies have shown that active labour market programmes that incorporate resilience-building mental health promotion programmes aimed at helping people retain or regain jobs can be cost effective.
In the UK, a programme has been developed for delivering psychological therapies to treat mild to moderate mental health problems (such as anxiety and depression) in the primary care setting as part of frontline provision. The programme, called Improving Access to Psychological Therapies (IAPT), is grounded in evidence showing that treating mental health problems in the early stages can prevent the later development of more severe problems, and can therefore result in better health outcomes for patients, while realising potential efficiency savings for secondary health services. IAPT services are being used to expand talking therapies in the UK as part of a cross-governmental mental health strategy.
IAPT services in the UK have integrated employment support services within psychological therapy services, thereby aiming to tackle both the symptom and the cause simultaneously.
What we did
In 2011, OPM conducted an economic evaluation of IAPT employment support services in partnership with the regional IAPT implementation team, Working for Wellness. It involved direct research with five employment support services delivered as part of IAPT in 15 London Primary Care Trusts. The principal aim of the study was to examine the return on investment for integrated employment services above and beyond the returns provided by IAPT clinical services alone.
The study involved the calculation of direct and indirect costs associated with these services, as well as the monetised benefits accrued to the individuals who use them, as well as to wider services and to the overall economy.
We analysed standardised employment data collected locally by each site and conducted primary fieldwork to understand the throughput and the outcomes associated with different pathways through the services. Across the five IAPT sites involved in the study, a total of 865 individuals had entered the employment support service in 2010.
The study identified the financial outcomes associated with these pathways in terms of the retention, or acquirement of, employment, or avoidance of unemployment, for the individual service users, employers and the state.
The findings from the monetisation of these benefits and costs show that overall the employment support services generated more financial benefit than cost. Benefits were accrued through a reduction in the actual and potential number of people out of work, calculated over a 24-month period.
Our findings are that:
After 12 months: every £1 spent by the state on IAPT employment support services generates £2.02 of benefits, of which £0.61 benefits the individual and £1.41 benefits the state.
After 18 months: every £1 spent by the state on IAPT employment support services generates £2.79 of benefits, of which £0.84 benefits the individual and £1.95 benefits the state.
After 24 months: every £1 spent by the state on IAPT employment support services generates £3.89 of benefits, of which £1.17 benefits the individual and £2.72 benefits the state.
This suggests that employment support services represent ‘value for money’ in supporting people to retain or to gain employment.
The study found that delivering employment support services as part of IAPT can result in a range of outcomes for the state, for employers, and for people affected by common mental health problems. This ability to demonstrate and communicate the value of IAPT employment support services, arguably, contributes towards the making of a compelling case for investment in such services at a time when health and other services are under pressure. Despite the programme of public spending cuts in the UK, the current coalition government remains committed to the continued roll-out of IAPT, seeing this very much as an ‘invest-to-save’ endeavour.
These findings provide conservative estimates of monetised benefits to individuals and the state, and demonstrate significant returns on the investment. In times of economic challenge, with services needing to increase efficiencies and make cuts, it can be hard to justify new or additional expenditure. However this work informs commissioning decisions by showing the value of IAPT employment support services, both in terms of the economic gains associated with employment (which are widely evidenced), but also through improvements in mental health which are accompanied by benefits to health services too.