Assessing the economic case for public health interventions provided in non-health public sector settings: a feasibility study in job centres in Cornwall, South West of England.

Background: Poor mental wellbeing costs society over £105 billion/year in England. Those with a mental health condition face significant health inequalities and lower employment rates. This feasibility study assessed the cost benefit of a public health intervention to help unemployed people with poor mental wellbeing to access employment.

Methods: Mental health employment advisors located in all 11 job centres supported people aged over 16 years. Support was provided over a 2-to-4-month period via an agreed action plan. Employment status, baseline and follow up wellbeing outcomes (using the Short Warwick-Edinburgh Mental Wellbeing scale) were obtained and used to estimate the return on investment.

Results: Of the 540 people with baseline and follow-up wellbeing scores, a total of 57.79% had probable depression and/or anxiety when they accessed the intervention. The number of people with probable depression and/or anxiety reduced at follow up (23.82%). A total of 235 people accessed new employment after receiving the intervention. The resulting benefit/cost ratios were 8.4 and 17.6 (depending on whether a cost of illness or income equivalence approach is used to value the improvement in wellbeing).

Discussion: This cross-sector public health intervention may provide a cost-effective way to reduce health inequalities for those who are unemployed, especially those whose mental wellbeing acts as a barrier to employment. The resultant outcomes may also be influenced by a range of other factors such as social isolation, financial precarity and housing. Despite this, the findings support the development of this approach to reduce health inequalities but is reliant on a close collaboration between local authorities, NHS, Department for Work and Pensions and the voluntary sector.