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.