Analysing the cost-effectiveness of Place2Be’s in-school counselling services

1. Analysing the cost-effectiveness of Place2Be’s in-school counselling services Tilly Forster, Nikhil Naag, Lauren Herlitz, Jemma White, and Mick Atkinson Background Mental health and emotional problems in childhood are associated with mental health problems and conduct disorders in adult life12345. Good mental health in childhood is associated with: • Good educational outcomes • Better employment prospects • Greater capacity to maintain emotionally satisfying relationships • Less use of health services, social care, criminal justice services and welfare benefits6 To calculate the full costs of mental ill health, the associated human costs above and beyond others who do not have mental health concern, including the impact on carers, should also be taken into account7. Research question What are the potential long-term economic and social benefits and savings of Place2Be’s in-school counselling service? Method The sample • 2,344 children, mean age 8 years old, from 119 schools in 13 local authority areas received counselling in the 2007/08 academic year. • Analysis was carried out on children who had both pre- and post-intervention Strengths and Difficulties Questionnaires8 (SDQ) from teachers and parents. Complete data was available for 936 of the 2344 children (40%). The cost-analysis Cost-savings were calculated by analysing the improvement of children for whom complete data was available, applying these results to the whole sample, and estimating costs based on the findings of previous research on conduct problems. Due to gaps in the data, learning and research available, we have had to make a number of measured and conservative assumptions to arrive at our estimates. We have consulted widely on this analysis – for further details see Place2Be (2010)9. Results • Of the 936 children with complete data, 10% of children (n=90) showed clinically significant improvement in their mental health post-intervention. • Assuming the same improvement pattern occurs for the children without complete data (n=1408), 135 children (10%) would show clinically significant improvement. • Therefore, 225 out of the 2,344 children receiving Place2Be services would show clinically significant improvement. • Based on previous research9, 50% of improvements would continue into adulthood – 112 children would have continued mental health improvement9. What is Place2Be? Place2Be is a charity working to enhance the wellbeing and prospects of children and their families by providing access to therapeutic and emotional support in schools for children, parents and school staff. It was established in 1994 in response to increasing concern about the extent and depth of emotional and behavioural difficulties displayed in classrooms and playgrounds. Its universal and targeted school-based services are available to 58,000 children, coping with problems such as bereavement, family breakdown, domestic violence, trauma and bullying. Key findings • Using estimates of costs per individual from multiple studies9, the potential cost savings with this group of 112 children could be £15 million over their lifetime. • For every pound invested in the school- based individual and group counselling there would be a net return on investment of £6. • The benefits accrue not just to these individuals themselves, but to their families and to society more widely (see figure 1). References 1Meltzer H, Gatward R, Goodman R & Ford T (2000). Mental health of children and adolescents in Great Britain. London: The Stationary Office. 2Kim-Cohen J, Avshalom C, Moffitt TE, Harrington H, Milne BJ, Poulton R (2003). Prior juvenile diagnoses in adults with mental disorder. Arch Gen Psychiatry, 60(7), 709-717. 3Earls F & Mezzacappa E (2002). Conduct and oppositional disorder. In: Rutter M & Taylor E (eds). Child and adolescent psychiatry, 4th edition. Oxford: Blackwell Publishing Company (419-436). 4Richards M, Abbott R, in conjuction with Collis G, Hackett P, Hotopf M, Kuh D, Jones P, Maughan B, Parsonage M (2009). Childhood mental health and lifetime chances in post-war Britain: insights from three national birth cohort studies. London: Sainsbury Centre for Mental Health. 5Scott S, Knapp M, Henderson J, Maughan B (2001). Financial cost of social exclusion: follow up study of antisocial children into adulthood. British Medical Journal, 323: 1-5. 6Knapp M (2003). Hidden costs of mental illness. Editorial. British Journal of Psychiatry, 183, 477-478. 7Foresight Mental Capital and Wellbeing Project (2008). Final project report. London: The Government Office for Science. 8Goodman R, Ford T, Simmons H, Gatward R & Meltzer H (2000). Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disoders in a community sample. British Journal of Psychiatry, 177, 534-539. 9 Place2Be (2010). Cost effective positive outcomes for children and families: an economic analysis of The Place2Be’s integrated school-based services for children. London: Place2Be. Contact details: Nikhil.Naag@theplace2be.org.uk Evaluation@theplace2be.org.uk