How Effective is Mental Well-being Impact Assessment?

How Effective is Mental Well-being Impact Assessment?

TIHR carry out a first level review of evidence in order to assess effectiveness and identify gaps.

Tavistock Institute of Human Relations (TIHR) carry out a first level review of evidence in order to assess effectiveness and identify gaps.

Update: Download the Briefing Paper.

Mental Well-being Impact Assessment (MWIA) was originally developed by South London and Maudsley NHS Foundation Trust (SLaM) and partners in 2003. The diagnostic tool aims to orientate policy makers, commissioners, programme/project and service managers to consider in depth the wide ranging impact of proposals (from new services to implementing change) on the mental well-being of the target group.

Since its development, a wide range of initiatives have used MWIA in both high level strategic and grass roots projects. Areas as diverse as housing, arts, health, education, workplace and town planning have been covered. MWIA was not designed with an evaluation strategy and to date, no impact evaluation of the tool itself has taken place. SLaM commissioned the TIHR to carry out a first level review of evidence in order to assess effectiveness and identify where there are gaps.

The review

The review concluded that there is strong qualitative evidence that MWIA makes a difference to the way initiatives are implemented. For example, in 2012-13 the Kings Health Partners’ happier@work programme1 carried out a process evaluation to trace the influence of MWIA on participating NHS teams. MWIA’s were undertaken with 8 teams to identify key issues impacting on the mental well-being of staff to inform the development of a programme of well-being interventions for the organisation. The MWIA concretised the well-being policies of the organisation by creating staff led practical changes. For example a cross cutting theme of ‘the physical environment’ was identified as detrimental to staff well-being in work locations. As a result a new project ‘creating spaces for wellbeing’ was funded where staff work with an artist to improve working areas to meet the priorities reported by the MWIA.

There were several examples of ongoing use of MWIA by practitioners who have been trained, coaching of colleages in facilitation and some examples of embedding in whole service areas. In Merthyr Tydfil, Wales the Adult and Community Learning (ACL) partnership began using MWIA as way to structure their annual service user forums to focus on the wider social impacts of their service. They now conduct an annual MWIA to review how their services impact on well-being broader than what could be demonstrated by qualifications gained and attainment levels.

The review found little evidence of systematic monitoring of impacts identified through the MWIA and that this is likely to be because of the overlap with other statutory or funding monitoring requirements. However, there is potential to greatly improve the monitoring of impacts without extra burden on initiatives. For example, St Mungos has been using MWIA to shape services since 20082. This has included 5 MWIAs on different services. The St Mungos psychotherapy service ‘Lifeworks’ have created a monitoring system from the MWIA to use alongside clinical measures in order to demonstrate the broader social value of their work. Since 2009 they have been using the protective factors for well-being as outcome measures for clients and these are built into the therapist client report. Positive outcomes on wellbeing such as ‘social networks and relationships’ and ‘learning and development’ are recorded. This enables the service to report on ‘broader impacts that occur, regardless of what your impacts should be’.

MWIA has been found to have useful synergies with Equality Impact Assessments and Health Inequality Impact Assessments. Practitioners have drawn attention to the granular detail that MWIA provides, the broader social impacts it draws attention to, and the target group-led decision making process. Other key feedback was that MWIA has been useful in providing an evidence base for robust, transparent decision making useful for funding applications and reporting. There is also evidence that the MWIA workshop increases the participants’ awareness of mental well-being. Some practitioners said that justifying the resources required for MWIA could be a challenge especially as it requires investment early in the design phase. It is not a tick box exercise and requires wide ranging buy-in, political will and senior leadership.

In order for commissioners to be convinced of the value of this tool compared to other approaches it would be ideal to carry out a summative counterfactual evaluation of similar initiatives using different engagement and impact assessment tools. However, there is already plenty of evidence that MWIA does meet it objective of orientating initiatives towards supporting priority protective factors for well-being. The review concludes that in the current financial climate investment in understanding impacts that make sense to target groups concerned should be a priority, not a luxury.

More information

More information on Mental Well-being Impact Assessment (MWIA) can be
found here or for more information on TIHR’s work in this area please contact Sadie King.

Update: 24th June 2015 – Mental Wellbeing Impact Assessment: A one day Introduction and Screening Workshop (run by SLAM)

Download details here.


1. For more information contact Tony.Coggins@slam.nhs.uk
2. Example of a St Mungos MWIA see here.

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