The Scottish Government

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Background

Mental health and employment issues have gained increasing prominence in government policy over the last 10 years and Social Firms are therefore of increasing interest. Sixty percent of Social Firms have been set up to create employment opportunities for people with mental health issues.

Anecdotal evidence suggests that working in a Social Firm can positively impact on the mental health of participants and aid their recovery from mental illness. There has been however very little research which has set out to demonstrate the mental health impact of working in a Social Firm.

Aims

This study aimed to begin to support the development of an evidence base for mental health improvement through employment in Social Firms, by identifying potential indicators and ways of measuring mental health impacts. The study had two main aims:

• To identify, from the literature, indicators that had relevance in measuring the mental health impacts of working in a Social Firm
• To make recommendations to help inform a method for assessing the health impact of Social Firms.

Methodology

A brief literature review was undertaken of studies and publications, from peer reviewed and internet sources, relating to indicators for measuring mental health impacts of working in a Social Firm. Analysis of the literature search was used to inform a further search for indicators and tools.

A further information source involved a secondary analysis of Scottish research and development work which had specifically investigated mental health impacts using the Social Return on Investment method.

Workshop discussions and interviews were held with Social Firms' managers and service users working in Social Firms to inform the choice of indicators and tools.

Findings

1. Mental health improvement

There is no literature which has investigated mental health outcomes specifically in a Social Firms' context and only a limited output of work which has looked at mental health outcomes from employment in general. Of the studies that have investigated these issues, the only indicator that has been specifically studied has been 'self-esteem'.

Some evidence has been produced through the Scottish work on Social Return on Investment. This found reductions in service consumption and improvements in health status in the two social firms that were studied. Anecdotal evidence from workers in Social Firms also suggests that further study would reveal health improvements.

2. Impact measurement

Where mental health or general 'quality of life' outcomes have been investigated, due to the lack of studies, there is currently no evidence of improved mental health outcomes from employment.

A wide range of mental health outcomes have been studied, but there appeared to be no common or systematic approach to identifying outcomes, indicators or the tools used to measure them.

In general, the search results provided justification for the proposition that mental health outcomes achieved through Social Firms should be divided into two high level sets of outcomes: reduction in mental ill health and improvements in mental health and well-being.

3. Tools

There appears to be little evidence to draw on in deciding how best to measure the mental health gains experienced by people with mental health problems working in Social Firms.

There is no consensus in the literature of which tools would be best to use.

There is a desire from Social Firms' managers and service users that any tools used should be capable of integration into the normal working life of a Social Firm, should be understandable to service users and should measure positive mental health as well as the absence of symptoms.

The two tools which appear from this study to hold out most promise for meeting these objectives are:

• Warwick-Edinburgh Mental Well-being Scale ( WEMWBS) which measures positive mental health
• Clinical Outcomes in Routine Evaluation-Outcome Measure ( CORE- OM) which measures reductions in mental ill-health.

Feedback from managers and service users

A list of indicators of mental health gain was developed with service users, together with a set of principles for implementing a measurement system for mental health improvement.

Recommended next steps

The next steps would be to conduct a short term, research-based pilot of the use of WEMWBS and CORE- OM within live Social Firms' settings, and determine a method for:

• Integrating the administration of the tools into the working life of a Social Firm
• Preparing a manual for managers which helps them collect and analyse the information
• Collating and analysing the data in a way that is accurate and meaningful
• Consider how best to benchmark any results against other employment settings.

Further details from:

Pauline Graham

pauline.graham@socialfirms.org.uk

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