Improving Mental Wellbeing Pathfinder- From data to information

 Professor Lindsey Dugdill &

Dr. Margaret Coffey

School of Health Sciences, University of Salford

Policy context and current evidence base for the research: The NHS, loses over 10 million working days annually due to sickness absence - 25% is due to stress, depression and anxiety, and is required to make savings of up to £20 billion by 2015 Economic Co-operation and Development report ‘Sick on the Job’ (December, 2011) highlights the enormous costs of mental ill-health, with 30% - 50% of all new disability benefit claims being in respect of mental ill-healthThe report highlights “there is only little awareness about the connection between mental health and work, and the drivers behind the labour market outcomes and the level of inactivity of people with mental ill-health. Understanding these drivers is critical for the development of more effective policies”.

Aims/Objectives of the research:

to improve mental wellbeing of NHS staff employed in mental health trusts through primary and secondary level interventions, identified through the development and delivery of mental wellbeing needs assessment. Objectives:

Design, with participant trusts a mental wellbeing needs assessment process and guidanceDesign a systematic process for determining the necessary intervention(s) to meet the identified need(s), from those available with an evidence basePilot and qualitatively evaluate the process/toolkitSupport commissioning, by the trusts, of the identified interventionsQualitatively evaluate the interventions at an individual and organisation level

 

Research Design (1): Review evidence of effectiveness of mental health and wellbeing interventions (literature review) Develop (using PAR) a comprehensive mental wellbeing needs assessment process, to identify potential facilitators and inhibitors to good mental health at both organizational and individual level. In order to understand the mental wellbeing landscape within each organisation, secondary analysis of existing data was undertaken, which included:

sickness absence levels; staff satisfaction surveys; demographic data, including employment details, namely, grade, types of work etc.

The research team worked (where possible) with a key analyst in each organisation to assemble the required data set and analysis. Following the secondary analysis, any necessary augmentation of data, could be conducted in order to complete the mapping of need.

Research Design (2)

Intervention opportunities could then be aligned against the priority needs, on a short, medium and long-term basis. The outcomes of this work are:

comprehensive guidance to enable trust to undertake ongoing mental wellbeing assessments at a local level, including advising commissioners of what interventions to invest in. a legacy of the mental health needs assessment process, which will be embedded in the participant trusts, which will ideally enable organisations to be able to do this for themselves moving forward.

The final phase of the process has been a qualitative evaluation of the interventions at an organisational and individual level.

Health Needs Assessment (1)

“a systematic methods for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities” (NICE, 2005, pg. 3)

Health Needs Assessment

• Well used method to inform health at work development activities – e.g. Health at Work in the NHS (Dugdill, 1996).

• Philosophy – participation and joint decision making

• Clear evidence that involving stakeholders in planning for, and choice of health intervention is more likely to improve uptake & programme effectiveness (NICE 2006)

“One of the biggest pitfalls for well-being initiatives is ‘consultation without action’ – every year staff in organisations show a lot of good will when they complete all manner of surveys and they are entitled to expect to see a clear plan of action when the results are in” (Robertson & Cooper, 2010, pg. 333)

Objectives 1 & 2 Design assessment process & systematic process for determining interventions to meet identified needs

• Involved an iterative process to the design of a template for each trust to capture (3 years data by band, grade, inpatient/community and business unit):• Staff in Post Headcount & FTE • MWB Episodes & Calendar Days Lost • MWB FTE Days Lost • All Sick Episodes , all Sick Calendar Days Lost & all Sick FTE Days

Lost

This enabled us to capture:• Trends (by year, business unit, grade,

inpatient/community) of• FTE days lost• Average number of episodes & days lost per episode

• Rates per capita (again, by year, business unit, grade, inpatient/community of• FTE days lost

This data was combined with:

• Counselling data• RIDDOR data (violent incidents)• Staff Survey data• Trust narratives (to provide context)• Policies & Training

Needs assessment has been able to identify key trends, i.e.:• Detailed information on trends/patterns/rates of sickness absence, by grade, by business unit, by community/inpatient etc.

• This enables business units:• That are doing well to be identified, which can be interrogated &

shared• That are doing less well to be identified, to be investigated further

(qualitatively)

Data (other than ESR data) (1)• The OH, RIDDOR data was less informative –numbers,

rather than rates are recorded – with little information on the other variables (e.g. grade)

• “for evaluation and monitoring purposes it is important to have longitudinal data, involving a representative group of employees from relevant parts of an organisation” (Zwetsloot et al., 2010, pg. 152)

• Generally the Staff Survey data does not seem to map onto the findings from the ESR data (e.g. static ‘stress’ scores vs increasing absence due to MWB)

Data (other than ESR data) (2)• Trust narratives show the rate and pace of change within the trust, which is undoubtedly related to some of the trends identified

• Policies & training generally were more reactive than proactive, e.g. fewer policies related to improving lifestyles were chosen (e.g. physical activity policies)

Policies for workplace health promotion should include:

• Lifestyles, ageing, corporate culture, including:• Staff leadership; staff development; work-life

balance; stress and mental health; wellness; nutrition; and health and corporate social responsibility (European Network for Workplace Health Promotion, 2012)

Your reflections on the process• Designing the needs assessment template was

challenging, and resource intensive, “it would have been useful if every Trust had been given the same template to complete at the start of the data collection and not at the end of the process.

• However, once the data was collected:• “to manipulate this data to look at other areas of interest

and possible patterns/trends was relatively straightforward”

• “it was good however to look at all the data together, rather than in silos. This gave us a much bigger picture and colleagues can see how lots of things impact on wellbeing”

Your reflections on the process The Trust did receive

a lot of information from this and this generated other

avenues to explore

The Trust did receive a lot of information from this and this generated other

avenues to explore

I’m not sure that the report gave us any new information. But what it has taught

us is the process and to look at everything together. The main thing that I took away was about how we commission future services for our staff and how we

ask them to report…including rates!

I’m not sure that the report gave us any new information. But what it has taught

us is the process and to look at everything together. The main thing that I took away was about how we commission future services for our staff and how we

ask them to report…including rates!

The report did not provide the trust with any additional information that

was any different to what we already collect and submit on a monthly

basis…it did however highlight higher sickness levels in different

Boroughs…

The report did not provide the trust with any additional information that

was any different to what we already collect and submit on a monthly

basis…it did however highlight higher sickness levels in different

Boroughs…

What interventions were chosen against the data findings?• None yet…have meetings set up to decide

• Promoting Healthy Minds at Work – Mental Health Pathway – we are also looking at offering cCBT for all staff

• We are considering Rapid Access interventions, attendance improve plans and are still working with staff and the project group to identify other possibilities

Anything else you would like to say about the process?

• “it has been a good learning experience and I am sure some of the pilot group members will remain in touch to support each other. It has been beneficial and valuable to work with Salford University to debate and discuss issues”

• ”the project timescales have been pushed out significantly…it would have been better to already have the interventions in place…prior to the Showcase Event…to be able to demonstrate any outcome and impact of the project”

Our reflections on the process (1):

• Motivation and enthusiasm of staff

• The need to translate data to information, e.g. numbers to rates/trends

• The tremendous potential of the data as an ongoing ‘problem diagnosis’ to enable speedy interventions to improve health and wellbeing (particularly effective when resources are scarce)

Our reflections on the process (2):

• The potential for sharing findings from the different interventions, using the 3 steps:• Diagnosis; participatory interventions; evaluation

• The potential for linking OH & RIDDOR data to ESR data to enable:• Detailed understanding of impact of violence on

MWB & sickness absence• Evaluation of OH services, e.g. counselling on

MWB

Conclusions:• Previous research has highlighted that while organisations

gathered data that was potentially useful, these data were only available and useable in a fragmented manner. As a result, the business impact of health interventions was neither properly evaluated nor consistently managed” (Zwetsloot et al., 2010, pg. 143).

• This project has shown how ‘data’ can be translated into meaningful information to inform the development of targeted and focused interventions, whose effectiveness can be measured from a grounded research baseline

Any Questions? L.Dugdill@salford.ac.ukM.Coffey@salford.ac.uk