Social and emotional learning programs could return £83 in long-term savings for every £1 spent, a recent report finds.

The financial return on investment for social and emotional learning (SEL) programs was the highest of any of the mental health strategies evaluated by a team of academics for the UK Department of Health. But researchers found that several other mental health strategies also deliver impressive value for money, even in the short term.

The analysis of 15 strategies serves as a new resource for service commissioners as they take decisions about what programs to fund in the face of tight budget constraints.

Mental health problems cost the UK government billions every year, and the costs are only set to rise over the next 15 years. Depression and anxiety in England alone are predicted to cost £24.4 billion by 2026. Consequently, activity to prevent mental health problems and promote mental well-being might well be attractive not only to health services but also to the Treasury.

However, information about the effects of programs and policies on mental health, and the relative value for money of different activities, has not been routinely available to the commissioners of services. The recent report published by the Department of Health may go partway to rectifying this situation. The Department commissioned a group of well-regarded academics to analyze the costs and economic pay-offs of a wide range of health-promoting activities – from health visiting to reduce post-natal depression at one end of the age range, to befriending older adults at the other end.

The reviewers first identified interventions that had been found to be effective in at least one high quality controlled trial. They then made detailed estimates of costs and pay-offs using economic modeling. Their analysis distinguished between overall value for money and the budgetary impacts on the NHS and other agencies. They reported how programs were expected to pay off in the short term (within a year), medium term (between two and five years), and long term (more than five years).

Social and emotional learning: value for money
Social and emotional learning (SEL) programs were calculated to be the most outstanding value for money of the 15 programs evaluated. These programs consistently show strong effects on conduct disorder, which translate into potentially sizeable pay-offs.

The team's analysis suggested a very impressive £83.73 benefit for every £1 expended on SEL programs over the long term. The major beneficiary is society as a whole, with £57.29 of the benefit. The benefit to society includes the savings to victims of crimes that have been avoided by reducing conduct disorder, as well as increased earnings and therefore taxes paid by program participants. Public agencies also benefit: the NHS saves £9.42 for every £1, and other public sector agencies save £17.02.

Although impressive on paper, these overall figures might not be sufficient to persuade a budget holder, who also needs to know how quickly the investment could be recouped. Here the analysis of medium-term benefits helps. Within five years, SEL programs deliver a sizeable chunk of their pay-off. Total pay-off at five years is £48.30, with £5.39 going to the NHS and £9.42 going to other public agencies.

The best news is that in the shorter term, the intervention has a total economic pay off of just under £1 for every £1 spent. In effect, SEL programs pay for themselves in just over a year.

Parenting, anti-bullying, and health visiting strategies
The review included 15 different strategies in total, of which four, including SEL, were most relevant to children and families.

Parenting interventions for the prevention of persistent conduct disorders also fared well in the review. These types of programs improve parenting style and the parent-child relationship, and are targeted at parents of children with or at risk of developing conduct disorder. Overall, the pay-off is £7.89 for every £1 spent, including the value to the NHS, other public sector agencies, and wider society. However, it takes more than five years for the intervention to break even and, in the long term, the pay-off to the NHS is only just over £1.

School-based interventions to reduce bullying offer good value for money if a long-term perspective is taken. The economic pay-off comes from improved future earnings for those who have not suffered the ill effects of bullying. However, there is no economic pay-off for any public sector agency.

In this review, among child-focused approaches, health visitor interventions to reduce postnatal depression fared least well. In the first year the intervention does not break even. Longer-term savings are unknown because of the lack of long-term evaluations, but the authors assert that it is “likely” that cost savings would appear in the medium term as mothers who are treated are able to return to work and be more productive. Further, health visiting can have a positive impact on post-natal depression, and it has quality of life benefits for women, so it would be premature to dismiss health visiting on the grounds of short-term costs.

Taking tough decisions
These examples highlight how a comparison of costs and economic pay-offs give a new perspective on interventions. Who would have thought that SEL programs would stand out so prominently as such strong candidates for investment? That said, it would be wrong for economic pay-off to be the only metric for judging how tax money should be spent. For some interventions we simply do not know the long-term pay-off. Perhaps more important, economic pay-off leaves out other vital considerations such as quality of life benefits.

As well as reporting on the cost and economic pay-off of the 15 intervention areas, the review team also drew some more general conclusions. First, they note that, even when based on conservative assumptions, many interventions are extremely good value for money. Even from the narrow view of the NHS alone, some interventions are self-financing over time. However, there are very few “quick wins” where there is sufficient economic pay-off to the NHS within a year.

Second, the authors observe that many interventions are very low cost. For example, the school-based social and emotional learning (SEL) programs cost approximately £132 per child per year.

Third, they emphasize the importance of implementation. Targeting, take-up and drop-out rates are important contributors to cost effectiveness. Increased take up among high-risk groups or improved completion rates would maximize the economic benefit of some programs.

It remains to be seen if this information will help or hinder commissioners making tough decisions about how to invest their stretched budgets. If nothing else, it would seem reasonable to hope for increased investment in social-emotional programs since the figures are so compelling.

References: Knapp, M., McDaid, D., & Parsonage, M. (Eds.). (2011). Mental health promotion and mental illness prevention: The economic case. London: Department of Health.