Mental health as a determinant of work: Evaluating the impact of the national NHS Talking Therapies Employment Advisers Programme on mental health, work, inequalities, costs, and the economy (Support2Work)

Background: The economic cost of mental ill health due to lost productivity, including absenteeism, presenteeism, economic inactivity, and lost tax revenue, is huge and a key policy priority. NHS Talking Therapies (NHSTT) were introduced in 2008 as a first-line intervention for depression and anxiety disorders, with improved employment outcomes as an expected benefit. In 2018, Employment Advisers (EAs) were introduced alongside NHSTT to provide support for those unemployed, on sickness absence, or in work but struggling, helping individuals to gain, return to, or retain employment. However, a thorough evaluation of EAs has been lacking. Aims and objectives: The overarching aim of this research is to better understand mental health as a determinant of work. We will examine the impact of EAs within NHSTT on work-related and health outcomes using several different approaches. Research questions: We will address four key research questions: Does seeing an EA within NHSTT improve work-related outcomes and are there inequalities in these outcomes across different socio-demographic groups? What are the mechanisms through which EAs influence service users trajectories of absenteeism, presenteeism, and entry/maintaining/return to work, from the perspective of service users, EAs, and therapists? Does seeing an EA help reduce secondary healthcare costs via improvements in mental health and/or work functioning? Does the EA programme provide value for money? Methods: We propose 4 integrated work packages to address each research question. Research question 1 will be addressed through a novel, large linked dataset, using a staggered difference-in-difference design with matching to estimate the causal effect of seeing an EA on work-related outcomes. Research question 2 will comprise 20 qualitative interviews with EAs and therapists and 60 interviews with service users who have seen an EA in the last 12 months. Research question 3 will also use a large linked dataset and a staggered difference-in-difference design with matching, but will examine how changes in mental health and/or work functioning due to seeing an EA impact secondary healthcare costs. The final research question will synthesise all results and develop an economic model to capture health and wider economic impacts of EAs to assess value for money of the programme. A final work package will integrate findings across all work packages and use scenario vignettes of characters and situations that exemplify service users who may benefit, or not, from EAs. Together with our Policy Experts Advisory Panel and Service Experts Advisory Panel, these vignettes will be used to translate findings into concrete recommendations for employees, NHS services, and policymakers. Timelines for delivery: This ambitious three-year programme of work will provide timely real-world evidence on a large-scale population-based intervention. Anticipated impact and dissemination: Our dissemination activities are geared towards national policymakers and other relevant stakeholders and will include a scenario analysis toolkit for decision-makers, sharing findings through social media, policy briefs, conference presentations and publications, and an end-of-grant workshop. Support2Work will help improve the lives of people with poor mental health experiencing work difficulties, and impact through improved productivity and lower healthcare costs, on employers, the NHS, and English economy.