Mental Wellbeing Impact Assessment (MWIA) in the workplace

Introduction

Mental Wellbeing Impact Assessment (MWIA) was developed over a ten-year period by the South London and Maudsley NHS Foundation Trust and partners (MWIA National Collaborative). It has been used both nationally and internationally (West and Scott-Samuel, 2010). MWIA is an evidence-based diagnostic tool that aims to orientate decision makers such as policy makers and service managers towards considering the impact of policies, programmes and services on the mental wellbeing of the target group. MWIA is a stepwise process that begins with a desk-based screening tool and culminates in a workshop that engages multiple stakeholders and results in co-produced action plans. The action plans aim to develop the positive impacts on wellbeing and mitigate against any negative impacts.

MWIA was developed based on the health impact assessment methodology (European Centre for Health Policy, 1999), an evidence review about mental wellbeing influences that includes a social model of health and takes an assets-based approach. Initially, it was used in urban regeneration but has since been used in housing, children’s centres and education. In addition, over the past three years, we have been exploring, and finding success, in its application in workplace wellbeing.

The economic benefits associated with improved workplace wellbeing, in addition to the benefits to the individual, make it an increasingly attractive area to employers. Employees who are physically and psychologically healthy are more productive, better at decision making, have reduced absenteeism and reduced healthcare costs, have increased resilience, engage more and are better at coping with uncertainty and change (Boorman, 1999; Hillier et al., 2005; National Institute of Clinical Excellence (NICE), 2009).

Employers have previously approached wellbeing in a reactive rather than proactive manner. It has however been shown that interventions focussed on worker wellbeing can have a significant effect on commercial outcomes, and an effective human capital management is starting to be seen as indicative of companies’ long-term prospects (Litchfield et al., 2016). For example, it has been estimated that every pound spent on prevention and early intervention can result in ten pounds of savings for businesses, which are currently estimated to spend £554 per person on employee absences (Chartered Institute of Personnel and Development, 2015).

Major factors that directly affect the employee’s wellbeing and productivity include an organisational change and stress, in addition to relationships with employers, working arrangements, relationships at work and an employee’s work design and work demands (Hillier et al., 2005; Campaign for Social Science, 2013; Litchfield et al., 2016). Current workplace mental wellbeing interventions therefore range from approaches that focus on the individual’s ability to cope, endure stress and proactively manage a healthy work-life balance (resilience) to organisational and wider system-level approaches that consider structural and cultural aspects of organisational culture such as the access to work-based support, engagement and mental health awareness (Gravelling et al., 2008; Public Health England, 2014).

Stress management interventions, which focus on stress awareness and the development of techniques to minimise the impact of stressors, form a large part of workplace wellbeing programmes (Seymour and Grove, 2005; Public Health England, 2014). In addition, manager training has been shown to benefit the mental wellbeing of those who they oversee (Tsutsumi, 2011) and Mental Health First Aid training for managers has also been shown to be effective in improving the mental wellbeing of those who partake in it (Kitchener and Jorm, 2004). At the structural level, interventions such as flexible working hours, work-based support schemes, line manager training in mental wellbeing and increased staff participation can improve the workplace wellbeing (Gravelling et al., 2008).

MWIA is a unique approach that operates across the continuum of the above described interventions. It uses a reflective practice to identify underlying issues and the interventions that would be most appropriate for each specific set of circumstances. In this respect, it is both a diagnostic tool and an intervention in its own right.

An MWIA begins with a “screening” phase (Figure 1). In the screening phase, the proposal or issue is explored with a small number of people who represent different viewpoints such as frontline staff as well as management. Typically, the manager or human resources lead responsible for the proposal is present for the screening. This initial discussion provides the context and begins to unpack the potential impact on the wellbeing of a proposal or issue, and can lead to an action plan in response to any potential adverse impacts identified. The screening considers the same issues that will be discussed more completely as part of the full stakeholder workshop and can be found in the MWIA toolkit (Cooke et al., 2011).

The “screening” informs the “scoping” phase, which determines whether further investigation in the form of a full MWIA is necessary, given the possible impacts identified. In addition, the scoping identifies: the resources and time required to undertake the project; if those participating would have a safe space to have this engagement; and whether the findings from the MWIA would be taken on board by the organisations concerned. This requires in-depth conversations with the management of the workplaces in question and an honest appraisal of their commitment to supporting the outcomes of a full stakeholder workshop.

If a full MWIA is indicated, then a stakeholder workshop will be conducted in which the toolkit is used (Figure 1) to stimulate a discussion amongst those who are being affected by a proposal or issue. The toolkit asks the participants to consider how different factors, which are known to be associated with mental wellbeing, are being or will be impacted on. The toolkit asks the participants to consider both positive and negative impacts on these factors (Knapp et al., 2011). Actions to minimise the negative impacts and maximise the positive are then discussed and indicators are developed to assess the outcome of these actions. A short literature review is conducted after the workshop to analyse the suggestions in the context of best practice as well as examining demographic data (community profiling) of the affected population.

Methods

Two case studies are presented to help illustrate areas where the MWIA has worked well in workplaces and how it could be improved. These organisations underwent an MWIA between 2013 and 2014.

The first organisation was an academic health sciences collaboration centre composed of member organisations from different backgrounds such as clinical services (including NHS trusts), academic research and human resources. The organisation underwent the MWIA process as a result of funding awarded to improve the workplace mental wellbeing of staff. The seven teams that underwent the initial screening were from a range of different services and therefore faced a diverse range of issues. The experiences of staff undergoing the MWIA process was collected from the final report produced after the workshop and from the interactions with facilitators (TC, AC, SK).

The second organisation was a local authority. Similar to case study one, the local authority was composed of teams operating within different areas of the organisation and also included human resources personnel. A total of seven teams were also included in an initial screening process and six went on to complete a full MWIA workshop. During the screening phase, it was recognised that the environment within the seventh team would not enable an effective full stakeholder workshop and generate workable action plans due to issues around the relationships between the team members and management. The experience of the participants who underwent the workshops was collected by a telephone interview one year after the workshop was held (see the Appendix).

Interviewers had experience in facilitating a full MWIA stakeholder workshop and had been trained to deliver the MWIA screening (CB) or were involved in the original development of the MWIA (AC). Both interviewers were contracted to work on MWIAs by Maudsley International (MI) at the time of interviewing. In total, four participants were contacted by e-mail from different teams within the local authority to share their experiences anonymously. All four participants gave a full telephone interview and were aware that the interviewers worked for MI. The four team members were selected as they took part in both the initial screening and the full stakeholder workshops. The participants and researchers were both alone when the telephone interviews were being conducted. Written notes were taken during the interviews which lasted between 30 and 45 minutes.

The responses from participants in both case studies were compared and issues that were common to both were identified.

Results

The evidence from the case studies suggests that the MWIA is a useful tool for teams to assess and discuss the issues around wellbeing. It also enables the joined development of solutions that may require organisational-level change, and therefore commitment from the higher levels of management. MWIA’s external facilitation aids coordination, but also provides a safe space for the participants to freely voice their concerns that may affect their workplace wellbeing.

Discussion

The findings from the case studies support the use of the MWIA as both an intervention in its own right and a diagnostic tool. The process of sharing and exploring concerns can help improve mental wellbeing as it allows an individual to define the issues really impacting them (The Mental Health Foundation, 2016). The MWIA stakeholder workshop provides a forum for team members to do this and can therefore be of benefit even in teams unable to implement the recommended actions. The other role of the MWIA, as a diagnostic tool, is perhaps one of its most useful aspects. It helps to identify actions in response to the discussed issues, which are likely to make the greatest difference as they are generated based on the employee experience rather than being instituted in a top-down manner. Both organisations could have rolled out stress management training to employees, although this would not have addressed the most salient issues. There is no “one-size fits all” for mental wellbeing and it depends on the organisational culture and values. The MWIA can be used to “diagnose” the real problems affecting staff so the organisations’ time and efforts to improve mental wellbeing can be used more effectively.

In addition, the process can help to highlight the issues that may be impacting different members of the team and can raise the awareness of mental wellbeing in general. Increasing the awareness of good mental wellbeing can help lead to an early detection of mental health problems, which, in turn, leads to earlier intervention and better outcomes (NICE, 2009).

A challenge with the MWIA process is ensuring that the actions are implemented. When an organisation or team is unable to implement the actions suggested, it can cause individuals to feel more helpless, as they feel ignored. This can lead to a decreased sense of control and poorer mental wellbeing at work (Public Health England, 2014). Therefore, the MWIA should only be used in circumstances where there is an organisational support; the scoping phase can also be used for developing an understanding of whether an organisation is in a position to support a full MWIA workshop. In the case of the local authority, a more in-depth scoping phase would hopefully have identified the upcoming restructuring that had been planned for one of the teams, and therefore highlighted why this may have made them unsuitable for a full stakeholder workshop.

Paradoxically, MWIA also provides an opportunity to increase employees’ sense of control and wellbeing through the implementation of actions. Frequently, the actions proposed can be carried out by the employees without the need for a manager input. This can help provide a sense of control and empowerment as the individual, or individuals, become responsible for driving the change.

The case studies also demonstrate the challenging and complex nature of some of the issues raised by MWIA. It is important to explore this with management and make them fully aware of this possible outcome during the screening and scoping phase. This allows them to prepare for how they might navigate any potential issues.

Finally, it is important that quantitative methods for assessing the impact of MWIA are developed. During the MWIA workshop, participants are encouraged to decide on indicators for each of their proposed actions that will act as the measures of their success. Possible measures suggested in the local authority included number of sick days taken, staff retention and promotion, and number of staff suggestions submitted. However, it is important that quantitative measure can be applied across different organisations to allow the comparison of the impact of MWIA. The local authority suggested using the Warwick-Edinburgh Mental Wellbeing Assessment Scale (Tennant et al., 2007) to assess mental wellbeing before and after the workshop. A difficulty with this is that mental wellbeing may still decrease after the workshop, as a result of the change that necessitated the workshop in the first place, and it is not possible to know what mental wellbeing would have been like without the MWIA.

The experiences in these two cases studies suggest that the MWIA can be used as an effective assessment tool for workplace wellbeing. In both case studies, the MWIA toolkit was applied in full but highlighted how the screening alone can add value. In addition, the MWIA can be used to identify issues most important to the employees and therefore allow tailored solutions, which could save the organisations’ time and money over providing generic, “off-the shelf” mental wellbeing interventions.

The weaknesses of the MWIA are mainly related to the implementation of actions and depend on management cooperation. It may therefore be necessary to develop the engagement process so that organisations have a thorough understanding of what they are committing to. Finally, the assessment of the impact of the MWIA needs to be developed further. Although this is considered within the process, with participants trying to develop indicators for each of the actions they propose, it would be useful to be able to assess any overall global changes in mental wellbeing as a result of undertaking the MWIA.

It is important to note that results derived from case studies cannot be generalised, and are specific to the one particular case. In addition, bias and, in particular, observer bias and the “halo” effect may have impacted the results. More work is therefore needed to develop robust evaluation methodologies for the impact of the MWIA. The use of the MWIA in the workplace is in its infancy but these case studies suggest that it has the potential to provide an effective means of improving a workplace mental wellbeing (King, 2014).