Analysing the cost-effectiveness of
Place2Be’s in-school counselling
services
Tilly Forster, Nikhil Naag, Lauren Herlitz, Jemma White, and Mick Atkinson
Background
Results
Mental health and emotional problems in
childhood are associated with mental
health problems and conduct disorders in
adult life12345.
• Of the 936 children with complete data,
10% of children (n=90) showed clinically
significant improvement in their mental
health post-intervention.
Good mental health in childhood is
associated with:
• Assuming the same improvement pattern
occurs for the children without complete
data (n=1408), 135 children (10%) would
show clinically significant improvement.
• Good educational outcomes
• Better employment prospects
• Greater capacity to maintain emotionally
satisfying relationships
• Less use of health services, social care,
criminal justice services and welfare
benefits6
To calculate the full costs of mental ill
health, the associated human costs above
and beyond others who do not have mental
health concern, including the impact on
carers, should also be taken into account7.
Research question
What are the potential long-term economic
and social benefits and savings of
Place2Be’s in-school counselling service?
Method
The sample
• 2,344 children, mean age 8 years old,
from 119 schools in 13 local authority areas
received counselling in the 2007/08
academic year.
• Therefore, 225 out of the 2,344 children
receiving Place2Be services would show
clinically significant improvement.
• Based on previous research9, 50% of
improvements would continue into
adulthood – 112 children would have
continued mental health improvement9.
What is Place2Be?
Place2Be is a charity working to enhance
the wellbeing and prospects of children
and their families by providing access to
therapeutic and emotional support in
schools for children, parents and school
staff.
Key findings
• Using estimates of costs per individual
from multiple studies9, the potential cost
savings with this group of 112 children
could be £15 million over their lifetime.
It was established in 1994 in response to
increasing concern about the extent and
depth of emotional and behavioural
difficulties displayed in classrooms and
playgrounds.
• For every pound invested in the schoolbased individual and group counselling
there would be a net return on
investment of £6.
• The benefits accrue not just to these
individuals themselves, but to their
families and to society more widely (see
figure 1).
Its universal and targeted school-based
services are available to 58,000 children,
coping with problems such as
bereavement, family breakdown,
domestic violence, trauma and bullying.
• Analysis was carried out on children who
had both pre- and post-intervention
Strengths and Difficulties Questionnaires8
(SDQ) from teachers and parents.
Complete data was available for 936 of the
2344 children (40%).
The cost-analysis
Cost-savings were calculated by analysing
the improvement of children for whom
complete data was available, applying
these results to the whole sample, and
estimating costs based on the findings of
previous research on conduct problems.
Due to gaps in the data, learning and
research available, we have had to make a
number of measured and conservative
assumptions to arrive at our estimates.
We have consulted widely on this analysis
– for further details see Place2Be (2010)9.
References
1Meltzer
Contact details: Nikhil.Naag@theplace2be.org.uk
Evaluation@theplace2be.org.uk
H, Gatward R, Goodman R & Ford T (2000). Mental health of children and adolescents in Great Britain. London: The Stationary Office. 2Kim-Cohen J, Avshalom C, Moffitt TE,
Harrington H, Milne BJ, Poulton R (2003). Prior juvenile diagnoses in adults with mental disorder. Arch Gen Psychiatry, 60(7), 709-717. 3Earls F & Mezzacappa E (2002). Conduct and
oppositional disorder. In: Rutter M & Taylor E (eds). Child and adolescent psychiatry, 4th edition. Oxford: Blackwell Publishing Company (419-436). 4Richards M, Abbott R, in conjuction with
Collis G, Hackett P, Hotopf M, Kuh D, Jones P, Maughan B, Parsonage M (2009). Childhood mental health and lifetime chances in post-war Britain: insights from three national birth cohort
studies. London: Sainsbury Centre for Mental Health. 5Scott S, Knapp M, Henderson J, Maughan B (2001). Financial cost of social exclusion: follow up study of antisocial children into
adulthood. British Medical Journal, 323: 1-5. 6Knapp M (2003). Hidden costs of mental illness. Editorial. British Journal of Psychiatry, 183, 477-478. 7Foresight Mental Capital and
Wellbeing Project (2008). Final project report. London: The Government Office for Science. 8Goodman R, Ford T, Simmons H, Gatward R & Meltzer H (2000). Using the Strengths and
Difficulties Questionnaire (SDQ) to screen for child psychiatric disoders in a community sample. British Journal of Psychiatry, 177, 534-539. 9 Place2Be (2010). Cost effective positive
outcomes for children and families: an economic analysis of The Place2Be’s integrated school-based services for children. London: Place2Be.