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Evaluation: the essential ingredient of innovation in mental health

In the last 10 years, mental health issues have become an increasingly prominent part of the public sphere with more people willing to talk about their experiences of psychological distress.

Unfortunately, over the same period, publicly funded mental health services have faced significant financial pressures and are struggling to meet this rising demand for their help.

Confronted with challenges of this order, innovation is not just desirable, but essential. And innovation doesn’t always have to be in the form of technological solutions alone, it can also come from communities themselves to find creative approaches to meeting people’s mental health needs, particularly among groups of people who are the most marginalised and find existing service models least helpful.

But all too often, ‘innovation’ can be a euphemism for saving money or cutting back on evidence-based interventions, often compromising on their effectiveness in the process - while some new approaches might truly represent a new way of helping people and could be scaled up more widely.

It is crucial that we identify those innovations that hold promise, and deserve to be replicated , and those that do not. This is where robust and independent evaluation is so important

But evaluation of this kind costs money, requires people trained in evaluation and takes time - challenges most projects are not equipped to deal with. Evaluation can also be something of an afterthought when work has already begun – regarded as a luxury or an add-on – or it is a mechanistic process used to demonstrate the ‘outcomes’ or value for money of an individual project rather than a way of building up learning and understanding more broadly.

At Centre for Mental Health our mission is to change the lives of people with mental health problems by using research to bring about better services and fairer policies. An important way we do this is through evaluation - including developing  innovative ways of evaluating projects.

For example, we recently completed an evaluation, funded by Comic Relief, of the innovative Up My Street projects in Birmingham. Run by three local organisations with support from Mind and The Integrate Movement (TIM), the projects worked with young black men in the city to promote wellbeing and address the widely known inequalities in mental health faced by African Caribbean men in the UK.

The projects used creative arts, history and other activities to create a safe space for conversations about well-being; they offered positive role models for young men to aspire to be like; and they challenged racist stereotypes about black men.

Through a ‘peer research’ approach, which involved training young black men in evaluation, we were able to see the impact of these projects on participants’ well-being and sense of self.

By asking young black men to interview their peers, we learned more than a traditional research methodology would have offered. We saw the economic, social and cultural influences on young black men’s mental health – and the pervasive impact of racism – that these projects were seeking to reverse or mitigate. And as a result, we were able to identify not just the value of projects like Up My Street but the wider implications for policy and practice in schools, youth services, the justice system and the NHS.

Many of the innovative projects we have encountered and evaluated in recent years have incorporated strong elements of co-production: working in partnership with individuals, groups and communities to design solutions that work for them on their own terms. The work of MAC-UK with marginalised young people, for example, combines established, evidence-based psychological approaches with co-produced activities and engagement based on young people’s needs, and peer rather than individual referral (being brought to the project by friends).

Many of the approaches these projects are adopting (and sometimes adapting) could help statutory services to meet growing levels of need with little promise of extra resources.

Principles such as peer support and co-production are already widely used in NHS mental health services across the country

Working in partnership with communities, focusing on people’s basic needs (for shelter, money and safety, for example), and reaching people where they are, may in future become standard practice in mental health and skills that all workers are trained in.

Robust, independent evaluation that gets published and talked about means we will be far-better placed to learn from innovation in the future. And alternative approaches to evaluation can sometimes generate more insights than conventional approaches could ever hope to.

If we are to ensure everyone has fair access to effective support for their mental health, it is crucial that we see evaluation as a fundamental part of innovation, and a way of changing many thousands of people’s lives for the better.

Andy Bell, Centre for Mental Health, 2017

1. Khan L et al 2017 Against the Odds. London: Centre for Mental Health https://www.centreformentalhealth.org.uk/against-the-odds

2. Durcan G et al 2017 Meeting us where we’re at. London: Centre for Mental Health https://www.centreformentalhealth.org.uk/meeting-us-where-were-at

3. Durcan G et al 2017, The future of the mental health workforce. London: Centre for Mental Health