Our clients have complex lives and well-being can be both a driver for, and a consequence of the problems clients come to see us about. Understanding how far our services can measure and potentially improve well-being is vital. Evidence, argues Tamsin Shuker, will allow us to understand the needs of our clients, to determine what interventions are most effective in affecting well-being, and demonstrate the value of those interventions to funders (to ensure we can continue to provide them).
What is the link between advice and well-being?
People who come to CAB often need help with some serious problems, such as complex debt, and the impact of these problems on their well-being is reflected in the evidence. We know there is a direct correlation between debt and poor mental health[i], that people with debt problems are twice as likely to develop major depression[ii] and people with existing mental health problems are nearly three times more likely to be in debt[iii].
The evidence is clear; our clients’ wellbeing is directly affected by their problems. By offering high quality advice and support, we help client to make tangible progress towards sorting out their problems. Although the chains of cause and effect are complicated, we expect that by helping to bring about change in clients’ lives, we improve well-being.
What does CAB already know about what works?
Further robust evidence is needed to determine the impact of advice on well-being and identify which interventions in which circumstances are the most effective. CAB is already involved in several small scale well-being research efforts, these include:
- A Department of Health funded pilot has enabled us to trial measuring changes in clients’ levels of mental well-being before and after receiving general advice using the NHS Warwick-Edinburgh Mental Well-being scale. Results show that clients’ average levels of mental well-being improved significantly after advice. We are now looking to promote the use of this well-being measure to all bureaux.
- A 2 year clinical trial assessing the impact of debt counselling for depression in primary care. Funded by the NHS Institute of Research, this trial will start this year and seek to establish the clinical and cost effectiveness of the addition of a Primary Care debt counselling advice service to usual care, for patients with depression and debt.
- Local evaluation of the impact of advice intervention in health settings or for clients with specific health problems, ranging from mental health (mild, moderate and severe) to an array of health conditions for example tuberculosis, cancer, dementia, human immunodeficiency virus (HIV) to name a few.
- Sheffield Citizens Advice Mental Health Unit has been evaluated by the Centre of Mental Health, who have highlighted the compelling case for welfare advice services for mental health service users.
Unlike other advice agencies, CAB provide, holistic advice. Our service recognises that clients rarely have isolated problems, and our service addresses all of these, recognising that in addition to identifying the underlying causes of problems, the issues and anxiety relating to a problem can affect other aspects of clients’ lives such as relationships, finance and health. These connected problems may build up to have a significant negative impact on clients’ overall well-being. By providing holistic advice, we aim to help clients to make improvements in their lives as a whole – which may in turn go further to improving their quality of life.
The holistic dimension is important in the context of health inequalities. By helping our clients to make material improvements to their lives as a whole, we may help mitigate the socioeconomic inequalities that give rise to the health inequalities in our society.
CAB also has a workforce of 22,000 volunteers and we recognise the need to understand the impact of volunteering on their well-being. In research to be published in June 2014 we have evidenced the value the service has on our volunteers’ lives (for instance, 100% of our retired volunteers state that CAB volunteering keeps them mentally active, and over half feel less at risk of social isolation).
Research in all these areas would benefit from the resources to reach larger sample sizes and use control samples to assess attribution, but the early signs are promising. Where services have positive effects that go beyond immediate purposes, high quality evidence is essential to making the case for what works.
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[i] Royal College of Psychiatrists, Mental Health: What do we know? What should we do?, London: Royal College of Psychiatrists, 2009
[ii] Skapinakis et al. (2006). Socio-economic position and common mental disorders: longitudinal study in the general population in the UK.
[iii] Jenkins, R. (2009). Mental disorder in people with debt in the general population
Views expressed are the author’s own and do not necessarily represent those of the Alliance for Useful Evidence. Join us (it’s free and open to all) and find out more about the how we champion the use of evidence in social policy and practice.