Mental Wellbing Impact Assessment: a way for people to contribute to decision making

Anthea Cooke and Lynn Snowden, Directors of Inukshuk Consultancy.

Influencing the decision-making process in order to bring about evidenced-based improvements in mental wellbeing is core to Mental Wellbeing Impact Assessment (MWIA). A fundamental principle within MWIA methodology is to focus attention on tackling health inequalities within the subject of enquiry. It therefore gives a direct voice in the assessment process to those communities that are typically disempowered and less heard in decision-making tasks.

It is widely established that social relationships are important for wellbeing. The way MWIA seeks out and includes affected communities in a proactive manner in the assessment process enables it to assess risk and protective factors for a flourishing core economy of friends, family and neighbours.

Working with communities to collect their opinions and experiences on likely impacts, both positive and negative, requires time and effort - often by dedicated workers who are most in touch with them. The MWIA process includes holding community-based workshops, which has its own challenges. These have included convincing people it is worth participating, overcoming the lack of control people feel they have over decision making processes and breaking down the barriers of fear when people assume we're talking about mental ill-health.

There have been many successful MWIA workshops which have led to interesting dialogues between people who do not normally have an opportunity to talk about how they think and feel about their lives and experiences of services and programmes (see the box below for an example).

Affordable warmth services in Bolton

Through its Health Impact Assessment (HIA) and public consultation to evaluate, assess need and better understand the implications of fuel poverty, the affordable warmth service in Bolton recognised that psychological and social wellbeing was an essential health determinant in the relationship between fuel poverty and poor health outcomes. However, the literature and evidence base to support this observation was limited. The service used MWIA to more deeply understand the impact that fuel poverty has on emotional wellbeing.

The MWIA process helped to identify population groups that are impacted upon by fuel poverty. To give an example, MWIA allowed for broader consideration of how fuel poverty impacts differently across the age groups. In terms of social contact older people were more readily associated with getting out of the house and engaging with a range of community opportunities in response to a cold home while parents of younger families were considered more likely to stay at home and isolate themselves, particularly in terms of a general reluctance to invite people to a cold home, which is a form of social contact considered typical of this age group. It was concluded that in terms of social contact, fuel poverty has a different impact across the life course which supports the understanding that fuel poverty is not a phenomenon concerned solely with older people.

The final outcome of the process was to transform the outcomes generated by the adapted MWIA into Quality Adjusted Life Years (QALYs) data which takes into account both the quantity and quality of life generated by health care interventions. This work provides evidence that enriches the case for greater local commitment to the affordable warmth agenda. It also shows that when used as intended MWIA is a dynamic tool which can be considered across an organisation and applied creatively on any development to enable improved wellbeing.

There are a number of principles and ways of working that improve the MWIA workshop process, which include:

  • a focus on subjects and or proposals close to their hearts such as mental health services, carer's services, youth activities, arts programmes, timebanks, and many others
  • promoting it as being an integral part of the evidence collection for the MWIA - a platform for community members to take an equal part along with staff and other stakeholders involved with the proposal
  • promoting it as being their opportunity to talk about how they think and feel about their lives and services (people tell us this opportunity is rare)
  • promoting it as being highly interactive as well as structured - not being talked at
  • the findings are always written up and sent to all who participated for their information and comments
  • encouraging decision makers to participate in the workshops, which leads to increased ownership of the findings and subsequent recommendations.

Finally, MWIA works in ways that respect and reflect the main protective factors for mental wellbeing, by:

  • finding ways and encouraging people to have a sense of control over decision making by contributing to the MWIA
  • increasing the resilience and self-esteem of people having a chance to have their say and be heard
  • promoting participation and encouraging inclusion.

As a result, MWIA is an important tool for promoting the psycho-social wellbeing of communities more likely to experience health inequalities - and one which facilitates change from the bottom up. The process provides a mechanism for systematically shaping the way in which communities are supported and empowered to achieve high wellbeing.


Friedli, L. (2010). Mental Wellbeing Impact Assessment Toolkit, London: National Mental Health Development Unit

Page published November 2010.

30 November 2010

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