An Ounce of Prevention

“An ounce of prevention”—the case of NEWPIN

The old adage has it that “an ounce of prevention is worth a pound of cure.” It is abundantly clear that, to say nothing of the alleviation of human misery, if cheap ways existed of treating people so that they do not end up in prison, or in hospital, or have their children removed and taken into care, there would be massive savings in national expenditure.

Costs

There were 84,674 adults in prison in England and Wales in 2016–2017, between 10% and 90% of whom are thought to have mental health issues, according to the Government’s own Committee of Public Accounts (UK House of Commons Committee of Public Accounts 2017). The cost of keeping someone in prison in the UK is £42,670 pa—roughly £117 per day according to Inside Time 2023—Revealed: the cost of living in prison—insidetime & insideinformation.

According to MIND (40% of all GP appointments about mental health—Mind) approximately 40% of all general practice appointments involve mental health issues. About 7000 people are held in hospital in England and Wales under the Mental Health Acts, but a considerable percentage of other hospital inpatients have mental health issues. This particularly applies to bed blockers. Limb (2022) estimates that NHS hospitals as of January 2022 had 17,303 patients who “no longer met the criteria to remain in hospital.” An unknown but probably substantial proportion of these are undischargeable because they are not in a fit mental state to cope in the outside world (At an estimated cost to the NHS of £400 per day—How Much Does A Hospital Bed Cost In The UK?—excel-medical.com).

Government statistics show that there were 82,170 children in care in 2022, an increase of 2% from the previous year (OFSTED 2023). Research at York University suggests that the life-time cost to the state of children being taken into care and then not continuing into employment, education or training may be as much as £56,000 p.a.—Children in care—National Audit Office (NAO) report and certainly some local authorities are currently spending £4000 per week on housing children taken into care. (This huge sum is likely to increase with the growing involvement of private equity in the ownership of child care services—Childcare sector in England must not become “playground for private equity,” experts say | Children | The Guardian).

The “ounce of prevention”

There are innumerable projects described in this journal that would appear to be able to contribute to the reduction of these enormous costs. Taking just one issue—Journal of Mental Health 32[4] as a sample: Laker et al. (2023) found “statistically significant effects on burnout” using a programme of mind management skills. Reinius et al. (2023) found that “Daily Talks may facilitate helpful structures and meaningful relationships between patients and nursing staff.” Sanchez-Lara et al. (2023) assigned adults older than 95 to three groups given three different forms of assistance—Computerised Cognitive Training, Mindfulness, and a combination of the two, concluding that “combining CCT and mindfulness effectively improves selective attention and abstract reasoning in older adults.” Briggs et al. (2023) in an analysis of group-based gardening interventions for increasing wellbeing and reducing symptoms of mental ill-health came to the conclusion that “Meta-analyses suggest these interventions may increase wellbeing and may reduce symptoms of depression.” Owens et al. (2023) in a scoping review of interventions using the Qur’an to promote mental health conclude that utilising the Qur’an for Muslim patients, integrating it into routine health care interventions “aims to promote mental health and well-being.” All of this in one issue of one journal.

None of these interventions, and countless more like them, would be expensive to run, and all of them appear to have the capacity to contribute something towards reducing the cost of mental ill-health to society as a whole.

NEWPIN

In 1978 a group of English health-care professionals were worried about the lack of help for parents in deep distress and in danger of breakdown. There was a high and rising rate of child abuse and a low take-up of perinatal services (Kane 2021). In 1981 the name NEWPIN [New Parent Infant Network] was adopted, on the basis that “mothers could best be helped through a network of support, primarily one to another” (Jenkins and Cox 1987) and in 1982 the first of what became 21 UK NEWPIN centres opened. An evaluation of the scheme by Pound et al. (1985) followed up by Cox et al. (1991) found of the mothers interviewed:

70% separated from one or both parents in childhood

39% Three or more changes of caretaker in childhood

70% desertion by partner during or after pregnancy

61% single parents

65% dependent entirely on state benefits

83% suffered from depression or anxiety

The results were impressive. NEWPIN clearly achieved results which other professional schemes could not. None of the 500 or so parents still in membership between 1982 and 1994 is known to have severely abused their child. Not a single child was taken into care, and no parent ended up in a psychiatric hospital. Harris et al. (2004) found “women in the NEWPIN group were about half as likely as control group members to have experienced the onset of major depression.”

The costs were fairly basic. Most importantly, safe, secure, exclusive, permanent premises were needed, with a kitchen, an office for the administrator, rooms for groups, a playroom and an adjacent “living room” which acted as a drop-in centre with free tea and coffee. Staffing was purposefully minimal—aimed at training and encouraging parents to support each other.

At its peak there were 21 NEWPIN centres in Britain. This number is currently down to two, plus one in Northern Ireland. One of the two switched from being run by the charity Family Action to the local authority and had its name changed to Wandsworth Early Help Parental Mental Health Services. Even this superficial change meant it lost a lot of members—deeply distressed new mothers need stability above all: NEWPIN centres need continuous funding to operate successfully.

The demise of most centres was due to problems in getting grants, exacerbated when the UK government began to close children’s centres in 2011. There are still flourishing centres in Australia, and some similar developments in America but the future for the UK looks bleak.

Conclusion

NEWPIN, like countless other initiatives clearly provided an “ounce of prevention.” Unfortunately, in virtually all such cases the “ounce of prevention” has to be paid for up-front and will be clearly visible in a funding body’s accounts. The “pound of cure” will be spread over periods of years, and be hidden in the accounts of so many different organisations—health services, social services, police, prisons etc. that disentangling and identifying it seems an impossible task, even without the added complication of privatised service providers which obviously profit from extra business rather than a reduction in demand. The past decade has seen severe cuts in public spending in the UK [Local authorities’ budgets are roughly 26% lower since 2010—Full Fact] resulting in a significant shift from local authorities being able to spend their money on early intervention and support, to a focus on crisis intervention, even though the cost, to the nation as a whole, will be greater.

NEWPIN, like virtually all the other initiatives described in this journal, operates by facilitating human-to-human interaction. Unfortunately, any junior accounts clerk, budding politician or IT consultant can easily calculate the cost of human-to-human interaction. It seems to be beyond the capabilities of any accountant to calculate the cost of reducing-human-to human interaction.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.