A relationship with a partner has been shown to be an important driver of wellbeing for adults in the UK. However, when relationships lead to conflict it can have serious consequences for the health and wellbeing of parents and children alike. Adults who are dissatisfied with their relationship are nearly three times more likely to experience a major episode of depression and nearly four times as likely to misuse alcohol. Children exposed to destructive conflict are more likely to experience depression or anxiety, have physical health problems, develop behavioural problems and do worse at school.

Tavistock’s Mentalisation Based Therapy (MBT) for Parenting under Pressure exists to support the 12% of families that report relationship distress. It helps couples develop practical skills to support communication and problem solving, with the aim of reducing conflict and improving outcomes for the whole family.

We review evidence from the MBT programme in Hertfordshire to estimate the potential economic benefits generated from the programme. Our approach to valuing the wellbeing of participants is consistent with new guidance from HM Treasury.

Our analysis suggests that:

• The wellbeing improvement for parents that moved beneath the threshold for a clinically diagnosable state of mental illness over the course of the treatment is likely to be valued at between £15,900 and £25,400 per person for each year these effects last.
• We estimate that between 51 and 130 participants in the MBT programme in Hertfordshire moved beneath the threshold for a clinically diagnosable state of mental illness between 2019 and 2021, suggesting total wellbeing improvements for participants of between £0.8m and £3.3m for each year that these improvements are sustained.
• If mental health improvements are sustained for just one year, then it is possible that the economic benefits of the programme will outweigh the costs.
• If the benefits persist for 10 years, then less than 20% of the improvement in mental health seen by participants needs to be attributed to MBT for the benefits of the programme to outweigh the costs.
• Given that impacts from other forms of couples therapy have been found to persist for long periods, it seems likely that the benefits of MBT outweigh the costs of the programme.

There will be other non-monetary benefits that were observed in the Hertfordshire evaluation but that cannot be included in our analysis due to a shortage of evidence on their monetary value. For example, data shows improvements on a range of adult and child measures, including significant mental health improvements for the group of parents (including those who did not cross the threshold for clinically diagnosable mental health difficulties); improved couple communication; reduced conflict about children and violent problem solving; and improved outcomes for children.

We would encourage Tavistock Relationships to continue gathering evidence for the effectiveness of interventions to help improve the quality of relationships. For example:

• They have started to use the ONS Life Satisfaction question as part of their routine outcome measures. This will provide a more holistic picture of the wellbeing benefits generated.
• They should develop stronger evidence for the attribution of outcomes to the MBT intervention. Ideally this would be achieved through a Randomised Control Trial. If this is not possible, then they could match participants to a ‘synthetic’ control group from a major longitudinal survey that incorporate wellbeing measures (e.g., Understanding Society).
• They could incorporate additional outcome measures that can be used to estimate the economic benefits from improved children’s outcomes. Although evidence is currently captured that suggests outcomes are positive for children, they cannot currently be converted into economic benefits. To estimate the benefits from reduced demand for children’s mental health services, they should consider collecting measures of whether children are receiving mental health support from public services or adopt measures that have been used to assess clinical need for support.

If we can combine the evidence on the importance of relationships in driving wellbeing with ever more robust evidence on how interventions can support and improve these relationships when they go wrong, then we can help to build a compelling case for a greater policy focus and more support to help improve the lives of families across the UK.

Read the report in full