Valuing impact: Estimating return on investment of mental health and wellbeing projects for veterans and first responders

Background: Veterans and first responders like firefighters, police officers, paramedics, and military personnel face higher rates of mental health issues and suicide compared to the general population. Implementing and evaluating mental health projects for Veterans and first responders is crucial for enhancing their ability to serve society effectively. Economic evidence is increasingly used to improve the effectiveness and accountability of health and social programs. However, current methods are insufficient for comparing resource efficiency and value for money across different sectors and countries. This study introduces a novel methodology to accommodate heterogeneity across multiple projects within a grant program, enable standardization, and facilitate comparison in real-world implementation research. Methods: The choice of perspective in economic evaluation depends on context, stakeholder viewpoints, resource availability, and intended use. We used a flexible approach, combining various methods to standardize resource utilization, valuation, and outcome assessment. This allowed us to estimate an overall return on investment at the program level by pooling diverse projects together. We evaluated costs from the funder's perspective, using general population valuation for healthcare interventions. Results: We estimated overall and individual project Return on Investment ratios for the funder's investment in the Mental Health Program, considering both total and in-kind costs. Results show that for every $1 invested in the Veterans and first responders Mental Health Program, the program returns $1.14 in overall health value, slightly exceeding the financial resources invested. Conclusion: Standard economic evaluation methodologies do not accommodate real-world complexities and the heterogeneity across projects inherent in grant programs. Yet the development of pragmatic economic methods to assess value and return on investment of grant programs is essential given current funding pressures. Our study demonstrates the feasibility of addressing economic evaluations across heterogenous, international projects. Although not strictly adhering to established methods, our pragmatic approach focuses on funder return on investment. This methodology provides a pathway for economic analysis of grant programs.