 |
- When: Thursday 3 March 2011
- Where: Dexter House, Tower Hill, London
|
Chair - Steve Shrubb
Recovery and whole life outcomes are placed at the centre of the new mental health strategy.
Supporting people to retain or gain work is vital to people’s wellbeing and their potential to improve their life chances. But the challenge is to ensure that all organisations which provide employment support interventions use evidence-based approaches which work.
Presentation: Dr Bill Gunnyeon, Director for Health Work and Well being, Department for Work and Pensions
Ministers in DWP are interested in mental health – Chris Grayling, Minister for Employment is keen to improve outcomes for people with mental health problems and Lord Freud’s interest is not just in improving work outcomes but improving mental health for the population as a whole. The Government has asked Liz Sayce to review specialist disability programmes and the report will be published summer 2011.
Key points covered included:
- Mental health, employment & disadvantage are inextricably linked.
- The employment rate for the general population is over 70% - for people with severe mental health conditions it’s less than 5%.
- People with depression have significantly worse survival rates from cancer and heart disease.
- Men living in the poorest households are 3 times more likely to have a common mental health problem.
- Children from the poorest fifth of households have a threefold increased risk of mental health problems.
- Societal costs of unemployment due to mental health are the costs of benefits, lost productivity and wider disadvantage. But there are also health and personal costs.
A joined up approach is needed in order to
- Encourage positive mental health
- Tackle stigma
- Identify mental health problems early (childhood)
- Provide rapid access to appropriate support
- Develop stronger links between healthcare and employment support to improve work outcomes
What is being done?
- Universal Credits and Work Capability Assessment are designed to deal better with issues of mental health and learning disability than the Personal Capability Assessment. Prof Harrington is working on a more accurate measure of people’s fitness for work.
- Employment support is available through the Work Programme and Work Choice
- Access to Work is being made more accessible to people with mental health issues.
- The NHS Outcomes Framework has 2 relevant measures: employment for people with long term conditions and employment for people with mental health conditions.
- Support for employers is given through the training of Occupational Health nurses, the Fit for Work Service and ‘Fit note’.
- The public health white paper has a focus on health and mental health from birth to old age.
The future challenges within a challenged economic situation are:
- the commissioning landscape
the priority of mental health in the public health focus – alongside smoking, alcohol and obesity
- to ensure that people with mental health problems are not disadvantaged in the Work Programme
- the need to challenge stigma
Download the presentation.
Presentation: IPS: what is it and how do you flog it?! Rachel Perkins, Freelance Consultant and Author
Employment is important for personal identity and as a source of friends as well as improved income and the benefits this brings. Individual Placement Support (IPS) must deliver the 7 principles of evidence-based employment e.g. we must focus on real employment not voluntary work. The combination of clinical support alongside employment support is vital and we must retain the opportunity to work with anyone who wants to give it a try.
If IPS was a kidney machine we would be using it – so why aren’t we always using it? The reasons may be:
- A continuing culture of low expectations among service users and professionals
- Fear around what might happen with health and finances after taking up employment
- Generic employment services don’t give enough support to people with mental health problems
- Employment is not seen as a priority for mental health services
- Sticking with the established ways of doing things – advising that people should ‘build up skills in a safe segregated setting’ and being wedded to building-based services
The failure to implement IPS properly is a serious concern.
Employment must be core to the clinical assessment and support planning of everyone of working age.
We need a ‘can do’ attitude, which doesn’t exclude anyone.
Some services need support for ‘job-finding’ and linking with local employers. We need to be more than advocates for our service users we also have to support employers
The challenge is to provide ongoing support to people who need it where long-term support is not provided in secondary mental health services –What is the role of Access to Work to help with this?
The Government will direct outcomes not inputs or processes. Control is moving to individuals and communities: localism and personalisation. We will need to consider how employment can be funded through personal budgets.
Ways of increasing success
- We need to demonstrate that work is a realistic possibility through local examples of success.
- Clinicians have an important role – they are part of the solution to the question of employment.
- Increasing consumer demand by showing what people should be able to expect and providing them with the evidence of what works.
- Become better at knowing and supporting local employers.
- Jobcentre Plus and Mental Health services to work more closely together
- Understand the kinds of jobs that are out there in the local area.
- Having an overview of a career but starting small and building up from ‘starter’ jobs.
- Using time-limited internships and work experience to achieve permanent employment.
- Peer support and peer mentoring by people with mental health problems is really helpful to encourage others.
- There is support from some GPs: Clare Gerada, the president of the college of GPs (trained in psychiatry) is opening up conversations with the NHS Confederation about social inclusion and recovery.
Download the presentation.
Workshop 4 - Commissioning IPS: the role of local partnerships
Jonathan Allan Disability Services Manager, Shropshire Council
Jonathan is employed by Shropshire Council – he manages Enable, a supported employment service.
Shropshire has funding for an IPS development role in the West Midlands – with the aim of developing practice in 6 sites. Enable is funded by Shropshire Council and Shropshire PCT and also provides a service for people with learning disabilities. They are a provider for Work Choice subcontracted from Shaw Trust, which is funded through DWP.
- The Mental Health Strategy doesn’t prescribe how employment should be done – the clearest directive is that IAPT should have employment co-ordinators providing employment advice.
- An outcome which will need to be measured for Public Health Outcomes is the proportion of people with mental illness or disability in employment.
- IPS can be shown to be high quality through the application of the fidelity scale.
- Employment is an essential part of recovery as the key means of obtaining hope.
Download the presentation
Workshop 3 - Getting Employment Specialists established within clinical teams
Lynne Miller & Katherine Dawson
Central and North West London Trust covers 5 boroughs with mental health services and 7 boroughs with addictions services. The Vocational Team comprises a Vocational Services Manager, 4 Team leaders and 16 employment specialists.
Setting up Vocational services from scratch:
- Getting our own house in order, employing people with mental health problems within CNWL
- Selling the vision to key people throughout the organisation, gaining commitment from the CEO Directors, HR, Occupational Health,
- A launch of the service
- An employment charter.
- Sell the vision, have an implementation plan, work in an opportunistic way, start small and communicate success.
- CNWL created partnerships and worked with third sector employment providers, then sought out some funding from within the Trust.
Keys to successful implementation of IPS
- Being clear with the CMHT Manager and Senior Practitioner about a shared vision and clear expectations.
- Agree the boundaries between OTs who hold a Vocational Role and the role of the Employment Specialist. OTs can help with support for the service user around problems at work.
- The Employment Specialist needs to be someone really passionate who can show the clinical team that it works.
- Recruiting the right staff – someone who is clear about their role/purpose and who is not afraid of employer engagement and really understands the need for fidelity to IPS.
- Good supervision is vital. Effective monitoring and evaluation are also. The support of the team needs to be available and regular.
- Recovery stories are really helpful and an encouragement for other service users and for the multi-disciplinary team.
- Integration – the Employment Specialist needs to be in the clinical team and to attend business meetings, clinical meetings and client reviews.
Training
- Employment Specialists undertake in-house and external training, they also shadow other Employment Specialists and learn from more established services.
- Training is provided on vocational assessment, employer engagement, in-work support, benefits and all Employment Specialists attend the 5-day London Met University IPS course.
- A short training on Mental Health Act awareness was also recommended.
Staff Support
- These are local group meetings for the Employment Specialists in which they focus on peer support in relation to how to help clients.
- The Employment Specialists and Team Leader go out into the community together and target employers in a particular area.
- The Team Leader gives fortnightly supervision and support to the Employment Specialists.
- Meeting the needs of as many people as possible is achieved by a job club which is run in the local library and once a month job workshops for any Brent Mental health service users who are not on the caseload.
Challenges
- Finding the right Employment Specialists, achieving a seamless multi-disciplinary approach.
- Lack of commitment from team management or low expectations about what an Employment Specialist can achieve.
- Confusion over performance management issues where the team may have lower expectations of outcomes than the Vocational Services Manager/ Team Leader.
- Care Co-ordinators may gate-keep i.e. try to stop some service users from working with the Employment Specialists – the reason for this is explained as protecting the client or the Employment Specialist.
- Focussing on employment, the Employment Specialists don’t work with people whose sole goal is volunteering.
- In CNWL hundreds of people have gained paid employment since the service started in 2005.
Download the presentation
Plenary session: Is IPS value for money? Research update
Dr Eric Latimer, Associate Professor, Department of Psychiatry; McGill University, Canada
- Working for a reasonable amount of time leads people to have higher income and greater non-vocational benefits than for those who work a little or not at all.
- Spending money on IPS is justified even though not everyone will achieve paid employment. For instance, compared to cancer – some will not survive but money is spent in order to increase the quality of life for those who do.
- Costs of a Supported Employment programme are estimated at about £2,800 per place.
- A study with data from Indiana shows that when people are in stable employment their use of mental health services and the costs of those services are lower both during sustained employment and during interruption of employment than for those pre-IPS or in the job searching stage.
- Other studies are less conclusive at a statistical level as to whether IPS reduces hospital use and that costs are lower compared to other interventions.
- In co-occurring substance misuse the costs of service use by people in regular work is lower than for those in infrequent employment.
- Clients who are more actively interested in working are more likely to do well in supported employment.
- A number of studies show that IPS services demonstrating greater fidelity to the model produce more employment outcomes.
- Recent studies suggest that higher unemployment rates in the overall economy make employment outcomes more difficult to obtain.
Download the presentation