Employment for people with severe and enduring mental health problems – what have we learned?

Dr Bob GroveDirector, Employment Programme

Who are we talking about?

1 million people with mental health problems on long term working age benefits

C 500,000 in touch with secondary services (on CPA)

C 130,000 of working age on enhanced CPA Two thirds are over 36 years old, 75% white BritishEven numbers of men and womenDisproportionately from deprived backgrounds Many with co-existing substance use and very high rates of physical ill health

C 20% of those using specialist services are in employment but probably less than 10% of those with psychosis

Barriers to work

70-90% of people with severe mental health problems consistently say they would like to do some paid workBut they face:

Stigma and discrimination in the job marketPoor living circumstances, co-morbityLow expectations from professionals and othersBenefits system which is perceived as threatening and is a barrier to part time workGovernment programmes which historically have not been designed to meet their needs eg. Access to Work, WorkstepLack of effective, evidence-based services

Characteristics of those in employment

Diagnosis, social skills when out of work, severity of illness episodes are poor predictors of employment outcomes

Work history and length of time previously employed are better predictors but motivation and self-efficacy can override all

Those in work need to have:High levels of determination to workAn accommodating employerA good network of support – professional, friends, colleagues, familyStable, affordable accommodation

Overcoming the barriers to work

Agency approach plays a significant part in work outcomes

With the right kind of support 60% + of those entering supported employment can obtain paid, competitive employment

Strong evidence in favour of supported employment - especially Individual Placement and Support (IPS)

“place and train” vs “train and place”

Key features of IPS

Goal of competitive employment in integrated settingsClient control of timing and paceRapid job search and minimal prevocational trainingIntegration of clinical treatment & vocational rehabilitation – team approachJob matching based on user preferencesInitial assessment/adjustment – time unlimited support for employee and employerIndividual benefits advice

Becker IPS Fidelity scale 2008

Work with employers

Build relationships through regular contactSell the person not the disabilityExplore job carving and job developmentSupport and encourage both parties through the transition to workBuild in natural and longer term in-work support

Evidence-based supported employment in England

Development led by SW London & St Georges Trust beginning in 1995

Centres of Excellence with both in-house and contracted out models of delivery

User employment (“leading by example”) programmes also led by SWL & StG now in a number of other Trusts eg Central and North West London

Conclusions

The greater the fidelity to the IPS model the better the outcomes

Engaging employers is usually the activity that Employment Advisers find most difficult. Nonetheless is essential for the client and for job outcomes. Regular contact, recorded and reflected upon is supervision is effective.

Thank you

For further information contact: bob.grove@centreformentalhealth.org.uk