Newham Primary Psychological Services

Neelam DosanjhHead of Service

Monton Jienpetivate Deputy Head

Newham’s Model

Newham Profile Population- 308, 800- High transient population- 4th most deprived borough in London

Diversity - Young population - 60% aged between 25 and 45- 70% are from different ethnic backgrounds, 130 languages

Employment- Approximately 10% are unemployed double London’s average, no change post 2012 - Second highest in benefit claims - 60% of ESA claimants report having mental health issues

Health Inequalities

Service Profile

• Extended IAPT with specialist provision for LTC and MUS, Peri- Natal MH, Eating Disorders, Trauma

• Stepped Care Model – 0 to step 4a• 7000 Referrals per year• Approx. 5000 into treatment • Therapy choice is a priority but can’t always deliver

due to capacity - CBT, DIT, IPT, Systemic, Integrative• Sub contract to Third sector for counselling, a service

for DV and welfare and employment

Drivers • Mental ill-health is prevalent in the working age population and is

associated with high economic and social costs to individuals and society at large.

• Improving the wellbeing of people with mental health problems and helping them find and sustained employment remains a challenge to health and employment services alike.

• Unemployment and being out of work are seen as key drivers behind mental ill-health (Pevalin and Goldberg, 2003; Paul and Moser, 2009). Employability and returning to work helps to improve mental wellbeing (Paul and Moser, 2009; McManus et al., 2012.

Profile of Service Users accessing Employment Service

• Length of depression and anxiety – 2 to 5 years• Social isolation and exclusion• Poor motivation and self esteem – extrinsically driven• Low educational attainment • Workless-ness in the family• Co – morbidities – substance misuse, poverty, safeguarding

issues, poor social stability (welfare), physical ill health

Integrated Model

Barriers:• To employment for people with mental health problems is the stigma and

discrimination (Centre for Mental Health, 2013)• Is the ‘benefit-trap’ when benefits create stronger incentives to remain in the

system rather than return to work ( Lelliott et al., 2008)

Integrated Provision:• The integrated employment service within Newham IAPT offers opportunities

to overcome these barriers

Cultural shift :• Therapists to assist the engagement • SUs – suspicious, disengagement

Integrated Model - Benefits

• Provides social stability to better engage with the therapeutic process

• Ease of access for Service Users

• Learning , having a shared language and tailoring service provision

• Improves the Service User’s overall experience of care, engagement, quality, retention in employment and provides a longitudinal approach to improved well being

Integrated Model - Benefits

• Collaboration and close working ensures employment and wellbeing goals are aligned and realistic

• Employment service has excellent links with national and local employers and employer support services such as Access to Work

• The in work support provided by the employment service ensures early intervention for Service Users who are in work, and need additional mental health support to successfully retain their job.

Work of employment advisors

• Forming relationships with Service Users• Assessing literacy and skills• Employment steps - identifying competencies • Coaching on motivation and confidence building• Job searches – matching competencies• Assisting with CV writing and application forms• Preparing for interviews• Employer engagement• Liaising with educational and welfare agencies

Data for a year period- July 2013 to July 2014

Number of people referred for employment support 517 100%Number of people moving off sick pay and benefits 218 42%Total number moving from unemployment to paid work ( 15 self employment ) 40 8%Number moving from unemployment to part time or full time student 99 19%Number retaining full time work 124 24%Number retaining part time work 36 7%

IAPT Employment Initiative

• Newham IAPT and local partnership

• Letwin pilot project: Newham IAPT engagement

IAPT Employment Initiative: existing partnership

• Local initiatives between Newham IAPT and Work Programmes set up in 2012

• Initial meeting with all local main providers

• CDG and A4e signed up

IAPT Employment Initiative: Existing partnership

Planning and pre-referral stage

• Establishing relationships with advisors and fostering engagement– Training provided by IAPT– Ongoing contact, consultation, follow-up and engagement

• Pathway mapping and Referral and infrastructure configuration

• Evaluation: Joined by UCL Partners

IAPT Employment Initiative: Existing partnership

Success • Relationship• Commitment from staff

from both sides• Support and accessibility

of IAPT staff to advisors• Advisors increased

confidence in their role and engagement with customers

Challenges• Learning each other’s

“language” and system• Governance,

information sharing and data sharing

• Keeping on the task, and maintaining enthusiasm

Letwin Pilot Project: Aims

“The purpose of the pilot is to test the impact on benefit off-flows of a client receiving support from the NHS (provided by IAPT). The focus will be Employment and Support Allowance (ESA) claimants in the Work Related Activity Group (WRAG) who report a common mental health condition that may impact on their ability to job search. These claimants will be engaged with the Work Programme.”

Letwin Pilot Project: Scope

“Advisers to address job search and employment and establish if progress may be restricted by a common Mental Health Condition – advisers are not expected (nor should attempt to) to diagnose mental health conditions, but to identify where it impacts on Job search activities and employment and refer those who consent to the support.”

Letwin Pilot Project: Scope

• One thousand claimants • Eight providers across the course of four

months from September 14. • The referrals will be voluntary and no

sanctions can be applied for non-participation. Both existing claimants and new claimants of ESA.

Letwin Pilot Project: Newham IAPT engagement

• Preparation stage

– Being “introduced” to selected partners – Seetec and CDG (Shaw Trust)

– Process mapping, information sheets, data sharing, referral form and process

– Weekly conference call/ feedback with the pilot team

Letwin Pilot Project: Newham IAPT engagement

• Local implementation– Active engagement “at the top” - Three-way meeting –

IAPT, Primes and the project team– Negotiating a model, establishing contact points and

referral route with management– Establishing and maintaining relationships

Information session with advisors One-to-one, team consultation Maintaining contact

– In-house communication, configuring IAPTus, referral pathway, tracking and engaging booking and clinical staff

Letwin Pilot Project: Newham IAPT engagement

• Two models• A dedicated advisor as a link person

– Meeting with local manager and the advisor to clarify aim of the project, criteria and secure commitment

– Individual meeting with the advisor to help identify appropriate referrals

– Regular contact• All advisors make referrals

– A half-day information session, including “refreshers” session of previous training and referral route

– Establish referral handling, feedback and information sharing– Regular contact via dedicated team leader and individually about

outcomes of referrals

31 Referrals received Dec 14 – Jan 15

Current SUs of IAPT = 3

(10%)

Previous SUs of IAPT= 10

(32%)New SUs; 18;

58%

Initial engagement outcomes

Not contactable = 8 (26%)

Unable to process = 3

(10%)

Successful engagement

to assessment = 20 (64%)

Current status53% made it through to assessment completion; 47% dropped out at booking and pre-assessment

Pre-assn’t = 34%

Assm’t = 13%

Refer on = 13%

In Assm’t = 20%

In therapy = 20%

IAPT Employment Initiative: Letwin Pilot Project

• Learning points– Engagement and relationship is the key. – Commitment from the top is vital.– Be adaptive and understand our partners’ organisation needs and

pressure, e.g. avoid training at the end of the month, multiple sessions as needed to ensure enough advisors on the ground to keep the business open.

– Keep it simple. Advisors are busy and have a high caseload.– If plan A does not work, have a plan B in place.– Communication of outcomes – no-one would like to refer to a “black

hole”.– Ensure a robust and referral handling and tracking system.– Engage and communicate with your own staff – clinical and booking

team.

Neelam Dosanjhneelam.dosanjh@eastlondon.nhs.uk

Monton Jienpetivatemonton.jienpetivate@eastlondon.nhs.uk

0208 536 2161

www.newhamtalkingtherapies@nhs.uk