Improving the labour market participation of people with

histories of substance misuseand offending

Benefits, obstacles and interventions.

Paul Anders, Senior Policy Officer

Background- DrugScope – c.450 member organisations

- Policy, good practice, research, campaigning,

national & regional forums

- England (pop. 53m):

- 300,000 crack cocaine/opiate users (England)

- 200,000 adults in drug treatment

- c.1,600 adult drug/alcohol services

- c.£900m (€1.2bn) spent on treatment

- £15.4bn (€21bn) cost of drug addiction, of which

£13.9bn (€19bn) is drug-related crime

- Cost-benefit ratio estimated at 1:2.5

Recovery capital – whole person approach

Changing presentation

• 80s & 90s heroin spike appears to be over

• Fewer entrants to system and less opiate/crack cocaine

presentation – although adult drug services still c.70% OCU

• Ageing population in treatment

• Need to reconfigure services to reflect need

Prisons- 23rd Jan 2015: 84,865 in prison (inc. 3,811 women)

- Jan-March 2014

- 26,151 people sent to prison in total, of whom:

- 11,196 people were sent to prison to serve a short

sentence (below 12 months)

- 47% of all adults reoffend within 12 months

- 58% of short sentence prisoners reoffend in 12

months

- Highest per capita in Western Europe at 148 per

100,000

- £3bn (€4bn) cost of prisons per year

Montenegro & the UKMontenegro UK/England

Unemployment 15% (2014) 5.8% (UK, Q3 2014)

LT as % of unemployed 80% (2011) 39% (UK, Q2 2014)

18-24 unemployment 45% (2010, 33% to 30, 2013) 15.1% (UK, Q3 2014)

Industry 20% (2011) 18.2% (UK, 2013)

Services 73.9% (2011) 80.4% (UK, 2013)

Agriculture 6.2% (2011) 1.4% (UK, 2013)

Self employed 16% (2011) 15% (UK, 2014)

Seasonal Yes Somewhat

Regional disparity Yes (16%-48% - 2010)) Yes (4.4%-8.5% - 2013))

Poverty rate (income) 8.6% (2013 – Gini 26.7%) 23.2% (2013 – Gini 34%)

Employment service ZZCG/EAM Jobcentre Plus

Labour market programmes ZZCG/EAM Private, NGO, public (excluding

JCP), social enterprise

Jobseeker profiling Intermediate Limited

Wage incentives Yes (various) No (but £ to some disabled to

facilitate employment)

Complex needs

• SMD = severe & multiple disadvantage – substance use, offending,

homelessness (mental health excluded due to data quality)

• Treatment population – 75-85% mental health problems

• Prisons – 25% (women) & 15% (men) mental health problems; 57% &

62% personality disorder

• Mental health treatment – 40% illicit drugs and/or harmful alcohol

consumption

• Rough sleepers – 45% mental health problems

Employment & drug treatment

Finding work

• 50% JSA off-flow = <3 months

• 50% LDAN cohort job entry = c.12 months

N=115

Labour market interventions in the UK

• Supply side measures

• Deficit based

• Limited integration with skills & training

• Demanding conditionality

Eurostat 2011

Conditionality

• 2m sanctions in 2 years – up to 3 years withdrawal of benefits

• Disproportionate impact on people with mental health

problems, the young & socially excluded

Conditionality - consequences

• C.500k unemployed/inactive disengaged from main

employment service

Labour market programmes - UK

• DWP Work Programme – long term unemployed: 3, 9, 12

months

• Non-prescriptive ‘black box’

• Payment by results: £0 to £14,000 (€ 18,700) plus £5,000

(€6,700) drug/alcohol premium in pilot areas

• £2.8bn (€ 3.7bn) 5 year programme cost at £2,100 (€2,800)per

job

Dotted line = minimum

performance level

Employment - benefits• Drugs & alcohol

• >90% heroin & crack cocaine users unemployed

• Improved treatment outcomes

• Less frequent relapse

• Less severe relapse

• Direct savings (e.g. treatment, health, social security)

• Indirect savings (e.g. offending, social care)

• Potential savings up to c.£40,000 (€53,000) per person

• Offending

• 67% unemployed at time of arrest

• 27% enter employment on release

• Cost of prison place £37,000 (€49,000) p.a.

• Can reduce low level, persistent offending

• Complex interplay and causal relationship between

offending, reoffending and employment

• Employment improves health and wellbeing – but less clear

with poor jobs – low status, low paid, insecure, unsociable,

unpleasant etc.

Barriers to employmentPersonal barriers:

• Drug and alcohol addiction

• History of offending

• Low self-confidence, self-esteem & motivation -

discouraged workers

• Physical and mental health problems

• Poor employment histories,

• Low skill and qualification levels,

• Learning disabilities

• Behavioural problems

• Poor access to information

Structural barriers:

• Cost of labour market participation

• Employer attitudes – stigma & discrimination

• Absence of a compelling competing narrative despite

positive employer experiences

• Labour market conditions

• Inadequate macro measures

• Scarcity of effective interventions

• Silos – activity, policy and funding

Towards a solutionSeven interventions:

• Individual placement and support

• Counselling approaches

• Social enterprise

• Employer initiatives and corporate social responsibility

• Job subsidies

• Campaigns

• Toolkits and information for universal services

• An evidence-based model of employment support

• Originally developed in the US to support people with

• mental health problems

• IPS only used once before in the UK with an addictions client

group

• CNWL is a Centre of Excellence in IPS services

Measurable Outcomes:

• Job entry & sustainment

• Earnings

• Likelihood of dropping out of service/rehospitalisation

• Percentage of service users entering competitive employment

Individual placement & support

IPS key principles• Aims to get people into competitive

employment

• Open to all those who want to work

• Tries to find jobs consistent with people's

preferences

• Works quickly

• Brings employment specialists into clinical

teams

• Employment specialists develop

relationships with employers based upon a

person's work preferences

• Provides time unlimited, individualised

support for the person and their employer

• Includes benefits counselling.

IPS compared to generic interventions

Drake, Robert; Bond,

Gary (2011). "IPS

Supported Employment:

A 20-YearUpdate".

American Journal of

Psychiatric

Rehabilitation 14 (3):

155–164.

CNWL mental health IPS

service compared to

Work Choice (main UK

disability employment

programme), 2011-12.

Mental health – severe &

mild to moderate

IPS – diversity of job entry at CNWL

IPS strengths & weaknesses

• Evidence based – proven in mental health,

promising in substance use and elsewhere

• Off the shelf and replicable

• Intermediate skills required

• Inherently joins health care and employment

support

• Perceived as high cost (but arguably

comparable to traditional interventions for

equivalent client group)

• Culture, attitude and values essential

• Dependent on job market and economy

• Scalability untested

NEXT

Psychosocial approach including:

• Learning styles and reflective practice

• Active listening skills

• Models of substance misuse

• Psychology of prejudice & working with difference

• Understanding your emotional world

• Intro to cognitive behavioural therapy

• Communication skills and understanding family dynamics

• Career action planning

• Understanding and working with schemas

• Advanced listening skills & understanding personal responsibility

• Understanding group work

• Giving & receiving feedback

• Interpersonal boundaries and co-dependency

• Improving assertiveness

• Fight, flight or freeze? Understanding the response to trauma

• Working with anxiety

• Voluntary work placement

NEXT strengths & weaknesses

• Offers a consistent approach between

treatment and employment support

• Proven track record – 9 out of 10 participants

go on to employment, education, training or

volunteering

• Prepares people for work but not job

brokerage

• Requires experienced and skilled staff to

deliver

• Time limited

• Homelessness, substance use, socially excluded;

• Activities include:

• Job readiness training

• Job brokerage (Social Value Act readiness)

• Direct employment – Work Champions, distribution & The Handy

Help Co

• With Lambeth Jobcentre Plus:

• Engage: 480

• Employ: 36

• Support into mainstream employment: 51

• Cost to JCP: £28,500 – or £559 per person into competitive

employment

• Work Programme equivalent cost – c.£3,300 per job

Social enterprise

Social enterprise strengths & weaknesses

• Creates employment, supports targeted local &

regional economic activity

• Can actively engage and target particular cohorts

• Can leverage public spending and investment for

positive social gains

• Emerging practice - e.g. Social Value Act in UK,

Europe 2020

• Socially excluded employee premium

• Employer concern & customer risk aversion

• Cost implications of ethical employment

• Small base in Montenegro, limited infrastructure &

legislative support

Job subsidy/guarantee strengths & weaknesses

• Can stimulate employer engagement

• Existing framework in Montenegro

• Intermediate labour market can be more effective

than job coaching approaches – e.g. Future Jobs

Fund in UK

• Can be precisely targeted

• Can be costly

• Open to gaming and creaming

• Risk of displacement & excessive deadweight

• Competing priorities & groups

• EU State Aid rules

• Employer attitudes towards different cohorts have

cost implications

Employer initiatives

Timpson – 1400 high street

Shops

• Corporate social responsibility

• Backed by business case

• 5 prison academies

• Academies resemble shops & replicate shop

environment including corporate uniforms

• All attendees who complete skills training

offered paid work

• 300 ex-prisoners recruited in 4 years

• 16 shop managers recruited from prison

• 7 employees known to have reoffended

Employer initiatives strengths & weaknesses

• Demonstrates the business case

• Halo effect – for firm and employee cohort

• Scalable

• Public support progressive recruitment approaches

• Very limited employer take-up so far: Timpson is almost

unique. No equivalent for substance use clients

• Public supportive, but stigma still an issue

• Limits on what can be achieved: “for lots of people having a

job would be the least useful thing for them in their life. A

third of people in prison are right for employment, a third

have significant health problems and a third are people I

would not want to have in my business” – James Timpson

Campaigns• Ban the Box – Business in

the Community

• Launched in 2013

• Evidence from USA:

• Improved employment

rates

• Social & economic

benefits

• Time to Change – Mind &

Rethink Mental Illness

• Major national campaign to

tackle stigma and

discrimination

• 3% increase in the number of

people who say they face no

discrimination,

• 11.5% reduction in average

discrimination

• 2.4% improvement in public

attitudes.

Campaigns strengths & weaknesses

• Can utilise existing communication channels

• Impacts permeate beyond employment

• Turning the oil tanker – perceptions are

persistent

• Require public buy in

• Risk of competing messages

• Difficult to demonstrate direct effect on

employment – e.g. suggestion that Time to

Change has had limited effect on recruitment,

although it may have changed employer

attitudes to people they already employ.

Information products

DWP mental health toolkit

• Universal guidance for

non-specialists

• Aims to use a new

approach to getting more

suitable and sustained job

outcomes for people with

mental wellbeing needs

• Developed by

psychologists, Work

Programme providers and

mental health experts

• Comparatively quick and

cheap

• Offers few guarantees of

consistency, access and

efficacy

• Works best as part of a

coordinated strategy

including training, quality

assurance & user satisfaction

Co-locate services & improve practitioner skills;

Approaches from mental health appear to transfer well, e.g. Individual Placement

and Support – but pilot and learn from a range of interventions;

Introduce and assess early – part of the journey, not the destination, although

introduction should be planned, staged and build from a stable foundation;

Structured and intensive, but flexible – provision should reflect changing

circumstances and fluctuating ability to engage;

Skilled, motivated and experienced staff – not necessarily within the treatment

sector, but people who are able to understand and work with the client group;

Long-term planning – a career or pathway, not just a job. Understanding and

planning for the individual’s aspirations and motivation is important;

Include basic / functional skills alongside employability;

Addresses lack of recent/any work experience;

Include intermediate labour market approach;

Engage with employers locally and individually, and make the case nationally to

address negative preconceptions and stigma – negative preconceptions are the

norm, even among employers who are signed up to the agenda.

10 points to conclude:

Contact

Paul AndersDrugScopepaul.anders@drugscope.org.ukTel: +44 (020) 7234 9799

http://www.drugscope.org.uk/http://www.ldan.org.uk/employment.htmlhttp://www.nta.nhs.uk/uploads/employmentandrecovery.final.pdf