4Why is prevention & retention important? The economic argument Mental health disorders account for 23% of those on incapacity benefit in EnglandMental health & stress problems are now the leading cause of absence from workThe annual cost of lost employment in England is £19.4 billionCost borne by employers in sick leave, lost production, recruitment & retraining, compensation, litigation & insurance, early retirement.
5Australian Study 1993 for every dollar spent on rehabilitation, 4 dollars saved
6Response from questionnaire relating to Job Retention In our Trust 78% lost their jobs as a result of their mental health difficulties, and through lack of advocacy or effective case managementOnly 11% had found our Occupational Therapy service helpfulOnly 7% had found the Disability Employment Advisors helpful
7Dr Chris Manning – PRIMHE/ Depression Alliance There is huge concern about this group in primary careGP’s often do not have the time, knowledge or skill to deal effectively with work absence or sickness due to mental ill healthSigning off is seen as protective, but is often at the expense of individual’s longer term healthThese clients often pick up labels such as fat-filers, heart sinkers, psychosomatics
8GP’s – the factsIt is estimated that around 40% of all GP consultations include a mental health problemAround 90% of mental healthcare is provided by Primary Care30-50% of those with SEMI, who engage with statutory services, use only Primary Care Services
9The 3 tiers of prevention, retention and rehabilitation Primary Prevention: health promotion, reducing stress, prevention of illness and injury wherever possibleSecondary Prevention: Job Retention, early intervention, managing sickness & absence policiesTertiary Prevention: Vocational Rehabilitation
10As Vocational Rehabilitation Services spread in Mental Health, there will be more need for job retention to keep these individuals in jobs when they secure them
11The sick absence trajectory The chances of those individuals signed off sick returning to work after a period of 6 months is only 50%After 1 year it is 25%After 2 years it is practically nil – 5%
12Outcomes relating to Job Retention – before the pilot The successful creation of a job retention service, helping over 35 people to remain in their jobs, and 15 to find other career pathsDevelopment of ‘key stages’ in job retention guidelinesTraining and education to OT’s and other health professionals in Trust
13The Avon Job Retention Pilot June 2002-3 Commissioned by NHS ExecutiveFunded by DWP, DoH and AWMHPTQualitative Evaluation by IAHSP, King’s College, LondonOur aim was to provide a ‘one stop resource’ for employers – case management for employees and all the interventions that are vital in creating healthy work environments
15Public Initiatives Health Promotion Job Retention Specialist Mental Health Services
16Key Points from the evaluation What a service user said:“ I don’t know what I’d have done without their support. It meant so much to have someone on my side, who could understand what I’d been through, and speak for me when I wasn’t well enough to deal with anything. I think I have them to thank for still being in my job. I’d have given up, I’m sure of that.”
17Key Points… What an employer said “ We knew she was involved we knew she had a nurse, but they had never included us in things. It was so much easier when (the JRT) came on board. They made some useful suggestions on how to proceed, and the support they gave her and us made all the difference really.We’d have had to let her go, as things couldn’t carry on as they were”.
18Key points… What GP’s said “It saves my time, and I know they will be able to help them, I know they will support my patient in sorting it out.”“They negotiate with work and stop the patient being frightened.They negotiate with the employer and know the patient’s rights. They also give them the confidence to go back. To have somebody they trust to do that, I just don’t have the time.”“I honestly think it’s great. I really like having a service that recognises there’s an issue I can’t deal with as well as I’d like to.”
19Ongoing support at work “It’s just knowing that he is there. You know six months down the line, if I feel I can’t keep it together, I’ll ring him up.It’s nice to have someone like that. It’s the ongoing support in case any problems come up that I can’t deal with.”“My case manager has been helpful in ironing out the problems I’ve had since returning to work, and there are so many still going on. It takes a lot of the pressure off, and I don’t feel so much on my own anymore.”
20Saving the job, saving the marriage 69% of job retention cases are in ‘permanent’ relationships80% unemployed clients are single“ My husband thought I should let the situation go and not complain… This caused problems between us. Financial stress! My case manager briefed him on my state of mind, this made a big difference. So then I had the support of my husband as well.”
21Life after the pilotRolling out a nationally co-ordinated Job Retention ServiceGiving an effective response to the SEU ReportAnswering the need for training with Diploma and Certificate in Case ManagementDeveloping Public/Private Partnership Initiatives with joint investment
22Key ElementsFull range of professional services- qualified and accreditedStandards across the professional boundaries, in addition to their ownTraining to manage cases proactively“ I could not have mustered all the services I needed – thank-you.”
23Summary The Strategy for Mental Health & Work is clear Models tested in the UK are robust and confirmed by overseas experienceTraining & Development is urgent – we must have capacity – it is ready to goFunding currently being reviewedWe now need ‘planes not pilots’!!