Employment for people with severe and enduring mental health problems – what have we learned? Dr Bob Grove Director, 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 British Even numbers of men and women Disproportionately 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 work But they face: Stigma and discrimination in the job market Poor living circumstances, co-morbity Low expectations from professionals and others Benefits system which is perceived as threatening and is a barrier to part time work Government programmes which historically have not been designed to meet their needs eg. Access to Work, Workstep Lack 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 work An accommodating employer A good network of support – professional, friends, colleagues, family Stable, 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 settings Client control of timing and pace Rapid job search and minimal prevocational training Integration of clinical treatment & vocational rehabilitation – team approach Job matching based on user preferences Initial assessment/adjustment – time unlimited support for employee and employer Individual benefits advice Becker IPS Fidelity scale 2008

Work with employers Build relationships through regular contact Sell the person not the disability Explore job carving and job development Support and encourage both parties through the transition to work Build 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.

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