1. Vocational Service Birmingham Early Intervention Service

2. Why Set up a Vocational Service? Employment and education promotes social inclusion (Social Exclusion Unit, 2004) Important in maintaining mental health and social functioning in people with severe mental health problems (Royal College of Psychiatrists) Majority of young people with mental health problems want to work/enter education (Scottish Executive, 2003)

3. Why Set up a Vocational Service? Some people recovering from severe mental health problems obtain vocational/educational roles within mainstream settings (Bond et al., 2001) Social and governmental policies (SEU, 2004) have supported the importance of employment for young people with severe mental health problems Governmental policies have ensured lack of equality and lack of discrimination in the labour market (Discrimination Disability Act, 2005).

4. Why Set Up a Vocational Service? Developments in the UK (DoH, 2000) have resulted in development of Nationwide Early Intervention Services to provide intensive psychiatric care to young people experiencing severe and enduring mental health problems Despite these developments over 70-80% of young people have disengaged from vocational/educational roles upon contact with mental health services (including early intervention and community mental health teams)

5. Traditional Services Mental health services have attempted to help service users to engage with educational and vocational roles in addition to managing mental health This approach not successful due to: lack of vocational expertise poor communication between services vocational services not equipped to manage mental health needs lack of time to provide ongoing support

6. Integrated Services Two studies in London demonstrated that mental health services which employed a vocational worker produced improved vocational outcomes (Rinaldi & Perkins, 2007) St Georges EIS: Services users not in employment or education (NEET) dropped from 65% to 7% after 12-months Two CMHTs: NEET levels dropped from 70% to 37% at 12-month follow up

7. Birmingham Vocational Service Resource Manager 4 Vocational Outreach Workers Connexions Worker These staff work alongside mental health staff to improve vocational outcomes of service users

8. Service Provides Assessments Social Support Short Courses Preparation (e.g., CVs; Application Forms) Links with mainstream educational organisations Support with college applications Links with mainstream vocational organisations (e.g., Job Centres; Connexions, Work Directions, Employment Agencies Ongoing support (transport; advocacy)

9. Social Support Social activities in the community Individual support sessions with residual symptoms including anxiety; paranoia; negative symptoms Individual support includes bus runs, visits to cafes, cinema, local communities Working alongside clinical psychologists Formulate a plan to increase social engagement Establish rapport and develop trust and develop goals with service users Social activities in groups including pool, gym, football

10. Assessments Daily routine/activity levels Functioning These assessments are aided by information from mental health staff If poor provide individual/group support along with clinical psychologist and care-coordinator Educational/Vocational Assessment Educational history (qualifications) Employment and training history Vocational/educational aims

11. Following Assessment Development of vocational pathway Referral to support services within vocational service Job Club 1: 1 Support OR Referral to mainstream services Connexions; Work Directions Training Providers (e.g., Learn Direct) Colleges

12. Job Club Basic Skills Training Support and Guidance with CVs Completing application forms Interview preparation Accessing work data bases Access to Learn Direct which is a mainstream organisation that provides Literacy and numeracy courses

13. Other Activities Advice to service users and employers on Disability Discrimination Act Advice to employers and training providers on mental health Guidance and advice to employers on needs of individual service users Advocacy and support to service users once employment is taking up

14. Music Courses Provide 1:1 music courses 2007: Developed 12-week music course with Birmingham University Aim to familiarise service users with mainstream college/university setting Provide a qualification that can lead onto a diploma/degree level qualification

15. Media Courses Jump LTD-Professional Media Company Service users enrolled on a media course Received training on web design, filming, editing, interview skills and storyboarding At end of course service users conceived, developed, filmed, edited a series of short films on mental health and early intervention Course increased confidence and led to further training and education

16. Audit of Service 92 Service Users referred to service between January 2006-January 2007 Males = 75; Females = 17 In employment: 13% In education/training: 27% Currently seeking employment following support: 15% Deemed not ready and needing further support: 23% Discharged from vocational service: 22% (e.g., due to relapses; non engagement due to symptoms)

17. Attendance at Different Activities Job Club: 63% Completed CVs: 50% One to one Support: 25% Music Group: 10% Gym Group: 9% Social Group: 30% Fork Lifting Course: 2% Mechanics Course: 3%

18. Type of Work Clerical: 35% Construction: 16% Retail: 22% Security: 16% Factory Work: 8% Skilled:3%

19. Hours Worked 16-36 Hours: 27% 12-15 Hours: 47% 9-11 Hours: 26% Paid? 72 % Paid Employment 28% Unpaid Employment

20. Conclusion Still low employment rates Not all full time employment Lowly paid jobs BUT Currently not a fully integrated service Vocational workers not placed within individual teams Currently a randomised trial (ENRICH) taking place in Birmingham investigating this issue based on Renaldi & Perkins (2007) model