helping people with enduring mental health problems gain and retain employment: from research to...

Helping people with enduring mental health problems gain and retain employment: from research to practice

Miles Rinaldi

Why work?Work is central to the lives and well -being of most people, and is important in maintaining and promoting mental health - there is a particularly strong relationship between unemployment and mental health difficulties (Warr, 1987)

People with mental health problems are particularly sensitive to the negative effects of unemployment and the loss of structure, purpose and identity that it entails (Anthony et al, 1984)

Via work the quality of lives is enhanced (Hill et al, 1996)

Admission rates among those who are in work are reduced (Warner, 1994)

Employment is the most significant outcome for people who have experienced mental health problems (Kinderman and Cooke, 2000)

Unemployment and Public HealthUnemployed >12 weeks4-10 times prevalence of depression anxiety and physical illness

Strong relationship between suicide & unemployment in youngwith 2/3 not in paid work

Evidence shows that work is good for physical and mental health and well-being

Strong evidence that worklessness is harmful to physical and mental health

Individual PerspectiveLiterature of Recovery ( for example, Anthony 1993)Meaningful roleOccupation

Do people want to work?70-90% people want to return to work (Grove, 1999; Rinaldi & Hill, 2000; Secker & Seebohm, 2001)52% said they had not received any help (Healthcare Commission, 2005)

Latent effects of employment (Jahoda 1979)Time structure on waking dayShared experiences and contacts social networksDefines aspects of personal status

Less than a quarter of adults with mental health problems are in workMain barriersfear of losing benefitsemployers attitudesfluctuating nature of conditionlow expectations of health professionals

Sheet:

whole population

physical health problems

mental health problems

Comparative Employment RatesWinter 2003 - Spring 2005 (Labour Force Survey)

Chart1

2416215081

2414215180

2315215181

2417225281

2514225281

2611215180

Depression/bad nerves

Mental illness

All mental health problems

All disabled people

Non-disabled people

Time series

Depression/bad nervesMental illnessAll mental health problemsAll disabled peopleNon-disabled people

Winter 20032416215081

Spring 20042414215180

Summer 20042315215181

Autumn 20042417225281

Winter 20042514225281

Spring 20052611215180

Time series

00000

00000

00000

00000

00000

00000

Depression/bad nerves

Mental illness

All mental health problems

All disabled people

Non-disabled people

Comparative Employment Rates: Winter 2003 - Spring 2005

Disability Status (2)

Disability Status BY Whether Suffering from Depression or Bad Nerves or Mental Illness, Phobias or Panics: Working Age Persons in England: Summer 2002 - Spring 2005

Not Seasonally Adjusted

In employmentEmployment RateILO unemployedInactiveTotal

Summer 2002DDA disabled and work-limiting disabledDepression bad nerves487761911638194812255226

- Spring 2003Mental illness phobia panics13722106256115320135298

DDA disabledDepression bad nerves243256227621188438971

Mental illness phobia panics24384066727065811

Work-limiting disabled onlyDepression bad nerves164894034722152941489


Not disabledDepression bad nerves574386672042233086972


TotalDepression bad nerves1102622718878182744311884


Three catsDepression bad nerves89590


Depression bad nerves147028

Mental illness phobia panics

Summer 2002DDA disabled and work-limiting disabledDepression bad nerves4754819.912028178851238427

Mental illness phobia panics1458410.72731119546136861

DDA disabledDepression bad nerves2722664.114531379742476


Work-limiting disabled onlyDepression bad nerves1938339.837982554448725


Not disabledDepression bad nerves5384869.459341777177553


TotalDepression bad nerves14800536.323213235963407181


Autumn 2002DDA disabled and work-limiting disabledDepression bad nerves5251321.111958184917249388










Winter 2002DDA disabled and work-limiting disabledDepression bad nerves4675718.312618196128255503










Spring 2003DDA disabled and work-limiting disabledDepression bad nerves4828717.49948219351277586








Did Not SpecifyDepression bad nerves00000





-Sping 2004Mental illness phobia panics16560125474118537140571


































Mental illness phobia panics3315818.910471132038175667No in workTotal%

Winter 2003DDA disabled and work-limiting disabledDepression bad nerves4994318.89978206183266104Three catsDep8288335190124

Mental illness phobia panics1713812.17388117477142003MI2615316146316

DDA disabledDepression bad nerves1985147.356121646341926All10903651336421










Spring 2004DDA disabled and work-limiting disabledDepression bad nerves4870516.311545238323298573Three catsDep9127438216824


DDA disabledDepression bad nerves254725647261528445482All11416954625521





















Mental illness phobia panics376631910260152231200154No in workTotal%

Summer 2004DDA disabled and work-limiting disabledDepression bad nerves5094016.715459239520305919Three catsDep9200839947223












Autumn 2004DDA disabled and work-limiting disabledDepression bad nerves4673516.612160223126282021Three catsDep8678036617724












Winter 2004DDA disabled and work-limiting disabledDepression bad nerves544401917183215147286770Three catsDep9376737132925












Spring 2005DDA disabled and work-limiting disabledDepression bad nerves5814819.518042221453297643Three catsDep9827538238126












Source: ONS Labour Force Survey

Three categoriesDepression bad nerves9827525.700806263925078259028382381


Total11961320.968035985434136416705570454

Four categoriesDepression bad nerves16644934.094847540132733289012488194


Total19883828.480862169245793453515698146

Depression/bad nervesMental illnessAll mental health problemsAll disabled peopleNon-disabled people

Winter 2003

Spring 2004

Summer 2003

Autumn 2004

Winter 2004

Spring 2005

Disability Status

Disability Status BY Whether Suffering from Depression or Bad Nerves or Mental Illness, Phobias or Panics: Working Age Persons in England: Summer 2002 - Spring 2005


In employmentEmployment RateILO unemployedInactiveTotal






















































-Sping 2004Mental illness phobia panics16560125474118537140571































































































Winter 2004DDA disabled and work-limiting disabledDepression bad nerves544401917183215147286770

























Three categoriesDepression bad nerves9827525.700806263925078259028382381


Total11961320.968035985434136416705570454

Four categoriesDepression bad nerves16644934.094847540132733289012488194


Total19883828.480862169245793453515698146

Qualification Level

Level of Highest Qualification BY Main Health Problem and Region of Residence: All Disabled Persons of Working Age in England: Spring 2005


NVQ Level 4 and aboveNVQ Level 3Trade ApprenticeshipsNVQ Level 2Below NVQ Level 2Other qualificationsNo qualificationsN/ADNATotal

Tyne and Wear

Arms hands39515171511296716868042201--11081

Legs or feet2557167321544928620831145561--26195

Back or neck876348623584073119145638376-38325306

Difficulty in seeing---379385357---1121

Difficulty in hearing-413--743-776--1932

Speech impediment448413-------861

Skin conditions allergies391--1341-843383--2958

Chest breathing problems3927359213426197205513362260--20709

Heart blood pressure circulation22151221513484913049154492--16130

Stomach liver kidney digestion8671684177113101350-2401--9383

Diabetes3931237-5432625-1600--6398

Depression bad nerves824735141128231529-3141--10463

Epilepsy-1032-56011307841204--4710

Learning difficulties-550--10547882989--5381

Mental illness phobia panics-357-1456375-2399--4587

Progressive illness n.e.c.81817735204081288859972--6638

Other problems disabilities2549752828137530134081737--10662

N/A538--------538

DNA---------0

Total16798204351702929209259361477140492-383165053

Rest of North East

Arms hands2098124825363951183118484851--18363

Legs or feet4908212533964181134122798265--26495

Back or neck73534432429969605918398212495-36845807

Difficulty in seeing484---331-419--1234

Difficulty in hearing-492431-438-408--1769

Speech impediment---------0

Skin conditions allergies447830890716417-448--3748



Stomach liver kidney digestion26964101362142212528341820--9796

Diabetes228585239322513959001819--8895


Epilepsy900--4365373951235--3503

Learning difficulties-537-6941966-3273--6470

Mental illness phobia panics-372-4614135573032--4835


Other problems disabilities2905197517818053151-1279--11896

N/A------449--449

DNA---------0

Total32479208601979330393280791551060209-368207691

Greater Manchester

Arms hands2252-10222848514320726141--19478

Legs or feet42795962632326982878514013783--41063

Back or neck63304235601954797038576316774--51638

Difficulty in seeing-619-626527----1772

Difficulty in hearing1940502-453947-1006--4848


Skin conditions allergies600-11531054426-618--3851

Chest breathing problems65394515-5384415932736747--30617



Diabetes1640103816531904281222595457--16763

Depression bad nerves19992077130233631038415819766--30472

Epilepsy2616575-1936-4952692--8314

Learning difficulties709626--66510604251--7311

Mental illness phobia panics119810924951336280519157604--16445



N/A1736-455------2191

DNA---------0

Total50213301153414238144533182912698457--333515

Merseyside

Arms hands19031414152143913554472869--9948

Legs or feet14672700297194299929528048--20079

Back or neck272620741384430971034618116--26173

Difficulty in seeing1026495478473-4611418--4351

Difficulty in hearing976---927----1903


Skin conditions allergies1023509511---990--3033


Heart blood pressure circulation5225293423711931419638324341-43525265


Diabetes2107933928973193319702817--11661


Epilepsy1547--473878-2413--5311


Mental illness phobia panics479--10015449051581--4510

Progressive illness n.e.c.287059211279682444-1358--9359

Other problems disabilities20122923109438721963-3379--15243

N/A426--513--918--1857

DNA---------0

Total29589183481550721208310791438160461-435191008

Rest of North West

Arms hands2965309240781399330324582373--19668

Legs or feet48495022445949343500395410783--37501

Back or neck82003622630596556881422316135--55021

Difficulty in seeing573-40226001013-2417--7005

Difficulty in hearing----4114361439--2286


Skin conditions allergies172213864681762470400428--6636




Diabetes2202407822592484195314505318--19744


Epilepsy1980830571435-8411663--6320

Learning difficulties5641485-1311--5345-4909195

Mental illness phobia panics977530459-11918986075--10130



N/A608---461----1069

DNA---------0

Total67803401443425446874460572456784710-490344899

South Yorkshire

Arms hands13314341761159014754734128--11192

Legs or feet1934311821282325457945485407--24039

Back or neck6761199926494952465143009540--34852

Difficulty in seeing1468935469-443----3315



Skin conditions allergies497945-449--1337--3228




Diabetes2309155926052694139919003291--15757


Epilepsy-811475893-3781876--4433

Learning difficulties538---18279661872--5203

Mental illness phobia panics468889-4921270-1842--4961



N/A---------0

DNA---------0

Total27910178311674123573342962392154062--198334

West Yorkshire

Arms hands2141125845626263188-5712--15381

Legs or feet257592322092543185826355811--18554

Back or neck5443353643693978704737259615--37713



Speech impediment521---425----946

Skin conditions allergies406--878438----1722




Diabetes939-26391328133113272931--10495


Epilepsy3894315025001482-890--4194

Learning difficulties-1539---4398610--10588




N/A--439-423----862

DNA---------0

Total38619217232016326413343431967871518--232457

Rest of Yorkshire & Humberside

Arms hands1355-13303425419214891241--13032

Legs or feet5014334627965752241535865880--28789

Back or neck5554340925311976384740447532-40229295

Difficulty in seeing--411-507----918

Difficulty in hearing-550-10171010----2577

Speech impediment----907----907

Skin conditions allergies6161648-458-446376--3544




Diabetes2606187717764232455-810--9947

Depression bad nerves145248086010708695032919-4178570

Epilepsy944507---5042342--4297

Learning difficulties----10464473902--5395

Mental illness phobia panics427--431902-1508--3268



N/A951--445--1218--2614

DNA---------0

Total34104196791275328952372511612144212-819193891

East Midlands

Arms hands27902324391743395901538310570--35224

Legs or feet62087292550181498504587713385--54916

Back or neck154049981103711129913264747124666--92456


Difficulty in hearing47689751118921551506---5833


Skin conditions allergies-1129-21431063-368--4703




Diabetes875925391946419448985468330--31212


Epilepsy493571-2058314610283573--10869

Learning difficulties-502-4854651-7906--13544




N/A-1063----573--1636

DNA---------0

Total842715704540695703758913948274125309--515108

West Midlands Metropolitan County

Arms hands-236512411596164927313897--13479

Legs or feet53121234321124115678671714490--39053

Back or neck334759153779505111318665520631--56696

Difficulty in seeing-12514044941073-1355--4577



Skin conditions allergies1114793-30419914521044-12778712



Stomach liver kidney digestion33351621-16772037-3027--11697

Diabetes4879561615421255238321566921--24752


Epilepsy956--1177921-2835--5889

Learning difficulties-510--5349257573--9542



Other problems disabilities48172493-48922966-3460--18628

N/A---2027-1017---3044

DNA---------0

Total409333836018390388964099036241100932-1277316019

Rest of West Midlands

Arms hands467407424432461292538565697--21923

Legs or feet34782280332317431400223812567--27029

Back or neck108754358538673168207426214137--54541

Difficulty in seeing-1093-3791570-1400--4442

Difficulty in hearing-1010---10281636--3674


Skin conditions allergies1692379-1091704381---4247

Chest breathing problems394952814509672455517525830-121332702



Diabetes31502634450143522489292812--13658


Epilepsy519954-558-4161942--4389


Mental illness phobia panics1590-449-28305344571--9974



N/A----951501448--1900

DNA---------0

Total52136370581989838648436782731287096-1213307039

East of England

Arms hands5389439030203453532168005820--34193

Legs or feet689654763824630112564341215214--53687

Back or neck9581771259981046018016872721897--82391



Speech impediment------389--389

Skin conditions allergies1599124254620091359907---7662




Diabetes5111457522854719310636776389--29862


Epilepsy1585155555717701087-1786--8340

Learning difficulties994544-99919424946507--11480




N/A----984-482--1466

DNA---------0

Total993105981539609717119121049882127117--538654

Inner London

Arms hands4354115854049345450985096--17193

Legs or feet3902-179930182306255911969--25553

Back or neck71135219195633696421862917459--50166

Difficulty in seeing1263--645640-3184--5732

Difficulty in hearing33061522--1313-2060--8201


Skin conditions allergies12761630-------2906




Diabetes3568--826190115095577--13381

Depression bad nerves39461909-21974836196612588-108728529

Epilepsy-597-5221419-2638--5176

Learning difficulties-625-63712516956313-69910220


Progressive illness n.e.c.54781373-2969159322334279--17925


N/A1387704688--2101736--5616

DNA---------0

Total64623231308094239813082644199116273-2377313503

Outer London

Arms hands6871118222072350270975837089--29991

Legs or feet98173704221249794175456111438-48341369

Back or neck145917567236510639156621031916919--78062

Difficulty in seeing2752515-1634-15532151--8605

Difficulty in hearing106065154811668112527---6763


Skin conditions allergies2869-1097612613608---5799




Diabetes7709503123632130403474985657--34422


Epilepsy5721455-1220121712762845--8585

Learning difficulties----15188635032--7413




N/A5641149--61716281286--5244

DNA---------0

Total1006244437724684497886372969722115064-483468471

South East

Arms hands87553987363655424715330112074--42010

Legs or feet14510987152031359213152494519145--80418

Back or neck27471123741293616928221181027022379-465124941


Difficulty in hearing27943092-38358745181014--12127

Speech impediment-610--585-503--1698

Skin conditions allergies57382962-1257359110661282--15896



Stomach liver kidney digestion12174625630595194836123417999-49745881

Diabetes143711090849544263951051427968--57116


Epilepsy34222558905429945194706458--22631


Mental illness phobia panics2054351513201607498315157319-92223235



N/A17211459-105012319401687--8088

DNA---------0

Total19114310320759175122687141375669041570913802246844208

South West

Arms hands6048532218276188604522645570-50733771

Legs or feet790992745423841013823400215421--64262

Back or neck1726110879728714950167541218014691--94002








Diabetes6093278327553450717427654924--29944


Epilepsy2204338953513911527492830--10368




Other problems disabilities102616594305212988990246165348-46653227

N/A547---355-454--1356

DNA---------0

Total10710673792353708760010080148565991794321518554363

Total

Arms hands49114337653304645667518924660785329-507345927

Legs or feet856156400056932769068538062519177167-483609002

Back or neck148886907987999212139415543699574241362-1618939060

Difficulty in seeing211941253450441535116687587618488--95174

Difficulty in hearing154981382628131173111679605416533--78134

Speech impediment20722096--1917-2901--8986

Skin conditions allergies20413148625232176521096455719414-127785385

Chest breathing problems130708852663083611350493861562741175954321804630280



Diabetes68121456602854834872501573402872621--334007


Epilepsy181271526535451822817863707937222--117329

Learning difficulties60368496-10454299171102891322-1189158442

Mental illness phobia panics1873818102735518026277311742779772-922188073


Other problems disabilities112910513162256274136950423473681066-466472234

N/A8478437515824035502261878251--37930

DNA---------0

Total10376616259194162977484528921075491741442182812116095724213


NVQ Level 4 and aboveNVQ Level 3Trade ApprenticeshipsNVQ Level 2Below NVQ Level 2Other qualificationsNo qualificationsN/ADNATotal

Benefits

Type of Benefit Claimed BY Main Health Problem: All Disabled Persons of Working Age in England: Spring 2005


Unemployment Benefit NI creditsIncome Supprt (not as unemployed pers)Sickness or Disability (exc DPTC)State PensionFamly rel. benefits (exc Ch B exc TCs)Child BenefitHsng/Council Tax GB Rent/rate rebate NIOther

Arms hands88364391699000433649765557570843548

Legs or feet110111021992312109053-839961222367212

Back or neck234861432773003726610151817437117594610146

Difficulty in seeing25621690033816925-13791156941622

Difficulty in hearing2234518010699419-1099964571555

Speech impediment44816923751--21141715449



Heart blood pressure circulation116996331514188410200196763782721365328


Diabetes906229081363723169-45947370092323

Depression bad nerves11815124293183432-2447957801453446750

Epilepsy2786197173551696398324385177231260

Learning difficulties58964463991648495-7662165873238


Progressive illness n.e.c.424943222130490235647850810474804112

Other problems disabilities9640555201235859671250109664642756825

N/A1133765512952--55547413-

DNA--------

Total1355258907651725649448341007099327899873068530


PLEASE NOTE: As this is a multi-response variable (ie respondents can identify themselves as fitting into more than one category)

totals have not been included in order to avoid duplicate responses.

Secondary Health Problem

Number of People With Mental Health Problems as a Secondary Health Problem: All Disabled Persons of Working Age in England: Spring 2005


Number of People With Mental Health Problems as a Secondary Health Problem

Arms hands45377

Legs or feet74746

Back or neck125856

Difficulty in seeing7289

Difficulty in hearing2354

Speech impediment1502

Skin conditions allergies10464


Heart blood pressure circulation53153

Stomach liver kidney digestion40565

Diabetes19675

Epilepsy14780

Learning difficulties21939

Progressive illness n.e.c.35092

Other problems disabilities60452

N/A11633

DNA-

Total565441


Secondary MH services employment rates

Perkins & Rinaldi (2002) A Decade of Rising Unemployment. Psychiatric Bulletin. 26, 8, 295-98

Chart1

94.519.712

91.118.110.1

8815.88.3

86.212.37.7

87.215.67.4

88.713.37.7

89.510.35.5

92.38.74.9

94.19.55.7

95.18.14.4

Wandsworth Employment Rate

Longer Term Service Users

Long Term Cleints with a Diagnosis of Schizophrenia

Year

% of People in Employment

Sheet1

199094.519.712

199191.118.110.1

19928815.88.3

199386.212.37.7

199487.215.67.4

199588.713.37.7

199689.510.35.5

199792.38.74.9

199894.19.55.7

199995.18.14.4

199096.620.4

199193.819.3

199290.917.7

199389.514.7

199490.312.2

199591.410.4

19969215.1

199794.112.1

199895.812.9

199995.511.8

Sheet1

000

000

000

000

000

000

000

000

000

000

Wandsworth Employment Rate

Longer Term Service Users

Long Term Cleints with a Diagnosis of Schizophrenia

Year

% of Employment

Wandsworth general and MH Employment Rates

Sheet2

Sheet3

Barriers to return to work and job retentionWrong assumptions about work and the management of long term conditions

Negative thinking

Inflexible employment practices

Stigma, discrimination and ignorance about rights

Fear of disclosure of mental ill health

Inability/unwillingness to negotiate adjustments

Unable to self-manage stress and symptoms

Lack of timely help

The low expectations of professionalsExpert professionals say thatpeople with mental health problems are unlikely to be able to workEmployers believe that people with mental health problems cannot work so dont employ themPeople with mental health problems believe that they cannot work and give up trying to get jobsVery few people with mental health problems in employmentA vicious circle that erodes hope and reduces opportunity

Research EvidenceA large proportion of people with serious mental health problems can, with support, gain and retain open employment (Drake et al, 1994, 1996, 1999; Becker et al, 1998; Bond et al, 1995, 1997, 1999, 2001)

Sheltered workshops: Universally poor vocational outcomes (Pozner et al, 1996; Grove, 1999, 2000)

Pre-vocational training: No advantage in enabling people to move into competitive employment over standard care (Drake et al, 1994, 1996; Crowther et al, 2001, 2004)

Supported employment: More effective than pre-vocational training at helping people with severe mental illness to obtain and keep competitive employment (Crowther et al, 2001, 2004)

Evidence Based Supported EmploymentIndividual Placement & SupportThere is strong evidence that:Services should be focused on competitive employment as a primary goalEligibility should be based on the individuals preferencesRapid job search and minimal pre-vocational training

There is moderately strong evidence that:Integrated into the work of the clinical teamAttention to client preferences is importantAvailability of time unlimited support

There is weak evidence from one study that:Benefits counselling should be provided to help people maximise their welfare benefits

(Bond, 2004)

Employment is a realistic goalJob Ready?

Diagnosis and symptoms do not predict success in gaining a job or being able to go to college

Wanting a job and believing that you can work are the best predictors of success

What about my benefits?

Permitted WorkLinking rule for Incapacity BenefitTax CreditsDisability Living Allowance

Implementing research into routine clinical practice

South West London & St Georges Mental Health NHS TrustService Outcomes

Aim:Evaluate the impact of the introduction of IPS within the Community Mental Health Teams (CMHTs) of 3 London Boroughs

IPS was introduced into 8 CMHTs:4 in Kingston,4 in Merton but,not introduced into the 4 Sutton CMHTs

The ServiceJanuary 2002

Comprised three components:

Occupational Therapists (OTs) were designated as Clinical Vocational Leads within the CMHTs and had one dedicated session per week to fulfil this role.

Within each Borough an Employment Specialist linked with employers, Jobcentre Plus, employment agencies, colleges, etc. and provided information, advice and support to the team OTs and care co-ordinators.

Care co-ordinators were expected to provide vocational support, where appropriate, to clients on their caseload with support from the OTs and Employment Specialist

Role of Employment SpecialistCo-ordinates vocational plans with clinical team

Works directly with clients and their care co-ordinators

Direct client interventions:EngagementAssessmentHelped clients to find and keep jobs / education coursesProvided welfare benefits adviceAddressed the support needs and any adjustments

Method

January 2002 - June 2005: CMHTs collected monthly data on all those clients who were receiving a vocational intervention.

Vocational status was collected on first contact with each client and thereafter on a monthly basis.

Impact evaluated in two ways:IPS was introduced at different times in Kingston and Merton - before and after - possible to ascertain whether any changes were likely to be a result of the introduction of IPS or from other factors

Sutton, IPS was not introduced in the period January 2002 to June 2005.

Royal Borough of KingstonTeam OTs supported by 1 Employment Specialist across 4 teams0.5 Employment Specialists per CMHT1 full-time Employment Specialists per CMHT

Chart1

733

953

1094

12144

13154

14195

152020

151720

17197

18198

17188

17187

22176

23168

23167

32169

32208

36248

33249

352511

362815

372914

382714

412616

432216

442316

452314

542411

602221

602326

612923

593523

724122

814631

925532

1025733

1055827

1105728

1156225

1197423

1277024

1286923

Open employment

Mainstyream education/training

Mainstream work experience/voluntary work

Number of people supported

Sheet1

Merton: Number of people supported in employmentMerton: Number of people supported in mainstream education/trainingMerton: Number of people supported in mainstream voluntary work/work experienceMerton: Number of people supported in work/education in mainstream integrated settingsKingston: Number of people supported in employmentKingston: Number of people supported in mainstream education/trainingKingston: Number of people supported in mainstream voluntary work/work experienceKingston: Number of people supported in work/education in mainstream integrated settingsSutton: Number of people supported in employmentSutton: Number of people supported in mainstream education/trainingSutton: Number of people supported in mainstream voluntary work/work experienceSutton: Number of people supported in work/education in mainstream integrated settings

Jan-0273313

Feb-0295317

Mar-02109423

Apr-021214430

May-021315432

Jun-021419538

Jul-0215202055

Aug-0215172052

Sep-021719743

Oct-021819845

Nov-021718843

Dec-021718742

Jan-0333158562217645

Feb-03301510552316847

Mar-03301412562316746

Apr-03291517613216957

May-03291617623220860

Jun-03291819663624868

Jul-03311817663324966

Aug-033014176135251171

Sep-032612175536281579

Oct-032612165437291480

Nov-032511165238271479

Dec-032511165241261683

Jan-042410165043221681

Feb-04269165144231683

Mar-043110175845231482

Apr-043211186154241189

May-0431131761602221103

Jun-0433131763602326109

Jul-043181352612923113

Aug-043481759593523117

Sep-0437112068724122135

Oct-0440122072814631158

Nov-0442152481925532179

Dec-04451422811025733192

Jan-055923181001055827190

Feb-056334221191105728195

Mar-057933241361156225202

Apr-058631231401197423216

May-058834261481277024221

Jun-058934271501286923220

Sheet1

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

Open employment

Mainstyream education/training



Sheet2

Sheet3

London Borough of MertonTeam OTs supported by 1 Employment Specialist across 4 teamsFull time Employment Specialist in 3 of the 4 CMHTs1 full-time Employment Specialists per CMHT

Chart2

716

1312

19113

21413

23514

23614

24813

25813

281011

281011

28911

28811

33158

301510

301412

291517

291617

291819

311817

301417

261217

261216

251116

251116

241016

26916

311017

321118

311317

331317

31813

34817

371120

401220

421524

451422

592318

633422

793324

863123

883426

893427

Open employment

mainstream education/training



Sheet1


Jan-027161473313823

Feb-02131216953171024

Mar-0219113331094231046

Apr-02214133812144301477

May-02235144213154321489

Jun-0223614431419538161110

Jul-02248134515202055191211

Aug-02258134615172052181110

Sep-02281011491719743201513

Oct-02281011491819845181612

Nov-0228911481718843181616

Dec-0228811471718742181616

Jan-0333158562217645181421

Feb-03301510552316847151434

Mar-03301412562316746181639

Apr-03291517613216957161635

May-03291617623220860201433

Jun-03291819663624868221533

Jul-03311817663324966201529

Aug-033014176135251171211530

Sep-032612175536281579231827

Oct-032612165437291480242027

Nov-032511165238271479262227

Dec-032511165241261683262029

Jan-042410165043221681292745

Feb-04269165144231683262138

Mar-043110175845231482272127

Apr-043211186154241189252018

May-0431131761602221103272114

Jun-0433131763602326109272015

Jul-043181352612923113252319

Aug-043481759593523117282418

Sep-0437112068724122135282419

Oct-0440122072814631158282520

Nov-0442152481925532179282620

Dec-04451422811025733192282721

Jan-055923181001055827190272521

Feb-056334221191105728195272523

Mar-057933241361156225202282625

Apr-058631231401197423216313123

May-058834261481277024221313222

Jun-058934271501286923220323020

Sheet2

Sheet3

London Borough of SuttonTeam OTs supported by 0.5 Employment Specialist across 4 teams

Chart2

716

1312

19113

21413

23514

23614

24813

25813

281011

281011

28911

28811

33158

301510

301412

291517

291617

291819

311817

301417

261217

261216

251116

251116

241016

26916

311017

321118

311317

331317

31813

34817

371120

401220

421524

451422

592318

633422

793324

863123

883426

893427

Open employment

mainstream education/training



Chart3

823

1024

1046

1477

1489

161110

191211

181110

201513

181612

181616

181616

181421

151434

181639

161635

201433

221533

201529

211530

231827

242027

262227

262029

292745

262138

272127

252018

272114

272015

252319

282418

282419

282520

282620

282721

272521

272523

282625

313123

313222

323020

Open employment

Mainstream education/training



Sheet1


Jan-027161473313823

Feb-02131216953171024

Mar-0219113331094231046

Apr-02214133812144301477

May-02235144213154321489

Jun-0223614431419538161110

Jul-02248134515202055191211

Aug-02258134615172052181110

Sep-02281011491719743201513

Oct-02281011491819845181612

Nov-0228911481718843181616

Dec-0228811471718742181616

Jan-0333158562217645181421

Feb-03301510552316847151434

Mar-03301412562316746181639

Apr-03291517613216957161635

May-03291617623220860201433

Jun-03291819663624868221533

Jul-03311817663324966201529

Aug-033014176135251171211530

Sep-032612175536281579231827

Oct-032612165437291480242027

Nov-032511165238271479262227

Dec-032511165241261683262029

Jan-042410165043221681292745

Feb-04269165144231683262138

Mar-043110175845231482272127

Apr-043211186154241189252018

May-0431131761602221103272114

Jun-0433131763602326109272015

Jul-043181352612923113252319

Aug-043481759593523117282418

Sep-0437112068724122135282419

Oct-0440122072814631158282520

Nov-0442152481925532179282620

Dec-04451422811025733192282721

Jan-055923181001055827190272521

Feb-056334221191105728195272523

Mar-057933241361156225202282625

Apr-058631231401197423216313123

May-058834261481277024221313222

Jun-058934271501286923220323020

Sheet2

Sheet3

Individual experienceFrom the start, Catherine [Employment Specialist] was a very positive influence. She always had a firm idea through our discussions about what area of industry I was best placed to go for. When I looked through the job description, it shone out as the one. At the beginning of our working relationship I would have been happy to take any job. Catherine helped me to realise that I had the potential to fulfil the level of responsibility that I am working at right now. Our frequent meetings over a long time all amounted to eventual success. I am very happy in my job and we still meet up regularly to discuss relevant issues which I find important at this stage.

Individual OutcomesAim:Evaluate the individual client outcomes at 6 & 12 months

Results:6 month follow-up data was available for 451 clients12 month follow-up data was available for 210 clientsremaining clients (n=241) had either not received a vocational intervention for 12 months or had left the service between 6 & 12 months

Demographic and Clinical characteristics

Vocational Status at 6 and 12 months

Employment Specialist and Care Co-ordinator outcomes Vocational status improvement: Employment Specialist significantly greater than Co-ordinator at 6 months (2 =17.0, d.f. 2, p

Other outcomesGender

At the start women were significantly more likely to be in open employment than men : 24% and 13%At 6 months, difference was maintained : 37% of women were in open employment as compared with 24% of menby 12 months the difference had ceased to be significant

Diagnosis

There was no significant difference between the employment status of those clients with a psychotic diagnosis and those with a non-psychotic diagnosis at the start of the intervention or at 6 months or at 12 months

How does this compare?Cochrane Review: Vocational Rehabilitation for People with Severe Mental Illness.

Drake et al (1996)12 months = 34% paid employmentDrake et al (1999)6 months = 27%12 months = 25%

Most studies show an average of 30% people supported in employment with IPS intervention in comparison with an average of 12% with other interventions

Comparing a traditional vocational service with an evidence based service Individual Placement and Support

Integrating clinical and vocational serviceWhat are the benefits?

Clinically sensitiveAddresses concerns that:Employment serves as a stressorWill interfere with stability of clientMore effective engagement and retentionBetter communicationIncorporation of vocational information into care plansObservation can convert sceptical or disinterested cliniciansBetter outcomes clinicians carry responsibility of coordination, consistency and coherence

Implementation ObstaclesLack of early intervention

Failure to adopt best practice

Lack of focus on work resumption

Lack of integrated service / fragmented provision

Lack of case management

Low priority for clinicians

Interagency co-operation poor

Thank you.

helping people with enduring mental health problems gain and retain employment: from research to...

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