Individual Placement and Support
(IPS)
for people on ESA
with a mental health condition
Nicola Oliver
Centre for Mental Health
Nic Taylor-Barbieri
South Essex Partnership University NHS Foundation Trust
Number of people on ESA with
mental health needs
• In February 2013 there were
1,591,040 ESA claimants
• 46% of these were claiming
on the basis of mental or
behavioural disorders.
Mental and Behavioural Disorders
Musculoskeletal
(Department for Work and Pensions (2013) Statistics)
Respiratory
Other
ESA breakdown
Support group and WRAG group
• Proportions of people at each stage of ESA are
broadly similar across the impairment groups.
(Department for Work and Pensions (2013) Statistics)
100%
90%
80%
70%
60%
50%
Support group
40%
Work Related Activity
30%
Assessment/unknown
20%
10%
0%
Mental and
Behavioural
Disorders
Musculoskeletal
Other
Unemployment and mental health are
linked
• Unemployment can cause
poor mental health; people
who have been unemployed
for six months or more are likely
to develop depression.
• And poor mental health is often at least a part of
the reason for unemployment.
•
(Diette et al Causality in the relationship between mental health and unemployment, 2012)
(Rinaldi, et al Increasing the employment rate for people with longer-term mental health problems,
2011)
Unemployed people with a mental
health condition need help
• Of the 700,000 people on
ESA with a mental health
condition, there are
probably today 300,000
needing appropriate help
to get back to work.
Work Choice outcomes for people
with mental health problems
• From June 2012 – June 2013
Work Choice the DWP scheme for
people with disabilities and
health conditions has supported
10,170 people into work.
• 15% of these job outcomes were
for people with mild to moderate
mental health conditions
• just 1% (100 jobs) were for those
with more severe mental health
problems.
(DWP, Work Choice: Official statistics Aug 2013)
Work Choice job outcomes
Severe Mental Illness
Mild to Moderate Mental Health condition
Other health condition
Mental health stigma and
discrimination in the workplace
• The stigma attached to
mental health is still a
problem.
• Time to Change, the antistigma campaign is seeing a
very slow improvement in
knowledge and behaviour
among the general public
towards people with mental
health needs.
(Smith, Anti-stigma campaigns: time to change, 2013.)
Because of the stigma
associated with the Black Dog
of depression, I tried to keep
him hidden at work
© SANE - Mental health charity - Meeting the challenge of mental illness
Overcoming barriers to employment
caused by mental health problems
• People need:
• Not to be written off as unemployable
• A personalised approach (small caseloads)
• Someone to convince employers
• A bridge-builder between support with
health and employment needs
• Access to advice on benefits
• Time-unlimited support
Could Individual Placement
and Support be a more
effective method?
Individual Placement and Support (IPS)
8 evidence-based principles:
1. Eligibility is based on individual choice;
2. Supported employment is integrated with treatment;
3. Competitive employment is the goal;
4. Rapid job search (within 4 weeks);
5. Job finding, and all assistance, is individualised;
6. Employers are approached with the needs of individuals in mind
7. Follow-along supports are continuous;
8. Financial planning is provided.
Individual Placement and Support
(IPS) evidenced effectiveness
• IPS has an established evidence-base of more than
20 clinical trials
• A six-centre European trial (EQOLISE) found:
o IPS participants were twice as likely to gain employment
(55% v. 28%) compared with traditional vocational
rehabilitation alternatives;
o IPS participants sustained jobs longer and earned more
than those who were supported by the best local
vocational rehabilitation alternatives;
o Better results were obtained by implementing all IPS
principles in full;
Recommendations for working
with people claiming ESA
• Train the employment workers in NHS Mental
Health Trusts to use IPS
• Promote IPS practice to all DWP funded
employment workers who support people
with mental health problems
• Place IPS workers with primary care
psychological therapy services (IAPT)
• Enable Job Centre workers (DEAs, ESA
advisers) to refer customers to IAPT services
• Attach IPS workers to GP practices
• Replace general Work Choice schemes for
people with mental health needs with
specifically ‘IPS method’ services
Thank you
For more information contact
Centre for Mental Health:
www.centreformentalhealth.org.uk
0207 827 8300
@CentreforMH