CPFT
Mental Health
Employment
Strategy
Compiled by:
Jane Joel
Trust AHP Lead &
Recovery and Social
Inclusion Project Manager
Q. Why would I / we want to employ someone with a mental
health problem, I have enough problems already with my
existing workforce?!
A. You already employ people with a mental health problem
… and they may not be „the problem‟…
For all employers, existing workforce
implications:
• 1 in 6 people experience common mental health
problems such as anxiety or depression at any one
time (Singleton et al 2001)
•Poor health is a cost to employers through
both absenteeism and lowered job performance
and critically affects staff and their families.
•Harvard business school estimated cost of
presenteeism to be between 2 to 3 times more
than direct costs incurred as a result of illness
• Sickness absence can cost roughly £495 per
employee per year
• Estimated that £100 billion is spent each year on ill
health absenteeism.
• EoE cost £10 billion every year.
• 172 million days lost each year
• Time lost to business approximately 13.8 million
working days were lost in 2006/7 due to workrelated stress, depression and anxiety.
• If you start to suffer from stress you are more likely
to report depression and other psychosomatic
complaints, resulting in greater need for recovery
due to exhaustion and fatigue compared to workers
without high levels of work-related stress.
• For those who have been out of work unwell for
over six months all the evidence shows it is likely to
be a long time before they return to work with an 80
per cent chance of being off for five years.
•For those off work and claiming incapacity
benefit for two years or more, they are more
likely to retire or die than ever return to work.
•Poor mental health is one of the most commonly
cited reasons for claiming incapacity benefit.
• At the end of 2008 in the east of England over
175,000 people were claiming incapacity benefit as
ill health was keeping them from work.
• The government has pledged to get a million
people off IB by 2015
CPFT Implications; Us as an NHS employer and influencer:
• EoE 175,000 claiming IB
• 38% = 66,500 with mental health problems
• 2500 employees
• 1:6 equates to 417 people experiencing mental
health problems at any one time
• @£495 per person = £206,252
• This does not take account of presenteeism costs
or associated psychosomatic complaints.
DWP research
• More than 90% of people with health problems can be
helped to return to work by following principles of good
health care and work place management
• Simple measures could reduce long term sickness absence
and long term incapacity benefit recipients by up to 60%.
•Two key strands:
-Healthcare which includes a focus on work – this
means early intervention which is tailored to meet the
individual needs
-Workplaces that are accommodating – incorporating a
proactive approach to supporting return to work and
the temporary provision of modified work.
DWP research
• Social Policy Research Unit shown:
- with the right support people with mental health problems
can get back to work and for many having a job may
actually help with their recovery.
- Many employers and employees are very supportive of
mental health conditions.
- Employers keen to learn more about mental health issues
and plan better for their return to work.
As a Health service provider:
•For the Long-term unemployed or those who have never
worked they are between 2 & 3 times more likely to have
poor health than those in work.
• The unemployed are far more likely to smoke.
• and have been shown to drink more and have a higher
likelihood of alcoholism and drug taking.
• Unemployment also decreases your physical activity and
results in a higher level of obesity and weight gain.
Underpinning Research for mental health and employment:
•70-90% people want to return to work (Grove, 1999;
Rinaldi & Hill, 2000; Secker & Seebohm, 2001)
• 50% said they had not received any help (Healthcare
Commission, 2007)
•People with mental health problems are less likely to be
employed than any other group of disabled people
•Average employment rate 74% (ONS 2006)
• 47% for all disabled groups
• 21% for people with long-term mental illness
• Rates for severe mental illness much lower between 4 and
8% (Rinaldi & Perkins 2002)
Unemployment leads to a range of social problems:
•People with mental health problems are nearly three
times more likely to be in debt
•One in four tenants with mental health problems has
serious rent arrears and is at risk of losing their home
• Two thirds of men under the age of 35 with mental
health problems who die by suicide are unemployed.
(SEU 2004)
• Mental Health and Social Exclusion Report identifies
employment and maintaining social contacts improves
mental health outcomes, prevents suicide and reduces
reliance on health services.
Predictors of success
Assumptions
– gulf between existing workforce and people with mental
health problems;
- Already have a hard time recruiting and maintaining
workforce, people with mental health problems will only make
this worse
Work is too stressful - As compared to what?
If you think work is stressful, try unemployment (Marrone &
Golowka, 1999)
Not ready / too ill - Diagnosis and symptoms do not predict
success. Having previously had a job but wanting a job and
believing that you can work are the best predictors of
success (Grove B et al 2009)
Predictors of success?
•Client characteristics little impact on vocational outcomes
(Bond et al, 1995, 1997, 2001; Grove, 2000; Meuser et 2004, Catty et al, 2007)
•No relationship between psychiatric symptomatology /
disability outcomes of vocational rehabilitation (Anthony, 1984, 1995)
• Most studies show no relationship between employment
outcomes and diagnosis, severity of impairment and social
skills (Drake et al, 1994, 1996, 1999; Bond et al, 1995,1997, 1999, 2001;Meuser et al,
2004; Latimer et al, 2006; Burns et al, 2007)
• There is a relationship between hospitalisation history and
work outcomes, the direction of causality is not clear
• Employment history is a robust predictor of work outcomes,
but motivation and self-efficacy appear to be more important
(Tsang et al, 2000; McDonald-Wilson et al, 2001)
Predictors of success?
•A 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, Meuser et al, 2004; Latimer et al, 2006; Burns et al 2007)
• Around £140 million a year is invested by health and social
care in vocational and day services but not all of these
promote social inclusion effectively and links to employment
services such as job centre plus can be poor.
Predictors of success?
•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)
• IPS: when compared to other vocational interventions IPS is
more effective in enabling people get real jobs with real
wages, even for service users who experience multiple
problems in addition to their mental health problems.
• So is it about employability
Or
• About service delivery culture?
Barriers to employment
• Financial disincentives
• Stigma and discrimination
• Negative thinking, Low expectation and a lack of
resources
• Inflexible employment practices
• Inability/unwillingness to negotiate adjustments
• Lack of timely help
The vicious circle of despondency (Rinaldi & Perkins 2005)
Expert professionals say that people
with mental health problems are unlikely
to be able to work
Employers believe that people
with mental health problems
cannot work – so don‟t employ
them
People with mental health
problems believe that they
cannot work and give up trying
to get jobs
Very few people with mental health
problems in employment.
What works – Vocational Services for people with severe mental health
problems: commissioning guidance DH 2006
•Implement evidence based practice with vocational services,
in particular, the Individual Placement and Support (IPS)
approach.
• Work towards access to an employment advisor for
everyone with severe mental health problems
• Aim for the provision of vocational and social support to be
embedded in the Care Programme Approach and
integrated into pathway teams
• Base provision around needs of the individual
Vocational and Social Support embedded in CPA process
•Establishing employment status on admission to hospital
•Supporting job retention
• Promoting involvement of carers and family
• Development of vocational and employment specialists
embedded in secondary teams
• Strengthening links to key local partners, in particular
Jobcentre Plus and education providers
• Promoting access to advice and support on benefit issues
• Monitoring vocational outcomes for people on CPA
• Monitoring employment rates of people with mental health
problems within own organisation
Evidence Based Supported Employment
‘Individual Placement & Support’ (IPS)
• Focus on competitive employment as a primary goal
• Eligibility should be based on the individual‟s choice
• Rapid job search and minimal pre-vocational training
• Integrated into the work of the clinical team
• Attention to client preferences is important
• Availability of time unlimited support
• Benefits counselling should be provided to help people
maximise their welfare benefits (Bond et al, 2008)
RECOVERY:&EMPLOYMENT
RECOVERY
SOCIAL INCLUSION:
WORKSTREAM
EMPLOYMENT WORKSTREAM
Overall Objective:
To develop processes and an organisational culture that
maximises opportunities for people with mental health issues to
be successful in employment
Overall Aims:
For people with mental ill health:
1.Increase employment opportunities within the Trust
Trust
2.Increase
employment opportunities across our
2.Increase employment opportunities across our
community.
community.
Integration:
Evidence highlights that this initiative will
be best served by clear alignment between
CPFT‟s role as an employer, a service
provider and as an influencer.
Service Provider Objective: Develop CPFT services to
maximise employment and training opportunities for service
users with mental health issues:
SERVICE
PROVIDER
INFLUENCER
Influencer Objective: Promote good mental health
employment practice across the wider employment
community.
1.Establish partnership working arrangements with
Regional Development Centre, NHS Employers‟
Organisation and other key agencies in order to
understand and influence national and local agendas.
2.Establish Best Practice Mental Health Resource
Pack including stories of success, key research and
information.
3.Work with NHS, charities, public sector and private
employers networks and the media to share and
inform best practice, and promote success.
4. Develop a recognition scheme or kite mark for local
employers who commit to mental health employment
standards.
Refs: DH 2002, SCMH 2006 & 2007, Irvine 2008,
Waddell et al 2008, Grove et al 2005
1.Establish a clear dashboard including (i) employment
status of service users and (ii) care plans with specialist
vocational interventions.
2.Work with partners to implement a “vocational service”
and an Individual Placement Support Service (IPS) across
CPFT pathways.
3.Ensure all inpatient units have service user Internet
access.
EMPLOYER
4.Establish explicit roles in CPFT pathways where direct
experience of mental ill health provides improved quality of
care for service users
users.e.g.Peer Support Worker roles.
5.Share our employment action plan and outcomes with our
partners in care.
Refs: Mindful Employer, Grove et al 2008, SCMH & COT
2008, SCMH 2006 & 2009, DH 2006, DH 2002, Irvine 2008,
Rinaldi & Perkins 2007
Employer Objective: Establish CPFT‟s processes and culture works to ensure that new
recruits and existing employees with mental health issues are successful employees.
1.Make a visible commitment to employing and retaining those with mental ill health e.g. Mindful
Employer, NHS „Exemplar Employer‟ standards.
2.Establish a User Employment Programme for new and existing staff.
3.Establish a simple MH dashboard including (i) Absence attributable to mental ill health (ii)
Staff who return from long term mental ill health (iii) ill health retirements from mental ill health
(iv) Staff accessing the User Employment Programme (iv) Staff Survey data.
4.Research and actively promote the outcomes of the initiative including stories of success and
“what works”.
Refs: DH 2002, Mindful Employer, SCMH 2006, 2007, Grove et al 2005, Waddell et al 2008