Vocational services for people with severe mental health problems: Commissioning Guidance

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Vocational services for people with severe
mental health problems Commissioning Guidance

• Wednesday 7th June 2006

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(No Transcript)
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Some facts about exclusion

• Only 24 per cent of adults with long-term mental
  health problems are in work the lowest
  employment rate for any of the main groups of
  disabled people. They have more than double the
  risk of losing their job than others.
• Two-thirds of men under the age of 35 with mental
  health problems who die by suicide are
  unemployed.
• Employment tends to lead to improvements in
  peoples mental health inactivity is associated
  with worsening mental health.
• Barriers to employment include low confidence,
  low expectations among staff, employer attitudes,
  and difficulties moving from benefits to work.
  There can also be a lack of support to help
  people retain jobs.
• Action on Mental Health, A guide to promoting
  Social Inclusion, ODPM 2004

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MH Services
Employment
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Sport exercise
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Education
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Family neighbourhood
Volunteering
Faith communities
Arts and Culture
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• Paid work gives people a real sense of their
  own value, improves self esteem and gets them out
  of their illness.
• Mental Health and Social Exclusion Social
  Exclusion Unit Report , ODPM,2004

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Commissioning Guidance

• It will assist in the implementation of
• the National Service Framework for Mental Health
• the Mental Health Social Exclusion Report
• Framework for Vocational Rehabilitation
• the Choosing Health White Paper
• the Joint Strategy on Work, Health Wellbeing.

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And enable Commissioners to

• implement evidence based vocational services,
  particularly the Individual Placement and Support
  (IPS) approach.
• Work towards access to an employment advisor for
  all people with severe mental health problems.
• Aim for the provision of vocational and social
  support to be embedded in the CPA with the full
  involvement of the service user and
• Base the provision around the needs of the
  individual regardless of whether it is received
  in primary or secondary care.

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Vocational Services will include

• Establishing employment status at assessment
  stage.
• Supporting job retention.
• Promoting involvement of carers and families.
• Identifying a lead contact on vocational and
  social issues in secondary care teams.
• Strengthening links to key local partners,
  particularly with Jobcentre Plus and educational
  providers.
• Promoting access to advice and support on
  benefits issues.
• Monitoring vocational outcomes for people on CPA
  and
• Monitoring the employment rates of people with
  mental health problems within their own
  organisations.

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Definition of work and employment

• Work is an activity that involves the exercise of
  skills and judgement taking place within a set
  of limits prescribed by another.
• It is essentially something you do for others.
• Employment is something you get paid for.
• Volunteering is unpaid work.

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5 key elements to support this are

• Clinical leads within secondary services.
• Employment specialists integrated into clinical
  teams
• Public services as Exemplar Employers.
• Supported work opportunities and
• Multi Agency Forums

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7 Characteristics in determining success

• Services should be based upon paid employment
  with a primary goal of paid employment within
  integrated settings.
• Eligibility should be based on the individuals
  preferences.
• It should involve rapid job searches with minimum
  pre-vocational training.
• Vocational programmes should be an integral part
  of the clinical teams work.
• Attention should be paid to the clients
  preferences and based upon their choices.
• Time unlimited support should be available which
  should be tailored to meet individual need.
• Benefits counselling should be made available to
  maximise work welfare benefits.

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Services focused on the primary goal of paid
employment.

• Targeting attention and resources on work as a
  goal from the moment the individual enters the
  programme
• Stating the benefits of work and encouraging
  success
• Avoiding spending time and resources on work
  readiness experiences or extended lengthy periods
  of assessment
• Assuring that assessments occur rapidly and build
  on the desire and motivation of the individual to
  seek work

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Eligibility based on individuals preferences

• Creating an atmosphere where anyone who chooses
  to work can work zero exclusion
• Promoting employment consistently and regularly
  as a positive, achievable outcome
• Encouraging individuals to talk about their fears
  and concerns about work and providing the
  assistance needed to address these concerns
• Building confidence by giving attention to each
  individuals strengths and motivation

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Rapid job search and minimal pre-vocational
training

• Rapid job search means that contact will be made
  with employers normally within the first month
• Providing direct assistance in job finding
  through job leads and active job development
• Emphasising on-the-job training with support
• The job search process will vary in strategy and
  timing from person to person

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Integrated into clinical teams

• Employment Specialists are in close and frequent
  contact with the mental health care co-ordinators
  structural relationship
• CPA plans and employment plans are coordinated
  and mutually supportive
• Mental health team meetings include the
  Employment Specialist and consideration of
  employment plans and issues
• For integration of employment and mental health
  services to be effective, there must be genuine
  collaboration and mutual problem solving
• Lower vocational dropout rates care
  co-ordinators are involved in keeping the
  individual engaged

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Attention to client preferences and choice

• Process emphasises use of a individuals
  preferences, strengths, and prior work
  experiences
• Working closely with individuals personal
  interests
• Seeking jobs and workplace environments that
  match individual preferences
• Helping individuals make informed choices about
  disclosing the presence of a disability to
  employers
• Working closely with the individual and employer
  on identifying and negotiating needed workplace
  adjustments

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Availability of time unlimited support and
tailored to the persons individual needs

• Assisting individuals in discovering their true
  job interests by working in paid employment
• Maintaining direct supports to individuals and
  employers after obtaining work
• Assisting people with moving into new jobs as
  long-term job interests are clarified

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Benefits counselling provided to help people
maximise their welfare benefits

• Assuring that individuals have access to benefits
  advisers and understand the interaction between
  work earnings and disability-related benefits
• Addressing fully the many concerns individuals
  have about the potential loss of benefits after
  employment, fears that are frequently based on
  rumours and misconceptions
• Assuring that job plans (hours of employment, pay
  and benefits) are coordinated with benefit plans
  developed with benefits advisers

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• Companies that do not embrace diversity,
  including disability, as a core business issue,
  are simply missing the point.
• Sir Peter Bonfield, Chief Executive, BT plc.
• To support our staff when mental health goes
  wrong means that we support them in the whole of
  their lives, which in turn means we get the best
  out of them at work
• Annie Ralph, Chief Executive, Braintree Borough
  Council.

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Group Exercise 1 (15 mins)

• Stigma is a barrier for people when they look
  towards employment.
• JobCentre Plus play a key role in enabling people
  to return to work.
• What is the commissioners role in ensuring the
  spread of options across all services including
  mainstream employment.
• Options are available to train and access
  education.
• Vocational services are provided in primary care.

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Group Exercise 2 (20 mins)

• In your locality groups please discuss the
  following questions and agree a spokesperson to
  feedback.
• What is currently happening in your locality
  with regard to vocational issues?
• What examples of good practice are happening in
  your locality?
• What support could CSIP offer?
• What would you like to see from a network of
  this kind, do you want a network (frequency,
  venue, content)

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Contact details

• Please feel free to contact me regarding support
  or to share positive achievements.
• Jennette.fields_at_nemhpt.nhs.uk
• 0774 9829210