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					 Employment and People with
Serious Mental Health Problems
              Rachel Perkins
 South West London and St George’s Mental
              Health NHS Trust
   Most people with serious mental
             health problems
• are currently unemployed
• want to work
• can work if they are provided with
  the right kind of support
... and clinical treatment is not enough
            What is the right kind of support?
                 ‘Individual Placement with Support’ (IPS)
                  evidence based supported employment
• Competitive employment – real jobs
     sheltered work, work training in segregated settings do not work
• Rapid job search – ‘place-train’ rather than ‘train-place’
• Integration of employment support and clinical treatment
    employment specialists in clinical teams
• Eligibility based on client choice
    if a person wants a job help them to get one – don’t select on the basis of ‘’diagnosis’,
    ‘severity’, ‘employability’ ‘work readiness’ .,..
• On-going supports
    fluctuating conditions require ongoing support – often episodic
• Job matching based on client preferences
• Benefits counselling
(Becker IPS Fidelity Scale, 2008) (Bond, 2004)
Competitive employment rates in 16 randomised controlled
trials of supported employment ... all getting the same
treatment but different kinds of employment support
• European randomised controlled trial compared traditional vocational
  service (non-integrated ‘train-place’) with IPS for people with
  schizophrenia ... all being treated by the same clinical teams (Burns
  et al, 2007):
    – 55% gained employment in IPS vs. 28% in traditional ‘train-place’ service
    – 13% drop-out in IPS vs. 45% in traditional service
    – 20% readmitted in IPS vs. 31% in traditional service

• Four studies with 10-year follow-ups show that work outcomes
  improve over time (Test, 1989; Salyers 2004; Becker, 2006; Bush,

• Employment associated with improved self-esteem, symptom
  control, quality of life ... no changes with sustained sheltered
  employment (Bond, 2001)
And it’s not just research trials – it also
works in regular day to day practice ...
Employment Specialists in 11 out of 18 South West London
  Community Mental Health Teams (2007/8) – in just one
• 1984 people received vocational support
• 1155 people successful in working/studying in mainstream
  integrated settings:
   – 645 people supported to get/keep open employment
   – 293 people supported to get/keep mainstream education/training
   – 217 people supported in mainstream voluntary work

   And they are not just stacking shelves
Wholesale        Catering             IT Helpdesk       Civil Servant       Hairdresser
  manager          assistant          Admin Assistant     (administrator)     assistant
Accountant       Chambermaid          Civil servant -   Production          Indian
IT Assistant     Cleaner                executive         assistant           Restaurant
Mental health    Hotel Porter            officer        Assistant special     waiter
  development    Labourer             Baker               needs teacher     Leisure
  worker         Leaflet dropper      Carpenter         Administrative        assistant
Ward assistant   Plumber’s            Caretaker            Assistant x5     Driver
Bookmaker –         assistant         Hairdresser       Regeneration        Bar work
   retail        Post assistant       Sales Assistant     project worker    Barista
Call centre      Recycling            x8                Glazier             Sales Advisor
  handler           assistant         IT Support desk   Plumber             Boatyard worker
Retail           English Teacher      Administrator     Catering            Café Assistant
    assistant    Actor                                     manager          Catering
Receptionist     Journalist                             IT trainer            assistant
Baker            Admin worker                           Nurse               Teaching
                                      Street cleaner
Hairdresser      Credit controller    Warehouse         Health records        assistant
MH advocate      Project worker         worker             officer          Social worker
Occupational                                                                Youth Worker
                   (private sector)   Market research
  Therapy                                                                   Financial
   Assistant                                                                  controller
                                      Care assistant
Many people with serious mental
       health problems are in
 employment/education when they
         are first diagnosed
  ... so helping people to retain
employment/education is important
    (maybe in a different job)
               The typical picture ...
In comparison with people with other health conditions, people
   with mental health problems are twice as likely to lose their
   jobs following the onset of problems (Burchardt, 2003)

Rapidly decreasing employment rates following onset of
  serious mental health problems.
   – one study found that 52% of people were in employment at first
     hospital admission but only 25% at 2 month follow-up …
   – another found only 13% in employment 12 months after first
   – people with a diagnosis of schizophrenia using services for at
     least 2 years – 4% in employment

       But it doesn’t have to be this way
       Early Intervention for First Episode Schizophrenia (mean age = 21 years)
                      including ‘Individual Placement with Support’
       After the two years 73% in employment or mainstream education/training
                                                   Open employment
                               50%                                                    48%
                               10%          13%

                                        Start     6 months 12 months 18 months 24 months

           Mainstream education/training                                  Unemployed and unoccupied
60%                                                            60%
50%                                                            50%
40%                                                            40%
30%                                                            30%
             25%                                       25%                 27%
20%                                                            20%
10%                                                            10%
 0%                                                             0%
-10%     Start     6 months 12 months 18 months 24 months     -10%     Start     6 months 12 months 18 months 24 months
  Raising expectations ... of health
   workers and people with mental
           health problems
If you provide employment support
 fewer people ‘write themselves off’
 as unable to work because of their
       mental health problems


30%                                25%

      National service user London Borough with Early Intervention
             survey            employmnent        team for people with
                             specialists in every     first episode
                             community mental        schizophrenia
                                health team
• Provide specific employment support as well as treatment
• Integrate employment support and health treatment
• Intervene very early – provide employment support from
  the start
• Help people to maintain employment/education they
  already have before they become ill (including helping
  them to find a new job if necessary)
• Focus on real work – open employment
• Don’t select people on the basis of their diagnosis
• Provide ongoing support and accommodate fluctuating
  conditions ... perhaps Access to Work could be used to
  pay for this?

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