launch of the works welcome · rehabilitation used by ahp’s in mental health and will produce...
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Launch of The WORKS
Welcome
Chairperson – Alison MeiklejohnOccupational Therapy Manager
Royal Edinburgh and Associated Services
& Edinburgh Community Health Partnership,
NHS Lothian AHP Clinical Lead Mental Health
Dr Alison McCallumDirector of Public Health and Health Policy,
NHS Lothian
NHS Lothian & Health
Works
• Scottish Executive (2004) Healthy Working Lives – a plan for action
• Scottish Government (2009) Health Works A Review of the Scottish Government s Healthy Working Lives Strategy
Work is, for most people,
good for long-term health
outcomes• By supporting those with health
problems to work
– improve their health
– reduce the negative impact of unemployment on health
– reduce health inequalities.
To Achieve These Outcomes
• Healthcare professionals
– recognise work as an important clinical outcome.
– advise and support patients in their return to work
• Work collaboratively across health, employability and other agencies.
NHS Lothian – The WORKS
• Work is prioritised as part of mental health services
• Early access through self referral to evidence based service.
• Effective collaborative working
– Employability
– Employers
Work is,
for most people,
good for long-term
health outcomes.
Elaine HunterAllied Health Profession Adviser
in Mental Heath
Scottish Government
Vocational Rehabilitation
AHP Policy Context
Elaine HunterAllied Health Professions Advisor in
Mental Health
The Policy Context
Real Life, Real People, Real
Stories
“Support When you
Need It”
“Keeping Well”
“Self Discovery and
Skills for Living”
“A Meaningful Life”
The Way Forward
What would it mean to service users
if timely access to AHP services
was available?
What would it mean to service users
if there was collaborative
working between primary care
services and AHP’s in mental
health
The Way Forward
What would it mean to service users if
AHP’s delivered evidence basedpsychological interventions to support rehabilitation, self management and recovery approaches
What would it mean to service users if
AHP’s worked from a recognition of the importance of work in promoting recovery?
Integrating Vocational Rehabilitation
in Mental Health
• Aspiration to work – recommendation 9
• Skills for work – recommendation 10
• Vocational Rehabilitation:
“The Scottish Government has commissioned a review of current models of vocational rehabilitation used by AHP’s in mental health and will produce national guidance by spring 2011”.
Linda IrvineStrategic Programme Manager
for Mental Health and Wellbeing
NHS Lothian
A sense of belonging
Lothian’s joint mental health and wellbeing strategy 2011-16
Commitment to Change – 4 areas
• Tacking Health Inequalities
• Embedding Recovery
• Building Social Capital and Wellbeing
• Improving Services
Reducing potential adverse impact on mental health in a recession
• Retaining people in employment
• Ensuring that men and women are earning
• Supporting kinship and informal carers to reduce the risk of family breakdown
• Supporting volunteering, education and skills developments
• Maintaining people in their home (financially and practically)
Tackling Health Inequalities: Focusing on specific people and communities
• This means focusing on individuals and communities more likely to experience mental health problems -so that we make better health for everyone
• Strong link between unemployment and health inequalities. Supporting people with mental health conditions gain/retain employment has positive health outcomes.
• The WORKS team are working with employers so influencing the role of workplaces in promoting mental health and wellbeing
Embedding Recovery: Making sure all services and places have a recovery focus
• “Recovery” has a range of meanings – living well
• Employment and worker roles are often identified as goals in people own recovery journey.
• The WORKS provides individualised services encouraging aspirations to work and providing tailored support to enable people to achieve their goals and manage their mental health condition at work.
• Work can in itself improve people mental health and wellbeing
Building Social Capital and Wellbeing: Building involvement and a sense of belonging within communities and increasing wellbeing
• Important to look at activities that are not within services.
• Building healthy communities , building resilience - make sure that people see the strengths they have themselves to make changes and improve their community.
• Effective working relationships with local employers are pivotal to the WORKS.
• The team offer advice and support to employers and can signpost to information and training.
• Working together with the Healthy Working Lives team -employer training
• All helps to build resilience in wider community.
Improving services for people
• We want to have excellent services for people when and where they need them
• Building on our stakeholder involvement, the WORKS is:– community based – offers early access through self referral system – Provides rapid response to applications, contact within 1
working day of receipt (where someone is supported by secondary care mental health service we seek a health professionals supporting statement, we allow 1 week for receiving this).
– First appointment is then offered within 10 working days of contact.
Outcomes of Previous Service
Goals at the WORKS
Efficient Use of Resources
Average Length of Stay
Capacity over 5year period
Investment and Cost Efficiency
Delivering on a “Sense of belonging”
Knowledge Transfer Partnerships: – support new research– promote dissemination of good practice – build capacity for change and leadership – bridge the knowledge gap between research and practice
by facilitating collaboration and partnership between academia, service users and health and social care
• Committed to developing further - encompassing new teams and services under the three clusters –knowledge, action and research.
• ACTIVATE will now work with colleagues in Midlothian, East Lothian and West Lothian
Rachel PerkinsFreelance Consultant
Mind Champion of the Year 2010
The Works:
Realising Ambitions, Rebuilding Lives
Rachel E. Perkins BA, MPhil (Clinical Psychology), PhD, OBE
19th April 2011
A view from five perspectives
• 30 years working in mental health services
• 20 years working with a long term mental health condition
• 15 years employing people with mental health conditions within mental health services
• 10 years experience of developing evidence based programmes (IPS) to help people with more mental health conditions to gain and retain employment
• Leading a review to government ‘Realising Ambitions. Better employment support for people with a mental health condition’ (2009)
What have I learned?Work is important
Recognition of the importance of work in
people’s lives is not new ...“Work is nature’s best physician and central to human happiness”
Galen, Greek philosopher and physician, 172AD
“the absence of occupation is not rest, a mind quite vacant is a mind distressed”
18th century poet William Cowper, who himself experienced periods of mental illness throughout his
life and was confined to an asylum for over a year
People need two things – love and work . Work “binds the individual to reality”
Freud, 1961
“Work is the closest thing to a panacea known to medical science.”
Szasz, 1974
“The best thing you can do for someone with schizophrenia is to get them a job.”
Drake, 2006
“Work is just about the only thing you can do for 8 hours a day”
20th century US novelist William Faulkner
We know the devastating impact of unemployment
on the lives of people with mental health problems
“Out of the blue your job has gone, with it any financial security you may have had. At a stroke, you have no purpose in life, and no contact with other people. You find yourself totally isolated from the rest of
the world. No one telephones you. Much less writes. No-one
seems to care if you’re alive or dead .” (Bird, 2001)
“For some of us, an episode of mental distress will disrupt our lives so we are pushed out of the society in which we were fully participating.
For others, the early onset of distress will mean social exclusion throughout our adult lives, with no prospect of ...a job or hope of a
futures in meaningful employment. Loneliness and loss of self-worth lead us to believe we are useless, and so we live with this sense of
hopelessness, or far too often choose to end our lives.” (cited by SEU,2003)
We know that employment is important to mental
health and to the recovery of people with a mental
health condition
• It is good for our health: employment reduces mental health
problems and decreases the likelihood of relapse
• It links us to the communities in which we live and enables us to
contribute to those communities: the opportunity to contribute is
central to recovery
• It provides meaning and purpose in life
• It affords status and identity
• It provides social contacts
• It gives us the resources we need to do the other things we value in
life
The right to work – a human rightArticle 23 of the United Nations Declaration of Human Rights (1948)
“Everyone has the right to work, to free choice of employment, to just and favourable
conditions of work and to protection against unemployment.”
Article 27 of the United Nations Convention on the Rights of Disabled Persons
Article 6 and 7 of the International Covenant of Economic, Social and Cultural Rights
… but a right deniedMost people with a mental health condition want to have a job – in the UK people with
mental health problems have the highest ‘want to work’ rate of all disabled people
(SEU 2003)
BUT few have the opportunity to do soIn the UK
• Overall employment rate stands at around 74%,
• The employment rate for disabled people in general is 47%,
• The employment rate for people with a mental health condition is 21%.
• The employment rate for people using secondary mental health services 13.5%
(Work, Recovery and Inclusion 2009)
But it does not have to be this way ...
we know that, with the right kind of support many,
many people with mental health problems can
gain employment and prosper in their careers
The 7 key principles of evidence based supported
employment• Competitive employment – real jobs – and a ‘can do’ approach
• Eligibility based on client choice – help anyone who wants to give it a try
• Integration of employment support into support and treatment plans from the start
– employment specialists in support and treatment teams and employment
integrated into the work of all mental health workers
• Rapid job search – ‘place-train’ rather than ‘train-place’
• On-going supports for both employee and employer
• Job search based on client preferences
• Benefits counselling
We know it works ...
Competitive employment rates in 16
randomised controlled trials
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
2007 Aust
1996 NH
1994 NY
2007 IL
2004 CT
2005 HK
2006 SC
2006 MA
1999 DC
2007 CA
1995 IN
2007 EUR
2006 QUE
2000 NY
1997 CA
2002 MD
Supported employment Control
European research compared traditional vocational service (non-integrated ‘train-place’)
with IPS for people with schizophrenia (Burns et al, 2007):
– 55% gained employment in IPS vs. 28% in traditional service
– 13% drop-out in IPS vs. 45% in traditional service
– 20% readmitted in IPS vs. 31% in traditional service
Follow-up studies show that work outcomes improve over time
it’s not just research trials – it also works in regular day to day practice Employment Specialists in South West London Community Mental Health Teams
(2007/8):
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
In a service for people with 1st episode psychosis – 73% were in employment or education after
2 years
And in lots of other places .... Central and North West London, Mid Surrey, Essex, Shropshire,
Somerset, Cardiff ...
and here, for the first time in Scotland, at The Works
Not just ‘them out there’ ... employing people with
mental health problems in mental health services
Why employ people with mental health problems in
mental health services?• Provides much needed employment
• Expertise of ‘lived experience’ is important in promoting
recovery: people who have successfully lived with mental health
conditions have expertise that is valuable in helping others who face
similar challenges
• Offers images of possibility: challenges myths and stereotypes
and counteracts despair and pessimism in both staff and service
users, demonstrates that employment is a real possibility
• Breaks down destructive ‘them’ and ‘us’ divide within services
that devalues those who use them
South West London User Employment Programme
• A supported employment programme: 1995 – 2010 people
supported in 257 jobs in the Trust (44% diagnosis of psychosis)
... but not everyone needs special support ...
• A charter for the employment of people who have
experienced mental health problems designed to:
• decrease employment discrimination against people with mental health problems throughout the organisation
• recognise the important contribution that people with mental health problems can make to the work of the organisation
– Personal experience of mental health problems ‘desirable’ on person specifications
for all posts
– Advertisements encourage people with mental health problems to apply
– Confidential equal opportunities monitoring includes mental health problems
Beware - if you go to work in South West London you don’t know whether your
colleague (or your boss) is one of ‘them’ or one of ‘us’!
Every year since 1999 at least 15% of recruits have personal experience of mental health problems
Ten years after the charter was adopted 23% of recruits had mental health problems
And the higher up you go the more of them you find ...
21%
24%
31%
23%
0%
5%
10%
15%
20%
25%
30%
35%
Recruits to bands 1-4
Recruits to bands 5-7
Recruits to bands 8-9
All recruits
Lowest
grades –
support staff
Qualified
mental health
professionals
Team/service
managers
Heads of
profession
Senior managers
What you are doing here is very, very important ...
it will transform lives
“I have re-entered full-time employment. Over a year later I am still working. I now focus more on opportunities in life and less on my condition. I regularly socialise with my colleagues after work and
actually feel content to be a taxpayer again … The support has been immeasurably important …[it] has enabled me to make the journey
towards recovery and realise my aim of contributing to society again through fulfilling employment.”
“My passion for my career is immense. A job defines you, provides money, personal fulfilment and a sense of achievement. This is what
I am, this is what I do, I am no longer a mental health condition.”
“Now I’m a contributing member of society because of my employment. It’s worth is altering the life of someone with a mental illness …
helping me to change direction from hopelessness to being worthwhile.”
If you we are to be successful we must, above all else,
raise our expectations ...One of the biggest barriers to employment, and the development of
evidence based supported employment, is low expectations
From ‘yes, but ...’ to ‘yes, how ...’
Times are tough ... a ‘can do’ approach even more important
• If those of us with mental health conditions are to gain employment and pursue our
careers we must believe in our own abilities and possibilities
• If those of us providing mental health and employment services are to help people
to help people realise their ambitions we must believe the abilities and possibilities
of those whom we serve
In the words of Michelangelo
“The greater danger for most of us lies not in setting our aim too
high and falling short, but in setting our aim too low and
achieving our mark.”
To conclude with some words from the experts ...
People who have rebuilt their lives with mental
health problems
“Stay positive – have hopes and dreams and
aspirations and move towards them. Anything is
possible ... there are real opportunities out
there.”
“Never lose sight of the light at the end of the
tunnel, if it’s not there, look for it because it may
not find you.”
Robin BurleyNon executive board member
NHS Lothian
Susan PriorResearch Practitioner
ActiVate Collaboration
Collaboration
9th March 2011
Aims of ActiVate
• To redesign NHS Lothian mental health
vocational rehabilitation services
– Vital role for service users in planning change
– Partnership working with service providers in
Edinburgh.
Consultation Groups
Action Group
Action Group developed recommedation
Value Based
• Recovery focused services
• Individualised services
• Evidence based services
• Integrated services
• Efficient services
Decision Group
Thank You
Linda Irvine
Alison Meiklejohn
Prof Kirsty Forsyth
Dr Mike Walsh
Consultation Group
Action Group
Decision Group
Old & New Partners
The WORKS team
Lynn RitchieLead Occupational Therapist
The WORKS
The WORKS
• Thoughts from early stages
• An illustrative journey
• Some words from our stakeholders
The WORKS beginnings
• Developing skills
– Online training
– Train the trainer
– Applying what we learnt
• Marketing The WORKS
• Job development
• Developing operational systems
What we’ve found
• Service users in Edinburgh are similar
to those in other areas…
… they want to work
What we’ve found
• Mental health professionals in
Edinburgh
are keen to support service users
achieve their work goals
Supporting referees
What we’ve found
• Employers in Edinburgh are willing to
employ people with mental health
conditions
Outcomes
A typical journey
• Long standing
depression
• Lost job through ill-health
• Discussed work with
CPN
• Applied to the WORKS
Jennifer
Initial Assessment
• Strong work ethic & very motivated to return
to employment
• Experience & confidence in food preparation
• Chaotic routine since loss of work role and
routine it provided
• Financial concerns
• Relationships deteriorating since loss of
work
The WORKS
• Rapid Job Search
• Financial Advice
• Job development
• WRAP for Work
• Ongoing support
• Engagement with employer
• Close working with mental health team
The WORKS Partners
• Our clients
• Employability Providers
• Community Help and Advice Initiative
• Local Employers
The WORKS Partners
• Our clients
• Employability Providers
• Community Help and Advice Initiative
• Local Employers
• Support@work
• Mental Health Teams