Mental Health & Employment

6 Common Myths That Prevent

Effective Delivery

Kevin Moore, Future Path

Bob Kitchin, Twining Enterprise

www.future-path.co.uk/mythbusters

Terminology Used• “Common mental health problems”: Mild to

moderate anxiety &/or depression, phobias etc.

• “Severe & enduring mental health problems”: Severe anxiety/depression, personality disorders, psychotic disorders

• IAPT – Improving Access to Psychological Therapies; national network of local primary care services that provide talking therapies to people with common mental health problems

London-based local authority-funded provider

Use unique PACES© Model

At the heart of multi-agency approaches across 8 London

boroughs

Specialise in supporting people with common, often undiagnosed

mental health issues

Charity specialising in mental health & employment

IPS Centre of Excellence

Working in 14 London boroughs, embedded within

mental health teams

Services covering common and severe & enduring mental

health disorders

Common Ground• Similar values, ethics and ethos.

• IPS is a strong feature, but doesn’t define us.

• Strong willingness to work together.

• Co-located teams an essential feature.

• Both seen by funders as high performing, flexible, reliable partners.

• We’re on a mission…..

Myth OneThe Identification Myth

“we know who has mental health problems”

The 3 “Tells” That Support the Myth

Claimants will tell you

Referrers will tell you

You can tell

The Barnet Example

• MaPS service designed to identify and work with unemployed people with common mental health issues.

• 453 clients supported in under 2 years

• 74% mild to moderate depression

• 70% mild to moderate anxiety

• 64% both

• Just two percent were already receiving therapy

Myth extension; we need specialist provision for people with poor mental health

• Mental health issues are common

• 1 person in 4 will experience some form of mental health issue in any year

• Approximately 1 person in 100 will get a diagnosis of psychosis at some time in their lives

• Approximately 1 person in 100 will get a diagnosis of bipolar disorder at some time

Mental Ill Health & Unemployment

Depression and anxiety are 4-10 timesmore prevalent among people whohave been unemployed for more than12 weeks

Royal College of Psychiatrists (2008). Mental Health and Work

ESA (WRAG) Claims - Primary Condition

DWP: assessments completed December 2013 – February 2015

Doing the Maths

Overall ESA MH

83%4-10X more likelyJSA

ESA MH Primary

Condition

48.1%

ESA MH Secondary Condition

66%(Anecdotal)

Mental ill health is almost inevitable in unemployed people

who are claiming ESA, or who have been without work for 3 months or more. Your model needs appropriate support as

standard.

Myth TwoThe Well-Being Myth

“your level of mental ill health = your closeness to the labour market”

Myth extension; well-being is the same as diagnosis

Positive Well-Being

Negative Well-Being

Diagnosed

Undiagnosed

Myth ThreeThe Integration Myth

“the work & health sectors work well together…. it’s straightforward”

But integration varies wildly from one area to the next.

IAPT providers have an employment KPI,

including number supported into work.

Both IAPT and secondary care may

already offer an employment service.

Your model needs to be informed by the services and focus of each care provider in the

CPA.

Get ready for a very mixed

bundle.

Please don’t have a model that exists in a

vacuum. Service

providers willwork with you. But you need

to be the catalyst.

NHS Good – DWP Bad?

One of the biggest barriers toemployment that people withmental health problems face isthe low expectations that somemental health professionalshave of them.

Myth FourThe Recovery Myth

“people don’t recover from mental illness”

Ciompi in 1976 (228 patients with a diagnosis of schizophrenia followed up over 37 years) found:

• 26% experienced complete remission of symptoms

• 21% minor residual symptoms remained

• 23% intermediate course: symptoms arose episodically

The EPPIC study in 2005 (following 723 first episode psychosis patients over 7.5 years), demonstrated:

• Symptomatic remission in 37-59% of the group

• Social/Vocational recovery in 31% of the group

• Approximately 25% achieved both

Myth extension; work is something you do after recovery from MH problems

• Your role is not to refer claimants with mental health problems to health care and then wait for them to come back when they are well.

• MH professionals’ role is not to refer clients after they are well either.

• Recovery requires a “whole-person” approach

Traditional Treatment

Modern Treatment

“Employment - tough on mental illness and tough on the causes

of mental illness.”

- Farley Davidson, CEO Vauxhall and Southwark NHS

Recovery is not just about treatment

Employment Related Support & Mental Health Recovery Go Hand in Glove

• With the right training, your staff can proactively support recovery.

• Techniques that we have used successfully include:

Psycho-Education MindfulnessMotivational Interviewing

Low Level CBT NLPThe 5 Ways to

Well-Being

• Originally an Australian initiative, created by Betty Kitchener and Prof Antony Jorm.

• International initiative currently being delivered in 23 countries.

• The Department of Health encouraged all employers in England to provide MHFA training as one of three steps in its “No Health Without Mental Health” paper.

• In 2016 MHFA was recommended for all workplaces by Business in the Community.

Myth FiveThe Employment Myth

“work is something you endure once you are well”

Myth One; employment is harmful to people with mental health problems

• Employment contributes to improvement in health and well-being.

• There is no evidence that work is harmful to the mental health of people with serious mental health conditions.

• Effective recovery places employment at its core.

Myth Two; mental health employment discrimination is a thing of the past

• Over 25% of people think that someone with a mentalhealth condition should not have the same rights to a jobas anyone else.

• Less than 40% of employers would consider recruitingsomeone with a declared mental health condition (62%would consider recruiting someone with a physicaldisability).

However, 85% of employers who do employ people withmental health conditions do not regret doing so.

Myth SixThe Suicide Myth

Deaths in the UK Each Year (2014/15)

Road Traffic Accidents Known Suicides

6,2

33

1,7

13

SEVEN

TEENp

eo

ple every d

ay

Suicide Myths• People who talk about suicide are just trying to get attention.

• People who die by suicide usually talk about it first. They are in pain and often reach out for help because they do not know what to do and have lost hope. Always take talk about suicide seriously.

• Suicide always occurs without any warning signs.

• There are almost always warning signs.

• Once people decide to die by suicide, there is nothing you can do to stop them.

• Suicide can be prevented. Most people who are suicidal do not want to die; they just want to stop their pain.

• Asking someone if they’ve had thoughts of suicide might put the idea in their head.

• There is NO evidence to support this, in fact it suggests the absolute opposite.

• Identification

• Well-Being

• Integration

• Recovery

• Employment

What Does

Good Look Like?

Staff

Delivery Model

Structural

Staff

Proactively look for

signs and symptoms

Formally screen to

enable access to treatment

Are suicide and self-

harm aware

Monitor changes in well-being

Can advise clients on disclosure

and how to go about it

Tools used to quantify MH

progress/decline

Clients encouraged to report changes in

symptoms

Clients are supported into

work with “mental health friendly”

employers

Employers are encouraged to destigmatise, including through the Mindful Employer scheme

and Access to Work

Diagnosis not used to judge well-being

Support is integrated with a wide range of other,

positive recovery services

Bespoke MH interventions being

co-designed and co-delivered

Regular case-conferencing

between agencies

Support is joined up with family and social networks

In-work support is longer

Pre-employment support is rapid

DeliveryModel

StructuralCulture of

encouragement and disclosure

Stigma-free environment

Co-location at either, or preferably

both, your site & IAPT Relevant,

compliant data sharing

Clients’ overall well-being is the primary

concern of all agencies

Questions?

kevin@future-path.co.uk

b.kitchin@twiningenterprise.org.uk

www.future-path.co.uk/mythbusters