Working Your Way Through Recovery

Maria Hilditch, Specialist OT

Jan McGall, Lead OT

Objectives Provide an overview of current mental health policy

and drivers for change in Northern Ireland and United Kingdom

Review the link between employment and mental health recovery

Provide an overview of the supported employment initiatives within the Belfast Health and Social Care (BHSCT) for mental health service users

Outcomes Gain a greater understanding of

the impact of mental ill-health on the worker role Recognise the necessary change in policy and

service provision in supporting employment;

Gain an understanding of mental health care priorities in Belfast in ensuring employment is a realistic recovery goal for service users

Where are we now?

32% of people with a disability are in employment in Northern Ireland

Mental and behavioural disorders make up the largest diagnostic category for Employment Support Allowance

Long term unemployment and increased risk of mental health problems

Unemployment: increased risk of suicide

Drivers for Change

Research shows that those in paid employment are 5 times more likely to achieve functional remission than those who are unemployed or in unpaid employment

Recovery and Work Recovery: an ethos to guide practice and also a

personal journey for individuals Benefits of work in recovery

Policy Perspective

Dame Carol Black: Working for a Healthier Tomorrow 2008

The Review of Mental Health and Learning Disability (Northern Ireland) June 2005: The Bamford Report

Recovering Ordinary Lives, The Strategy for Occupational Therapy in Mental Health Services 2007-2017

Key Service Changes

Where have we come from?• Principle that work is important in in everyone’s life

has always been there

• 50 years ago, large psychiatric institutions on the outskirts of city which were self sustaining in many ways but with many issues around individual rights

• Move towards community care and reintegration and need to develop real employment initiatives reflective of individual skills

Key Service Changes

How has this developed:

Recovery focused Individualised No ceiling on what you can and cannot do Continuum of options – voluntary work, paid work,

part-time etc with a value on productive roles, including homemaking

Overview of Supported Employment Initiatives in BHSCT

Individual Placement and Support (IPS)

Exemplar Employer

Acute Care Job Clinic

Where we started from

Images supplied courtesy of www.belfast-murals.co.uk

Video

Why IPS• Zero exclusion• Competitive employment is the goal• Specialist integrated within the mental health team• Rapid job search• Individual job preferences• Employment specialists develop relationships with

employers based upon a person’s work preferences• Ongoing time-unlimited support• Personalised benefits counselling

Barriers to employment• Stigma (3 components – ignorance, prejudice and

discriminatory practices)• Over protective families/professionals• Self stigma (negative past experience, low self

efficacy)• Benefits trap• Resources for employability• Side effects of medication

IPS Process and Implementation• Referral received• Initial joint meeting with client within one week• Service explained – OT role and ES role• Job search initiated – clinical needs addressed in

parallel• Key worker remains involved• Ongoing support from ES and OT for client and

employer

Roles within IPS

• Role of Employment Specialist

• Role of Occupational Therapist

Where are we going? Increase in the employment rate for our service

users

Work is firmly on the agenda

Independent evaluation

Chairman’s Award

Implementation across Recovery and Early Intervention Teams

Exemplar Employer Rationale – BHSCT

Process

Ring fenced posts

Support of Workable and other partnership working

Outcomes

Acute Care Job Clinic

Ethos

Location

Outcomes / Formative Evaluation

Summary