Working Towards Better Mental Health 

After the General Election – what next for mental health and employment?

Andy Bell, Centre for Mental Health
Andy spoke about the importance of mental health in the context of employment and the effect mental ill health can have on businesses in the UK. He also compared the mental health policy pre-election with the Conservative Party manifesto pledges and the suggestions which emanated from the Work and Health Green Paper. Finally, Andy explained the features of an Individual Placement and Support (IPS) model and floated the notion of building mental health and employment policy being built on existing evidence of what does and doesn’t work. 

Plenary One: Making the system work for mental health and jobseekers – the opportunity at national and regional levels

Huw Meredith, Programme Lead, Health-led Trials, Work and Health Unit
Huw talked about how the Work and Health Unit was formed and its aim of developing an integrated approach to work and health, seeking to help those unable to work and those ill at work. He talked about how the green paper determines where the £70 million Innovation Fund will be spent. He also talked about IPS pilots in Sheffield and the West Midlands, which have been set up to test new cohorts which could eventually be rolled out to 11 devolution areas. These cohorts look to bring physical and mental health together and seek to improve employment and wellbeing at a local level.

Adam Swersky and Gary Johnston, Social Finance on THRIVE West Midlands
Adam and Gary talked about how the West Midlands has led the way on mental health, with the WMCA stating that it would focus on mental health and supporting those with complex needs into work. Gary outlined the overall objectives and approach of THRIVE – using a time-limited IPS model, engaging clinicians in viewing employment as a health outcome and deploying teams of employment specialists in primary and secondary care settings. He also explained how the trial works – all users entering the trial would be randomised between receiving and not receiving IPS. This allows the evaluators to measure impact. Finally, Gary talked about the opportunity to grow IPS through the Mental Health and Employment Partnership (MHEP). MHEP can offer 20-30% extra funding and practical support to commissioners who are keen to grow IPS.

Elizabeth Armstrong, Chief Executive, Better Pathways
Elizabeth echoed the importance of IPS as a delivery model but also stressed that it isn’t the panacea, due to the way it is structured – some service users are not able to navigate such structure due to the chaotic nature of their lives. Elizabeth felt that there is still a long way to go before there is parity between mental and physical health understanding, and a lot of work will need to be done around empowering employers with knowledge of IPS. Elizabeth also said that vacancies and clients should be shared and that working together at a local level, including sharing best practice, is key to helping those in need.

Breakout 1 – Supporting residents’ mental health: the opportunity for housing associations

Richard Bellis, Head of Genesis Connect, Genesis Housing Association and Sue Scott, Head of Business Development, Wandsworth and Westminster Mind
Richard and Sue gave an overview of the individual work of Genesis and Mind’s work respectively. Richard then talked about their partnership in delivering the V50 programme. Funded by Nesta, the programme looks to address issues of social isolation and poor mental health among residents aged 50 and over. This is achieved by using volunteer wellbeing mentors. These mentors are also residents and commit 150 hours’ over a four month period. V50 incorporates two government priorities – mental health and the employment of over 50s. A good percentage of volunteers have since gone on to secure paid work and promotions following their participation in the V50 programme. Mental health and wellbeing awareness and monthly group support and supervision allow the volunteers to be well equipped to help beneficiaries. The future aims of the partnership are to learn from V50, to strengthen the relationship, to use the sector to influence policy and ultimately, try to scale up V50 to a pan-London programme or if possible, nationally.

Breakout 2: IPS: Supporting the frontline

Jonathan Allan, Disability Services Manager, Enable and Bob Kitchin, Chief Executive, Twining Enterprises
Through their work, Enable has found that Clients on IPS are twice as likely to gain employment as other vocational interventions. This is due to several reasons, including that the focus on paid employment means better outcomes for customers; job searches are individualised and the bespoke nature supports outcomes, and finally, they provide financial support and guidance provided regarding topics such as on Benefits for customers. In order to ensure that IPS continues to be effective, they use internal auditing using fidelity measures. The Centre for Mental Health, who works alongside Enable Services has a substantial amount of resources regarding IPS. Finally, in order to ensure that the measures used are accurate and valid, Triangulation is used to test the effectiveness of IPS.

Twining’s Bob Kitchin spoke of the challenges that are faced in delivering IPS. These included a lack of clarity around the model, and challenges regarding data sharing and joint working which would ideally need to be organised before procurement.  A key consideration remains how the model will ensure it protects people with mental health issues without ‘sanctions’. A lack of capacity building capability is also a key operational consideration.

Moreover, too many KPI’s surrounding IPS makes it challenging, and currently, too much regulation is also making IPS problematic. For providers, demand is creating challenges too, including recruitment, capacity building and joint working.  A lack of hierarchical communication means that it is not effective as it could be, particularly by limitations in providers’ geographical constraints.  Therefore, providers are immensely keen for Primes to take a leap of faith and commit to IPS as a model, as for the initiative to succeed, you cannot simply ‘throw money at it’. To ensure that Twining are leading by example, they need to ensure that all staff at Twining are trained in Mental Health First Aid, and have invested in employer engagement, which is central to effective IPS Staff. In IPS, the adviser is responsible for employer engagement, with the results suggesting that this holistic effect is better.

Overall, however, commissioners have very low understanding of Mental Health and Employment, and this is a key underlying issue for delivery of IPS. Within Work Step and IPS, the adviser is central and the inclusion of individual’s opinion is what makes this most successful.

Breakout 3: Employment and wellbeing: the evidence so far

Dr Mark Bryan, Reader in Economics, University of Sheffield and What Works Centre for Wellbeing, and Barry Fletcher, Managing Director, Ingeus
Dr Bryan delivered a presentation on the latest evidence on the relationships between mental health and wellbeing, and transitions into and out of work. Key findings from his systematic review of which pulls together a global evidence base included that unemployment is always statistically bad for wellbeing, irrespective of its income impact, and so it’s not about money. However, although re-employment is good for wellbeing, the quality of the job matters hugely. Interestingly, the research also points towards several mitigating variable when measuring the impact of unemployment on wellbeing, including the person’s social capital, employability, how many other people are employed around them, and gender. Finally, Dr Bryan suggested that on the back of this research, policymakers should focus on preventing unemployment amongst young people, where the effects can be most scarring, and on promoting high quality, sustainable jobs. Barry Fletcher then complemented Dr Bryan’s research by drawing on his practical experience from Ingeus, emphasising the importance of condition management. He also agreed with Dr Bryan that good work was crucial to wellbeing, but pointed out that all employment should be seen as a stepping stone to more work in the future. Finally, he underlined the need for medical professionals to recognise work as a health outcome.

Breakout 4 – Offenders, mental health and employment

Kate Markey, Managing Director, Blue Sky and Lesley Clark, Solutions Director, Novus
Lesley described how the prevalence of mental health issues amongst prisoners and prison leavers is a significant issue, compounded by the increased likelihood of individuals developing mental health conditions whilst in custody. Offenders are often left with low resilience, difficulty to adapting to change and confidence issues, all of which can increase their risk of reoffending and lead to disengagement with support services. Kate followed on by discussing how important employment is to good outcomes for prison leavers by giving them purpose, structure and routine to readjust to life in the community. A ‘work first’ approach is therefore beneficial, and Blue Sky focuses on building resilience and coping mechanisms to ensure that clients are able to sustain work. In this respect peer engagement and support is important; at around 6 weeks post-release individuals will often experience a wobble, at which point suitable support is crucial. Both speakers stressed the importance of building trust, beginning by training prisoners in the estate.

The session then moved into discussion. Key points included the importance of RoTL as a pathway to work experience and good outcomes, and how governors can be best engaged with; Kate highlighted the value of providers in an ‘account manager’ role bringing together governors and their frontline staff. One of the biggest challenges for treating mental health issues in custody was mentioned as being reliant on the individual actively accessing services for treatment. The fragmentation of services was raised a barrier to effective provision through the gate and within prisons, with CRCs, NPS, regional heads of employment and prisons often working largely separately. Housing was discussed as a huge difficulty for prison leavers, and inappropriate KPIs were raised as a key problem for through-the-gate services. Maintaining training and provision between different institutions as prisoners are moved was also raised as a significant challenge to delivering effective services in the longer-term.

Breakout 5: Mental Health and Work: What’s gender got to do with it?

Laura Busfield, Director of Employment Services at Renaisi, and Louisa Thomson, Head of Impact and Evaluation, Renaisi
Laura Busfield and Louisa Thomson talked attendees through their recent research into gender, mental health and employment.  Key findings included that there is a perception and a reality that women are more likely to be unemployed and care givers than men, and this has mental health implications. Equally, men and women often respond differently to becoming unemployed. To tackle this, employment service should be more gender sensitive, and training should be provided so that staff are aware of specific risk factors for men and women. More broadly, the research also suggested that more needs to be done to embed a wellbeing

Breakout 6 – Supporting young people’s mental health

Chris Harris, Mental Health Advisor, Prince’s Trust and Natalie Spence, Mental Health Advisor, Centrepoint
Chris Harris described the importance of good mental health for young people, and described how the Prince’s Trust developed its Mental Health Strategy to ensure that mental health is no barrier to young people finding employment. Chris emphasised the importance of strength building language when approach mental health with young people (developing and building on the individual rather than ‘needing help’). 25% of Prince’s Trust’s intake have a diagnosable mental health issue, but crucially they do not require a diagnosis for accessing support – self-identification is all that is needed. Understanding that often long-term support is needed; young people often push others away in periods of mental ill-health, so persistence and patience is needed to build trust.

Natalie outlined Centrepoint’s approach to supporting young people with mental health issues, having started out working with care leavers, where chaotic lives lead to some young people developing coping mechanisms that persisted and created issues once they became settled. She also highlighted how different backgrounds can create mental health issues, giving the example of a young orthodox Jewish man cut off from his family and support network after coming out as homosexual. Mental ill health can appear at any point for anyone, though some can be more susceptible. Centrepoint adopts a ‘housing first’ as a foundation for supporting the myriad problems young people can face through holistic tenancy support. As young people rarely access support for mental health, early assessment and identification is crucial to good support.

Breakout 7: IPS – Birmingham pilot

Pat Russell, Integrated Health Director, APM and Jane Clark, Consultant Occupational Therapist, Birmingham and Solihull Mental Health NHS Foundation Trust
The key finding from the breakout was that trust between organisations is a key priority for any partnership, and that one of the key challenges that clinical staff have is a lack of resources to work and engage employment support endeavours, therefore, integration is beneficial to support Trusts in enhancing their outcomes. However, there are some who argue that the risk associated with work could be worse than the benefits for mental health. It is important that this view is tackled by health specialists. APM have taken initiatives to ensure staff members are trained to be aware of mental health concerns.

The Fidelity model assumes that the manager and the employment adviser are supported by the contract, but in reality, this can prove to be a concern. These are difficult on the Fidelity Scale. Overall however, the pilot has been remarkably successful in integrating numerous elements of Work and Health.  To continue ensuring that we change the view concerning W+H Programme, there is a need for more evidence based data to challenge pre-existing concerns. Some of the challenges include the difficulties of combining the MOJ and the expectations of the service users.  

As such, the investment in partnerships has been key to APM’s success in the Pilot. Private Sector involvement and ERS Specialists is really helpful to accessing numerous resources than NHS trusts would have access to. The key lesson from this is that it is beneficial to stick to what you’re good at in partnerships and attempt not to cover all bases with un-separated Institutions which ignore specialised talents and skills. Similarly, it is important to consider service user expectations, as they know themselves very well, and that is key to achieving good outcomes. In order to overcome challenges such as data sharing, the clinician becomes the key facilitator of all of the sensitive data and this has meant that data and outcomes remain solely between the clinician and the client.

Breakout 8 – Homelessness and mental health

Sylvia Tijmstra, Head of Policy, Campaigns and Research, St Mungo’s and Maeve McGoldrick, Head of Policy and Campaigns, Crisis
Sylvia explained that 4 in 10 rough sleepers suffer from mental health problems and that in London, the number of rough sleepers with mental health problems has more than tripled in the last five years. Causes are wide ranging and include evictions, relationship breakdowns and domestic violence. Sylvia said that mental health issues on the street can lead to suicide, assault and sexual assault, and a general apathy towards life itself. There are services available to those sleeping rough, such as outreach centres, health services, the police and the criminal justice system. However, many rough sleepers are not aware of the services and their availability to someone without a fixed abode. Sylvia said that to ensure the improvement of these services, they must strive to be accessible, attentive, understanding, caring and persistent.

Maeve gave some background on the work Crisis does and explained that they are not restricted to existing methods – their funding is not a payment by results model and this allows them to innovate and discover better practices to best aid their service users. Crisis’ aims to help by providing people with a progression coach, a housing coach and an employment coach, and this help is suitable for the homeless, the former homeless and those at risk of being homeless. Last year, 54% of Crisis’ clients (that declared their support needs) identified a mental health problem and both Crisis and St Mungo’s see the symbiotic relationship that mental health and homelessness can foster. Going forwards, Maeve insisted that Crisis would like to see a duty to refer in health provision, easier access to health services, health professionals looking for signs of homelessness, specific hospital discharge pathways and Housing First for those with the most complex needs.

ERSA Employability Awards 2017 Finalist: Pluss Mental Health Services Team

The Pluss session had a key focus on how work can save lives.  Pluss’s mental health team is embedded in the NHS, and has had extensive experience with supporting service users into sustainable and fulfilling employment.

The majority of the session focused on Tracy’s story. Her experiences included being thrown out of her house by her husband suffering from PTSD; Alcoholism and substance abuse followed. However, voluntary work kept her going and helped her continue her life, working through her problems and being supported by the structure. This strength allowed her to recently overcame the physical and abusive relationship, and progress in life.

Plenary Two: Making it work for employers

Diane Lightfoot, Chief Executive, Business Disability Forum
The Business Disability Forum is a not for profit and membership organisation, committed to better supporting the life chances of disabled people.  Its members are predominantly large blue chip organisations.

The current policy landscape means that mental health more in the news than ever before. One in four people will develop a mental health problem over the next 12 months. Additionally, 60% of people who have a disability that is non-visible choose to not disclose it. Therefore, it is important that employers need to create an environment that says it’s okay to have mental health issues, and become responsible for anyone who has become unwell due to mental ill health.
Mechanisms to support this include language as a key factor; using the word “disclosing” makes it sound more serious than it is. Networks, peer support and sponsors are incredibly effective, and HR teams can succeed immensely by ensuring hiring practices are more inclusive by changing language around behaviours.

The crucial point is that mental health is a critical factor that affects everyone; “If you’re not already disabled, you’re a disabled person in waiting”. Therefore, stigma busting and normalising disability is important.

Gareth Parry, Chief Executive, Remploy
Employers acknowledge that there is a problem in terms of inclusion and there isn’t a large amount of opposition in theory to supporting mental health initiatives, but rather, there are challenges and practicalities.

Current services can learn a huge amount from Access to Work which is a fantastic initiative and this is a free service and is available and very well received. Examples of positive legislative changes with include supporting Work Choice retention referral to help people, which is at immediate risk. With mental health, there is a lot of provision is available but a few know about it. Moreover, employees don’t just want support, they want high quality support.

Within Remploy, the ERS Level 3 Qualification has been adapted to include mental health support. They are confident that the investment across the business has proven immensely beneficial to staff. The introduction of flexible working, which is a key tool for tackling mental health problems, has paid dividends for the organisation, with 40% of the workforce now using it.

Legislatively, the removal of the 16 hour rule is a fantastic initiative and the earning threshold is much, much better; recognition of the gig economy too, and part time work is amazing for supporting individual mental health. IPS is an amazing initiative, even where challenges with scalability exist. All in all, we need to do more ourselves as a sector and lead by example as mental health leaders. 

Kevin Moore, Chief Executive, Future Path
Kevin highlighted some key statistics regarding the link between work and mental health.  Once unemployed for 13 weeks, your risk of developing a mental health conditionally dramatically increases, and that one in five suicides globally is linked to unemployment. He highlighted that Mental Health First aid is not only for mental health professionals, and is central to any organisation. The key aim is to ensure that every workplace has a mental health first aider. The session concluded by covering the contents of the Mental Health First Aid course.