1. Supported Employment Schemes
Traditionally people with long-term and severe
mental health problems have been offered pre-vocational training
and sheltered employment. However there is now a great deal
of evidence that an alternative approach called ‘Individual
Placement and Support’ (IPS) is much more effective in getting
people into open employment. The difference is that IPS emphasises
rapid placement in work and on-going support after placement
(‘place-and-train’) rather than the traditional ‘train-and-place’
models which focus on a prolonged period of assessment and
preparatory training.
The key principles of the IPS approach
are:
- Services should be focused on competitive employment, with a
primary goal of integration into the general workforce.
- Eligibility should be based on the individual’s
preferences.
- Programmes should involve rapid job search and minimal
pre-vocational training.
- Vocational services should be integrated into the work of the
clinical team
- Support should be available for an unlimited period, which
should be tailored to the individual’s needs
The effectiveness of IPS has been
internationally evaluated in over 15 randomised controlled trials
in North America, Europe, Australia and Hong Kong and only one
trial has shown no effect. On average those who are give IPS
show employment rates of 30-40% compared to rates in the control
group of 10-12%. Those supported by IPS work significantly
more hours per month, have higher earnings and better job
tenure. There is no evidence that they have a negative effect
on clinical well-being and relapse and some show reduced rates
of hospital admission and less time spent in hospital.
Follow-up studies over 8-12 years confirm that the better
outcomes are maintained over the longer term. These schemes
have also been shown to be cost-effective.
IPS should be routine practice for specialist
mental health services which aim to improve the employment
opportunities of people with long-term mental health problems who
are currently unemployed. Unfortunately it is not yet widely
instituted in the UK, although some NHS Trusts have successfully
deployed this approach in routine clinical practice in a number of
NHS Trusts, notably South West London and St George’s Mental Health
Trust.
2. Schemes for
people with common mental health problems
The evidence for schemes to help people with
anxiety and depression stay in or get back to work is less clear
cut and little evaluative work has been done in the UK. The
existing evidence suggests that:
- To help people keep their jobs -
individual approaches are more effective than organizational ones -
the most effective programmes focused on personal support,
individual social skills and coping skills training. Multiple
approaches have the most long lasting effects.
- To help people get back to work after
mental health problems at work - brief individual psychological
therapy, especially those which are cognitive/behavioural in
nature, are effective. These techniques had a stronger effect
in employees in high-control jobs and may be effectively delivered
face-to-face or via computer-based applications.
Different practitioners have valuable and
complementary roles to play, in achieving positive work outcomes –
including the General Practitioner, Occupational Health
practitioner, line manager, and independent case managers (for
example, labour experts or employment advisers). A revised
medical statement – the fit note – now enables GPs to
provide better return-to-work advice for patients to share with
employers.
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The value of a WRAP
(Wellness Recovery Action Plan)
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