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The Royal College of Psychiatrists Improving the lives of people with mental illness
Work and mental health

The value of a WRAP

Wellness Recovery Action Plans include strategies for keeping well, dealing with difficulties and crises, returning to work after a relapse, and self-management.

People can become experts in their own self-care, but to do this they may require access to information and support. Whilst there are many of these initiatives, some people have found it helpful to develop their own Wellness Recovery Action Plan (WRAP).

These plans are created by and for the person with the mental health problems, but they need to be supported by, and may be shared with, health and social service staff and possibly the employer. They may also be developed in concert with Crisis Plans and Advance Statements.

Links to resources:

Common mental health problems at work: What we now know about successful interventions. A progress review

Centre for mental health and BOHRF, June 2010

This review draws on and extends the systematic review carried out by British Occupational Health Research Foundation (BOHRF) in 2005. It looks at common mental health conditions such as anxiety and depression which are the predominant health problems in people of working age. Among the key findings of this review are that :-

* different practitioners have valuable and complementary roles to play, in order to achieve positive outcomes. The role of GPs in providing advice and support as part of the ‘fit note’ process and having the time, the relevant skills and seeking support from occupational health and employment advisers is stressed.

* Independent case management by third party specialists, such as labour experts or employment advisers, is critical to achieving successful outcomes for individuals and organisations where employees are not recovering as expected.

Advising Patients About Work: An evidence-based approach for General Practitioners and other healthcare professionals
Department for Work and Pensions, 2007
This eight page leaflet was developed as part of the Health, Work and Wellbeing initiative. It includes basic information that GPs and healthcare professionals should seek and record about a patient’s work status as well as topics for discussion with the patient. It includes a short list of evidence base publications and other resources.

Health Work Wellbeing

Health, Work and Well-being is a cross-Government initiative to protect and improve the health and well-being of working age people. It is sponsored by five Government departments including the Department of Health, Department for Work and Pensions and the Health and Safety Executive. The ‘our work’ section includes links to projects such as the National Education Programme for GPs which is due to run until March 2011. There are also links to the regional Health, Work and Wellbeing coordinators who bring health and employment specialists together and the Employment Advisers in the Improving Access to Psychological Therapies programme.

(Please note that some of the content on the website is being dispersed to other websites such as Business Link and Direct Gov).

Systematic review of workplace interventions for people with common mental health problems: A summary for health professionals, 2005

This leaflet summarises the findings of a systematic review and highlights the importance of Cognitive Behavioural Therapy (CBT) conducted by GPs or occupational health physicians or via referral to psychologists or psychotherapists

Computerised cognitive behaviour therapy (CCBT) for depression and anxiety (Review of Technology Appraisal 51),
National Institute for Health and Clinical Excellence (NICE), 2010
This is the link to NICE recommendations for using CCBT for mild and moderate depression and also for panic and phobia conditions.

Doing what works: Individual placement and support into employment
Briefing 40, Centre for Mental Health, February 2009
People who experience severe and enduring mental health problems have one of the lowest employment rates in the UK. Yet the vast majority want to work, and with the right support many people can. Large numbers of people have and can be supported to get and keep paid competitive employment through Individual Placement and Support (IPS).

Individual Placement and Support has seven key principles, each of which is needed for the service to work well. They include focusing on paid employment of an individual's choice, and support that continues once the person gets a job.

This briefing outlines the evidence base for IPS and provides information on how to 'do what works'.

Realising ambitions: Better employment support for people with a mental health condition

Rachel Perkins, Paul Farmer and Paul Litchfield

Department for Work and Pensions, December 2009

This review was commissioned by the Secretary of State for Work and Pensions to look at mental health and employment and to identify how Government could help people with mental health conditions fulfil their employment ambitions. Chapter 5 of the report sets out the evidence base for effective support for people with mental health conditions to access work compared with traditional vocational rehabilitation schemes. It includes a clear diagram of how health and social services should link with welfare to work services, Disability Employment Advisors, mental health coordinators in Job Centre Plus etc. It includes a summary of the seven principles of the IPS approach and its implementation in the UK. Appendix 3 sets out examples of the additional support that people with mental health conditions might need at different stages in the transition to work.

Commissioning what works: the economic and financial case for supported employment

Briefing 41, Centre for Mental Health, September 2009

This briefing paper examines the cost of providing Individual Placement and Support (IPS) services against that of other employment services. It shows that IPS, which helps people into paid competitive work, is effective, is good value for money and is affordable to the NHS. The review concludes that IPS is by far the most effective way of helping people who use mental health services to get jobs. And those who work regularly make less use of mental health services, needing fewer hospital admissions, as well as having a better quality of life and a higher income.

Mental health and employment: Key opportunities to put policy into practice

Centre for Mental Health, April 2010

This summarises the four interlinked policy initiatives launched in December 2009 (Working our Way to Better Health, New Horizons, Work, Recovery and Inclusion and Realising Ambitions: better employment support for people with a mental health condition) and sets out how these are being implemented. This publication includes links to information on the ‘Centres of Excellence in IPS’ which are exemplars of how IPS can be implemented across England.

Work Matters – Vocational Guidance for Occupational Therapy Staff

Social Inclusion Unit, Department of Health and College of Occupational Therapists, November 2007

This is a joint publication which looks at the barriers to employment, and how occupational therapists (OT) can help their clients overcome them. It describes a process of vocational navigation in which the OT co-operates with the client in the journey back to work. Hints are given on how to conduct ‘the work conversation’ and there is a list of useful resources including various tools for OTs relating to occupation.

Vocational Rehabilitation: What works, for whom, and when?

Gordon Waddell, A Kim Burton and Nicholas AS Kendall, July 2008

This review assessed the evidence on the effectiveness (and cost-effectiveness) of vocational rehabilitation interventions and contains practical suggestions on what vocational rehabilitation interventions are likely to work, for whom and when. One finding is the importance of the first six weeks of sickness absence where most people with common health problems can be helped to return to work by following a few basic principles of healthcare and workplace management.

Using NICE guidance in mental health

Ingrid Torjesen, Nursing times, 2007

This article summarises an audit carried out by a community mental health team of their practice against NICE guidance. The article includes information on an employment initiative set up by the team which offers service users paid employment mentoring nursing students, occupational therapists and social workers.

100 ways to support recovery: a guide for mental health professionals

Mike Slade, Rethink, May 2009

This report was written by Dr Mike Slade and identifies 100 ways in which people working across the mental health sector can support the recovery of people with mental health problems. It is divided into four sections, one of which looks at ‘developing valued social roles’.

Making Recovery a Reality

Geoff Shepherd, Jed Boardman, Mike Slade. Sainsbury Centre for Mental Health, 2008.

This paper provides an introduction to the ideas of Recovery and says mental health services need to change radically to focus on Recovery. They need to demonstrate success in helping service users to get their lives back and giving service users the chance to make their own decisions about how they live their lives.


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Work and mental health for clinicians

Work is a key clinical outcome

Working together to support people recovering from mental ill health at work

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