How to help hundreds of people with serious mental illness find fulfilling work
The UK employment rate has hit 75%, the highest on record. But that still leaves one in four working age people without work. Take out the students, early retirees, stay-at-home parents, and carers, and you’re left with a staggering 3.5–4 million people out of a job.
Most of these people are out of work with a health condition or disability. And although some are discouraged or feel their condition is too great a barrier, surveys say up to 90% of them would like to work if they could find the right job.
People want to work. The government saves money if they do. So why is the gap in employment so huge between those with a disability and those without?
The search for solutions
When Social Finance started looking at the problem, we saw a system of two halves. On the one side, large-scale DWP-backed programmes that were pretty efficient at helping mainstream jobseekers into employment, but had almost no success for people with disabilities and health issues.
On the other side, we found pockets of excellence. Locally-funded employment programmes, closely tied in to the health system, that help hundreds of people each year into fulfilling and lasting jobs.
Like Work Programme, many of these initiatives “cherry-picked” their clients. Except they weren’t cherry-picking the easiest to help; they were targeting the so-called hardest to help. People with serious mental health issues, some of whom had been out of work for many years or had never worked before.
Many of these local services follow the principles of a model called Individual Placement and Support (IPS). Developed in the States, this model has been tested in academic studies time and time again and has found to get at least twice as many jobs as traditional programmes for those with severe mental illness.
It works like this: An individual suffering with mental health issues talks to their psychiatrist or nurse about whether they are interested in work as a route to recovery. If so, they are rapidly contacted by a trained employment specialist, who spends up to a month understanding their background, skills, and goals.
Within just 30 days, someone who has been out of work for years is given support to start applying for jobs that might suit them. If they need help approaching employers, they get it; if they need help interviewing, they get it; if they want to disclose their condition to their future employer, the specialist will help them do it in a sensitive and constructive way. And once they secure a job, the specialist continues to support employee and employer to make the placement a success for everyone.
Bridging the gap
The IPS model is proven to work. Which led us to our next question: Why is it only available in a handful of areas, supporting a few thousand people a year, when the scale of the problem reaches into the millions?
IPS falls into a gap. It’s the gap between large-scale national funding, targeted at getting people into work, and locally-supported recovery services, tightly integrated into health provision.
That’s why set we up the Mental Health and Employment Partnership (MHEP). MHEP is a social purpose organisation that aims to massively expand high-quality employment services for people with mental illness.
We do this by bridging the gap between national and local funding, bringing more resources to bear without trampling on local ownership and delivery.
We started by partnering with three local areas — Tower Hamlets, Haringey, and Staffordshire. We wanted to see if we could add national funding to a locally-driven programme and help each area develop their employment services to the best-practice IPS standard.
The extra money came in the form of outcomes-based payments from Cabinet Office and Big Lottery Fund. Keen to avoid squeezing out small, charitable providers with financially risky Payment-by-Results contracts, we raised a flexible pot of socially-motivated investment from Big Issue Invest to allow us to pay some of the costs up-front.
Since the investor only gets repaid if the service works, MHEP asks providers each month to report on the outcomes they’ve achieved. And every month our Board of experts and investors reviews the results to see what’s going well and where action is needed to tackle issues.
And the outcome is…
18 months later and our early results are encouraging. Half way through the initial programme, we have helped around 190 people with serious mental health issues into work. Almost 100 of those people fall into the “Support Group” of the Employment and Support Allowance benefit — that’s the group who are never expected to work again.
More than 60 people who have got jobs haven’t worked in at least 3 years. And 8 of them have never worked before.
Of course, it’s the lives that are changed that matter most. One client had been told by medical professionals that she would never work again. Then she joined the IPS service. She told us simply: “It’s as if a door opened and there was hope”.
Rowing through rough seas
As one of the first set of IPS services with ongoing independent validation of outcomes, we can say with confidence that IPS delivers.
But there is no room for complacency. Significantly fewer people have come through our programme than we hoped. And there’s plenty of room to help even more of our clients to transform their lives through a fulfilling, paid, competitive job.
IPS isn’t an easy model to get right. It demands that clinical mental health services change their ways of working, making employment a core part of the way they help patients recover. It needs talented team leaders and frontline employment specialists — people who can be empathetic with clients; engaging with clinicians; and persuasive with employers. And it requires a single-minded focus on helping people into jobs.
We see our role at Mental Health and Employment Partnership as being an active player in helping services succeed.
Our monthly performance monitoring is not an exercise in ritual punishment, but an opportunity to get leaders in the field to offer advice and steer on really tricky issues. We offer operational support, such as team leader coaching, and help providers with data systems, recruitment processes, and integration with NHS teams.
Because our span covers multiple areas, we can offer the benefits of being part of a network: opportunities to learn from others; sharing of tools and tips; and events that bring disparate teams together in a way that is too rare in our sector.
Going for the double
Our ambition is a massive expansion of high-quality employment services. For that, our first three areas take us to the starting block, not the finishing line.
We’ve learnt a great deal from our partnerships with councils and NHS funders and from 18 months of nose-to-the-grindstone service delivery. Riding that learning curve has allowed us to expand from those three initial areas to three more in just a year, with further growth in the pipeline.
Even more excitingly, last year the NHS committed to doubling access to IPS for people with severe mental illness by 2021. A huge pledge that will transform the landscape of employment support and put work at the heart of recovery in mental health teams across the land.
It won’t be easy. Everything we’ve seen has taught us that helping people with complex health conditions into sustainable jobs, even with the power of the IPS model, takes perseverance and will.
But what really matters is knowing that it’s possible.
For up to four million people who don’t wake up to a bustling morning commute and don’t get a paycheck at the end of the month, that means there’s a reason to hope.
Which means there’s plenty more work for us to do.
Adam Swersky is an Associate Director at Social Finance and the programme lead for health and employment and for the Mental Health and Employment Partnership (MHEP).
To find out more about our work on health and employment, contact us on HealthandEmployment@socialfinance.org.uk
