Improving employment support for people with mental health issues

Dr Geraldine Strathdee, National Clinical Director for Mental Health, who today addressed the Westminster Health Forum’s keynote seminar on the next steps for delivering policy, details how NHS England and its partners are tackling employment issues for patients:

A new outcome indicator for CCGs will measure the percentage of people using specialist mental health services who are in employment.

This is a vital step to improving the lives of people of working age with mental health problems who, for too long, have not been given the help they need to get or keep a job.

Today, fewer than one person in ten using mental health services is in work. Many more would like to try out work yet far too often are discouraged from seeking employment. Some are told by health professionals ‘you’ll never work again’ or warned to postpone their job search because they are ‘not ready’.

Yet we know that for many people, work is a big help to recovering from mental illness. So the introduction of this new measure will be warmly welcomed by people who use mental health services, especially the 43 per cent who, according to successive CQC surveys, have wanted help with employment but not received it.

For NHS organisations, meanwhile, it presents some significant challenges. They will need to measure accurately employment rates and take steps to raise the numbers of people able to get into work and maintain their employment.

The good news for CCGs and mental health providers is that there is a tried and tested model available to support people into paid work. And evidence suggests that when people are placed in sustained employment they make less use of health services and have fewer hospital admissions. (see ).

The model, Individual Placement and Support (IPS), is endorsed by NICE in its guidelines for promoting recovery in patients with schizophrenia, and it is supported by twelve randomised controlled trials (see the Centre for Mental Health website for more details).

Skilled IPS employment specialists persuade employers to place people in work, and provide on-going support to enable their clients to maintain that employment. They work as part of a person’s clinical team and look for jobs based on a person’s individual skills and preferences.

The outcomes can be surprisingly good. IPS even works well in areas of high unemployment or during times of recession because success relies on the development of trusting relationships between the employee, employer and employment specialist.

About half of England’s NHS mental health trusts have explored how their service users can get access to IPS, making it available through their own staff, or in partnership with third sector IPS experts based within community teams.  And the charity Centre for Mental Health has identified 14 IPS Centres of Excellence, who work faithfully to the international IPS model and whose job outcomes are exemplary. But too many people are still not given the option of an IPS service and as a result miss out on opportunities that might help them to recover.

  • You can follow Dr Geraldine Strathdee on Twitter: @DrG_NHS
Dr Geraldine Strathdee OBE,

Dr Geraldine Strathdee, OBE, MRCPsych, is the National Clinical Director for Mental Health, NHS England, a consultant psychiatrist in Oxleas NHS FT, and Visiting Professor, Integrated mental health education programme at UCL Partners.

For over 20 years she has held senior roles in mental health policy, regulation and clinical management, at national and London regional levels, and advises internationally on mental health service design and quality improvement, while working as a practising clinician. She has been involved in transformational large scale service development programmes, moving services from hospital based, to 24/7 home care and primary care models, in roles which have included: the Trust Director of Clinical services in Oxleas NHS FT (2005-2007), Director of Service development at the Sainsbury Centre for Mental Health and Senior Lecturer, UMDS ( 1995-1998). She was the National Professional Adviser in mental health to the Healthcare Commission and the Care Quality Commission (2005-2012).

Her particular commitment is to the translation of policy and best practice evidence into front line routine clinical practice, empowering service users to reach their potential, and staff to maximise their time to care. She is passionate about the development of leadership competencies and using information to enable informed decision-making.

As London SHA Associate Medical Director (2009-2013), with responsibility for mental health, she led transformational change through the development of clinical networks for dementia and primary care mental health CCG leaders, developed ground breaking commissioning support care pathway profiling informatics tools, and high impact educational programmes. She was awarded the prestigious RCpsych Psychiatrist of the Year award in 2012.

Clinically, she has worked in a wide range of primary care, inpatient and community services, and latterly with people with complex and multiple needs, as a Consultant Psychiatrist for the Bromley Assertive Community Treatment team in Oxleas. She is committed to providing services which enable services users to live in their own homes, develop their own personalised care plans and self management expertise to achieve recovery, while at the same time working with community agencies to deliver coordinated, responsive, care pathways.

Service evaluation and research interests: Her teams have won awards for their use of technology in improving care, using patients as experts in staff training and leadership awards for new Ways of Working, the redesign of roles. Her research interests have included the fields of primary care mental health, evaluation of community services and dual diagnosis. Current research interests include the evaluation of competency based leadership programmes and clinical networks to drive transformational improvements, and high impact educational programmes.

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  1. Margherita Cardoni says:


    I was diagnosed with that ambiguous labe ‘ borderline personality disroder’ some twelve years ago. I have had several spells as a voluntary patient on acute wards but rhought my ups and downs in health have ALWAYS stayed in employment, even when it has been a real struggle and even when I had periods of not wanting to live.
    work can be an escape out of the house, a deflection from the issues that are causing pain, a change of focus and can help build some sense of achievement and purpose. I cannot understand how not going to work would have ever helped me. In fact I think it would have achieved the opposite.
    my only concern is how hard it can be to manage though bad periods and the tendancy to try to hide any health issuse from employers who have no understanding of how hard it is for you.

  2. Lyn Brankin says:


    really interesting and pertinent article!

    I am about to leave the NHS by means of early retirement due to the restructuring of primary care and the fact that billions of pounds worth of premises were transferred last year to a DH owned company.

    My brother has a mental illness, is deaf and has been unemployed for over a decade.

    Each month he buys items ready for when he starts work again!!

    He has very little external support as I do not feel that the professionals doe not provide a ‘joined up’ service. Support workers come and go frequently.

    My mother is the current main carer – she is 79 and her health is suffering due to the fact that my brother takes his frustration out of her.

    There definitely needs to be more all round support generally and in getting people in my brother’s position back into society one way or another as he is more or less isolated.

    My brother attends a biannual appointment with a Dr Darvil here in Tameside. The appointment is around 30 minutes and he is prescribed various drugs. That is it…. and that is how it has been for years …

    If you need a case study, my brother’s position would be a good start…

    Kind regards


    Lyn Brankin
    Greater Manchester Interim Primary Care Asset Manager
    NHS Property Services
    Premises Advisor
    Greater Manchester NHS England Area Team