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.