Case study summary
In autumn 2017 talking therapies service Let’s Talk-Wellbeing (LTW) Leicestershire County and Rutland (provided by Nottinghamshire Healthcare NHS Foundation Trust), with the government’s Joint Work and Health Unit, agreed to be part of a pilot to integrate Improving Access to Psychological Therapies (IAPT), healthcare and employment support. Launched in December 2017, LTW Leicestershire County and Rutland’s Employment Advisory Service has created personalised packages of care by working alongside IAPT practitioners – resulting in 100 people being supported to gain or sustain employment in its first three months.
The main focus of the Employment Advisory Service for Let’s Talk-Wellbeing (LTW) Leicestershire County and Rutland, which is provided by Nottinghamshire Healthcare NHS Foundation Trust and commissioned by the three Clinical Commissioning Groups in Leicester, Leicestershire and Rutland, is to support people using IAPT talking therapies by providing practical advice and interventions to help them retain or enter sustainable new employment.
At its foundation in 2008, one of the objectives of the IAPT initiative was to increase the availability of talking therapies to individuals absent from work through mental health difficulties whose aim was to return to employment. IAPT also recognised that offering therapeutic interventions could act as a preventative measure to employees taking time off work for symptoms of stress, anxiety and depression.
“The principal aim of this integrated approach is to create a culture of prevention and early intervention to make sure people get timely access to health support and suitable employment support so they avoid long-term unemployment,” says Ajay Maisuria, Senior Employment Advisor at LTW Leicestershire County and Rutland.
“The integrated Employment Advisory Service promotes the link between being in work and achieving improved health outcomes. For example, a service user receiving low intensity psychological treatment for depression in the form of National Institute for Health and Care Excellence (NICE)-approved behavioural activation could also be supported with employment support by setting small, realistic employment goals to improve mood and motivation,” he explains.
“Our service model has been created to promote ease of referrals from IAPT practitioners, and provide timely, confidential and impartial support for individuals who require additional interventions based on their employment needs. Ultimately, it’s a service which addresses the emotional challenges of continuing in, starting, or resuming work through integrated psychological treatment and employment support,” says Ajay.
A team of six Employment Advisors cover north-east, west and south-east Leicestershire County and Rutland. Referrals are accepted from IAPT practitioners via an integrated system that ensures a smooth patient care pathway. In developing the service, local partnerships have been formed comprising the Job Centre, local government, voluntary sector, housing, employment and education-based organisations.
The service model includes following up service users one year after completing psychological treatment to see if their mental health and employment status has been maintained or improved.
In the first three months of the Employment Advisory Service at LTW Leicestershire County and Rutland, 100 people accepted employment support via their IAPT practitioner, and were offered an assessment with an Employment Advisor shortly afterwards. Analysis shows 46% of individuals referred opted to receive employment support (64% employed, 36% unemployed).
By focusing on employment and mental health, people of all ages and backgrounds can be supported, through the NHS and local partnerships, in accordance with the Five Year Forward View for Mental Health. This commits the NHS to provide employment support to 29,000 extra people with mental health conditions by 2021 and the Employment Advisers in IAPT programme will make a major contribution to that target.
Kathy Elson, Service Manager at LTW Leicestershire County and Rutland, adds: “Assessments within the Employment Advisory Service are completed over the phone. This stage encourages identification of the person’s main employment needs and objectives to reduce the impact on mental health. Clear goals aid advance planning of interventions.”
Individuals who are employed but signed off through sickness are supported to consider an offer to attend workplace meetings to reduce mental health stigma and empower their managers to consider reasonable adjustments. Shared goals can be developed with employers to promote a return to work that addresses the employee’s needs.
“Informed conversations within the workplace can empower individuals, particularly in relation to addressing work-related issues, in accordance with their existing policies,” Kathy adds. “Where needed, Employment Advisors can liaise with employers to complement existing policies in support of mental health.”
Follow-up sessions are scheduled over the phone or face-to-face at venues easily accessible for service users to encourage engagement, such as libraries and community venues. Collaborative working between IAPT practitioners and the Employment Advisor is encouraged to ensure each service user receives a comprehensive care package relevant to their mental health and employment needs.
Fatima Essat engaged with the service last December. She was on sickness leave as a result of work-related stress. She felt anxious and uncertain about her future direction and was referred to the service by her GP.
“It was the first time I’d ever seen an Employment Advisor and it’s the best thing I’ve ever done – it really, really helped,” Fatima said. “When I was first told about the Employment Advisor I wasn’t in the right frame of mind. You are anxious, you really don’t know if it’s going to help, but actually they know so much more. If you want to get out of your current situation you have to make yourself do it.
“I felt low and was thinking, ‘Am I going to get my job back? How do I handle this long-term sick leave? What are the rules about going back?’ The Employment Advisor told me about how I was protected as an employee.” Following six weeks of support Fatima was successful in finding full-time work with another employer.
Ajay says: “We are always striving to further refine and enhance the service user experience. At present we can deliver our service using face-to-face and telephone support, and aim to expand our methods of delivery to include web-based technology. As momentum and awareness of the Employment Advisory Service increases, our vision is to improve partnership working to recognise the benefits our LTW Service can bring to individuals and employers to better manage mental health.”
Nationally, there are approximately 150 new Employment Advisors working in IAPT talking therapy services – this more than doubles the current employment support capacity within IAPT services. Plans are in place to recruit a total of over 300 by January 2019, supported by £39 million of government investment. To ensure employment support is available in all IAPT services across England, the Department of Health and Social Care/Work and Pensions Joint Work and Health Unit is evaluating the impact of the investment with a view to a possible bid for further investment in Employment Advisors in IAPT services.
For further information please contact:
Let’s Talk-Wellbeing Leicestershire County and Rutland
Nottinghamshire Healthcare NHS Foundation Trust
Tel: 0115 876 0157
Ajay Maisuria, Senior Employment Advisor at the Employment Advisory Service for Let’s Talk-Wellbeing, Leicestershire County and Rutland, explains how the service provides practical advice and interventions to help people remain in, get back into or find work.
‘It was the first time I’d ever seen an Employment Advisor and it’s the best thing I’ve ever done – it really helped,’ – following six weeks of Employment Advisors in IAPT support, Fatima Essat was successful in finding full-time work with another employer.