Case study summary
Rates of employment for people with severe mental illness (SMI) are lower than for any other group of health conditions. The Individual Placement and Support (IPS) service at Northamptonshire Healthcare NHS Foundation Trust is an example of an initiative which uses evidence-based strategies to support people with SMI into employment as part of their wider recovery.
IPS is an employment support service integrated within community mental health teams for people who experience severe mental health conditions. It is an evidence-based programme that aims to help people find and retain employment. For the service user the benefits of being in employment include an income and a greater sense of purpose and wellbeing, while for the health system there is an overall reduction in the use of primary and secondary mental health services, leading to improved efficiency and savings.
Nicola Oliver, Recovery Lead, Individual Placement and Support, at the Employment Services and Recovery College, Northamptonshire Healthcare NHS Foundation Trust (NHFT), says: “IPS supports individuals to gain and sustain employment and helps them live the type of life they want to lead, irrespective of their symptoms, diagnosis or previous experiences. For many people who have experienced mental ill-health employment is an important part of their recovery which is why NHFT provides this popular service. NHFT believes it is important to extend healthcare services beyond simply providing clinical interventions.
“Quite often a service user with a mental health condition, perhaps struggling with their symptoms and isolated at home, wants to work. If you help someone into a job they really like – which means they are inspired to get up in the morning and want to manage their symptoms – they’re likely to say to their clinician ‘This is what I want to do, help me to overcome these barriers.’”
Accessing the IPS service
Lucy Anson-Golding is a Senior Employment and Vocational Advisor at Hertfordshire Partnership University NHS Foundation Trust and an experienced IPS Employment Specialist; previously she was IPS Team Leader at the Northamptonshire trust.
“People access IPS when they begin to receive the support of a community mental health team and when they have expressed a wish to find paid employment,” she says. “Conversations about the service user’s employment status take place at an early stage and occur regularly while they’re supported by the community mental health team.”
The trust’s Employment Specialists are embedded in community mental health teams. Co-location enables them to work as part of the clinical team to support service users who may have experienced mental illnesses including psychosis, bipolar disorder, major depression or a personality disorder. Members of the clinical team can ask for advice and guidance about a service user who is accessing employment support, which means the person is supported holistically.
Role of the Employment Specialist
In addition to providing support to service users seeking employment, the role of Employment Specialist entails regularly updating the service user’s clinical record so clinicians in the community mental health team are aware of progress being made towards securing employment, and regular attendance at community mental health team meetings.
The Employment Specialist will have a caseload of 20 to 25 service users, each of whom will receive intensive support from the IPS service. From the point of referral to the IPS service, each individual will be supported by their Employment Specialist to complete a vocational profile which instigates discussion about their work aspirations and goals, workplace preferences, and any barriers they are concerned about.
“A discussion on whether the service user is in receipt of benefits is a key part of IPS because it can be a cause of significant anxiety,” explains Lucy. “The role of the Employment Specialist is to make sure the person has access to individualised benefits advice which will enable them to move forward on their employment journey, equipped with the knowledge of how starting or resuming employment will affect their financial position.”
The Employment Specialist will also help the individual think about what they might want to say to employers and peers about their health condition. If the service user is happy for potential employers to know that a NHFT Employment Specialist is supporting them, he or she can approach employers directly on their behalf.
“When I first meet a service user we put together a vocational action plan that lists the actions we’ve agreed,” Lucy adds. “I support them to take some responsibility for their employment journey and that can include attendance at a weekly job club, updating their CV and obtaining job references. Then we start looking for work – current vacancies and employers to engage with – face-to-face employer engagement is a key part of ensuring successful outcomes.”
Interview preparation and support in employment
The Employment Specialist and service user will work together on interview preparation. Where appropriate, the specialist may agree with the prospective employer that the selection process is conducted through a working interview rather than a panel interview. This may enable the service user to showcase their skills better.
Lucy adds: “If the service user is successful at interview the Employment Specialist will continue to support them through the appointment process and, importantly, offer ongoing support to build confidence and help them overcome any challenges that may affect their ability to sustain employment. Ongoing support is something that differentiates IPS from other employment models. For example, meeting once a week to discuss any ongoing concerns at work, potential health issues or issues around the social world of work. IPS support is time unlimited so as long as a person wants support they will get it.”
The Employment Specialist may meet regularly with the employer and service user to discuss how things are going, and whether any additional training is needed. Sometimes the specialist may be asked to provide general information about mental health issues to an employer, or act as a mediator with the service user over potential situations that could affect their wellbeing at work. Tenacity, good communication skills and the ability to build relationships are key qualities for an Employment Specialist, Lucy says.
Service user experience
Charlotte Medway explained how the IPS service at NHFT had supported her. “There was a time that I did expect my illness to be a barrier of finding work,” she said. “I was worried about stigma, what people would think of me if I couldn’t cope. It wasn’t until I received support from the Employment Support Specialist that I was able to deconstruct these negative thoughts and focus on my strengths and the positive skills I could contribute in the work-place. This support, alongside my other treatment at my community mental health team, helped slowly build me up and I began to gain confidence.
“My Employment Support worker would help me set goals and praise me for my progress. They supported me and would encourage me to keep going. They helped me with job applications, interview preparation, suggested things to add to my CV, and helped me figure out where I wanted to work. Once I started employment they would contact my manager to see how I was doing and offer any support they could. I also found really helpful a plan that we made to help me stay in work.”
Charlotte is working as a Trainee Mental Health Worker in a NHS Trust. “I am finally doing what I want to do,” she said. “I very much doubt without the support I received from my Employment Support Specialist I would be where I am today. My life has transformed now I am in employment. I have purpose and my confidence is building every day.”
Measuring performance and outcomes
At NHFT Employment Specialists are targeted to support 42 per cent of their service users into secure competitive, paid employment – the job-gain rate. Like other good quality IPS services NHFT assesses the quality of its service using a fidelity scale which ensures the service adheres to the IPS model. Next steps at NHFT are to expand IPS provision across Northamptonshire using the transformation funding. This will enable it to become a county-wide service and ensure access to employment support for those who would like support to enter employment irrespective of where they live.
Commitment of commissioners
Catherine O’Rourke, Head of Integrated Commissioning and Assistant Director for Strategic Change, at NHS Nene and NHS Corby Clinical Commissioning Groups, says commissioners are committed to embedding the IPS model in Northamptonshire, and keen to understand how the principles can be used across levels of need as a standard approach in a care and support system which is implementing an outcomes-based model of contracting and delivery.
‘’The active support provided to individuals with mental health needs into paid employment is recognised as paramount in the recovery pathway and in helping people to stay well,” she says. “The IPS programme forms an important part of our local approach and commitment to a model of care and support that focuses on hope, recovery and control. The IPS model is intrinsic to each of these elements, and the approach and principles can be replicated or translated across the system into different settings and applied to differing levels of need.”
As a key commitment in the Five Year Forward View for Mental Health and Implementing the Five Year Forward View for Mental Health, NHS England has committed to doubling access to IPS services nationally by 2020/21, enabling more people who experience SMI to find and retain employment. Earlier this year, NHS England launched transformation funding to support the national expansion of IPS services.
- Schizophrenia Commission (Rethink Mental Illness) report: Schizophrenia – The Abandoned Illness.
- Northamptonshire Healthcare NHS Foundation Trust.
- An independent consortium commissioned by the government’s Joint Work and Health Unit has produced useful tools and templates to support the growth of consistently high quality IPS services. These tools, templates and more resources can be accessed on the IPS Grow website.