Sharing what works in the UK

Sharing what works Experiences and challenges from UK policy and practice Helen Lockett Associate Director, Employment Programme

Presentation
Barriers to implementation – systems/macro level
Barriers to implementation – micro level
Our ‘Centre’s of Excellence’ programme of systematic implementation across England

A reminder of the evidence from Gary Bond, Phd
“ Only about 5% of people with severe mental illness get the services they want.
The chance of consumers getting a job is at least twice as high if they receive evidence-based Supported Employment (SE) services.
After ten years, nearly half of the people in the studies who received SE services were still working.
Consumers who were employed had better control of symptoms and higher self-esteem.
Research shows that SE is effective not only in the United States but also in Canada, Europe, Japan, Australia, and Hong Kong.
SE is effective with many different cultural groups.

Barriers to implementation (systems/macro level)
Government Policy?
Welfare system?
Separation of mental health and employment services?

Policy ‘Desert’ 1999
Where we’ve come from
National Service Framework for Mental Health, 1999

10 years on ‘Wave’ of Policy
Cross-government mental health and Public Service Agreements (HM Treasury, 2007)
Health, work and well-being (Cross-government department)
Commissioning Framework for Health and Well-being (DH, 2007)
Reaching Out: An action plan on social exclusion (SEU, 2006)
Our Health, Our care, Our say: a new direction for community services (DH 2006)
Vocational services for people with mental health problems: Commissioning guidance (DH 2006)
Disability Discrimination Act 1995 (amended 2005)
Mental Health and Social Exclusion (SEU, 2004)
Mental health and employment near top of our political agenda

Cross Government Policy Explosion!
National Strategy for Mental Health and Employment
New Horizons: 10 year mental health strategy
The Perkins Review
Work, Recovery, Inclusion
Launched together: 7 December

Headlines
Public health approach – whole spectrum i.e. early identification and support from workplaces; addressing sickness certification process; evidence-based services for people out of work
EBSE should be available across primary and secondary mental health services
Employment integral to treatment and a key part of recovery orientated approach
Consistent measurement across Health and Employment Agencies
Public sector leading by example

Welfare Benefits Reform
Greater emphasis on ‘capacity’ and what people can do
Change from Incapacity Benefit to Employment Support Allowance
Move to ‘contracting out’ employment services, through a prime contractor model
Major review of Disability Employment Schemes
Increase in Access to Work funding and targeted support to people with mental health problems

Mental Health & Employment Services
Different worlds:
Separate departments and funding
Different definitions
Different geographical locations
Different philosophies
Different providers
Health Employment

In summary
Now have supportive, evidence-informed policy framework
Culture of welfare reform good direction; but concerns that some funding mechanisms actively promote poor practices and exclusion
Separation of health and employment needs to be addressed at strategic and operational levels as part of successful implementation of EBSE

Challenges (micro-level)
People don’t know about the evidence base
People know about it but don’t believe it
Most frequently in practice:
Health and employment services aren’t integrated
Intensity, continuity and individualised nature of support need to be strengthened
Financial planning is not provided

Integration - key ingredient
People with mental health problems can require extended periods of mental health care which needs to be coordinated with any vocational services provided
Employment services can facilitate engagement in mental health treatment and care
Employment outcomes can demonstrate the effectiveness of a recovery orientated mental health service
Discharge plans can be linked to real world milestones such as stable housing and employment.

Advantages
More efficient use of existing resources; knowledge and expertise flow to both sectors
Health staff implement a recognised evidence-based practice; benefit from seeing more individual recovery and develop new skills and expertise
Employment specialists can facilitate re-access to mental health services if needed
Early intervention, forensic services, substance use and acute care teams can participate
Employment specialist can assist clients most in need of this assistance and build more expertise compared to those in segregated services.

Sainsbury Centre Centre’s of Excellence Programme
Information
Resources for a range of stakeholders including:
Tools for commissioner’s (purchasers)
Establishing EBSE centres of excellence

Series of Information Papers
Doing what works
Summary of IPS and the evidence base

Measuring what matters
A set of Key Performance Indicators for supported employment services:
Context indicators
Input indicators
Process indicators
Outcome indicators

Commissioning what works
Cost effectiveness and value for money
EBSE costs certainly costs no more than traditional vocational services, and probably costs less
Long term savings to health

About Time
Changing investment
A step-by-step guide to undertake and manage change to transform traditional ‘day and vocational’ services
Includes on-line tools to:
Involve service users in change process
Develop evidence-based contracts
Assess needs in your local area

Establishing EBSE Centres of Excellence
Tender process to select local mental health and employment partnerships; led mainly by NHS Trusts
9 Partners: 5 full, 4 emerging; agreed outcome measures
Undertaking regular fidelity reviews and action planning
Modelling the process of effective systematic implementation (based on the US Dartmouth – Johnson and Johnson Programme)
Leadership collaborative to Dartmouth US (Jan 2010)

Key features for successful implementation
Recruitment, training and supervision
Organisational commitment
Outcome and process measurement
Learning networks

Training and Supervision
Getting the right people in posts
Providing initial training – then on-going ‘field mentoring’
One full-time supervisor to no more than 10 employment consultants
One ‘State’ Trainer to 3 or 4 supervisors initially to reach high fidelity in all teams

Organisational commitment
Commitment to the goals and principles of EBSE
Coherent strategy for funding including ceasing funding ineffective services
Recovery-oriented mental health services
Inspiring leadership (local and strategic level)
Ability to make structural organisational change where necessary
Continuing education and training in IPS (practical understanding of the evidence base)

Measurement
Input, processes, context, as well as outcomes
Agree a common indicators set consistent with local purchasing requirements and national policies
Collection of good quality data requires time and effort
Set regular returns (monthly)
Use computer systems where possible
Feedback reports

Learning networks
Communities of practice – encourage collaboration and mutual support
Regular meetings
Reciprocal visits
Celebrations

Conclusions
Implementing EBSE is not difficult
Strong evidence base and clear quality criteria (fidelity scale)
EBSE is cost effective against alternatives
Is cost neutral if we stop funding ineffective alternatives and will bring long-term savings to health services
Requires training, but training as an ongoing learning/mentoring process
Requires good management and leadership
Sharing information about process and outcomes is a central driver for change

Thank you Helen Lockett [email_address] www.scmh.org.uk/employment

Sharing what works in the UK

by Centre for Mental Health on Mar 09, 2011

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