Mental Health and Support into Employment: Is it Working?

research in the newsAs the recent report from the Mental Health Taskforce points out, only 43% of people with mental health problems are in work, compared with 65% of people with other health conditions, and 74% of people in the general population. The figures are far lower for people with severe mental illness – for example, the employment rate for people with schizophrenia is around 8%.

The current programme of welfare reforms are aimed at moving working age people off benefits and into paid employment. For anyone relying on Employment Support Allowance, the main benefit for people who are unemployed due to a physical or mental health condition, this can mean undergoing a reassessment of their eligibility. The Work Capability Assessment (WCA) or ‘fit-for-work’ test has attracted a lot of attention in the press, much of it negative. First, there are claims that there has been a failure to adequately assess the impact of mental health on ability to work, and although changes have been made to respond to these criticisms, it appears that there are still question marks over whether the tests are fit for purpose.   Second, the impact of the test itself has the potential to cause deterioration in mental health. While much of the evidence to support this has been anecdotal in a recently published research study that also attracted attention from the press, Barr et al (2015) found a link between the WCA and rises in suicide rates, self-reported mental health problems and antidepressant prescribing rates. That is, where a higher percentage of the population in a local area were subject to the WCA process, there was a greater increase in these three mental health outcomes. Although the study controlled for variables that might have had an impact on the findings, such as deprivation and long-term mental health trends, it was not able to make a direct link between the people undergoing the WCA and those experiencing the adverse mental health outcomes. Nevertheless, the authors believe that the study provides sufficient evidence for a policy rethink.

Yet many people who have a mental health problem do want to find and stay in employment, and workplaces and back-to-work programmes need to understand and respond to the impact of mental health problems and the kinds of support that are genuinely helpful.

One evidence-based approach to supporting people with long-term mental health needs to get into work and stay in work is the Individual Placement and Support (IPS) model. The IPS model is based on the idea that not only is it possible for most people with a long term mental health needs to work, but that work itself is therapeutic. The model provides support aimed at rapidly finding paid, competitive employment, and continuing to support the individual once they are in work. It is also based on integrating employment support with clinical support. Developed and shown to be successful in the United States, it is increasingly being used in the UK. While to date the success rates have not matched those in the US – and it is suggested that there are some important differences between the two contexts to explain this – work to implement and evaluate the model continues. We are interested in this model because of our own work in this area. We are fortunate enough to be working with the Centre for Mental Health, Trust for London and the DWP on a project called “100 People into Employment”, evaluating a pilot programme based on the IPS model, aiming to support people with schizophrenia or psychosis into employment. As part of this project, we are undertaking a longitudinal study, interviewing people with schizophrenia or bipolar disorder about their experiences of being supported to find and stay in work. Through this project we hope to develop an understanding not just of the ways in which the IPS model can be adapted, but more broadly of the journey into work for people with long term mental health needs; to understand more about what it is like, what is most helpful, and to celebrate their successes.

There are multiple facets to the relationship between work and mental health and supporting people at whatever stage of their journey requires joined up thinking. This is something the McPin Foundation wants to continue to engage with and understand. Tell us what you think are the important areas for research.