For all employers, existing workforce implications: 1 in 6 people - - PowerPoint PPT Presentation

For all employers, existing workforce implications:

• 1 in 6 people experience common mental health problems such as anxiety or depression at any one time (Singleton

et al 2001)

• Poor health is a cost to employers through both absenteeism and lowered job performance and critically affects

staff and their families.

• Harvard business school estimated cost of presenteeism to be between 2 to 3 times more than direct costs

incurred as a result of illness

• Sickness absence can cost roughly £495 per employee per year
• Estimated that £100 billion is spent each year on ill health absenteeism.
• EoE cost £10 billion every year.
• 172 million days lost each year
• Time lost to business approximately 13.8 million working days were lost in 2006/7 due to work-related stress,

depression and anxiety.

• If you start to suffer from stress you are more likely to report depression and other psychosomatic complaints,

resulting in greater need for recovery due to exhaustion and fatigue compared to workers without high levels of work-related stress.

• For those who have been out of work unwell for over six months all the evidence shows it is likely to be a long time

before they return to work with an 80 per cent chance of being off for five years.

• For those off work and claiming incapacity benefit for two years or more, they are more likely to retire or die than

ever return to work.

• Poor mental health is one of the most commonly cited reasons for claiming incapacity benefit.
• At the end of 2008 in the east of England over 175,000 people were claiming incapacity benefit as ill health was

keeping them from work. The government has pledged to get a million people off IB by 2015

CPFT Implications - Us as an NHS employer and influencer:

• EoE 175,000 claiming IB
• 38% = 66,500 with mental health problems
• 2500 employees
• 1:6 equates to 417 people experiencing mental health problems at any one time
• @£495 per person = £206,252
• This does not take account of presenteeism costs or associated psychosomatic complaints.

DWP research

• More than 90% of people with health problems can be helped to return to work by following principles of good

health care and work place management

• Simple measures could reduce long term sickness absence and long term incapacity benefit recipients by up to

60%.

• Two key strands:
• Healthcare which includes a focus on work – this means early intervention which is tailored to meet the

individual needs

• Workplaces that are accommodating – incorporating a proactive approach to supporting return to work and

the temporary provision of modified work. Social Policy Research Unit shown:

• with the right support people with mental health problems can get back to work and for many having a job may

actually help with their recovery.

• Many employers and employees are very supportive of mental health conditions.
• Employers keen to learn more about mental health issues and plan better for their return to work.

As a Health service provider:

• For the Long-term unemployed or those who have never worked they are between 2 & 3 times more likely to have

poor health than those in work.

• The unemployed are far more likely to smoke.
• and have been shown to drink more and have a higher likelihood of alcoholism and drug taking.
• Unemployment also decreases your physical activity and results in a higher level of obesity and weight gain.

Underpinning Research for mental health and employment:

• 70-90% people want to return to work (Grove, 1999; Rinaldi & Hill, 2000; Secker & Seebohm, 2001)
• 50% said they had not received any help (Healthcare Commission, 2007)
• People with mental health problems are less likely to be employed than any other group of disabled people
• Average employment rate 74% (ONS 2006)
• 47% for all disabled groups
• 21% for people with long-term mental illness
• Rates for severe mental illness much lower between 4 and 8% (Rinaldi & Perkins 2002)

Unemployment leads to a range of social problems:

• People with mental health problems are nearly three times more likely to be in debt
• One in four tenants with mental health problems has serious rent arrears and is at risk of losing their home
• Two thirds of men under the age of 35 with mental health problems who die by suicide are unemployed. (SEU 2004)
• Mental Health and Social Exclusion Report identifies employment and maintaining social contacts improves

mental health outcomes, prevents suicide and reduces reliance on health services.

Predictors of success

Assumptions – gulf between existing workforce and people with mental health problems;

• Already have a hard time recruiting and maintaining workforce, people with mental health problems will only make this worse

Work is too stressful - As compared to what? If you think work is stressful, try unemployment (Marrone & Golowka, 1999) Not ready / too ill - Diagnosis and symptoms do not predict success. Having previously had a job but wanting a job and believing that you can work are the best predictors of success (Grove B et al 2009)

• Client characteristics little impact on vocational outcomes (Bond et al, 1995, 1997, 2001; Grove, 2000; Meuser et 2004, Catty et al, 2007)
• No relationship between psychiatric symptomatology / disability outcomes of vocational rehabilitation (Anthony, 1984, 1995)
• Most studies show no relationship between employment outcomes and diagnosis, severity of impairment and social skills (Drake et al,

1994, 1996, 1999; Bond et al, 1995,1997, 1999, 2001;Meuser et al, 2004; Latimer et al, 2006; Burns et al, 2007)

• There is a relationship between hospitalisation history and work outcomes, the direction of causality is not clear
• Employment history is a robust predictor of work outcomes, but motivation and self-efficacy appear to be more important (Tsang et al,

2000; McDonald-Wilson et al, 2001)

• A large proportion of people with serious mental health problems can, with support, gain and retain open employment (Drake et al, 1994,

1996, 1999; Becker et al, 1998; Bond et al, 1995, 1997, 1999, 2001, Meuser et al, 2004; Latimer et al, 2006; Burns et al 2007)

• Around £140 million a year is invested by health and social care in vocational and day services but not all of these promote social

inclusion effectively and links to employment services such as job centre plus can be poor.

• Sheltered workshops: Universally poor vocational outcomes (Pozner et al, 1996; Grove, 1999, 2000)
• Pre-vocational training: No advantage in enabling people to move into competitive employment over standard care (Drake et al, 1994,

1996; Crowther et al, 2001, 2004)

Supported employment: More effective than pre-vocational training at helping people with severe mental illness to obtain and keep competitive employment (Crowther et al, 2001, 2004)

• IPS: when compared to other vocational interventions IPS is more effective in enabling people get real jobs with real wages, even for

service users who experience multiple problems in addition to their mental health problems.

What works – Vocational Services for people with severe mental health problems: commissioning guidance DH 2006

• Implement evidence based practice with vocational services, in particular, the Individual Placement and Support (IPS)

approach.

• Work towards access to an employment advisor for everyone with severe mental health problems
• Aim for the provision of vocational and social support to be embedded in the Care Programme Approach and

integrated into pathway teams

• Base provision around needs of the individual
• Establishing employment status on admission to hospital
• Supporting job retention
• Promoting involvement of carers and family
• Development of vocational and employment specialists embedded in secondary teams
• Strengthening links to key local partners, in particular Jobcentre Plus and education providers
• Promoting access to advice and support on benefit issues
• Monitoring vocational outcomes for people on CPA
• Monitoring employment rates of people with mental health problems within own organisation

Barriers to employment

• Financial disincentives
• Stigma and discrimination
• Negative thinking, Low expectation and a lack of resources
• Inflexible employment practices
• Inability/unwillingness to negotiate adjustments
• Lack of timely help

Evidence Based Supported Employment ‘Individual Placement & Support’ (IPS)

• Focus on competitive employment as a primary goal
• Eligibility should be based on the individual’s choice
• Rapid job search and minimal pre-vocational training
• Integrated into the work of the clinical team
• Attention to client preferences is important
• Availability of time unlimited support
• Benefits counselling should be provided to help people maximise their welfare benefits (Bond et al, 2008)