IPS: what is it and how do you flog it?! Rachel Perkins

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Employment is important for personal identity and as a source of friends as well as improved income and the benefits this brings. Individual Placement Support (IPS) must deliver the 7 principles of evidence-based employment e.g. we must focus on real employment not voluntary work. The combination of clinical support alongside employment support is vital and we must retain the opportunity to work with anyone who wants to give it a try.

Text of IPS: what is it and how do you flog it?! Rachel Perkins

  • 1. Individual Placement and Support evidence based supported employment:What it is and how to flog it! Rachel E. Perkins BA, MPhil (Clinical Psychology), PhD, OBE Freelance Consultant and Trainer Recovery Employment Participation Mind Champion of the Year 2010[email_address] 3 rdMarch 2011

2. We know its important ...

  • For some of us, an episode of mental distress will disrupt our lives so we are pushed out of the society in which we were fully participating.For others, the early onset of distress will mean social exclusion throughout our adult lives, with no prospect of training for a job or hope of a future in meaningful employment.Loneliness and loss of self-worth lead us to believe we are useless, and so we live with this sense of hopelessness, or far too often choose to end our lives.(SEU,2003)
  • It is good for our health: employment reduces mental health problems and decreases the likelihood of relapse
  • It links us to the communities in which we live and enables us to contribute to those communities: the opportunity to contribute is central to recovery
  • It provides meaning and purpose in life
  • It affords status and identity
  • It provides social contacts
  • It gives us the resources we need to do the other things we value in life

3. We know what weve got to do ...

  • The 7 key principles of individual placement with support
  • evidence based supported employment
  • Competitive employment real jobs and a can do approach
  • Eligibility based on client choice help anyone who wants to give it a try
  • Integration of employment support into support and treatment plansfrom the start employment specialists in support and treatment teams and employment integrated into the work of all mental health workers
  • Job search based on client preferences
  • Rapid job search place-train rather than train-place
  • On-going supports for both employee and employer
  • Benefits counselling

4. We know it works when we do it properly ...Competitive employment rates in 16 randomised controlled trials 5. So why arent we always doing it?

  • Four inter-related problems
  • A culture of low expectations
  • Fear
  • Failure to provide the sort of support we know works
  • Failure to implement it properly

6.

  • A continuing culture of low expectations
  • Low expectations on the part of health professionals, people with mental health conditions, employers and society as a whole (its a well known fact that people with schizophrenia cannot work)
  • Ignorance of research evidence
  • Disbelieving research evidence Yes, but ...
    • Yes, people with mental health conditions can work BUT my clients are different...
    • Yes, it may work elsewhere (in the USA, in London ...) BUT it is different here ....

Expert professionals say that people with mental health problems are unlikely to be able to work Employers believe that people with mental health problems cannot work so dont employ them People with mental health problems believe that they cannot work and give up trying to get jobs Very few people with mental health problems in employment A conspiracyof low expectations 7.

  • Fear on the part of professionals, individuals and employers
  • that getting a job worsen the persons mental health
  • that people will not be able to work
  • that getting a job and moving offbenefits will make the person worse off
  • that if it doesnt work out this will leave the person worse offpersonally (the impact of failure) and financially
  • Failure to provide the support we know works
  • people with mental health problems not seen as a priority for employment service programmes
  • employment not seen as a priority for mental health services
  • in challenging economic times we cannot afford it
  • challenges sacred cowsand established ways of doing things:
    • you have to be better before you can go back to work
    • you have to build up your skills and confidence in a safe, segregated setting before you can go back to work
    • staff and service users and local politicians investment in existing services

8.

  • Failure to implement it properly
  • With IPS the higher the fidelity to the model the better the outcomes
  • Is employment really considered as a core part of assessment and support planning for everyone of working age from the start?
  • Are employment workers really integrated into the teams there at assessment and review meetings, writing in the same notes ...?
  • Do we really have a can do attitude?
  • Are we still selecting who we help on the basis of our judgements about employability?
  • How good are we at job-finding?
  • Do we really know our local employers?How good are our relationships with them?How good are we at supporting them?
  • How good is the advice and information we offer about benefits?
  • How can we really provide ongoing support in a situation where long-term support is not provided in secondary mental health services? (use of Access to Work?)
  • So how can we flog it? How can we make it happen?

9. Understanding the context:The times they are a-changing

  • An increased attention to mental health and employment
  • An unholy alliance between therapeutic radicals and fiscal conservatives
  • Increased concern about the HEALTH, PERSONAL and SOCIAL costs of unemploymentand the right to work
  • AND
  • increased concern about the ECONOMIC costs of welfare and the rising number of people with mental health conditions receiving out of work benefits

10. Less state direction and provision

  • Centrally directed outcomes but not inputs/processes
  • Desire to increase range of providers voluntary and charitable sector, private sector, less provided directly by the state
  • More control to individuals and communities:
    • Localism and local decision making
    • Personalisation and individual health and social care budgets, right to control trailblazers

11. A new mental health strategy No Health Without Mental HealthFebruary 2011 Employment central to mental health and central to mental health services Six core shared objectives - Objective 2 More people who develop mental health problems will have a good quality of life greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, the skills they need for living and working, improved chances in education , better employment ratesand a suitable and stable place to live. 12. An outcomes framework

  • Public Health Outcomes Framework:Key indicators for Domain 2 (Tackling the wider determinants of ill health tackling factors which affect health and well-being) include:
  • the proportion of people with mental illness and/or disability in employment.
  • The NHS Outcomes Framework : Improvement areas for Domain 2 (enhancing the quality of life for people with long-term conditions) indicator is
  • employment of people with mental illness.
  • The Adult Social Care Outcomes Framework:Outcome measure for Domain 1 (Promoting personalisation and enhancing quality of life for people with support needs) outcome measure for enhancing quality of life for people with mental illness
  • the proportion of adults in contact with secondary mental health services in employment.
  • It tells us we have to increase the employment rates of people with a mental health condition BUT it does not tell us how to do it

13. Breaking the Conspiracy of Low Expectationsand Decreasing Fear

  • Demonstrating to clinicians, service users and employers that work is a realistic possibility for people with mental health problems.
  • Making research evidence accessible but seeing is believing - need local examples of success collecting and publicising journey to work stories
  • Demonstrating what works to clinicians, managers and commissioners.
  • Making research evidence accessible but again seeing is believing visits to services where IPS has been implemented
  • Showing clinicians they have an important role.
  • A critical part of the solution, not a problem.
  • Increasing consumer demand
  • Making service users aware of what they should be able to expect in the way of employment support providing them with the evidence

14. Surviving and Thriving at Work-toolkits for individuals and employers A Work Health and Well-BeingToolkit Going Back to Work After a Period of Absence(author Rachel Perkins, published by RADAR The Disability Rights Organisation) available from[email_address]

  • Knowing and supporting employersproviding an ongoing point of contact for help and