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Local Practice
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Developing a North East Mental Health and Employment Strategy Consultation Event – Wednesday 25th October 2006 – facilitated by Andy Cox – Economic Partnerships Ltd. The event attracted 12 people who use mental health services and are currently in paid work. Individuals had experiences of severe and mild to moderate mental health problems, were from a cross section of the north east and in a significant position to answer the following; Questions/discussion areas shaping event: What are the barriers to employment for people with mental health problems? What are your solutions based on your personal experiences? Can you give examples of areas of good practice? Are there any messages you would wish to give those who invest in “back to work” schemes? Could you identify any mental health friendly employers? With justification. What models are out there that we ought to replicate? Can you share thoughts on Retention! Well Being! Self Determined! Maintenance Models! Work Life Balance! Notes were taken by an independent person. The following themes came out of the consultation event; Employer’s reluctancy to employ people with mental health problems. Users were particularly referring to SME’s who they thought were worried about an individuals ‘relapse’. Little sympathy was shown for public sector bodies such as Health & Social Care orgs who did not actively recruit from the target group ~ and were seen as having sufficient resources, an explicit responsibility to be ‘inclusive’ as well as an expertise to handle their employees mental health and employment. Whilst employer’s (SME’s) main worry was seen as the potential increase in sickness costs, user’s main concern was the lack of flexibility with the 9-5 mentality for those suffering from the effects of medication. Employers need to be encouraged to make individual accommodation within employment practice. Need for guidelines on how to employ & retain workforce. Users felt that small businesses lacked the motivation and immediate access to appropriate (& to scale) ‘solutions’ to be good employers of people with mental health problems. A suggestion was that industry ‘clusters’ may benefit from say a ‘social enterprise’ staffed by ‘champions’ (and not celeb’s) who can offer real practical solutions on how employers can support staff with their mental health. Guidelines (including the assessment of policies & procedures) could be implemented by voluntarism and an awards scheme be developed to celebrate ‘responsible’ employers. Mental health awareness raising for potential employers. There is a need to sell the benefits of employing people with mental health problems. Users argue that they offer diversity and significant life experiences which add value to organisations. In the end, users felt that it had to be employers and their trade associations who had to convince the less advanced organisations to ‘open-up’ to the opportunities of employing people with mental health problems. There was significant agreement that an awards scheme which rewarded employers who ‘normalised’ the whole process ~ i.e. where it comes naturally rather than driven by policy or by a contrived culture was key. Users felt that mental well-being needed to be made ‘sexy’ rather than portrayed as a stigmatised illness. Collecting examples of good practice. All were particularly concerned that the subject ‘mental health and employment’ had created an industry of so called experts, most of whom had not created sufficient impact to justify their existence. It was felt that whilst it might be difficult to pull together an all encompassing source for the storing of employment models, research and practice that it would be helpful to have one central point for those looking at developing or replicating good practice. A number of successful employment schemes in the north east were identified by participants as having either helped or inspired them into work. E.g. Cap-A-Pie, Coffee Life, MHM telephone helpline, and the new PNE micro-enterprises. Some felt Mindful Employer and Pathways to Work had shown signs of success particularly for those with mild problems. Users felt that social enterprise ought to become a champion ‘sector’ for promoting employment for marginalised groups like people with mental health problems. Benefits system and incentives (win/wins). Whilst the benefits trap was a topic of discussion and in particular the need for individuals to ‘hold’ onto DLA and SP (according to individual need) benefits whilst gaining employment ~ so that ‘better off’ calculations were able to show positive results. Universal cut-off points became a disincentive, and needed to be re-thought. Users were unanimous about the value of offering ‘incentives’ to employers but which followed an individual (Finland was cited as having such models). The idea of developing a buffer for potential mental health sickness for employers was suggested to overcome employer worries about ‘relapse’ in employment. This would also offer comfort to an individual even though in most cases the buffer would not be used. A three month salary buffer (per annum) was suggested but could only be drawn down via an agreement between an employer and the individual (or trustee). Benefits system needs to follow new paths eg; people who retire find it a shock to go from 5 days to none, people with mental health problems find it difficult to go from 0 days to 5.There needs to be a transparent transitional period linked directly to what people need. Maybe potential retirees and people moving into work need to support each other. Public sector services. Users questioned the role of CMHT’s and the fact that individuals were seen as patients and not potential workers. This they thought was an instrumental barrier to an individual gaining employment. Some individuals who have worked with nurses in NHS said that they would prefer to admit that they had an STD than a mental health problem ~ owing to the NHS macho-culture. This they believed was the reason why mental health and employment schemes ought to be ran independently outside NHS/Social Care. However, some colleagues working for NHS/Social Care thought that this would be an excuse for Health/Social Care organisations to ditch day services & save money ~ they wanted to see partnerships to bring about reform (i.e. a planned approach to transfer and transform). All welcomed DWP ‘Pathways to Work’ new tendering guidelines to attract independent sector deliverers. However, there was an acknowledgement that providers of employment & training services to people with mental health problems ought to prove their expertise within the mental health field i.e. show some form of accreditation. Employment programmes needed to concentrate more on impact than on outputs ~ outputs leads to ‘cherry picking’ and ignoring those with greatest support needs who may have most to offer. Political. There was a general feeling that the current ‘governmental’ focus for getting 1m people off ICB was by fear. Such an approach would have the opposite effect and put more pressure back onto primary and specialist mental health services. A targeting of those who genuinely want to go back to work with severe mental health problems and wrap ‘bespoke’ services like direct payments or individual budgets was seen as key. An over emphasis is being given to getting back to work via employers and an under emphasis on being your own boss. Similarly an over emphasis on full time work and an under emphasis on part-time work and utilising the flexibilities of a workforce made up from people with mental health problems. A number of users were confused by CBI’s take on mental health. They appear to say the right thing when prompted but fail to do much about encouraging their members about the real benefits of employing and retaining a diverse workforce. Mental Health paradigm. Lord Layards paper on CBT centres was discussed and in particular the approach of CBT rather than drug treatment keeping people out of specialist NHS services and in a job. The spin-off savings for the economy and NHS is forecasted as significant. However, for those with more severe mental health problems a similar argument could be given e.g. when an individual has a meaningful occupation their demands on Care/NHS reduces, their esteem increases and they can make a significantly greater economic contribution. Maybe Layards argument supports this approach also. Again users were keen to point out to investors in work preparation and ‘back to work’ schemes the value of counting an individuals increased economic activity rather than whether they have a full-time job or not. Some felt that a social accounting tool needed to be developed to measure the impact of this. It could sit within the ‘Guidelines on how to employ & retain workforce’ toolkit. Much was discussed with regard to self sustaining tools of mental well-being and the fact that there is evidence about its value for mild and moderate mental health problems but of very little value to those most severely affected. Basically, users were keen to say that much attention, quite rightly so, is being given to mild to moderate mental health management, however in so far as severe mental health ~ services are not joined up, don’t provide what users need and clearly don’t offer much prospect of providing the right atmosphere to get people back into work.
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