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Current Policy and Guidance

Policy & Guidance Overview

Review of Literature

Service Mapping

Mental Health & Employment

Terms of Reference

Statement of Prorities

Sunderland Vocational Partnerships

Local Study Cover Report

Final Service User Employment Report

Local Study Thematic Report Voluntary and Statutory Sector

Local Study Thematic Report Private Sectors Employer Report

Region Wide Electronic Consultation Report

Developing North East Mental Health and Employment Strategy Consultation Event

Meetings & Minutes

RAG RATING RET SOP ACTION PLAN

RET Map May 2008

Mental Health and Employment the Current Policy and Guidance Picture June 2006 (England)

1. Introduction

A search has been undertaken on the major national Policy and Guidance documents which provide a picture of the current political priorities in relation to mental health and employment. Provided below and in Appendix A (Policy and Guidance Overview) is an overview of these documents highlighting key relevant priorities and delivery partners. Comment is also provided on the relevance and influence of a number of recommendations and targets.

2. Main Themes

There are a number of key themes, which are recurrent in a number of policy and guidance documents:

•Promoting best practice within the Public Sector

•Development of specialist mental health services to better address the vocational needs of service users

•Engaging with employers and improving working conditions/mental health promotion within the workplace

•Altering the way in which benefit claimants are assessed and allocated and developed

•Increasing access to mental heath support within primary care

•Development of occupational health provision

•Development and use of multi-agency partnerships

•Tackling stigma and discrimination

3. Stakeholders

Key Policy Agents

In coordination and delivery of the agenda are National Health Service, Department of Work and Pensions, Employers, Local Strategic Partnerships,

Partners

Service Users and Carers, Employers, Health and Safety Executive, Employer Coalition, Regional and Local Government, Learning and Skills Council, Regional Development Agency, Voluntary and Community Sector,

4. Key Issues

4.1Quality and Authority of Recommendations and Targets

Recommendations for developments within the NHS are largely aspirational, advisory and unclear. For example, Choosing Health (DoH, 2004) highlights good practice without providing any authoritative priorities for public health in relation to mental well being and employment. Additionally, the guidance for the development of day services and vocationally focussed services for mental health service users(CSIP, 2006) provides excellent quality information with clear structures and processes for improving vocational outcomes for service users within specialist mental health trusts, however, what it fails to provide is the incentives necessary for many trusts to follow the guidance i.e. target related performance management against the development of vocationally focussed services. Additionally Health Work and Well-being(DWP, DoH, HSE, 2005) makes a number of commitments of what will be provided centrally e.g. funding for pilot programmes and a national Director for Health and Work, without stating with any authority what PCTs and their partners must achieve. In documents which have a strong performance management focus e.g. Standards for Better Health(DoH, 2006); the activity in relation to mental health and employment comes only under developmental areas of work as opposed to forming part of the core activity. Where mandatory activity is outlined e.g within the National Service Framework(DoH, 1999), the activity often fails to take full advantage of that which could make a measurable difference e.g mandatory employment element within Care Programme Approach documentation is positive but, without addressing the structures necessary to access any opportunities coming out of these discussion, this could become a paper exercise. In contrast documents led by DWP are able to have a much clearer outcome focus with clear proposals for how changes in structures will take place e.g. addressing the way in which benefits are calculated and the voluntary and mandatory components of the benefits process.

4.2 Priorities and Financial Restraint

The need to improve both engagement with employers and the delivery of mental health promotion within the workplace requires significant capacity and investment. Within the Local Strategic Partnership framework, PCTs are well placed to provide a lead role on this issue, possibly through public health improvement teams. However, to develop this capacity in the policy climate described above, where other public health priorities e.g. sexual health and stop smoking services have very clear performance management indicators and targets, may prove difficult. In spite of the high profile given to mental health and employment in recent policy and guidance, only a clearer link to meeting performance indicators can ensure investment from within PCTs.

4.3 Key Levers

The most prominent multi-agency targets, and perhaps the most useful to draw upon, given the need for complex partnership working to achieve it, are the National Floor Targets in relation to employment and health. Of particular relevance is the fact that several North East areas have set targets to reduce the gap between unemployment of the most disadvantaged groups and that of the overall population, as one way of meeting these national targets. The key drivers for these targets are the Local Strategic Partnerships, which provide access to a number of key agencies in delivering on this agenda. However, contributions to LSPs are lacking in some areas from specialist mental health services and employers. If this agenda is to be comprehensively addressed there needs to be formal engagement between the two.

4.4 Profile

Despite the above policy and guidance picture lacking authority in places, what is clear is that the profile of mental health and employment has risen significantly in the last 5 years. Although policy makers may be unsure of the most effective way to manage and measure performance in this area, there is evident recognition that, without addressing mental health and employment, the government will fail to address a number of the core functions of the NHS, of DWP and of others ( e.g. improving health, reducing health inequalities). The significance of this realisation, and the influx in policy and government recommendations that comes with it, ought not be underestimated.

5. Existing Opportunities

There are undoubtedly existing opportunities to use national policy and targets both directly related to and relevant to mental health and employment. These include:

• Clearer information sharing and action planning between partners on how there activity can directly and indirectly influence those targets which do have stringent performance management attached to them e.g. numbers of bed days in acute in patient i.e. making it clear how partners can tick each others boxes.

• Careful planning to ensure the opportunities of commissioning are fully exploited as the PCTs widen their commissioning role. With particular reference to the growing role of the voluntary and community sector in providing core, performance managed services.

• More effective and utilisation of the voluntary sector. Much of the support provided for individuals is currently delivered by the voluntary sector. However, without a clear understanding of how their activity is relevant to policy context, existing local activity and statutory provision, such programmes, whilst successful in some areas, are not exploiting their full potential nor will statutory bodies be able to gain the full benefit of their local voluntary and community infrastructure.