Mental Health and Employment: Current Policy Summary
August 2006
Mental Health and Social Exclusion Report (ODPM, 2004) • Challenge Stigma and discrimination targeting particular key groups including employers
• Promote best practice within the public sector Embed social and vocational support into the CPA process by establishing employment status on admission to hospital, supporting job retention, promoting involvement of carers and family, identifying lead vocational contract in secondary care teams, strengthening links to local partners, promoting access to advice on benefits issues, monitoring vocation outcomes, monitoring employment rates of people with mental health problems in their own organisation.
• Development of day services to promote access to mainstream opportunities Provision and testing of models of support through primary care
• Ensure training opportunities are available for people to become skilled in the provision of advice and support an vocational and social issues
• Improve access to employment programmes through programmes such as Pathways to Work, Access to work and New Deal
• Improve the transition form benefits to work by ensuring a flexible client based system is developed
• Promote enterprise by self employment
• Support and engage with employers and provide employers with tools and information to assist recruitment and retention of staff with mental health problems through the HSE management standards for stress at work, framework for Vocational Rehabilitation and Employer engagement strategy.
• Promote access to adult education and learning, further and higher education
• Remove barriers to community roles for example payment of service users for involvement in service redesign
• Recruiting, training and expanding the roles of clinical staff to deliver an extended range of interventions in community settings and workplaces.
• Commitment is made to develop capacity for return to work support and publish additional evidence on the effectiveness of vocational rehabilitation.
• Promise to map existing initiatives through cross departmental working groups
• Commits to ensuring people with health problems and disabilities have optimum opportunities to engage in work.
• There is also a focus on the management and prevention of problems within the workplace and assures that there will be an expansion of support for those with health problems in work and returning from sickness absence
Standards for better health (DoH, 2006)
• 7th Domain developmental Standard D13 requires PCTs to identify and act on inequalities by implementing programmes to improve health and reduce health inequalities
Vocational Services for People with Severe Mental Health Problems: Commissioning Guidance (CSIP, 2006)
• Review of evidence
• Outlines 5 key elements to a comprehensive range of vocational services for people with severe mental health problems:
• Clinical Employment leads within secondary services
• Employment specialists integrated within clinical teams
• Public services as exemplar employers
• Supported work opportunities
• Local partnerships between specialist and mainstream providers
• Provides Job description for employment specialist
From Segregation to Inclusion: Commissioning Guidance on Day services for people with mental health problems (CSIP, 2006)
Highlights key principles for refocusing day services in line with recent policy and guidance including:
• Promoting recovery
• Focussing on Community participation
• Reduce social isolation
• Offering opportunities for people with mental health problems to support each other and run their own services
• Maximise choice and self- determination
• Meet the needs of diverse groups
• Ensure services are accessible to people more seriously disabled by their mental health problems
• Involve service users and carers
• Increase diversity of provision
• Improve cross sector working.
Outlines 4 key functions of day services:
• Provide opportunities for social contact and support
• Support people to retain existing social roles, relationships and existing social/leisure activities that they value
• Support people to access new roles, relationships and mainstream social/leisure opportunities of their choosing
• Provide opportunities for people with mental health problems to run their own services
A New Deal For Welfare: Empowering People to work (DWP, 2006)
• Green Paper consulting on changes to benefit system to make participation in work related action plans mandatory for new health related benefit claimants, applying to all but the most severe conditions.
• Commits to the additional support both in gaining and retaining employment for clients and employers.
• Introduction of employment Support Allowance for all new claimants. Abolition of Incapacity Benefits for all new claimants.
• New mandatory work-related activity for all Employment Support Claimants- See attached report for implications for Mental Health service users, carers and professionals in County Durham and Darlington.
• Focus on three groups single Parents, Over 50s and Ill or disable People- most relevant is Ill or Disabled People.
• Mandatory work related activity would be introduced for all but those with the most serve disabilities. This will involve a range of activity from therapies to training and work placements.
• Importance of this agenda and Health Work and Well Being working together. Implications for individuals with mental health problems are significant.
A new Deal for Welfare: Empowering people to Work. Consultation Report. (DWP, 2006)
• Outlines public and professional support and concern for the above.
Welfare Reform Bill DWP (2006)
• Mandate of above
Budget 2006
• Chapter 6 ‘Increasing Opportunities for All’ – commitment for funding for ‘Pathways to Work’ roll out
Our Health Our Care Our Say (DoH, 2006)
• The white paper promises better support around mental health and emotional well being and commits to the establishment of demonstration sites for expanding psychological therapy to address retaining and returning to employment for people of working age with health problems and disabilities.
• Access to computerised CBT is to be improved and an appraisal of the programme carried out through NICE.
• Commissioning frameworks are to be improved to focus on services, which address prevention and early intervention.
• Highlighted the important of the Health Work and well being agendas, outlined below.
• Support is to be provided for G.Ps in training for fitness to work and though pilot of Occupational Helpline for G.Ps
• The paper highlights the importance of reducing stigma around mental health. Notes the SHIFT campaign as a vehicle for achieving this.
National Service Framework for Mental Health (DoH, 1999)
• Standard 1: Mental Health Promotion.
• Requires every care plan for people receiving care under CPA to address the needs of employment, training or other vocational activity.
• Requires service providers to reduce stigma and discrimination and increase employment opportunities as a means to this end
DWP plan for Vocational Rehabilitation
• Changes to conditions on which benefits for those out of work due to ill health will be granted
National Suicide Prevention Strategy
• Goal 2: To promote well-being in the wider community
The Joint Investment Plan: Welfare to Work for disabled People (DoH, 2000)
• Ensure independent sector and community based agencies support aspirations to work amongst disabled people, including mental health service users
Crosscutting issues in Public Policy and Public Service, full Report (1999)
• Chapter 3 deals with social inclusion
Saving Lives: Our Healthier Nation, (DoH, 1999)
• Commits to use of partnership working to tackle the wider determinants of health e.g. employment
The Health Act (DoH, 1999)
The Health Act, 1999 gives statutory bodies new powers to improve partnership working including
• Pooled funds - the ability for partners each to contribute agreed funds to a single pot, to be spent on agreed projects for designated services
• Lead commissioning - the partners can agree to delegate commissioning of a service to one lead organisation
• Integrated provision - the partners can join together their staff, resources, and management structures to integrate the provision of a service from managerial level to the front line A new commitment to Neighbourhood renewal: National Strategy action plan (SEU, 2001)
National Floor Targets for Reducing overall unemployment
Reducing gap between employment in excluded groups and overall rate and outlines the provision of funding to achieve this in key priority areas. Making it Happen: The Northern Way (ODPM, 2004)
New deal for communities partnerships are seeking to reduce unemployment, create new businesses, and raise household earnings. Projects include:
• Training and skills development;
• Provision of advisors;
• Child care facilities; and
• Business development interventions.
Helping people into employment- Pathways to Work (DWP, 2003) Consultation paper on the Introduction of Pathways to Work
10 High Impact Changes for Mental Health (CSIP, 2006)
• Treat home base care and support as the norm for delivery of mental health services
• Improve flow of service users and carers across health and social care by improving access to screening and assessment
• Manage variation in service user discharge processes
• Manage variation in access to all mental health services
• Avoid unnecessary contact for service users and provide necessary contact in the right care setting
• Increase the reliability of interventions by designing care based on what is known to work and that service users and carers inform and influence
• Apply a systematic approach to enable to recovery of people with long-term conditions
• Improve service user flow by removing queues
• Optimise service users and carers flow through an integrated care pathway approach
• Redesign and extend roles in line with efficient service user and carer pathways to attract and retain an effective workforce.
From Values to Action (DoH, 2006)
Recommends that :
• Mental health nursing should incorporate the broad principles of the Recovery Approach into every aspect of their practice.
• Mental health nursing should take a holistic approach, seeing service users as whole people and taking into account their physical, psychological, social and spiritual needs.
Health Work and Well Being – Caring for our Future. A strategy for the health and well-being of working age people (DWP, DoH, HSE, 2005)
• Commits to finding ways of supporting employees to get swift treatment so that they can remain in work.
• Support healthcare professionals to help people who are pout of work due to ill health and access specialist support in managing their condition and returning to work.
• Helping people avoid work related ill health through increasing access to occupational health support
• Appointment of a National Director for Occupational Health to oversee strategy implementation and develop appropriate outcome measures, raise awareness, lead national debate and develop innovative proposals for funding.
Choosing Health, Public Health White Paper (DoH, 2004)
• Commits to reducing barriers to employment and reduce inequalities through employment. Suggests programmes to Improve working conditions to reduce the causes of ill health related to work and to promote work environments as a source of better health.
• Supports the use of ‘Pathways to Work’ pilots and commits to the introduction of work based pilot programmes.
• States the governments obligation to lead by example on health and employment and commits to ensuring that national management training programmes equip managers with the tools necessary to protect the well being of their staff.
• Investment is promised in pre employment training and skills escalators to make employment in the public sector more accessible.
• Emphasises use of partnerships with HSE (Management Standards for Work related stress)
Independence Well-being and Choice, Adult Social Care Green Paper (DoH, 2005)
Makes a commitment to the development of Prevention, enablement and early intervention services, including: employment, training and access schemes; and the improved accessibility and take up of direct payments and Individual Budgets allowing individual service users to dictate they way in which funding is used to best meet their needs
Life Chances for Disabled People (Prime Minister’s Strategy unit, 2005)
The report make a number of recommendations including:
• Independent living through initiatives such as individual budgets to give disabled people more choice and control in their
• Improved support and incentives for getting and staying in employment.
Disability Discrimination Act-Amended (2005)
• The 2005 Amendments remove the requirement in the DDA that a mental illness must be ‘clinically well recognised’ before it can count as an impairment for the purposes of the DDA. Making it Happen: A guide to delivering Mental Health Promotion (DoH, 2001)
• Chapter 3 makes the case for mental health promotion within the workplace and makes recommendations for addressing mental health promotion within the workplace, highlighting the benefits of this and pointing to the potential problems that will arise if staff mental wellbeing is not taken account
• Care Programme Approach (CPA) must show plans to secure suitable employment or other occupational activity
• Service users must be made aware of their appropriate entitlement to welfare benefits.
• By March 2002, implement strategy to promote employment of people with mental health problems within health & social services.
• Recommends a strategy, action plan and local targets for reducing stress at work within local NHS organization and within the local authority. • Recommends links between NHS organizations and partners to promote social inclusion: through positive employment opportunities for people with a history of mental illness
• Recommends a programme of health promotion targeted at local employers and employment agencies through specific arrangements to support and promote the mental well being of people who have become unemployed or have experienced long-term unemployment operated by NHS and local authority organizations for their former employees and promoted to other employers and employment agencies.
Securing Health Together. HSC strategy for workplace health and safety in Great Britain to 2010 and beyond (HSC, 2004)
By 2010 interested parties will work together to achieve the following targets:
• a 20% reduction in the incidence of work-related ill health
• a 20% reduction in ill health to members of the public caused by work activity
• a 30% reduction in the number of work days lost due to work-related ill health
• everyone currently in employment but off work due to ill health or disability is, where necessary and appropriate, made aware of opportunities for rehabilitation back into work as early as possible; and
• everyone currently not in employment due to ill health or disability is, where necessary and appropriate, made aware of and offered opportunities to prepare for and find work.
Mental Health and Employment in the NHS (DoH, 2002)
Relevant Principles laid down include:
Selection should be based on the best person for the job.
• Every assessment for a post is specific to that situation;
• All NHS staff should have a pre employment health assessment;
• NHS employers should ensure their policies and procedures comply with the
Disability Discrimination Act 1995;
• No applicant should be refused employment on health grounds unless expert occupational medical advice has been sought;
• No person should be refused employment, or have their employment terminated on mental health grounds without the NHS employer first having made any adjustments that it would be reasonable to make in relation to that person in accordance with any duty placed upon them by the DDA
• All NHS staff need help to develop an awareness of their own mental health, when to seek help and from whom;
• The NHS needs to develop a culture where staff can be open about their mental health status, are treated fairly and are encouraged to seek help when it is needed; From Here to Equity (NIMHE, 2004)
Target Audience Priorities 2 and 3 to work with public sector, private, voluntary and professional sectors to help them reduce stigma and discrimination in their employment practices
The NHS Plan a plan for investment, a plan for reform (DoH, 2000)
Developmental of LSPs to increase partnership working on issues such as health and employment. Commits to 1000 graduate m\mental health workers to provide support in primary care for common mental health problems. Commits to the introduction of early intervention teams to reduce to period of untreated psychosis in young people.
Mental Health Policy Implementation Guide (DoH, 2001)
• Providing a pathway to valued education and occupation vocational assessment should take place within 3 months of referral. An education or training plan/pathway to valued employment should be produced within 3 months.
• Formal links with key agencies and schemes such as local careers advisory services, Connexions, New Deal, Training and Enterprise Agency, Further Education Colleges, voluntary organizations, etc. must be established.
• Early referral is vital. The longer an individual remains out of work/education in the early phase, the harder it becomes to gain employment/participate in education later on.
European Employment Strategy (European Commission, 2005)
• Guideline No. 18: Promote a lifecycle approach to work
• Guideline No 19: Ensure inclusive labor markets, enhance work attractiveness and make work pay for job-seekers, including disadvantaged people and the inactive
• Guideline No. 20: Improve matching of labor markets needs
• Guideline No. 21: Promote flexibility combined with employment security and reduce labor market segmentation, having due regard to the role of the social partners
• Guideline No 22: Ensure employment-friendly labor cost developments and wage-setting mechanisms
• Guideline No. 23: Expand and improve investment in human capital
• Guideline No 24: Adapt education and training systems in response to new competence requirements
Commissioning A Patient Led NHS (DoH, 2005)
• Outlines detailed proposals for Practice Based Commissioning which will allow G.P. practices to commission services (Previously commissioned by PCTs) to meet the needs of their local population including improving patient pathways, working in partnership to create community based services.
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