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North East Mental Health and Employability Statement of Priorities

INTRODUCTION

This Statement of Priorities has been drawn up by regional agencies involved in supporting people with mental health problems¹ into employment. It sets out recommendations to improve employment opportunities for people with mental health problems, for the benefit of those individuals, their employers and the region’s economy. A list of agencies involved in the Mental Health and Employability Steering Group which oversaw the development can be found in Appendix A.

In this statement of priorities the Mental Health and Employability Steering Group have identified a number of common issues and have developed four key overarching priorities aimed at addressing the multi-facetted barriers which currently prevent and deter individuals with mental health problems from engaging in employment. This document and its supporting evidence form part of the Regional Employability Framework (REF) for the North East. The REF provides an overall strategic framework, to which this statement of priorities adds a policy vision within that framework that is focussed on the needs of people with mental health problems. This Regional Framework is intended to provide clarity and direction through which localities can respond to local need.

POLICY CONTEXT

There has been a significant amount of attention given to the issues of employment and health nationally in the last five years. The Department for Work and Pensions and Department of Health alike have demonstrated, through a raft of national policy and guidance documents, a commitment to address employability and ensure our work is good for the health of the people living in this country.

An overview of the key policy documents, relating to and useful for, addressing mental health and employability is provided in the supporting information (please click on the link to download a copy of report 1 ‘Current Policy and Guidance Picture’ and 1A ‘Policy and Guidance Overview Appendix A). Comment on the content, accessibility and authority of the policy portfolio is also provided, the key content of which included:

• The promotion of best practice within the Public Sector as an employer

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

• The engagement of Private Sector employers and provision of support to develop healthy and accessible workplaces

• An overhaul of the way in which benefit claimants are assessed and allocated support and a reduction of the numbers of Incapacity Benefit claimants nationally and in high claimant areas.

• An increase in access to mental heath support within primary care through counselling and self help

• The development of occupational health provision

• The development and use of multi-agency partnerships

• A crosscutting priority to tackle stigma and discrimination

The prevalence of policy and national guidance relating to mental health and employment has increased significantly in the last five years demonstrating the recognition by the current Government of the scale of the problem. A number of issues regarding the policy portfolio are discussed in detail in the report which are largely concerned with the authority with which recommendations are made, particularly those aimed at the NHS which come without targets or ring fenced funding. As a result, and as evidenced by the local studies, these documents are not currently being effectively implemented. Many of the issues and concerns raised in the study sites (below) are those which have been addressed by policy and guidance, however without the clear incentive to implement this the problems remain despite the tools to address them being available.

EVIDENCE OF NEED

It is recognised that mental health and employability is a significant issue both regionally and nationally.

Rates of employment amongst individuals with mental health problems are the lowest of any group covered by the Disability Discrimination Act and make up a significant percentage of those in receipt of Incapacity Benefit

The number of people claiming Incapacity Benefit because of a mental health problem has almost doubled in the last decade (Sainsbury Centre, 2004) with around one third of new claimants citing mental health as the primary cause of the incapacity (DWP, 2006)

Individuals with mental health problems have lower employment rates and higher non-employment rates than the population as a whole. The estimated total lost output from these lower employment rates is in the order of £9.4 billion. (DWP Overview of Mental Health and Employment in the UK, 2006)

Mental Health Problems are a significant cause of sickness absence

The estimated number of working days lost in 2004/05 due to stress, depression or anxiety was 12.8 million (Health and Safety Statistics 2004/05.) The CBI has recently estimated that time off work from depression, anxiety and stress costs the economy around £4 billion a year in lost output. (DWP Overview of Mental Health and Employment in the UK, 2006)

Work-related stress alone accounts for over a third of all new incidences of ill health (Health and Safety statistics 2004/05)

Work can provide significant benefits in obtaining and maintaining good mental health

“Enabling people to retain or gain employment has a profound effect on more life domains than almost any other medical or social intervention” (Boardman et al, 2003)

“Meaningful occupation is a critical factor in clinical improvement, improved social functioning and reduction of symptoms” (Grove, 1999)

Work can be a significant factor in people staying out of hospital and reducing their use of medication and day treatment centres (McKeown et al, 1992)

The North East has a number of specific issues in relation to mental health and employment including:

Having some of the lowest levels of employment in the UK, with significant differences at sub-regional level.

Nearly 1 in 5 of the working age population claiming state benefits relating to work (Adams, 2005)

The most common cause of Incapacity Benefit claim being mental and behavioural disorders accounting for 39% of all claims (DWP, 2005)

Hosting significant numbers of communities and households in which employment is not the norm with more than a quarter of the streets being concentrations of worklessness. (Adams, 2005)

STRATEGIC PRIORITIES

In light of the regional and national picture and based on the research outlined in the supporting information, the North East sees it as a priority to:

1. Engage and work more effectively in partnership, placing the views and contributions of service users at the centre of the partnerships.

2. Address cultural factors, encourage positive attitudes from employers and affect broad societal change tackling the negative contribution that stigma and discrimination play in employability through targeted and effective education, awareness raising and training

3. Ensure local need assessments and meaningful outcome measures are embedded in commissioning to enable effective distribution of resources and maximise the opportunities of new funding arrangements in health and social care

4. Develop and maintain joined up responsive services which work in the most effective and efficient way to meet locally assessed need and ensure services can access the right tools to provide a quality service

To ensure that actions to help people with mental health problems to move into sustained employment are embedded across the Regional Employability Framework (and that the Regional Employability Framework is updated to reflect those actions) we seek to ensure that the following arrangements are in place:

Engagement: developing a joined-up approach to encouraging people with mental health problems, where appropriate and with due support, to consider and actively move towards appropriate employment as part of their care. Ensuring that there is close liaison of health and social care partners with employment support agencies

Case management: ensuring that the transition between health and social care support and employment focussed support is carefully managed in a client-centred way

Employability services: assessing employability services to ensure that they meet the needs of people with mental health problems, and seeking to gap fill to meet specific unmet needs where necessary

Job Placement: working with employers to address and overcome any perceived or actual barriers that might prevent employers from taking on people with mental health problems

Aftercare & retention: maintaining support for both employers and employees with mental health problems to address any issues arising and minimise the risk of those who obtain employment not sustaining it.