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Local Practice
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North East Mental Health and Employment Local Study Thematic Report: Voluntary and Statutory Sector Background As part of the wider local study exercise (see overarching study report) key individuals were identified from within local voluntary and statutory organisations and invitations to participate in a short interview were extended. Some prospective interviewees declined/postponed/did not respond, others passed on the invitation to individuals who they felt were more appropriate to participate. Those who participated in the process included: Specialist Mental Health Trust: Directors, Service managers and front line staff, Voluntary Sector: managers and front line staff, and coordinators Primary Care Trust: Public Health Manager and Service Managers Local Council: Local Strategic Partnership coordinators, managers and human resource staff. Key Themes and Trends Joined Up Working Interviewees consistently reported a lack of joined up working in relation to supporting individuals back to work, specifically so in relation to individuals with mental health problems. This causes problems to a greater or lesser extent in each area issues in relation to the following:
Knowledge of Services, Support and Legislation A contributing factor to the above is that often organisations were not aware of the existence of potential partners. In some cases this extended to little knowledge of the existence of local strategic partnerships. Essentially this has resulted in services being available which meet specific client needs but which are not accessed. Additionally some services are struggling to meet the needs of their client group whilst the expertise to do so is left untapped on their doorstep. A common example of this is services not being competent to advise on the flexibilities available in the benefits system and the implications for benefits during the transition to employment, whilst each area has dedicated welfare rights teams who are experts in this field. Lack of Capacity, Training and Resources There were significant concerns in relation to the capacity of staff to respond to the vocational needs of individuals with mental health problems. This was apparent both in the ability of specialist mental health professionals vocational skills and in the mental health knowledge and skills of JobCentre Plus staff. In particular, Disability Employment Advisors felt that they were seen as the on site experts in this field when in reality mental health training for DEAs is limited. Information Sharing Information sharing between services in some areas was poor for a number of reasons including client confidentiality. However, this led to a number of problems including inappropriate referrals between specialist mental health and generic employment services. Additionally the lack of client information available within generic employment services meant that untrained staff were making uninformed judgements about individuals mental health and the implications of this for employment. A fuller understanding of the role of partner services and formal referral protocols between services could assist in addressing some of these issues. Additionally there are significant pockets of good practice within the study sites; there must be a formal mechanism for this to be shared across the region. Causes of Unemployment and Barriers to Work On the surface the main cause of unemployment in each of the areas is poor health. However, the true reasons why those individuals are not in/seeking employment are wide ranging from issues with housing, drug and alcohol problems, confidence levels, accessibility and responsiveness of services and the impact of common mental health problems which often had work as a causal factor. These multiple causal factors make clear the need for the availability of a wide range of support which adopts a flexible person centred approach to supporting individuals into employment. Additionally it was widely held that the stigmatised views of employers and the discrimination which many professionals had witnessed was a significant barrier to individuals returning to work, there were also concerns that individuals would be supported to a “job ready” point and then be unable to complete their employment goals/maintain employment as a result of discrimination. The benefits system was also a significant concern on two counts. Firstly there was a poor understanding of the flexibilities within the benefits system and the implications of the transition to employment for an individual financially. Secondly the way in which the benefits system is currently administered meant that several professionals had begun work with service users on a gradual transition to employment, as a result of which benefits had been stopped. The effect of this on service users had been significant, with several accounts of this process resulting in individual withdrawing from support altogether, despite engaging in successful appeals. In these cases the welfare rights teams were accessed to support appeal claims to reinstate benefits. It is questionable whether if this expertise was accessed at a different point in the system individuals would have to go to appeal at all. For example, if the expertise in relation to receipt of benefits during the transition to employment and the part recovery plays in this was accessed at the initial point of contact with an employment support service, in many cases benefits would may be stopped inappropriately. Culture and Attitudes A number of interviewees referred to the attitudes of individuals, low expectations and poor levels of aspiration as a significant causal factor of unemployment. Generations of unemployment were alluded to and it was highlighted that there are streets and communities in which unemployment is the norm. It is interesting to note that these issues were not alluded to within the service user consultation as contributory factors to their own unemployment. In fact clear ambitions and aspirations were expressed by the majority of participants. This difference in conceptions could be attributed to a number of factors including professional assumptions and ineffective/insufficient communication between service users and professionals. Additionally, it may be the case that low aspirations are present in the general out of work population but that these factors are not as prevalent amongst individuals who are out of work because of a mental health problem. It is important that professionals and service users communicate effectively regarding these issues to ensure that services are designed which meet actual and not perceived or historical need. Labour Market and Local Infrastructure Travel to work was also seen as a significant issue. Despite the Sedgefield Study site housing one of the country’s biggest industrial estates there was a perception here, more so than in the other two sites. that work was practically inaccessible. Additionally the employment landscape has shifted significantly in the last twenty years and questions were raised as to whether the work ethic of the communities which related to manual work, with little need for formal educational qualifications, matched the current employment opportunities in more technical fields. Role of the Voluntary Sector The role of the voluntary sector was acknowledged by statutory and voluntary sector interviewees alike as having a central role in the employability agenda. It was felt that non statutory, community based provision had the ability to effectively address many of the issues associated with employability. It was felt that such service had the flexibility and approachability required to deliver the necessary support. However, funding restrictions played a significant part, both in the way in which they were commissioned by statutory services and the requirement to renew external funding frequently. The requirement of external funders often affected the design of voluntary sector provision rather than locally identified need and reporting to funders and making bids frequently removed essential capacity from the frontline. Site Comparisons Mining heritage is a significant factor within both Sedgefield and Durham city. This has resulted in inward looking communities who were traditionally self sufficient and had no need to travel outside of the village in which they lived. This type of community is likely to perceive additional barriers in relation to the accessibility of employment in their area. Geography and transport were also more significant issues in Sedgefield and Durham than in Newcastle. Transport links were poor and inconsistent in some parts of these areas. Despite the significant differences in local infrastructure, heritage, levels of deprivation and population between the three study sites, the issues which arose from the statutory and voluntary sector were broadly shared. This paves the way for a clear regional approach which, if coordinated locally, ought to be responsive to locality issues.
Key Messages (M) and Recommendations(R) Contributions of Partners M Improved partnership working will go a significant way to addressing several of the issues raised in this paper. However, people can not access or work in partnership with services and partners that they do not know exist or do not understand and communication is also a major concern. M Many services impact on employability from early intervention to housing. Service development therefore needs to be cohesive and engagement broad to reap the benefits for employability. M There are significant cultural issues to tackle which cannot be done by services working with individuals. Work within communities and with professionals is also required . M Mental Health Trusts are underrepresented in many Local Strategic Partnership structures in which the employability agenda largely sits. R Local partnerships to give “ownership” of the coordination of employability to a single body or organisation such as the Local Strategic Partnership with an understanding of what this entails e.g. ensuring they are providing up to dateinformation on local need and service provision and providing a platform for cross sector working for ALL relevant stakeholders R Professionals need to receive training and development to ensure that they understand and act out their role in supporting clients/patients into employment from the G.P to the psychiatrist to the social worker. Employers M Employers and workplaces require substantial attention and are a key factor in the success of employability and preventing the flow into worklessness and contributing to the success of employment support. R Support is required for employers and line managers to manage individuals with mental health problems both through internal coping mechanisms and external environmental factors, policies and working practices R Development of additional services is required in some areas, particularly in relation to job retention and employer engagement R Development of Health and Safety regulations in workplaces to include mental health- specifically stress management as a mandatory requirement. Targets ought to be set to ensure that every workplace has mental health as a core part of their health and safety and human resource policies and procedures. Skills and CompetenciesM Those who are in contact with individuals with mental health problems who want to return to work do not comprehensively have the right skills set to achieve employability; this must be addressed through training and partnership working. M Mental Health Expertise within Job Centres is lacking in terms of capacity of experts (e.g. work place psychologists) and knowledge and skills of generic and disability workers. This is despite clients with mental health problems making up a significant proportion of the Job Centre client group. R Development of appropriate working relationships between JobCentre Plus and specialist mental health trusts including cross sector skills training and expert time dedicated from each side. This philosophy could also be expanded to cover the voluntary sector R Provision of an accessible and well-staffed work psychology team in all localities R Inclusion of more robust employment training in mental health qualifications (particularly social workers) ideally with the development of a specific mental health and employment social work degree. Funding and Commissioning Services M Partnerships with commissioners are not currently strong enough in some areas; this must be addressed if the way in which services are delivered to meet individual employment needs at every stage in the transition to/ retention of employment is to be effectively addressed. M Voluntary sector organisations are well placed to provide much of the individual support required, however they are not always well equipped with the capacity to network appropriately and the capability to harness funding. M Funding requirements and current related outcome measures are often unhelpful in enabling service to respond to local need R Set targets for the increase of direct payments in specific relation to employability to ensure that services are responsive to local need rather than external finding requirements R Development of meaningful measurements for use in local area agreements, service level agreements, funding bids and Local Strategic Partnerships which can be applied to progress at any distance from the labour market i.e. not just counting numbers into jobs.
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