There is more to gain from employment than income

There is more to gain from employment than income

In the final of a three-part blog series on employability and mental health, Max Lohnert looks at what mental health services gain from integrating employability into their service provision

Employment can have a positive impact on people’s mental health and wellbeing. A recent study has found that people’s wellbeing is higher if they have a job than not – even if controlled for their increased income. In the past two blogs, we have discussed mental health in the context of employability, now we explore employability in the context of mental health services.

So, what can mental health services gain from integrating employability into their service provision? And what has been happening in this area?

Many mental health services are now conceptualising their services using a recovery journey, similar to the concept that underpins many alcohol and drug services. Recognising the role that work can play in people’s recovery, Glasgow’s Health and Social Care Partnership funds a range of employability services for those with health and social care barriers to employment, including mental health. These services see employability as part of a recovery journey.

During our evaluation of their employability services, we got to know Mental Health Employability Services across all stages of the employability pipeline. These started with pre-employability services providing clients who are not job-ready with the opportunity for “meaningful activity”.

At the other end of the journey was the provision of Individual Placement and Support (IPS) schemes where people receive individualised support to gain competitive employment. IPS schemes challenge the assumption that competitive employment is too stressful for people with mental health problems. Instead, building on the insight that someone’s desire to work is a strong predictor of success in achieving and sustaining employment, they work with everyone that is motivated and committed to move into work. Access to IPS support is now available as part of the national Fair Start Scotland service.

 Bringing people into positive destinations, volunteering or employment, was also the goal of a recovery service of the Scottish Association for Mental Health which we evaluated recently.

During our research, participants of the programme emphasised how important it was for their recovery, and for managing their mental health, to fill the void that their addiction has left behind. For many of these participants, working towards employment, no matter how far away employment was, played an important role in filling this void.

While moving into employment can itself be stressful, there is more to gain from employment than income: a structure to their everyday life, meaningful activities as well as social connections and support. The extent to which this works of course depends on the quality of work that people move into.

There is a considerable evidence of the negative effects of social isolation on people’s physical and mental health, for example, social isolation increasing the likelihood of depression. The importance for everyone to have meaningful connections is now high on the political agenda: in December last year Scotland published its first national strategy – “A Connected Scotland” – on tackling social isolation and loneliness and building stronger social connections. The Strategy outlines the importance of empowering communities, tackling stigma, and of supporting an infrastructure and providing opportunities for people to connect.

Our work has shown that for people in recovery – for example previous drug users who had to leave their previous networks of active users – work or volunteering can be an opportunity to re-build their social networks. Employment can make a meaningful contribution to keeping people’s social isolation in check and can play a vital role in their recovery.

While we have seen employability services integrating mental health support elements into their programmes and mental health services employability elements, there is still more scope for organisations to align their service offer, share resources, and provide coordinated care. We are excited to be working alongside our clients to help them ensure that both mental health and employability clients receive the right type of support at the right time.

 

 

Max Lohnert is a Consultant in Rocket Science’s Edinburgh Office.

This blog is part of a wider series of blogs on the intersection between employability and mental health.

There is more to gain from employment than income

How employability providers are adapting to the mental health challenge

In this second of a three-part blog series on employability and mental health, Max Lohnert talks through four lessons of how employability providers are adapting to the mental health challenge 

With a growing focus on mental health within employability services, how have providers adapted their service offer? What options do they have for developing their services, ensuring that they are sensitive and responsive to the needs of people experiencing mental health problems?

We have identified four lessons from our recent work with employability programmes.

Lesson One: Success comes when mental health and employability issues are addressed together

The importance of people with (mental) health problems receiving additional support when moving into work is part and parcel of No One Left Behind, Scotland’s latest employability strategy. The Strategy emphasises how crucial an inter-agency approach is to enabling people with multiple barriers, including mental health, move into employment.

EmployabiliTAY, one of the Scottish Government’s Employability Innovation and Integration Fund’s pilots which we have been evaluating, has done exactly that: integrating their employability service with housing, criminal justice, money advice and mental health services. One session of the three-week programme is led by an NHS Mental Health Nurse – here, the focus is not on treating clients’ mental health problems per se, but on making clients aware about how their lifestyle choices, such as their sleep or eating habits, affect their mental health and wellbeing. The programme also has Growth Mindset specialists delivering a session focusing on changing clients’ negative self-image and growing their confidence.

Lesson Two: Staff roles and skills need to be broader than they were in the past 

For services to support mental health and employability together, the traditional skills found in employability staff need to widen. Many services are addressing this by having mental health experts and employability experts work side by side. However, even where this is occurring, there is an increasing recognition of the need for all employability service staff (and their volunteers) to have a core set of skills in relation to mental health. This means that, while not all staff are treating mental health issues, they are all able to identify issues, signpost, and tailor their support to their particular needs.

The importance of this was recognised by NHS Education Scotland who launched the National Trauma Training Framework in 2017. This recognised the need for all public services to be ‘trauma informed’: that is, recognising the impact of trauma on their service users and adapting their practices accordingly by establishing trusting relationships with clients and resist re-traumatisation.

 

Our training needs assessment for NHS Greater Glasgow and Clyde showed that staff members across a range of services feel that they have a good understanding of what trauma is but would value more training to build their confidence in using trauma informed practice as a core part of their services.

A youth employability programme we are currently evaluating recognised the high prevalence of mental health issues among their young participants. In response, mentors have received a one-day training on how to work with and support young people experiencing mental health problems. This ensures that they can identify mental health problems early on and engage with young people sensitively.

Lesson Three: Supporting someone into employment is only part of the job – ongoing support to manage mental health is required to ensure retention and progression in work

Our work has shown that moving into work is only a first step. Sustaining work can be at least as challenging as moving into employment. EmployabiliTAY ensures that mental health support continues when clients move into work. Participants are able to continue to meet with the NHS Mental Health Nurse if moving into work leads, for example, to increased stress and a resurgence in their anxiety.

Lesson Four: Mental health is a key reason why individuals leave employment. They need quick access to support to prevent them from falling out of work in the first place

Health problems, including mental health problems, are one of the major reasons for people dropping out of work. This has long been recognised through programmes such as Healthy Working Lives in Scotland. Recently steps have been taken to try to make it easier to know where to go for help for those struggling in work.

The Scottish Government’s Health and Work Support Pilot is an example of this. It focuses on providing quick access to support for clients who are at risk of losing their job or have recently left their job due to ill health. The Pilot aims to streamline the service landscape by bringing together work- and health-related services and providing clients with a single-entry point to access the support that they need, preventing people from falling out of work and becoming long-term unemployed.

There are a growing number of programmes across the UK working at this intersection between mental health and work, and it is exciting to see this spread and lessons being learnt and applied.

Stay tuned for the next blog in this series where we explore how mental health services have sought to include employability as part of the recovery journey.

 

Max Lohnert is a Consultant in Rocket Science’s Edinburgh Office.

This blog is part of a wider series of blogs on the intersection between employability and mental health.

There is more to gain from employment than income

The mental health challenge to employablity providers

In this first of a three-part blog series on employability and mental health, Max Lohnert explores what the high prevalence of mental health problems among employability clients means for providers and their staff

In the UK, almost every second adult identifies as having had a mental health condition at one point in their life. And there is a strong link between mental health and poverty. In Scotland, the health burden of mental health and substance abuse disorders is more than four times higher in the most deprived areas than in the least deprived areas.

Someone’s mental health affects almost every aspect of their life, including their physical health, close relationships, housing and their employment situation. It is the link between mental health and un/employment that I want to focus on in a series of three blog posts.

Unemployment often leads to social isolation and low self-esteem. Combining this with the stress and anxiety that come with an insecure income or rising debt, makes unemployment a key risk factor for mental health problems. Across almost all of the employability programmes we work with, more and more participants are presenting with mental health problems.

So, what does the high prevalence of mental health problems among employability clients mean for providers and their staff? How are they adapting their services? What can employability and health service providers learn from one another, and how can they coordinate their services?

Clients with mental health problems have particular needs that require attention by providers throughout the full cycle of an employability programme: ensuring that

· clients feel comfortable in disclosing their mental health problems at or near the beginning of a programme
· data collection tools are able capture the impact of the service on clients in recovery
· staff are responsive to the specific in-work support needs of clients with mental health problems.

Clients of employability programmes are often not disclosing their mental health problems at the beginning of the programme. They may be reluctant to speak about their mental health problems in front of a group or with a staff member who they have just met.

This poses challenges and is likely to effect if and how they engage with a programme and integrate with other participants. It can also be the reason behind unexplained absences.

When mental health problems remain undisclosed, staff members are less able to adapt their service to respond to a particular client’s needs. It is important that staff are provided with sufficient time and have the necessary skills to understand each client’s individual barriers and to build trusting relationships with clients. 

The reason is that recovery is not a linear process; it has ups and down and changes in direction. Each turn plays an important role in someone’s recovery journey. The reality of moving back into work is far more complex than the linear progression that funders may expect, especially for people managing mental health problems (the conflation between distance travelled tools and needs assessment tools is covered in an upcoming blog by my colleague, Clare Hammond). Where mental health concerns are present, sensitive data collection and a nuanced interpretation of data is vital. We are currently working with a number of organisations to help them to describe their impact to funders and decision makers with the nuance required to convey the non-linear journey of recovery. 

Understanding mental health as a complex recovery journey also means recognising that the support needs of clients do not end when they move into work. Being in a new job – a new environment with new colleagues, tasks and challenges – can put people under immense pressure. As such, clients with mental health problems, particularly those with anxiety, often require ongoing mental health support and confidence building in the early stages of employment.

If an increasing proportion of employability clients experience mental health problems, and if mental health problems can affect the kind of support that clients need at different stages, how are employability providers adapting to these challenges? This will be the focus of the next blog post in this series.

 

Max Lohnert is a Consultant in Rocket Science’s Edinburgh Office.

This blog is part of a wider series of upcoming blogs on the intersection between employability and mental health.