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.

How employability providers are adapting to the mental health challenge

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.

When is a distance travelled tool a bad idea?

When is a distance travelled tool a bad idea?

When is a distance travelled tool a bad idea? Clare Hammond explores when and how to use distance travelled tools

Distance travelled tools are a popular way of understanding the progression someone has made through a service. They are almost a standard part of any funder or commissioner’s monitoring ask and certainly feature heavily in evaluations and impact measurement.

But when is using a distance travelled tool a really bad idea?

The issue is that needs assessment and distance travelled tools can be seen as the same thing by funders, commissioners, service managers and others.

So, what is the difference?

  • Distance travelled tools are ways of understanding the progress an individual has made. They are particularly useful when assessing the growth in an individual’s knowledge or tracking a single outcome
  • Needs assessment tools are used by practitioners to identify needs and target interventions as part of their case management role.

Needs assessment tools are a vital part of providing holistic and person-centred support as they allow the practitioner to work through with the participant the various elements of their lives and identify the participant’s worries and needs. They tend to consider a wide variety of aspects of an individual’s life such as health, housing, relationships, employment and addiction.

It is common for practitioners to use these tools regularly throughout their engagement with a participant in order to understand the changing priorities for support.

For this reason, it can be easy to see how they could also be used to track an individual’s progression. If housing was scoring as a high area of concern and then after six weeks the concern level is significantly lower, then it could be reasonable to expect that this could be an impact of the programme.

However, needs assessment tools make terrible measures of distance travelled. They can provide a distorted and confused picture of progression for two main reasons:

  1. Progression is not a linear pathway – particularly for participants with chaotic lives – and can be distorted by how individual’s feel on a particular day. Recovery or improvement is never linear and variations in scores can be misleading when considering overall progress

 

2. Needs assessment tools can ask individuals how they feel (on a scale) on a wide range of broad issues such as employability, housing, and relationships. Practitioners quite rightly expect to see the figures on the scale to increase and decrease for reasons other than progress or regression. For example:

  • An individual may be focused on managing their addiction, so housing and relationship issues are likely to score low. Once the addiction is better managed, the focus of the individual may turn to their relationships and housing.
  • Initial scores may appear ok when individuals do not yet trust the practitioner they are working with. As the trust and relationship builds between the practitioner and participant, the individual may feel more comfortable expressing unhappiness with parts of their lives.
  • Not knowing what you don’t know can distort initial results. A participant may be happy with their housing situation initially, but as they build their self-esteem they can start to feel they deserve better. Or they can gain a better insight into  their rights when it comes to housing and they can recognise that their housing situation is unhealthy and not good enough.

In all these situations, it would be reasonable to expect to see scores worsen over time as the individual has the space to think about these areas, the trust in the practitioner to open up about what is concerning them, and the knowledge and self-esteem to know they deserve better.

There are two key differences between distance travelled tools and needs assessments to consider when working out how to measure impact:

  • Distance travelled tools should be used to test knowledge, understanding and confidence rather than feelings to avoid being distorted by a client’s feelings on a particular day
  • Distance travelled tools need to be focused and specific in what they are asking – broad questions like, ‘How are you feeling about your housing situation?’ should be reserved for needs assessment tools as they are useful questions to open up conversations about need.

So, when working out how to measure progress – beware!  What can appear to be a distance travelled tool may not provide you want you are looking for.

 

Until next time, Clare 

Clare is an Associate Director at Rocket Science who specialises in health and social care with expertise in understanding impact and conducting evaluations. To discuss anything further please get in touch at [email protected] of 0131 226 4949

Three Rocket Scientists talk about what it’s like to work at Rocket Science

Three Rocket Scientists talk about what it’s like to work at Rocket Science

Three Rocket Scientists give an insight into their day-to-day work 

Cristiana Orlando, Research Intern

Looking back to when I first started as an Research Intern in September 2018, it’s incredible how much I have learned in the span of six short months. I had just graduated from the University of Oxford with an MSc in Comparative Social Policy and I applied to the internship thinking it would be a great opportunity to dip my toes in the worlds of public policy and social justice. I can now say it’s been a lot more than that – from day one I have been working on tasks ranging from interviews with service managers and directors of health boards, to presenting to clients and writing our final reports. I have had the opportunity to work on a variety of projects including health and social care, criminal justice, and employability. During my time at Rocket Science, I have not only developed a wide set of skills, but I have also felt valued and that my work was having a genuine impact on both services and people.

Max Lohnert, Consultant

Much of what I do now as a Consultant was uncharted territory for me when I joined the Rocket Science team in Edinburgh as Research Intern in October 2017 after completing my MSc in the Psychology of Mental at the University of Edinburgh. Since then, every week has been filled with different activities for a range of projects across different sectors: ranging from doing fieldwork with vulnerable young people on employability programmes, large-scale survey analyses, all the way to conducting workshops with health service providers. Not only have I been supported through training and mentoring to develop a wide range skills, but our culturally flat structure means that there is much room for me bring my own ideas to the table and to develop my own areas of interest.

Charlotte Wu, Senior Consultant

I can honestly say that no day at Rocket Science is the same – we are always working on a revolving range of projects for a wide range of clients, which means we’re always getting to learn about new social issues and meet new people! There also isn’t a typical ‘Rocket Scientist’ – we have people from both humanities and sciences backgrounds (my BA was in English and MPhil in Gender Studies) and that variety helps us bring an interesting array of skills, interests and perspectives to any project. The thing that we all have in common is a commitment to supporting social change and fairness, and helping organisations to strengthen and demonstrate their impact.

I also appreciate that while it’s a busy and fast-paced working environment, Rocket Science is encouraging of us pursuing development (both professionally and outside the company) and work-life balance. I actually started at the organisation back in 2013 as a Consultant and decided I wanted to go back to studying, so went away and did a PhD in Global Health Humanities, freelancing for Rocket Science part-time, and then joined again full time in November 2018 as a Senior Consultant. The different ways that I’ve worked for Rocket Science over the years, which have changed with my own circumstances, is an example of the willingness to be flexible around individual staff members’ needs that I really appreciate and value.

 

See for more information about the open positions in Edinburgh or contact Clare Hammond for an informal chat on 0131 226 4949 or [email protected].

The mental health challenge to employablity providers

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.

Insight from our Rocket Scientists – Working with Young People

Insight from our Rocket Scientists – Working with Young People

This week we ask some of our Rocket Scientists What is important for services that support young people?

Over the last year, we have evaluated a range of programmes supporting young people. Our clients include the Wise Group, Venture Trust, Scottish Waterways Trust, Princes Trust, and Centrepoint. This work has given us the opportunity to refresh our insights into what works when helping young people to improve their education, employability and financial resilience.

Using this insight we have asked our Rocket Scientists to share lessons they have learned about what works for young people.

Dina Papamichael, Assistant Consultant

For me, it is crucial to understand the intersecting issues which young people can face. For young people, issues around health and employment are so closely linked with self-confidence, social inclusion, substance misuse, homelessness and mental health. The most successful interventions enable a young person to overcome multiple challenges on the road to the programme’s primary objective. A programme which helps young people gain a qualification while developing a social network can have the impact of boosting self-confidence, developing work-related skills and increasing the level of stability in a young person’s life, while health services that focus on the social drivers of the sexual and mental health of its young people can obtain better and more enduring health outcomes.

Richard Scothorne, Director

The transition to work is a very tough one for many young people. Some have never really succeeded at anything at school and have often lacked the stable support of parents or other carers.  The most effective programmes we have worked with have provided different kinds of support – in other words, support that young people can chose from in terms of the quality of the relationship and their different needs from time to time.  These sources include trainers, mentors and personal coaches – someone who can provide the young person with a fixed point in a shifting world – and who will listen to them and stay with them through their journey.  In addition, working on shared tasks in small, well-managed groups – often in quite demanding conditions – can provide invaluable peer support, show people they are still appreciated even when they may be struggling, and help to build a young person’s confidence in dealing with others.

Natalie Dewison, Senior Consultant

Traditionally, the effectiveness of employability services has been assessed by looking at the number of people moving on to ‘positive destinations’ (education, employment, training or volunteering). For employability projects supporting young people facing multiple barriers to work, particularly those that only run over the course of a few weeks, this approach fails to capture the full impact of support provision.

We have found that often the most valuable outcomes are increasingly recognisable over time. Improvements in a young person’s confidence and outlook for example, which make them more resilient to knock backs and motivated by new long-term goals and ambitions. These things have the potential to greatly improve future job prospects. We are currently supporting three organisations delivering employability projects to evidence the sustainability of these outcomes. This means developing methods of longer term data collection that are simple, effective and enjoyable for the young people involved.

 

Max Lohnert, Assistant Consultant

Vulnerable young people often come from unstable backgrounds and face a range of intersecting barriers to entering employment. Considering this, our experience shows that there is no “quick fix” and that vulnerable young people benefit most from sustained engagement with employability programmes. For example, young people often benefit immensely from the trusted relationships with trainers and mentors and from the peer network they establish – and such relationships take time to build. However, since funding arrangements often require organisations to prioritise the number of young people being helped over the length of time they can engage with a single person, organisations have found other means to engage young people for longer periods of time: ranging from trainers or mentors staying in touch with a young person informally after the official completion of the programme, to building linkages and strong referral networks with other organisations along the employability pipeline.

Clare Hammond, Associate Director

The job market is becoming more complex and more competitive. Teaching young people to navigate this complexity is so important. This includes helping them look beyond the well-known and more obvious opportunities. How many jobs did you know existed when you were in high school? Doctor, teacher, engineer, nurse and banker? Probably. How about business analyst, GP practice managers, food safety consultant, project manager? Probably not.

The role that employers can play in helping young people understand the lay of the land is well evidenced. However, engagement between schools and employers often focuses around larger private sector employers. These large businesses make up a small part of employment in the UK. Most people will work for small or medium sized private firms, or the public sector. Where schools partner with small and medium sized businesses and the public sector young people are able to have a fuller understanding of the labour market.

Eleanor Sanders White, Consultant

There are many assumptions out there about young people which can interfere with our ability to reach and support them. Sometimes, the only thing in common in a group of young people is their age – we need to be careful about treating them as a homogenous group. A lack of confidence or fear of failure can often be misinterpreted as apathy. While some young people want to engage online, others need to develop a trusting relationship to engage. Many young people are technologically savvy, but some won’t have the digital skills required to engage online. While some young people will need a tailored and very supportive experience, others will interpret this as patronising. The way through this? Some of the most successful examples we have seen go straight to the source and ask the young people, others have shown a huge flexibility in how they engage with the young person to tailor for the individual walking through the door.

 

For more information on our work with young people get in touch with Clare Hammond, one of our Associate Directors [email protected] or 0131 226 4949