Getting your life back: The role of employment in recovery Rachel Perkins Director of Quality Assurance and User Experience South West London and St George’s.
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Slide 1
Getting your life back: The role of employment in recovery
Rachel Perkins Director of Quality Assurance and User Experience
South West London and St Georges Mental Health NHS Trust
Slide 2
Mental health problems: a catastrophic and life changing
experience Strange and often frightening symptoms Prejudice,
discrimination, exclusion - within and outside services: many lose
all that they hold dear...including your job Out of the blue your
job has gone, with it any financial security you may have had. At a
stroke, you have no purpose in life, and no contact with other
people. You find yourself totally isolated from the rest of the
world. No one telephones you. Much less writes. No-one seems to
care if youre alive or dead. ( Bird, 2001) Loss of confidence and
self-belief Feel very alone and very frightened
Slide 3
But it doesnt have to be this way... Many, many people with
mental health problems have shown us that recovery is possible...
It is possible to live a valued, satisfying and contributing life
with mental health problems Statesmen like Parnell, Churchill,
Kjell Bondevik (Norwegian prime- minister until 2004) Scientists
like Einstein and Babbage Scholars, musicians, artists, writers
Businessmen like Ted Turner who set up Cable Network News and many
ordinary people living ordinary lives made harder by prejudice and
discrimination
Slide 4
Another way... ideas about recovery Ideas about recovery were
born not of learned academics or expert professionals but of those
who had faced the challenge of mental health problems First found a
voice as part of the USA Civil Rights Movement in the work of
people like Judi Chamberlin, Patricia Deegan.... Recovery is about
regaining control over your life and destiny building a new sense
of self, meaning and purpose rebuilding a meaningful, satisfying
and contributing life growing within and beyond what has happened
to you
Slide 5
Recovery is not the same as cure not a professional
intervention... an individual journey the lived or real life
experience of people as they accept and overcome the challenge of
the disability. They experience themselves as recovering a new
sense of self and of purpose within and beyond the limits of the
disability. (Deegan 1988) a deeply personal, unique process of
changing ones attitudes, values, feelings, goals, skills and
rolesThe development of new meaning and purpose in ones life as one
grows beyond the catastrophic effects of mental illness (Anthony
1993) not a linear process or an end point but a continuing journey
Professionals do not hold the key to recovery
Slide 6
What helps people in their journey of recovery? There is no
formula for recovery Everyones journey is different and uniquely
personal... but those who have embarked on the journey repeatedly
tell us that three things are important HOPE CONTROL
OPPORTUNITY
Slide 7
Recovery is impossible without hope If you cant see the
possibility of a decent future for yourself what is the point in
trying? Relationships are central to hope: It is difficult to
believe in yourself if everyone around you thinks you will never
amount to very much When you find it hard to believe in yourself
you need others to believe in you Not just relationships with
mental health providers friends, family and peers... We must never
forget the gift of hope that people who share the experience of
mental health problems give each other (Deegan, 1988)
Slide 8
Recovery involves taking back control Getting back in the
driving seat Taking back control over your life and how you live it
Making sense of what has happened to you Becoming an expert in your
own self-care Having control over the help you receive People often
feel demeaned by needing help to do ordinary everyday things... but
what is the difference between Prince Charles and a psychiatric
patient?
Slide 9
Recovery is impossible without opportunity You cannot rebuild
your life if everywhere you turn you are debarred from doing the
things you value The opportunity to be a part of our communities
not apart from them be a valued member of those communities access
the opportunities that exist in those communities contribute to
those communities always being on the receiving end of help from
others is a devaluing and dispiriting place to be There are many
ways in which people can contribute... but whether we like it or
not, work has a central role in our society
Slide 10
Employment: the opportunity to contribute It links us to the
communities in which we live and enables us to contribute to those
communities It provides meaning and purpose in life It affords
status and identity the 2nd question What is your name? What do you
do? It provides social contacts It is good for our health It gives
us the resources we need to do the other things we value in
life
Slide 11
Most people with mental health problems want to work few have
the opportunity to do so 21% of adults with longer term mental
health problems are in employment (2007 UK Labour Force Survey)
Among people using secondary mental health services the picture is
even worse. UK National Service User Survey 16% in paid employment
In comparison with people with other health conditions, people with
mental health problems are twice as likely to lose their jobs
following the onset of problems (Burchardt, 2003)
Slide 12
But can they work? The research evidence: Characteristics of
individuals have little impact on employment outcomes therefore
there is no justification for excluding people on the basis of
clinical history, employability, work readiness Segregated
sheltered workshops and pre-vocational skills training are not very
good at helping people with mental health problems to return to
employment There is strong evidence that with the right kind of
help around 60% of people with serious mental health problems can
successfully get and keep work
Slide 13
Individual Placement with Support evidence based supported
employment Competitive employment real jobs Team approach Client
choice Benefits counselling Rapid job search Job matching based on
client preferences On-going supports (Becker IPS Fidelity Scale,
2008) (Bond, 2004)
Slide 14
Competitive employment rates in 16 randomised controlled trials
of supported employment
Slide 15
European randomised controlled trial compared traditional
vocational service (non-integrated train-place with IPS for people
with schizophrenia (Burns et al, 2007): 55% gained in IPS
employment vs. 28% in traditional service 13% drop-out in IPS vs.
45% in traditional service 20% readmitted in IPS vs. 31% in
traditional service Four studies with 10-year follow-ups show that
work outcomes improve over time (Test, 1989; Salyers 2004; Becker,
2006; Bush, 2008) Employment associate with improved self-esteem,
symptom control, quality of life... no changes with sustained
sheltered employment (Bond, 2001)
Slide 16
Implementing Individual Placement with Support in community
mental health teams Recruiting Employment Specialists to work
within Teams and increasing the focus on vocational issues in the
care planning process Employment Specialists help people to keep
jobs they already have to decide what they want to do and apply for
the work they want to access mainstream employment agencies in the
transition to work They also: ensure that mental health
professionals attend to work related issues in care plans advise
and assist other mental health workers in providing ongoing support
support employers and advise them on adjustments the person may
need
Slide 17
Employment Specialists in 11 out of 23 South West London
Community Mental Health Teams: 1984 people received vocational
support 1155 people successful in working/studying in mainstream
integrated settings: 645 people supported to get/keep open
employment 293 people supported to get/keep mainstream
education/training 217 people supported in mainstream voluntary
work
Slide 18
Team OTs supported by 1 Employment Specialist across 4 teams
0.5 Employment Specialists per CMHT 1 full-time Employment
Specialist per CMHT Open employment Mainstream education/training
Mainstream work experience/voluntary work Number of people
supported in employment, mainstream education and voluntary work in
a borough where Individual Placement with Support had been fully
implemented in all community teams:
Slide 19
Team OTs supported by 0.5 Employment Specialist across 4 teams
Open employment Mainstream education/training Mainstream work
experience/voluntary work Number of people supported in employment,
mainstream education and voluntary work in a borough Individual
Placement with Support not implemented
Slide 20
The importance of early intervention Research shows rapidly
decreasing employment rates following onset of serious mental
health problems. For example, one study found that 52% of people
were in employment at first hospital admission but only 25% at 2
month follow-up another found only 13% in employment 12 months
after first admission But with Individual Placement with Support in
the South West London team for people with first episode psychosis
this downward trend was reversed
Slide 21
Early Intervention for First Episode Schizophrenia including
Individual Placement with Support After the two years 73% in
employment or mainstream education/training
Slide 22
Not just them out there employing people with mental health
problems in mental health services Why employ people with mental
health problems in mental health services? Provides much needed
employment opportunities Leading by example: NHS is a major
employer, not just a service provider People who have successfully
lived with mental health problems have expertise that is valuable
to others who are facing a similar challenge Counteracts despair
and pessimism: offers images of possibility to both service users
and staff Breaks down them and us divide
Slide 23
South West London User Employment Programme established 1995
Designed to increase access to employment in mental health services
for people who have themselves experienced mental health problems
employment in ordinary existing positions on the same terms and
conditions as everyone else
Slide 24
Types of objections raised What about transference will they be
objective? What about confidentiality? They will have access to
peoples psychiatric records Mentally ill people will be taking our
jobs Wont they be unreliable? Wont they be off sick all the time?
Wont they be dangerous a risk to clients? What happens if they go
mad at work? We wont be able to tell jokes in ward rounds any
more
Slide 25
A supported employment programme Assistance in the recruitment
process and transition to work Ongoing support to employees and
managers Reasonable adjustments in the work setting Outcomes 1995
2008 People with mental health problems supported in 191 posts
within the Trust diagnosis: 41% depression, 27% schizophrenia, 17%
bipolar disorder, 4% personality disorder (80% >= 1 psychiatric
admission) 66% in clinical positions, 27%
administrative/managerial, 7% support services 22% in posts
requiring professional mental health qualification At 1 st January
2008 86% continued in employment or professional training
Slide 26
A Charter for the Employment of People who have Experienced
Mental Health Problems Designed to: decrease employment
discrimination against people with mental health problems
throughout the organisation recognise the important contribution
that people with mental health problems can make to the work of the
organisation Personal experience of mental health problems
desirable on person specifications for all posts Advertisements
encourage people with mental health problems to apply Confidential
equal opportunities monitoring includes mental health problems
Slide 27
Beware - if you come to work in South West London you dont know
whether your colleague (or your boss) is one of them or one of us
Every year since 1999 at least 15% of recruits have personal
experience of mental health problems In 200724% had mental health
problems And the higher up you go the more of them you find...
Slide 28
2007
Slide 29
Beyond employment in existing positions do experts hold the
key? In traditional services power, hierarchy, claims to special
knowledge about others etc. remain and get in the way of people
working together and caring for themselves and each other Mental
health services and the professionals who inhabit them can, albeit
often unwittingly, serve to perpetuate exclusion and
marginalisation in a kind of vicious cycle. People with mental
health problems encouraged to believe that experts hold the key to
all of our problems Our nearest and dearest believe we are unsafe
in their untrained hands. And we all become less and less used to
finding our own solutions and, embracing distress and human
problems as a part of ordinary everyday life (see Mary OHagan,
2007)
Slide 30
Peer support in mainstream services Peer support:
groups/practices where people seek to learn and grow as equals
drawing on each other Mutuality: shared responsibility, shared
journey Starting point is peoples own stories rather than diagnosis
What has happened to you? rather than What is wrong with you?
Slide 31
Peer support workers on an acute admission ward Just two
workers two days per week employed trained and supervised by local
voluntary sector user organisation Evaluation: Opportunity to talk
about worries and concerns Support in recovery Hopefulness of being
able to do the things you want to do in life META in Arizona 70% of
staff = peer support workers
Slide 32
Slide 33
What did you find useful about spending time with a peer
support worker? The peer support worker understands what it is
like. She listened and was sympathetic because she had been through
things herself. You cannot always rely on the doctors for help as
they do not understand how it feels - the peer support worker does.
Being able to discuss my personal issues and also doing a
comparison with her own. Realising that there is life after mental
illness. Chatting about our problems - being with someone who has
been through it themselves. It helped me to feel more hopeful and
believe I could still do things because I could see they had. But
we have barely scratched the surface META - in Arizona - 70% of
staff = peer support workers
Slide 34
Beyond employment... issues of control Handing over control to
service users and communities by fostering service user leadership,
integrating with other sectors and fostering community development
and inclusion People with mental health problems, as well as
communities, need to start believing they hold most of the
solutions to human problems. (OHagan, 2007) And what of mental
health workers? on tap not on top - carriers of technologies that
we may want to use at times, just like architects, plumbers and
hairdressers. (OHagan, 2007)
Slide 35
Beyond being realistic...... We must all keep daring to dream
The value of dreams and ambitions lies not in their realism but in
their ability to motivate us give us a reason to get up in the
morning