Sharing what works in the UK

Sharing what works

Experiences and challenges from UK policy and practice

Helen Lockett

Associate Director, Employment Programme

Presentation

Barriers to implementation – systems/macro level

Barriers to implementation – micro level

Our ‘Centre’s of Excellence’ programme of

systematic implementation across England

A reminder of the evidence from Gary Bond, Phd

“Only about 5% of people with severe mental illness get the services they want. The chance of consumers getting a job is at least twice as high if they receive evidence-based Supported Employment (SE) services. After ten years, nearly half of the people in the studies who received SE services were still working. Consumers who were employed had better control of symptoms and higher self-esteem. Research shows that SE is effective not only in the United States but also in Canada, Europe, Japan, Australia, and Hong Kong. SE is effective with many different cultural groups.

Barriers to implementation (systems/macro level)

Government Policy?

Welfare system?

Separation of mental health and employment services?

Policy ‘Desert’ 1999

Where we’ve come from

National Service Framework for Mental

Health, 1999

10 years on ‘Wave’ of Policy

Cross-government mental health and Public Service Agreements (HM Treasury, 2007)Health, work and well-being (Cross-government department)Commissioning Framework for Health and Well-being (DH, 2007)Reaching Out: An action plan on social exclusion (SEU, 2006)Our Health, Our care, Our say: a new direction for community services (DH 2006)Vocational services for people with mental health problems: Commissioning guidance (DH 2006)Disability Discrimination Act 1995 (amended 2005)Mental Health and Social Exclusion (SEU, 2004)

Mental health and employment near top of our political agenda

Cross Government Policy Explosion!

1. National Strategy for Mental Health and Employment

2. New Horizons: 10 year mental health strategy

3. The Perkins Review4. Work, Recovery, Inclusion

Launched together: 7 December

Headlines

Public health approach – whole spectrum i.e. early identification and support from workplaces; addressing sickness certification process; evidence-based services for people out of workEBSE should be available across primary and secondary mental health servicesEmployment integral to treatment and a key part of recovery orientated approachConsistent measurement across Health and Employment AgenciesPublic sector leading by example

Welfare Benefits Reform

Greater emphasis on ‘capacity’ and what people can do

Change from Incapacity Benefit to Employment Support Allowance

Move to ‘contracting out’ employment services, through a prime contractor model

Major review of Disability Employment Schemes

Increase in Access to Work funding and targeted support to people with mental health problems

Mental Health & Employment Services

Different worlds:

Separate departments and funding

Different definitions

Different geographical locations

Different philosophies

Different providers

Health

Employment

In summary

Now have supportive, evidence-informed policy frameworkCulture of welfare reform good direction; but concerns that some funding mechanisms actively promote poor practices and exclusionSeparation of health and employment needs to be addressed at strategic and operational levels as part of successful implementation of EBSE

Challenges (micro-level)

People don’t know about the evidence basePeople know about it but don’t believe itMost frequently in practice:

Health and employment services aren’t integratedIntensity, continuity and individualised nature of support need to be strengthenedFinancial planning is not provided

Integration - key ingredient

People with mental health problems can require extended periods of mental health care which needs to be coordinated with any vocational services provided Employment services can facilitate engagement in mental health treatment and careEmployment outcomes can demonstrate the effectiveness of a recovery orientated mental health serviceDischarge plans can be linked to real world milestones such as stable housing and employment.

Advantages

More efficient use of existing resources; knowledge and expertise flow to both sectors

Health staff implement a recognised evidence-based practice; benefit from seeing more individual recovery and develop new skills and expertise

Employment specialists can facilitate re-access to mental health services if needed

Early intervention, forensic services, substance use and acute care teams can participate

Employment specialist can assist clients most in need of this assistance and build more expertise compared to those in segregated services.

Sainsbury CentreCentre’s of Excellence Programme

Information

Resources for a range of stakeholders including:

Tools for commissioner’s (purchasers)

Establishing EBSE centres of excellence

Series of Information Papers

Doing what works

Summary of IPS and the

evidence base

Measuring what matters

A set of Key Performance Indicators for supported employment services:

Context indicatorsInput indicatorsProcess indicatorsOutcome indicators

Commissioning what works

Cost effectiveness and value for moneyEBSE costs certainly costs no more than traditional vocational services, and probably costs lessLong term savings to health

About Time

Changing investment

A step-by-step guide to undertake and

manage change to transform traditional

‘day and vocational’ services

Includes on-line tools to:

Involve service users in change process

Develop evidence-based contracts

Assess needs in your local area

Establishing EBSE Centres of Excellence

Tender process to select local mental health and

employment partnerships; led mainly by NHS Trusts

9 Partners: 5 full, 4 emerging; agreed outcome measures

Undertaking regular fidelity reviews and action planning

Modelling the process of effective systematic

implementation (based on the US Dartmouth – Johnson

and Johnson Programme)

Leadership collaborative to Dartmouth US (Jan 2010)

Key features for successful implementation

Recruitment, training and supervisionOrganisational commitmentOutcome and process measurementLearning networks

Training and Supervision

Getting the right people in posts

Providing initial training – then on-going ‘field mentoring’

One full-time supervisor to no more than 10 employment consultants

One ‘State’ Trainer to 3 or 4 supervisors initially to reach high fidelity in all teams

Organisational commitment

Commitment to the goals and principles of EBSE

Coherent strategy for funding including ceasing funding

ineffective services

Recovery-oriented mental health services

Inspiring leadership (local and strategic level)

Ability to make structural organisational change where

necessary

Continuing education and training in IPS (practical

understanding of the evidence base)

Measurement

Input, processes, context, as well as outcomes Agree a common indicators set consistent with local purchasing requirements and national policiesCollection of good quality data requires time and effortSet regular returns (monthly)Use computer systems where possibleFeedback reports

Learning networks

Communities of practice – encourage collaboration and mutual supportRegular meetingsReciprocal visitsCelebrations

Conclusions

Implementing EBSE is not difficultStrong evidence base and clear quality criteria (fidelity scale)EBSE is cost effective against alternativesIs cost neutral if we stop funding ineffective alternatives and will bring long-term savings to health servicesRequires training, but training as an ongoing learning/mentoring processRequires good management and leadershipSharing information about process and outcomes is a central driver for change

Thank you

Helen [email protected]/employment