Helping people with enduring mental health problems gain and retain employment: from research to practice
Miles Rinaldi
Why work?Work is central to the lives and well -being of most people, and is important in maintaining and promoting mental health - there is a particularly strong relationship between unemployment and mental health difficulties (Warr, 1987)
People with mental health problems are particularly sensitive to the negative effects of unemployment and the loss of structure, purpose and identity that it entails (Anthony et al, 1984)
Via work the quality of lives is enhanced (Hill et al, 1996)
Admission rates among those who are in work are reduced (Warner, 1994)
Employment is the most significant outcome for people who have experienced mental health problems (Kinderman and Cooke, 2000)
Unemployment and Public HealthUnemployed >12 weeks4-10 times prevalence of depression anxiety and physical illness
Strong relationship between suicide & unemployment in youngwith 2/3 not in paid work
Evidence shows that work is good for physical and mental health and well-being
Strong evidence that worklessness is harmful to physical and mental health
Individual PerspectiveLiterature of Recovery ( for example, Anthony 1993)Meaningful roleOccupation
Do people want to work?70-90% people want to return to work (Grove, 1999; Rinaldi & Hill, 2000; Secker & Seebohm, 2001)52% said they had not received any help (Healthcare Commission, 2005)
Latent effects of employment (Jahoda 1979)Time structure on waking dayShared experiences and contacts social networksDefines aspects of personal status
Less than a quarter of adults with mental health problems are in workMain barriersfear of losing benefitsemployers attitudesfluctuating nature of conditionlow expectations of health professionals
Sheet:
whole population
physical health problems
mental health problems
Comparative Employment RatesWinter 2003 - Spring 2005 (Labour Force Survey)
Chart1
2416215081
2414215180
2315215181
2417225281
2514225281
2611215180
Depression/bad nerves
Mental illness
All mental health problems
All disabled people
Non-disabled people
Time series
Depression/bad nervesMental illnessAll mental health problemsAll disabled peopleNon-disabled people
Winter 20032416215081
Spring 20042414215180
Summer 20042315215181
Autumn 20042417225281
Winter 20042514225281
Spring 20052611215180
Time series
00000
00000
00000
00000
00000
00000
Depression/bad nerves
Mental illness
All mental health problems
All disabled people
Non-disabled people
Comparative Employment Rates: Winter 2003 - Spring 2005
Disability Status (2)
Disability Status BY Whether Suffering from Depression or Bad Nerves or Mental Illness, Phobias or Panics: Working Age Persons in England: Summer 2002 - Spring 2005
Not Seasonally Adjusted
In employmentEmployment RateILO unemployedInactiveTotal
Summer 2002DDA disabled and work-limiting disabledDepression bad nerves487761911638194812255226
- Spring 2003Mental illness phobia panics13722106256115320135298
DDA disabledDepression bad nerves243256227621188438971
Mental illness phobia panics24384066727065811
Work-limiting disabled onlyDepression bad nerves164894034722152941489
Mental illness phobia panics4311291602883314746
Not disabledDepression bad nerves574386672042233086972
Mental illness phobia panics9610611449476015819
TotalDepression bad nerves1102622718878182744311884
Mental illness phobia panics2276513704599308129118
Three catsDepression bad nerves89590
Mental illness phobia panics20471
Depression bad nerves147028
Mental illness phobia panics
Summer 2002DDA disabled and work-limiting disabledDepression bad nerves4754819.912028178851238427
Mental illness phobia panics1458410.72731119546136861
DDA disabledDepression bad nerves2722664.114531379742476
Mental illness phobia panics245030.9118842817919
Work-limiting disabled onlyDepression bad nerves1938339.837982554448725
Mental illness phobia panics315118.521721170417027
Not disabledDepression bad nerves5384869.459341777177553
Mental illness phobia panics1035569.8820366114836
TotalDepression bad nerves14800536.323213235963407181
Mental illness phobia panics3054017.36911139192176643
Autumn 2002DDA disabled and work-limiting disabledDepression bad nerves5251321.111958184917249388
Mental illness phobia panics1315910.15915111099130173
DDA disabledDepression bad nerves2228560.933901092936604
Mental illness phobia panics82426.8022483072
Work-limiting disabled onlyDepression bad nerves1925240.838432412147216
Mental illness phobia panics564631.918161023817700
Not disabledDepression bad nerves5782667.766862092985441
Mental illness phobia panics944957.81294560916352
TotalDepression bad nerves15187636.325877240896418649
Mental illness phobia panics2907817.49025129194167297
Winter 2002DDA disabled and work-limiting disabledDepression bad nerves4675718.312618196128255503
Mental illness phobia panics125119.27843115911136265
DDA disabledDepression bad nerves2588061.525131369642089
Mental illness phobia panics415158.7147914397069
Work-limiting disabled onlyDepression bad nerves1208633.531892076036035
Mental illness phobia panics635748.5933582013110
Not disabledDepression bad nerves5644464.181022353488080
Mental illness phobia panics842352.41989567416086
TotalDepression bad nerves14116733.526422254118421707
Mental illness phobia panics3144218.212244128844172530
Spring 2003DDA disabled and work-limiting disabledDepression bad nerves4828717.49948219351277586
Mental illness phobia panics1463410.68535114725137894
DDA disabledDepression bad nerves2190863.13692911334713
Mental illness phobia panics232844.9028555183
Work-limiting disabled onlyDepression bad nerves1523544.830571568933981
Mental illness phobia panics208818.71487757011145
Not disabledDepression bad nerves6163563.780932708796815
Mental illness phobia panics1021463.81694409416002
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves14706533.224790271240443095
Mental illness phobia panics2926417.211716129244170224
Summer 2003DDA disabled and work-limiting disabledDepression bad nerves497701811940218815280525
-Sping 2004Mental illness phobia panics16560125474118537140571
DDA disabledDepression bad nerves223455744931285339691
Mental illness phobia panics34495869122556396
Work-limiting disabled onlyDepression bad nerves141633527522386840783
Mental illness phobia panics4117311100741412631
Not disabledDepression bad nerves633816893982089993678
Mental illness phobia panics1045862953540016810
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves1496593328583276435454678
Mental illness phobia panics34584208218133605176407
Summer 2003DDA disabled and work-limiting disabledDepression bad nerves4995117.712982219943282876
Mental illness phobia panics1881913.64633114492137944
DDA disabledDepression bad nerves2302963.84086899336108
Mental illness phobia panics425949.8101832708547
Work-limiting disabled onlyDepression bad nerves1185333.327812098735621
Mental illness phobia panics188623.9060107896
Not disabledDepression bad nerves624546867042269491852
Mental illness phobia panics1089965.11336451616751
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves1472873326553272617446457
Mental illness phobia panics35863216987128288171138
Autumn 2003DDA disabled and work-limiting disabledDepression bad nerves5048218.413255210811274548
Mental illness phobia panics1852913.33802117442139773
DDA disabledDepression bad nerves2102859.735491067235249
Mental illness phobia panics171924.9174734416907
Work-limiting disabled onlyDepression bad nerves1461232.139062700945527
Mental illness phobia panics224319.12861666511769
Not disabledDepression bad nerves6233068.198351931791482
Mental illness phobia panics10667622061449017218
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves14845233.230545267809446806
Mental illness phobia panics3315818.910471132038175667No in workTotal%
Winter 2003DDA disabled and work-limiting disabledDepression bad nerves4994318.89978206183266104Three catsDep8288335190124
Mental illness phobia panics1713812.17388117477142003MI2615316146316
DDA disabledDepression bad nerves1985147.356121646341926All10903651336421
Mental illness phobia panics366966.3018615530
Work-limiting disabled onlyDepression bad nerves1308929.843222646043871
Mental illness phobia panics534638.41009757513930
Not disabledDepression bad nerves6664869.6115471756095755
Mental illness phobia panics972858.60687416602
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves14953133.431459266666447656
Mental illness phobia panics3588120.28397133787178065No in workTotal%
Spring 2004DDA disabled and work-limiting disabledDepression bad nerves4870516.311545238323298573Three catsDep9127438216824
Mental illness phobia panics117528.26074124736142562MI2289516408714
DDA disabledDepression bad nerves254725647261528445482All11416954625521
Mental illness phobia panics414990.204494598
Work-limiting disabled onlyDepression bad nerves1709744.902101638113
Mental illness phobia panics699441.3528940516927
Not disabledDepression bad nerves6209364.995052402595623
Mental illness phobia panics1053863.2414571816670
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves15336732.125776298648477791
Mental illness phobia panics3343318.57016140308180757
Summer 2004DDA disabled and work-limiting disabledDepression bad nerves525661815711224812293088
- Spring 2005Mental illness phobia panics18147125816133111157074
DDA disabledDepression bad nerves250336034881308841608
Mental illness phobia panics426349112334178803
Work-limiting disabled onlyDepression bad nerves151093345402549545143
Mental illness phobia panics37122311751124016126
Not disabledDepression bad nerves6783768637926241100457
Mental illness phobia panics11542642146446418151
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves1605453330117289635480297
Mental illness phobia panics376631910260152231200154No in workTotal%
Summer 2004DDA disabled and work-limiting disabledDepression bad nerves5094016.715459239520305919Three catsDep9200839947223
Mental illness phobia panics1834311.95462130149153954MI2708417872015
DDA disabledDepression bad nerves2558557.642811458444450All11909257819221
Mental illness phobia panics368448.846634047554
Work-limiting disabled onlyDepression bad nerves1548331.549042871649103
Mental illness phobia panics505729.410741108117212
Not disabledDepression bad nerves6463769.446292382793093
Mental illness phobia panics1109064.52024409217206
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves15664531.829273306647492565
Mental illness phobia panics3817419.59026148726195926No in workTotal%
Autumn 2004DDA disabled and work-limiting disabledDepression bad nerves4673516.612160223126282021Three catsDep8678036617724
Mental illness phobia panics2219214.25868128394156454MI3160918300517
DDA disabledDepression bad nerves270096230691346243540All11838954918222
Mental illness phobia panics535755.857736609594
Work-limiting disabled onlyDepression bad nerves1303632.150472253340616
Mental illness phobia panics406023.915341136316957
Not disabledDepression bad nerves6558866.483982481498800
Mental illness phobia panics974366.5955395314651
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves15236832.828674283935464977
Mental illness phobia panics4135220.98934147370197656No in workTotal%
Winter 2004DDA disabled and work-limiting disabledDepression bad nerves544401917183215147286770Three catsDep9376737132925
Mental illness phobia panics1717411.35581128637151392MI2445417821414
DDA disabledDepression bad nerves247646433491055238665All11822154954322
Mental illness phobia panics441842.21485457710480
Work-limiting disabled onlyDepression bad nerves1456331.744222690945894
Mental illness phobia panics286217.513511212916342
Not disabledDepression bad nerves7295070.1483326338104121
Mental illness phobia panics1428475.71601298318868
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves16671735.129787278946475450
Mental illness phobia panics3873819.710018148326197082No in workTotal%
Spring 2005DDA disabled and work-limiting disabledDepression bad nerves5814819.518042221453297643Three catsDep9827538238126
Mental illness phobia panics148778.96353145264166494MI2133818807311
DDA disabledDepression bad nerves2277457.332511375339778All11961357045421
Mental illness phobia panics359447.4196420277585
Work-limiting disabled onlyDepression bad nerves1735338.637852382244960
Mental illness phobia panics286720.57411038613994
Not disabledDepression bad nerves6817464.4765529984105813
Mental illness phobia panics1105150.54002682621879
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves16644934.132733289012488194
Mental illness phobia panics3238915.413060164503209952
Source: ONS Labour Force Survey
Three categoriesDepression bad nerves9827525.700806263925078259028382381
Mental illness phobia panics2133811.34559452989058157677188073
Total11961320.968035985434136416705570454
Four categoriesDepression bad nerves16644934.094847540132733289012488194
Mental illness phobia panics3238915.426859472613060164503209952
Total19883828.480862169245793453515698146
Depression/bad nervesMental illnessAll mental health problemsAll disabled peopleNon-disabled people
Winter 2003
Spring 2004
Summer 2003
Autumn 2004
Winter 2004
Spring 2005
Disability Status
Disability Status BY Whether Suffering from Depression or Bad Nerves or Mental Illness, Phobias or Panics: Working Age Persons in England: Summer 2002 - Spring 2005
Not Seasonally Adjusted
In employmentEmployment RateILO unemployedInactiveTotal
Summer 2002DDA disabled and work-limiting disabledDepression bad nerves487761911638194812255226
- Spring 2003Mental illness phobia panics13722106256115320135298
DDA disabledDepression bad nerves243256227621188438971
Mental illness phobia panics24384066727065811
Work-limiting disabled onlyDepression bad nerves164894034722152941489
Mental illness phobia panics4311291602883314746
Not disabledDepression bad nerves574386672042233086972
Mental illness phobia panics9610611449476015819
TotalDepression bad nerves1102622718878182744311884
Mental illness phobia panics2276513704599308129118
Summer 2002DDA disabled and work-limiting disabledDepression bad nerves4754819.912028178851238427
Mental illness phobia panics1458410.72731119546136861
DDA disabledDepression bad nerves2722664.114531379742476
Mental illness phobia panics245030.9118842817919
Work-limiting disabled onlyDepression bad nerves1938339.837982554448725
Mental illness phobia panics315118.521721170417027
Not disabledDepression bad nerves5384869.459341777177553
Mental illness phobia panics1035569.8820366114836
TotalDepression bad nerves14800536.323213235963407181
Mental illness phobia panics3054017.36911139192176643
Autumn 2002DDA disabled and work-limiting disabledDepression bad nerves5251321.111958184917249388
Mental illness phobia panics1315910.15915111099130173
DDA disabledDepression bad nerves2228560.933901092936604
Mental illness phobia panics82426.8022483072
Work-limiting disabled onlyDepression bad nerves1925240.838432412147216
Mental illness phobia panics564631.918161023817700
Not disabledDepression bad nerves5782667.766862092985441
Mental illness phobia panics944957.81294560916352
TotalDepression bad nerves15187636.325877240896418649
Mental illness phobia panics2907817.49025129194167297
Winter 2002DDA disabled and work-limiting disabledDepression bad nerves4675718.312618196128255503
Mental illness phobia panics125119.27843115911136265
DDA disabledDepression bad nerves2588061.525131369642089
Mental illness phobia panics415158.7147914397069
Work-limiting disabled onlyDepression bad nerves1208633.531892076036035
Mental illness phobia panics635748.5933582013110
Not disabledDepression bad nerves5644464.181022353488080
Mental illness phobia panics842352.41989567416086
TotalDepression bad nerves14116733.526422254118421707
Mental illness phobia panics3144218.212244128844172530
Spring 2003DDA disabled and work-limiting disabledDepression bad nerves4828717.49948219351277586
Mental illness phobia panics1463410.68535114725137894
DDA disabledDepression bad nerves2190863.13692911334713
Mental illness phobia panics232844.9028555183
Work-limiting disabled onlyDepression bad nerves1523544.830571568933981
Mental illness phobia panics208818.71487757011145
Not disabledDepression bad nerves6163563.780932708796815
Mental illness phobia panics1021463.81694409416002
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves14706533.224790271240443095
Mental illness phobia panics2926417.211716129244170224
Summer 2003DDA disabled and work-limiting disabledDepression bad nerves497701811940218815280525
-Sping 2004Mental illness phobia panics16560125474118537140571
DDA disabledDepression bad nerves223455744931285339691
Mental illness phobia panics34495869122556396
Work-limiting disabled onlyDepression bad nerves141633527522386840783
Mental illness phobia panics4117311100741412631
Not disabledDepression bad nerves633816893982089993678
Mental illness phobia panics1045862953540016810
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves1496593328583276435454678
Mental illness phobia panics34584208218133605176407
Summer 2003DDA disabled and work-limiting disabledDepression bad nerves4995117.712982219943282876
Mental illness phobia panics1881913.64633114492137944
DDA disabledDepression bad nerves2302963.84086899336108
Mental illness phobia panics425949.8101832708547
Work-limiting disabled onlyDepression bad nerves1185333.327812098735621
Mental illness phobia panics188623.9060107896
Not disabledDepression bad nerves624546867042269491852
Mental illness phobia panics1089965.11336451616751
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves1472873326553272617446457
Mental illness phobia panics35863216987128288171138
Autumn 2003DDA disabled and work-limiting disabledDepression bad nerves5048218.413255210811274548
Mental illness phobia panics1852913.33802117442139773
DDA disabledDepression bad nerves2102859.735491067235249
Mental illness phobia panics171924.9174734416907
Work-limiting disabled onlyDepression bad nerves1461232.139062700945527
Mental illness phobia panics224319.12861666511769
Not disabledDepression bad nerves6233068.198351931791482
Mental illness phobia panics10667622061449017218
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves14845233.230545267809446806
Mental illness phobia panics3315818.910471132038175667
Winter 2003DDA disabled and work-limiting disabledDepression bad nerves4994318.89978206183266104
Mental illness phobia panics1713812.17388117477142003
DDA disabledDepression bad nerves1985147.356121646341926
Mental illness phobia panics366966.3018615530
Work-limiting disabled onlyDepression bad nerves1308929.843222646043871
Mental illness phobia panics534638.41009757513930
Not disabledDepression bad nerves6664869.6115471756095755
Mental illness phobia panics972858.60687416602
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves14953133.431459266666447656
Mental illness phobia panics3588120.28397133787178065
Spring 2004DDA disabled and work-limiting disabledDepression bad nerves4870516.311545238323298573
Mental illness phobia panics117528.26074124736142562
DDA disabledDepression bad nerves254725647261528445482
Mental illness phobia panics414990.204494598
Work-limiting disabled onlyDepression bad nerves1709744.902101638113
Mental illness phobia panics699441.3528940516927
Not disabledDepression bad nerves6209364.995052402595623
Mental illness phobia panics1053863.2414571816670
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves15336732.125776298648477791
Mental illness phobia panics3343318.57016140308180757
Summer 2004DDA disabled and work-limiting disabledDepression bad nerves525661815711224812293088
- Spring 2005Mental illness phobia panics18147125816133111157074
DDA disabledDepression bad nerves250336034881308841608
Mental illness phobia panics426349112334178803
Work-limiting disabled onlyDepression bad nerves151093345402549545143
Mental illness phobia panics37122311751124016126
Not disabledDepression bad nerves6783768637926241100457
Mental illness phobia panics11542642146446418151
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves1605453330117289635480297
Mental illness phobia panics376631910260152231200154
Summer 2004DDA disabled and work-limiting disabledDepression bad nerves5094016.715459239520305919
Mental illness phobia panics1834311.95462130149153954
DDA disabledDepression bad nerves2558557.642811458444450
Mental illness phobia panics368448.846634047554
Work-limiting disabled onlyDepression bad nerves1548331.549042871649103
Mental illness phobia panics505729.410741108117212
Not disabledDepression bad nerves6463769.446292382793093
Mental illness phobia panics1109064.52024409217206
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves15664531.829273306647492565
Mental illness phobia panics3817419.59026148726195926
Autumn 2004DDA disabled and work-limiting disabledDepression bad nerves4673516.612160223126282021
Mental illness phobia panics2219214.25868128394156454
DDA disabledDepression bad nerves270096230691346243540
Mental illness phobia panics535755.857736609594
Work-limiting disabled onlyDepression bad nerves1303632.150472253340616
Mental illness phobia panics406023.915341136316957
Not disabledDepression bad nerves6558866.483982481498800
Mental illness phobia panics974366.5955395314651
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves15236832.828674283935464977
Mental illness phobia panics4135220.98934147370197656
Winter 2004DDA disabled and work-limiting disabledDepression bad nerves544401917183215147286770
Mental illness phobia panics1717411.35581128637151392
DDA disabledDepression bad nerves247646433491055238665
Mental illness phobia panics441842.21485457710480
Work-limiting disabled onlyDepression bad nerves1456331.744222690945894
Mental illness phobia panics286217.513511212916342
Not disabledDepression bad nerves7295070.1483326338104121
Mental illness phobia panics1428475.71601298318868
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves16671735.129787278946475450
Mental illness phobia panics3873819.710018148326197082
Spring 2005DDA disabled and work-limiting disabledDepression bad nerves5814819.518042221453297643
Mental illness phobia panics148778.96353145264166494
DDA disabledDepression bad nerves2277457.332511375339778
Mental illness phobia panics359447.4196420277585
Work-limiting disabled onlyDepression bad nerves1735338.637852382244960
Mental illness phobia panics286720.57411038613994
Not disabledDepression bad nerves6817464.4765529984105813
Mental illness phobia panics1105150.54002682621879
Did Not SpecifyDepression bad nerves00000
Mental illness phobia panics00000
TotalDepression bad nerves16644934.132733289012488194
Mental illness phobia panics3238915.413060164503209952
Source: ONS Labour Force Survey
Three categoriesDepression bad nerves9827525.700806263925078259028382381
Mental illness phobia panics2133811.34559452989058157677188073
Total11961320.968035985434136416705570454
Four categoriesDepression bad nerves16644934.094847540132733289012488194
Mental illness phobia panics3238915.426859472613060164503209952
Total19883828.480862169245793453515698146
Qualification Level
Level of Highest Qualification BY Main Health Problem and Region of Residence: All Disabled Persons of Working Age in England: Spring 2005
Not Seasonally Adjusted
NVQ Level 4 and aboveNVQ Level 3Trade ApprenticeshipsNVQ Level 2Below NVQ Level 2Other qualificationsNo qualificationsN/ADNATotal
Tyne and Wear
Arms hands39515171511296716868042201--11081
Legs or feet2557167321544928620831145561--26195
Back or neck876348623584073119145638376-38325306
Difficulty in seeing---379385357---1121
Difficulty in hearing-413--743-776--1932
Speech impediment448413-------861
Skin conditions allergies391--1341-843383--2958
Chest breathing problems3927359213426197205513362260--20709
Heart blood pressure circulation22151221513484913049154492--16130
Stomach liver kidney digestion8671684177113101350-2401--9383
Diabetes3931237-5432625-1600--6398
Depression bad nerves824735141128231529-3141--10463
Epilepsy-1032-56011307841204--4710
Learning difficulties-550--10547882989--5381
Mental illness phobia panics-357-1456375-2399--4587
Progressive illness n.e.c.81817735204081288859972--6638
Other problems disabilities2549752828137530134081737--10662
N/A538--------538
DNA---------0
Total16798204351702929209259361477140492-383165053
Rest of North East
Arms hands2098124825363951183118484851--18363
Legs or feet4908212533964181134122798265--26495
Back or neck73534432429969605918398212495-36845807
Difficulty in seeing484---331-419--1234
Difficulty in hearing-492431-438-408--1769
Speech impediment---------0
Skin conditions allergies447830890716417-448--3748
Chest breathing problems32203160441323629913885293--18729
Heart blood pressure circulation3529171334752143282829587550--24196
Stomach liver kidney digestion26964101362142212528341820--9796
Diabetes228585239322513959001819--8895
Depression bad nerves7851817-220438349345448--15022
Epilepsy900--4365373951235--3503
Learning difficulties-537-6941966-3273--6470
Mental illness phobia panics-372-4614135573032--4835
Progressive illness n.e.c.8698977899334364352125--6484
Other problems disabilities2905197517818053151-1279--11896
N/A------449--449
DNA---------0
Total32479208601979330393280791551060209-368207691
Greater Manchester
Arms hands2252-10222848514320726141--19478
Legs or feet42795962632326982878514013783--41063
Back or neck63304235601954797038576316774--51638
Difficulty in seeing-619-626527----1772
Difficulty in hearing1940502-453947-1006--4848
Speech impediment---------0
Skin conditions allergies600-11531054426-618--3851
Chest breathing problems65394515-5384415932736747--30617
Heart blood pressure circulation6877355285184650412530009514--40236
Stomach liver kidney digestion243711703251297137326193977--18157
Diabetes1640103816531904281222595457--16763
Depression bad nerves19992077130233631038415819766--30472
Epilepsy2616575-1936-4952692--8314
Learning difficulties709626--66510604251--7311
Mental illness phobia panics119810924951336280519157604--16445
Progressive illness n.e.c.354011812805234730926655250--18880
Other problems disabilities5521297111461095458512844877--21479
N/A1736-455------2191
DNA---------0
Total50213301153414238144533182912698457--333515
Merseyside
Arms hands19031414152143913554472869--9948
Legs or feet14672700297194299929528048--20079
Back or neck272620741384430971034618116--26173
Difficulty in seeing1026495478473-4611418--4351
Difficulty in hearing976---927----1903
Speech impediment---------0
Skin conditions allergies1023509511---990--3033
Chest breathing problems2355190120212408382214946127--20128
Heart blood pressure circulation5225293423711931419638324341-43525265
Stomach liver kidney digestion9779384949329624533317--8073
Diabetes2107933928973193319702817--11661
Depression bad nerves1938935607144213738748209--15378
Epilepsy1547--473878-2413--5311
Learning difficulties532--53225805324560--8736
Mental illness phobia panics479--10015449051581--4510
Progressive illness n.e.c.287059211279682444-1358--9359
Other problems disabilities20122923109438721963-3379--15243
N/A426--513--918--1857
DNA---------0
Total29589183481550721208310791438160461-435191008
Rest of North West
Arms hands2965309240781399330324582373--19668
Legs or feet48495022445949343500395410783--37501
Back or neck82003622630596556881422316135--55021
Difficulty in seeing573-40226001013-2417--7005
Difficulty in hearing----4114361439--2286
Speech impediment---------0
Skin conditions allergies172213864681762470400428--6636
Chest breathing problems12313464023988234460130296896--42111
Heart blood pressure circulation84736705604933174292409112660--45587
Stomach liver kidney digestion40302298232313662530957554--14058
Diabetes2202407822592484195314505318--19744
Depression bad nerves5281996503425275925015688--24813
Epilepsy1980830571435-8411663--6320
Learning difficulties5641485-1311--5345-4909195
Mental illness phobia panics977530459-11918986075--10130
Progressive illness n.e.c.50233448264091430054676035--21532
Other problems disabilities80432012134042114854862901--22223
N/A608---461----1069
DNA---------0
Total67803401443425446874460572456784710-490344899
South Yorkshire
Arms hands13314341761159014754734128--11192
Legs or feet1934311821282325457945485407--24039
Back or neck6761199926494952465143009540--34852
Difficulty in seeing1468935469-443----3315
Difficulty in hearing449-873793449-433--2997
Speech impediment---------0
Skin conditions allergies497945-449--1337--3228
Chest breathing problems30692704-1337459213495757--18808
Heart blood pressure circulation383547330441426445046466125--23999
Stomach liver kidney digestion1380438-307591823033301--11415
Diabetes2309155926052694139919003291--15757
Depression bad nerves4364538861383270412346947--14043
Epilepsy-811475893-3781876--4433
Learning difficulties538---18279661872--5203
Mental illness phobia panics468889-4921270-1842--4961
Progressive illness n.e.c.1744132647512631341912449--7510
Other problems disabilities16911747137690141989121757--12582
N/A---------0
DNA---------0
Total27910178311674123573342962392154062--198334
West Yorkshire
Arms hands2141125845626263188-5712--15381
Legs or feet257592322092543185826355811--18554
Back or neck5443353643693978704737259615--37713
Difficulty in seeing1324420-4321309474456--4415
Difficulty in hearing895497450-518-1291--3651
Speech impediment521---425----946
Skin conditions allergies406--878438----1722
Chest breathing problems680028118762841309636998619--28742
Heart blood pressure circulation4670282034982269378917989025--27869
Stomach liver kidney digestion1771222717122619180217872811--14729
Diabetes939-26391328133113272931--10495
Depression bad nerves1907771-1891221117666498--15044
Epilepsy3894315025001482-890--4194
Learning difficulties-1539---4398610--10588
Mental illness phobia panics445183812869891022-2258--7838
Progressive illness n.e.c.164513504281840128116063594--11744
Other problems disabilities674813021299167931234223397--17970
N/A--439-423----862
DNA---------0
Total38619217232016326413343431967871518--232457
Rest of Yorkshire & Humberside
Arms hands1355-13303425419214891241--13032
Legs or feet5014334627965752241535865880--28789
Back or neck5554340925311976384740447532-40229295
Difficulty in seeing--411-507----918
Difficulty in hearing-550-10171010----2577
Speech impediment----907----907
Skin conditions allergies6161648-458-446376--3544
Chest breathing problems42164522-4657425718275068--24547
Heart blood pressure circulation226310121671282438363965231--17233
Stomach liver kidney digestion1529853438782236614491330--8747
Diabetes2606187717764232455-810--9947
Depression bad nerves145248086010708695032919-4178570
Epilepsy944507---5042342--4297
Learning difficulties----10464473902--5395
Mental illness phobia panics427--431902-1508--3268
Progressive illness n.e.c.414494444019743885426882--12695
Other problems disabilities30335315003718475710043973--17516
N/A951--445--1218--2614
DNA---------0
Total34104196791275328952372511612144212-819193891
East Midlands
Arms hands27902324391743395901538310570--35224
Legs or feet62087292550181498504587713385--54916
Back or neck154049981103711129913264747124666--92456
Difficulty in seeing24031445-330928928921445--12386
Difficulty in hearing47689751118921551506---5833
Speech impediment---------0
Skin conditions allergies-1129-21431063-368--4703
Chest breathing problems119047766457496961256525358391--57431
Heart blood pressure circulation11185521976504118755491369505--54367
Stomach liver kidney digestion7954197714631975630821553985--25817
Diabetes875925391946419448985468330--31212
Depression bad nerves36562784109341214808389811539--31899
Epilepsy493571-2058314610283573--10869
Learning difficulties-502-4854651-7906--13544
Mental illness phobia panics14471570464229092415834885--13163
Progressive illness n.e.c.4793290114113250183710698142--23403
Other problems disabilities6799708517947057927361958046--46249
N/A-1063----573--1636
DNA---------0
Total842715704540695703758913948274125309--515108
West Midlands Metropolitan County
Arms hands-236512411596164927313897--13479
Legs or feet53121234321124115678671714490--39053
Back or neck334759153779505111318665520631--56696
Difficulty in seeing-12514044941073-1355--4577
Difficulty in hearing893427-553-10391537--4449
Speech impediment---------0
Skin conditions allergies1114793-30419914521044-12778712
Chest breathing problems65866454207857745930528710635--42744
Heart blood pressure circulation44213096360838071513571110075--32231
Stomach liver kidney digestion33351621-16772037-3027--11697
Diabetes4879561615421255238321566921--24752
Depression bad nerves25012279-3159206310155327--16344
Epilepsy956--1177921-2835--5889
Learning difficulties-510--5349257573--9542
Mental illness phobia panics128493245211069689324595--10269
Progressive illness n.e.c.14883374207587696616043530--13913
Other problems disabilities48172493-48922966-3460--18628
N/A---2027-1017---3044
DNA---------0
Total409333836018390388964099036241100932-1277316019
Rest of West Midlands
Arms hands467407424432461292538565697--21923
Legs or feet34782280332317431400223812567--27029
Back or neck108754358538673168207426214137--54541
Difficulty in seeing-1093-3791570-1400--4442
Difficulty in hearing-1010---10281636--3674
Speech impediment481496-------977
Skin conditions allergies1692379-1091704381---4247
Chest breathing problems394952814509672455517525830-121332702
Heart blood pressure circulation76664202274234314472609610356--38965
Stomach liver kidney digestion15703227940167184210613534--12845
Diabetes31502634450143522489292812--13658
Depression bad nerves526823199761426323923436265--21836
Epilepsy519954-558-4161942--4389
Learning difficulties566--66816635316927--10355
Mental illness phobia panics1590-449-28305344571--9974
Progressive illness n.e.c.570323781408230226724456072--20980
Other problems disabilities516223731331449554009392902--22602
N/A----951501448--1900
DNA---------0
Total52136370581989838648436782731287096-1213307039
East of England
Arms hands5389439030203453532168005820--34193
Legs or feet689654763824630112564341215214--53687
Back or neck9581771259981046018016872721897--82391
Difficulty in seeing12302731-21968231018894--8892
Difficulty in hearing4951443-15351137-2674--7284
Speech impediment------389--389
Skin conditions allergies1599124254620091359907---7662
Chest breathing problems143068583460475849286423011874--60467
Heart blood pressure circulation147776466972671297789581115395--67093
Stomach liver kidney digestion7043488617175335458147329238--37532
Diabetes5111457522854719310636776389--29862
Depression bad nerves4853314314025943632713608686--31714
Epilepsy1585155555717701087-1786--8340
Learning difficulties994544-99919424946507--11480
Mental illness phobia panics1730118513623714124714056785--17428
Progressive illness n.e.c.6533314129732916391932557516--30253
Other problems disabilities171882743159556481172240545571--48521
N/A----984-482--1466
DNA---------0
Total993105981539609717119121049882127117--538654
Inner London
Arms hands4354115854049345450985096--17193
Legs or feet3902-179930182306255911969--25553
Back or neck71135219195633696421862917459--50166
Difficulty in seeing1263--645640-3184--5732
Difficulty in hearing33061522--1313-2060--8201
Speech impediment------1280--1280
Skin conditions allergies12761630-------2906
Chest breathing problems60812751177725642603484310575-59131785
Heart blood pressure circulation8908225659824292678411010367--31346
Stomach liver kidney digestion4104675-100094452655189--17177
Diabetes3568--826190115095577--13381
Depression bad nerves39461909-21974836196612588-108728529
Epilepsy-597-5221419-2638--5176
Learning difficulties-625-63712516956313-69910220
Mental illness phobia panics1410529-209555621459558--16293
Progressive illness n.e.c.54781373-2969159322334279--17925
Other problems disabilities852721827361217191130467405--25024
N/A1387704688--2101736--5616
DNA---------0
Total64623231308094239813082644199116273-2377313503
Outer London
Arms hands6871118222072350270975837089--29991
Legs or feet98173704221249794175456111438-48341369
Back or neck145917567236510639156621031916919--78062
Difficulty in seeing2752515-1634-15532151--8605
Difficulty in hearing106065154811668112527---6763
Speech impediment622577-------1199
Skin conditions allergies2869-1097612613608---5799
Chest breathing problems11389586324705893553549825633--41765
Heart blood pressure circulation9852406460935165775180459857--50827
Stomach liver kidney digestion5042113817981747205012615164--18200
Diabetes7709503123632130403474985657--34422
Depression bad nerves702964749439873725467910073--30634
Epilepsy5721455-1220121712762845--8585
Learning difficulties----15188635032--7413
Mental illness phobia panics19632804-5544465284113052--25679
Progressive illness n.e.c.8502167019052466349725543722--24316
Other problems disabilities94206360113252465350694415146--49598
N/A5641149--61716281286--5244
DNA---------0
Total1006244437724684497886372969722115064-483468471
South East
Arms hands87553987363655424715330112074--42010
Legs or feet14510987152031359213152494519145--80418
Back or neck27471123741293616928221181027022379-465124941
Difficulty in seeing7877-24121211286911211305--16795
Difficulty in hearing27943092-38358745181014--12127
Speech impediment-610--585-503--1698
Skin conditions allergies57382962-1257359110661282--15896
Chest breathing problems1971211157561119332128881038510466--89551
Heart blood pressure circulation29533122281097711405110591042914571--100202
Stomach liver kidney digestion12174625630595194836123417999-49745881
Diabetes143711090849544263951051427968--57116
Depression bad nerves103127088145810912989342501340238036258057
Epilepsy34222558905429945194706458--22631
Learning difficulties10421015-34636759274111181--26201
Mental illness phobia panics2054351513201607498315157319-92223235
Progressive illness n.e.c.11423685431463860539434206450--40547
Other problems disabilities18234727335581493718874405011888--78814
N/A17211459-105012319401687--8088
DNA---------0
Total19114310320759175122687141375669041570913802246844208
South West
Arms hands6048532218276188604522645570-50733771
Legs or feet790992745423841013823400215421--64262
Back or neck1726110879728714950167541218014691--94002
Difficulty in seeing79430304689732305-2044--9614
Difficulty in hearing22142330-487550-2259--7840
Speech impediment------729--729
Skin conditions allergies42314095678418924682140--6740
Chest breathing problems1434295662194186951092658657424432-69444
Heart blood pressure circulation175506362623960539499794610571-54564765
Stomach liver kidney digestion4751371730581481527214476577--26303
Diabetes6093278327553450717427654924--29944
Depression bad nerves668840914523710490818577857--29563
Epilepsy2204338953513911527492830--10368
Learning difficulties1091563-166524615475081--11408
Mental illness phobia panics326624891068494323621972708--15458
Progressive illness n.e.c.566419944455824517219194551--25569
Other problems disabilities102616594305212988990246165348-46653227
N/A547---355-454--1356
DNA---------0
Total10710673792353708760010080148565991794321518554363
Total
Arms hands49114337653304645667518924660785329-507345927
Legs or feet856156400056932769068538062519177167-483609002
Back or neck148886907987999212139415543699574241362-1618939060
Difficulty in seeing211941253450441535116687587618488--95174
Difficulty in hearing154981382628131173111679605416533--78134
Speech impediment20722096--1917-2901--8986
Skin conditions allergies20413148625232176521096455719414-127785385
Chest breathing problems130708852663083611350493861562741175954321804630280
Heart blood pressure circulation1409796432381393629468113578920149635-980660311
Stomach liver kidney digestion61660335152338634557453072666464224-497289810
Diabetes68121456602854834872501573402872621--334007
Depression bad nerves5887532524114445388370295287611243533801866382381
Epilepsy181271526535451822817863707937222--117329
Learning difficulties60368496-10454299171102891322-1189158442
Mental illness phobia panics1873818102735518026277311742779772-922188073
Progressive illness n.e.c.70237351962258735110418222186964927--291748
Other problems disabilities112910513162256274136950423473681066-466472234
N/A8478437515824035502261878251--37930
DNA---------0
Total10376616259194162977484528921075491741442182812116095724213
Source: ONS Labour Force Survey
NVQ Level 4 and aboveNVQ Level 3Trade ApprenticeshipsNVQ Level 2Below NVQ Level 2Other qualificationsNo qualificationsN/ADNATotal
Benefits
Type of Benefit Claimed BY Main Health Problem: All Disabled Persons of Working Age in England: Spring 2005
Not Seasonally Adjusted
Unemployment Benefit NI creditsIncome Supprt (not as unemployed pers)Sickness or Disability (exc DPTC)State PensionFamly rel. benefits (exc Ch B exc TCs)Child BenefitHsng/Council Tax GB Rent/rate rebate NIOther
Arms hands88364391699000433649765557570843548
Legs or feet110111021992312109053-839961222367212
Back or neck234861432773003726610151817437117594610146
Difficulty in seeing25621690033816925-13791156941622
Difficulty in hearing2234518010699419-1099964571555
Speech impediment44816923751--21141715449
Skin conditions allergies195548998204--1959262051389
Chest breathing problems1878071225855264086930128195863649312
Heart blood pressure circulation116996331514188410200196763782721365328
Stomach liver kidney digestion643738243730951255-6556947956445
Diabetes906229081363723169-45947370092323
Depression bad nerves11815124293183432-2447957801453446750
Epilepsy2786197173551696398324385177231260
Learning difficulties58964463991648495-7662165873238
Mental illness phobia panics349675792124097--25510711063016
Progressive illness n.e.c.424943222130490235647850810474804112
Other problems disabilities9640555201235859671250109664642756825
N/A1133765512952--55547413-
DNA--------
Total1355258907651725649448341007099327899873068530
Source: ONS Labour Force Survey
PLEASE NOTE: As this is a multi-response variable (ie respondents can identify themselves as fitting into more than one category)
totals have not been included in order to avoid duplicate responses.
Secondary Health Problem
Number of People With Mental Health Problems as a Secondary Health Problem: All Disabled Persons of Working Age in England: Spring 2005
Not Seasonally Adjusted
Number of People With Mental Health Problems as a Secondary Health Problem
Arms hands45377
Legs or feet74746
Back or neck125856
Difficulty in seeing7289
Difficulty in hearing2354
Speech impediment1502
Skin conditions allergies10464
Chest breathing problems40564
Heart blood pressure circulation53153
Stomach liver kidney digestion40565
Diabetes19675
Epilepsy14780
Learning difficulties21939
Progressive illness n.e.c.35092
Other problems disabilities60452
N/A11633
DNA-
Total565441
Source: ONS Labour Force Survey
Secondary MH services employment rates
Perkins & Rinaldi (2002) A Decade of Rising Unemployment. Psychiatric Bulletin. 26, 8, 295-98
Chart1
94.519.712
91.118.110.1
8815.88.3
86.212.37.7
87.215.67.4
88.713.37.7
89.510.35.5
92.38.74.9
94.19.55.7
95.18.14.4
Wandsworth Employment Rate
Longer Term Service Users
Long Term Cleints with a Diagnosis of Schizophrenia
Year
% of People in Employment
Sheet1
199094.519.712
199191.118.110.1
19928815.88.3
199386.212.37.7
199487.215.67.4
199588.713.37.7
199689.510.35.5
199792.38.74.9
199894.19.55.7
199995.18.14.4
199096.620.4
199193.819.3
199290.917.7
199389.514.7
199490.312.2
199591.410.4
19969215.1
199794.112.1
199895.812.9
199995.511.8
Sheet1
000
000
000
000
000
000
000
000
000
000
Wandsworth Employment Rate
Longer Term Service Users
Long Term Cleints with a Diagnosis of Schizophrenia
Year
% of Employment
Wandsworth general and MH Employment Rates
Sheet2
Sheet3
Barriers to return to work and job retentionWrong assumptions about work and the management of long term conditions
Negative thinking
Inflexible employment practices
Stigma, discrimination and ignorance about rights
Fear of disclosure of mental ill health
Inability/unwillingness to negotiate adjustments
Unable to self-manage stress and symptoms
Lack of timely help
The low expectations of professionalsExpert professionals say thatpeople with mental health problems are unlikely to be able to workEmployers believe that people with mental health problems cannot work so dont employ themPeople with mental health problems believe that they cannot work and give up trying to get jobsVery few people with mental health problems in employmentA vicious circle that erodes hope and reduces opportunity
Research EvidenceA large proportion of people with serious mental health problems can, with support, gain and retain open employment (Drake et al, 1994, 1996, 1999; Becker et al, 1998; Bond et al, 1995, 1997, 1999, 2001)
Sheltered workshops: Universally poor vocational outcomes (Pozner et al, 1996; Grove, 1999, 2000)
Pre-vocational training: No advantage in enabling people to move into competitive employment over standard care (Drake et al, 1994, 1996; Crowther et al, 2001, 2004)
Supported employment: More effective than pre-vocational training at helping people with severe mental illness to obtain and keep competitive employment (Crowther et al, 2001, 2004)
Evidence Based Supported EmploymentIndividual Placement & SupportThere is strong evidence that:Services should be focused on competitive employment as a primary goalEligibility should be based on the individuals preferencesRapid job search and minimal pre-vocational training
There is moderately strong evidence that:Integrated into the work of the clinical teamAttention to client preferences is importantAvailability of time unlimited support
There is weak evidence from one study that:Benefits counselling should be provided to help people maximise their welfare benefits
(Bond, 2004)
Employment is a realistic goalJob Ready?
Diagnosis and symptoms do not predict success in gaining a job or being able to go to college
Wanting a job and believing that you can work are the best predictors of success
What about my benefits?
Permitted WorkLinking rule for Incapacity BenefitTax CreditsDisability Living Allowance
Implementing research into routine clinical practice
South West London & St Georges Mental Health NHS TrustService Outcomes
Aim:Evaluate the impact of the introduction of IPS within the Community Mental Health Teams (CMHTs) of 3 London Boroughs
IPS was introduced into 8 CMHTs:4 in Kingston,4 in Merton but,not introduced into the 4 Sutton CMHTs
The ServiceJanuary 2002
Comprised three components:
Occupational Therapists (OTs) were designated as Clinical Vocational Leads within the CMHTs and had one dedicated session per week to fulfil this role.
Within each Borough an Employment Specialist linked with employers, Jobcentre Plus, employment agencies, colleges, etc. and provided information, advice and support to the team OTs and care co-ordinators.
Care co-ordinators were expected to provide vocational support, where appropriate, to clients on their caseload with support from the OTs and Employment Specialist
Role of Employment SpecialistCo-ordinates vocational plans with clinical team
Works directly with clients and their care co-ordinators
Direct client interventions:EngagementAssessmentHelped clients to find and keep jobs / education coursesProvided welfare benefits adviceAddressed the support needs and any adjustments
Method
January 2002 - June 2005: CMHTs collected monthly data on all those clients who were receiving a vocational intervention.
Vocational status was collected on first contact with each client and thereafter on a monthly basis.
Impact evaluated in two ways:IPS was introduced at different times in Kingston and Merton - before and after - possible to ascertain whether any changes were likely to be a result of the introduction of IPS or from other factors
Sutton, IPS was not introduced in the period January 2002 to June 2005.
Royal Borough of KingstonTeam OTs supported by 1 Employment Specialist across 4 teams0.5 Employment Specialists per CMHT1 full-time Employment Specialists per CMHT
Chart1
733
953
1094
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13154
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152020
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Open employment
Mainstyream education/training
Mainstream work experience/voluntary work
Number of people supported
Sheet1
Merton: Number of people supported in employmentMerton: Number of people supported in mainstream education/trainingMerton: Number of people supported in mainstream voluntary work/work experienceMerton: Number of people supported in work/education in mainstream integrated settingsKingston: Number of people supported in employmentKingston: Number of people supported in mainstream education/trainingKingston: Number of people supported in mainstream voluntary work/work experienceKingston: Number of people supported in work/education in mainstream integrated settingsSutton: Number of people supported in employmentSutton: Number of people supported in mainstream education/trainingSutton: Number of people supported in mainstream voluntary work/work experienceSutton: Number of people supported in work/education in mainstream integrated settings
Jan-0273313
Feb-0295317
Mar-02109423
Apr-021214430
May-021315432
Jun-021419538
Jul-0215202055
Aug-0215172052
Sep-021719743
Oct-021819845
Nov-021718843
Dec-021718742
Jan-0333158562217645
Feb-03301510552316847
Mar-03301412562316746
Apr-03291517613216957
May-03291617623220860
Jun-03291819663624868
Jul-03311817663324966
Aug-033014176135251171
Sep-032612175536281579
Oct-032612165437291480
Nov-032511165238271479
Dec-032511165241261683
Jan-042410165043221681
Feb-04269165144231683
Mar-043110175845231482
Apr-043211186154241189
May-0431131761602221103
Jun-0433131763602326109
Jul-043181352612923113
Aug-043481759593523117
Sep-0437112068724122135
Oct-0440122072814631158
Nov-0442152481925532179
Dec-04451422811025733192
Jan-055923181001055827190
Feb-056334221191105728195
Mar-057933241361156225202
Apr-058631231401197423216
May-058834261481277024221
Jun-058934271501286923220
Sheet1
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Open employment
Mainstyream education/training
Mainstream work experience/voluntary work
Number of people supported
Sheet2
Sheet3
London Borough of MertonTeam OTs supported by 1 Employment Specialist across 4 teamsFull time Employment Specialist in 3 of the 4 CMHTs1 full-time Employment Specialists per CMHT
Chart2
716
1312
19113
21413
23514
23614
24813
25813
281011
281011
28911
28811
33158
301510
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291517
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241016
26916
311017
321118
311317
331317
31813
34817
371120
401220
421524
451422
592318
633422
793324
863123
883426
893427
Open employment
mainstream education/training
Mainstream work experience/voluntary work
Number of people supported
Sheet1
Merton: Number of people supported in employmentMerton: Number of people supported in mainstream education/trainingMerton: Number of people supported in mainstream voluntary work/work experienceMerton: Number of people supported in work/education in mainstream integrated settingsKingston: Number of people supported in employmentKingston: Number of people supported in mainstream education/trainingKingston: Number of people supported in mainstream voluntary work/work experienceKingston: Number of people supported in work/education in mainstream integrated settingsSutton: Number of people supported in employmentSutton: Number of people supported in mainstream education/trainingSutton: Number of people supported in mainstream voluntary work/work experienceSutton: Number of people supported in work/education in mainstream integrated settings
Jan-027161473313823
Feb-02131216953171024
Mar-0219113331094231046
Apr-02214133812144301477
May-02235144213154321489
Jun-0223614431419538161110
Jul-02248134515202055191211
Aug-02258134615172052181110
Sep-02281011491719743201513
Oct-02281011491819845181612
Nov-0228911481718843181616
Dec-0228811471718742181616
Jan-0333158562217645181421
Feb-03301510552316847151434
Mar-03301412562316746181639
Apr-03291517613216957161635
May-03291617623220860201433
Jun-03291819663624868221533
Jul-03311817663324966201529
Aug-033014176135251171211530
Sep-032612175536281579231827
Oct-032612165437291480242027
Nov-032511165238271479262227
Dec-032511165241261683262029
Jan-042410165043221681292745
Feb-04269165144231683262138
Mar-043110175845231482272127
Apr-043211186154241189252018
May-0431131761602221103272114
Jun-0433131763602326109272015
Jul-043181352612923113252319
Aug-043481759593523117282418
Sep-0437112068724122135282419
Oct-0440122072814631158282520
Nov-0442152481925532179282620
Dec-04451422811025733192282721
Jan-055923181001055827190272521
Feb-056334221191105728195272523
Mar-057933241361156225202282625
Apr-058631231401197423216313123
May-058834261481277024221313222
Jun-058934271501286923220323020
Sheet2
Sheet3
London Borough of SuttonTeam OTs supported by 0.5 Employment Specialist across 4 teams
Chart2
716
1312
19113
21413
23514
23614
24813
25813
281011
281011
28911
28811
33158
301510
301412
291517
291617
291819
311817
301417
261217
261216
251116
251116
241016
26916
311017
321118
311317
331317
31813
34817
371120
401220
421524
451422
592318
633422
793324
863123
883426
893427
Open employment
mainstream education/training
Mainstream work experience/voluntary work
Number of people supported
Chart3
823
1024
1046
1477
1489
161110
191211
181110
201513
181612
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181421
151434
181639
161635
201433
221533
201529
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262138
272127
252018
272114
272015
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272523
282625
313123
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323020
Open employment
Mainstream education/training
Mainstream work experience/voluntary work
Number of people supported
Sheet1
Merton: Number of people supported in employmentMerton: Number of people supported in mainstream education/trainingMerton: Number of people supported in mainstream voluntary work/work experienceMerton: Number of people supported in work/education in mainstream integrated settingsKingston: Number of people supported in employmentKingston: Number of people supported in mainstream education/trainingKingston: Number of people supported in mainstream voluntary work/work experienceKingston: Number of people supported in work/education in mainstream integrated settingsSutton: Number of people supported in employmentSutton: Number of people supported in mainstream education/trainingSutton: Number of people supported in mainstream voluntary work/work experienceSutton: Number of people supported in work/education in mainstream integrated settings
Jan-027161473313823
Feb-02131216953171024
Mar-0219113331094231046
Apr-02214133812144301477
May-02235144213154321489
Jun-0223614431419538161110
Jul-02248134515202055191211
Aug-02258134615172052181110
Sep-02281011491719743201513
Oct-02281011491819845181612
Nov-0228911481718843181616
Dec-0228811471718742181616
Jan-0333158562217645181421
Feb-03301510552316847151434
Mar-03301412562316746181639
Apr-03291517613216957161635
May-03291617623220860201433
Jun-03291819663624868221533
Jul-03311817663324966201529
Aug-033014176135251171211530
Sep-032612175536281579231827
Oct-032612165437291480242027
Nov-032511165238271479262227
Dec-032511165241261683262029
Jan-042410165043221681292745
Feb-04269165144231683262138
Mar-043110175845231482272127
Apr-043211186154241189252018
May-0431131761602221103272114
Jun-0433131763602326109272015
Jul-043181352612923113252319
Aug-043481759593523117282418
Sep-0437112068724122135282419
Oct-0440122072814631158282520
Nov-0442152481925532179282620
Dec-04451422811025733192282721
Jan-055923181001055827190272521
Feb-056334221191105728195272523
Mar-057933241361156225202282625
Apr-058631231401197423216313123
May-058834261481277024221313222
Jun-058934271501286923220323020
Sheet2
Sheet3
Individual experienceFrom the start, Catherine [Employment Specialist] was a very positive influence. She always had a firm idea through our discussions about what area of industry I was best placed to go for. When I looked through the job description, it shone out as the one. At the beginning of our working relationship I would have been happy to take any job. Catherine helped me to realise that I had the potential to fulfil the level of responsibility that I am working at right now. Our frequent meetings over a long time all amounted to eventual success. I am very happy in my job and we still meet up regularly to discuss relevant issues which I find important at this stage.
Individual OutcomesAim:Evaluate the individual client outcomes at 6 & 12 months
Results:6 month follow-up data was available for 451 clients12 month follow-up data was available for 210 clientsremaining clients (n=241) had either not received a vocational intervention for 12 months or had left the service between 6 & 12 months
Demographic and Clinical characteristics
Vocational Status at 6 and 12 months
Other outcomesGender
At the start women were significantly more likely to be in open employment than men : 24% and 13%At 6 months, difference was maintained : 37% of women were in open employment as compared with 24% of menby 12 months the difference had ceased to be significant
Diagnosis
There was no significant difference between the employment status of those clients with a psychotic diagnosis and those with a non-psychotic diagnosis at the start of the intervention or at 6 months or at 12 months
How does this compare?Cochrane Review: Vocational Rehabilitation for People with Severe Mental Illness.
Drake et al (1996)12 months = 34% paid employmentDrake et al (1999)6 months = 27%12 months = 25%
Most studies show an average of 30% people supported in employment with IPS intervention in comparison with an average of 12% with other interventions
Comparing a traditional vocational service with an evidence based service Individual Placement and Support
Comparing a traditional vocational service with an evidence based service Individual Placement and Support
Comparing a traditional vocational service with an evidence based service Individual Placement and Support
Integrating clinical and vocational serviceWhat are the benefits?
Clinically sensitiveAddresses concerns that:Employment serves as a stressorWill interfere with stability of clientMore effective engagement and retentionBetter communicationIncorporation of vocational information into care plansObservation can convert sceptical or disinterested cliniciansBetter outcomes clinicians carry responsibility of coordination, consistency and coherence
Implementation ObstaclesLack of early intervention
Failure to adopt best practice
Lack of focus on work resumption
Lack of integrated service / fragmented provision
Lack of case management
Low priority for clinicians
Interagency co-operation poor
Thank you.
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