Melanie J. Boyce

Mental health service users' experiences of returning to paid employment

Research into mental health and employment has focused largely on people who are unemployed. This paper reports the experiences of 20 clients of employment support agencies who had succeeded in returning to work. A number of barriers to getting back to work were identified, but receiving employment support could enable people to overcome them. There was consistency with previous studies of factors associated with high and low levels of job satisfaction. Even those participants who were less satisfied with their jobs identified benefits and none described any negative effects. The quality of the employment support provided was important, including advice and counselling during the job search, enabling informed choice about disclosure and support in work. Job retention targets are required for funding programmes in addition to placement targets. Further research into the timing and processes of disclosure and into occupational health screening processes would be helpful.

SESAMI study of employment support for people with severe mental health problems: 12-month outcomes.

In the context of UK policy to promote employment for people with disability as a means to greater social inclusion, this study investigated how people with severe mental health problems fare in existing supported employment agencies. The aim of the study was to identify factors associated with successful placement in work and to test the impact of working on psychological well-being in this group. One hundred and fifty-five users of six English agencies were followed up for 1 year (2005-2006). Information was collected about their employment status, job-seeking behaviour, perceived obstacles to work, self-esteem and hope, and the employment support received. Eighty-two per cent of those working at baseline were still in work a year later. The support agencies helped 25% of unemployed clients into work, a statistically significant increase in the proportion of clients in employment. Gaining employment was associated with improvements in financial satisfaction and self-esteem. There was a trend towards working half time. People who had been out of work longer were less likely to secure employment. No significant associations were found between getting a job and personal characteristics, the quantity of employment support given, nor the recipients rating of the support offered. The odds of moving into work were nearly four times higher for those people who visited a job centre prior to the start of the study. Clients of specialist agencies rated their provision more highly than clients of pan-disability agencies. These results demonstrate the benefits of working for this group and support the development of employment services with an individualised, rapid placement approach, linked to job centre advice and expert mental health service input. This is consistent with the Individual Placement and Support model, and highlights in addition the importance of job centres for its implementation in England.

Employment advice in primary care: a realistic evaluation

Every organisation in the UK is affected by mental distress and ill-health in the workforce. The first point of contact for most people with common mental health problems, such as mild to moderate anxiety or depression, is their general practitioner. The location of specialist employment advisers in GP surgeries is therefore a logical attempt to address the issue of people falling out of the workplace, through the provision of early intervention and combined vocational and psychological treatment packages. In 2007 the Richmond Fellowship, a national mental health charity, received a grant to provide four employment advisers to work with GP surgeries in Eastern England. The aim was to help people with mental health problems gain work (Regain clients) or retain their current employment (Retain clients). In this study a realistic evaluation framework was applied to address the question of what works, for whom and in which contexts through interviews with key stakeholders including 22 clients of the project, five primary health care staff and the four employment advisers. The interventions that Retain clients found most helpful were careers guidance (including psychological profiling) and developing strategies to negotiate and communicate with employers. These appeared to help individuals to take control, broaden their horizons and move forward. In many cases this was supported by assistance in helping clients think through whether they wanted to consider a career change. For Regain clients the most important interventions were help with interview skills, CV writing and assertiveness training. Employment outcomes were considerably higher for the Retain clients than for the Regain clients. The study indicates that it could be more effective for Retain and Regain services to be delivered through different care pathways to avoid diluting the services offered and consequently reducing their effectiveness.

Impact of supported employment on service costs and income of people with mental health needs

Background: A 12-month study of UK supported employment providers found that 77 (54.6%) of the participants in the study remained unemployed, 32 (22.7%) got jobs and 32 (22.7%) retained the jobs they held at the outset. Aims: To explore the impact of moving into employment on service use, earnings, benefits and tax allowances claimed. Methods: Service use and frequency were measured at baseline and 12 months. Comparisons paid particular attention to the differences between people entering work and those who remained unemployed. Costs were analysed from a government perspective (excluding earnings) and a societal perspective (excluding welfare benefits and taxes). Results: People who entered work reduced their consumption of mental health services (p < 0.001). However, use of supported employment increased (p = 0.04), in contrast to falling use by people who remained unemployed (p < 0.001) and those who had been working for more than one year (p = 0.002). The increase in earnings for those entering work (p = 0.02) was not offset by a similar reduction in benefits. Conclusion: This indicates that mental health services may make savings as a result of their clients engaging in paid work. It raises questions about the optimal nature and organization of employment support for this service user group.

The SESAMI evaluation of employment support in the UK: Background and baseline data

Aims: This study evaluates real world employment support for people with severe mental health problems in the UK. Given a policy context which promotes social inclusion and welfare to work, we wanted to find out about typical employment services and their effects on people with mental health problems. Method: A case study design was adopted, incorporating qualitative and quantitative interviews with staff and users of each service. After screening for severity, 182 individuals met our inclusion criteria for current use of the services. They were interviewed about their current engagement with support services, their employment and job satisfaction if employed. Measures of self esteem, hope/optimism and job satisfaction were taken as outcomes. Results: We report here associations between the outcome measures and: current working status; support from the agency; and demographic features at baseline. People who were working had higher outcome scores than those who were in work preparation or training. People working with support had higher job satisfaction. Conclusions: The study highlights the methodological issues raised by doing real world research. These findings were generated by heterogeneous interventions in non-experimental settings. Despite this, they tend to support previous evidence in favour of early placement and ongoing support in work. Declaration of interest: This study was financed by the European Social Fund and the six practice partners made contributions in kind.

Older people as researchers - why not? An overview of a partnership project to train older people to be researchers

Malcolm Ramsays article looked at the empowerment of older people through good advice and information. Continuing this theme in our next article, Carol Munn‐Giddings et al describe a unique project that has equipped older people with the necessary research skills to go after the information themselves and is giving them the confidence to directly shape local services. Providers and commissioners ‐ beware!

The impact of the arts in healthcare on patients and service users: A critical review

This review provides an updated evaluation of the emerging body of literature on the value of the arts in healthcare settings. Internationally, there is growing interest in the use of the arts in the healthcare context supported by the number of research studies reported in the nursing and medical literature. There is evidence that arts interventions have positive effects on psychological and physiological outcomes on patients in a hospital environment. A critical review of the literature between 2011 and 2016 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: cultural activities, outcomes and healthcare settings. Initial searches identified 131 potentially relevant articles. Following screening and review by the research team, a total of 69 studies were included in the final review. The majority of studies examined the effect of music listening on patients/service users (76.8%). These studies were primarily quantitative focusing on the measurable effects of music listening in a surgical context. Overall, the studies in the review support the growing evidence base on the value of the arts in a variety of healthcare settings for patients/service users. The review findings suggest that now is the time for different voices and art forms to be considered and represented in the research on arts in healthcare. Further research is also required to strengthen the existing evidence base.

“It’s a safe space”: self-harm self-help groups

Purpose The purpose of this paper is to present a qualitative analysis of the role of self-harm self-help groups from the perspective of group members. Design/methodology/approach A qualitative case study approach guided the research, which involved working with two self-harm self-help groups and all regularly attending members. Findings A thematic approach to the analysis of the findings indicates that self-harm self-help groups can provide a safe, non-judgemental space where those who self-harm can meet, listen and talk to others who share similar experiences for reciprocal peer support. Offering a different approach to that experienced in statutory services, the groups reduced members’ isolation and offered opportunities for learning and findings ways to lessen and better manage their self-harm. Research limitations/implications This was a small-scale qualitative study, hence it is not possible to generalise the findings to all self-harm self-help groups. Practical implications The value of peers supporting one another, as a means of aiding recovery and improving well-being, has gained credence in recent years, but remains limited for those who self-harm. The findings from this research highlight the value of self-help groups in providing opportunities for peer support and the facilitative role practitioners can play in the development of self-harm self-help groups. Originality/value Self-harm self-help groups remain an underexplored area, despite such groups being identified as a valuable source of support by its members. This research provides empirical evidence, at an individual and group level, into the unique role of self-harm self-help groups.

Learning from Older Citizens' Research Groups.

ABSTRACT This article adds to an ongoing conversation in gerontology about the importance of training and involving older people in research. Currently, the literature rarely distinguishes between the one-off involvement of older citizens in research projects and the development of research groups led by older people that sustain over time as well as the nature of educational initiatives that support their development. This article presents a case-study based on evaluative data from the WhyNot! Older Citizens’ Research Group that has been running independently for nearly eight years. Members’ evaluations of, and reflections on, the impact of the training program explore from their perspective: Why older people want to get involved in research training and research groups, what they value most in the training, and the types of impact their involvement has had. Creating an educational environment where participants were able to contribute their knowledge in a new context as well learn new skills through group-work based experiential learning were key. Regular role-modeling provided by inputs from successful established citizen research groups was also important. Of the many benefits members gained from being part of a research group, emphasis was given to the relational aspects of the experience. Likewise the benefits members’ accorded to taking part in training and research transcended individual benefits encompassing benefits to the collective and the wider community. Linking health, social care and educational policies is important in providing coherence and opportunity for older people’s voices to shape research, policy, and practice.