Mike Floyd

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.

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.

ASSESSMENT OF MEDICAL FITNESS FOR EMPLOYMENT: THE CASE FOR A CODE OF PRACTICE

The Code of Good Practice on the Employment of Disabled People issued in 1984 by Great Britains Manpower Services Commission permits employers to request information on the health and disabilities of prospective employees. While recognizing the need for disclosure of relevant medical information to employers, Floyd and Espir suggest guidelines to ensure that this information is treated responsibly. They propose that all job application forms should be accompanied by explanatory notes on the health standards required; that questions on health or disabilities should appear only on separate health declaration forms, to be inspected only after the job candidates have been selected and only by qualified occupational health personnel; and that rejection on health grounds should be allowed only after a medical examination.

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.

Vocational rehabilitation services in the United Kingdom

This paper reviews the way in which vocational rehabilitation services have evolved in the United Kingdom during the last 50 years, since the end of the Second World War. The services have changed in many ways since then but their overall structure and the aims set for them are still strongly influenced by the perceived needs of ex-servicemen, as embodied in the 1944 Disabled Persons Act. This Act provided the basis for a Quota Scheme and for the development of rehabilitation and placement services and of sheltered workshops. The paper outlines how each of these have evolved in three decades up until 1980 and then examines in a little more detail how somewhat more radical changes were introduced in the eighties and nineties. It concludes by speculating on how services may change in the future and emphasises the need for the UK to follow the United States in developing more professional approaches in this area and ensuring that rehabilitation staff receive proper training.