The University of Nottingham

An innovative support programme has helped to significantly transform the employment prospects of people in Nottinghamshire with a severe mental illness.

A study by researchers based at The University of Nottingham has shown that the Individual Placement and Support (IPS) approach alongside more tailored work-focused psycho-social support has delivered an overall employment rate of 57 per cent for patients in the county living with a range of serious mental health conditions.

This compares to just 12 per cent achieved by strategies currently employed by local healthcare trusts and three per cent through Government back-to-work schemes.

The implementation and evaluation study was led by Professor Justine Schneider and funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Nottinghamshire, Derbyshire and Lincolnshire (CLAHRC-NDL).

Professor Schneider said: “IPS works in Nottingham, helping more than half of young people with mental health problems towards employment. Now commissioners need to invest in the IPS approach as one of the few non-medical interventions that are known to work for this group.”

In the UK, of the 500,000 people with a mental health condition, just 20,000 are estimated to be in employment. However, research has shown that socially, psychologically and economically, having a paid job is beneficial to people living with mental health problems.

Commissioners in the UK are facing a challenge to increase employment opportunities for people with mental health disorders both to assist in their personal recovery and to help to meet NHS and social care targets. The research aimed to build on substantial knowledge about how to achieve this from other countries which has yet to be widely implemented in the UK.

IPS is focused on achieving paid work in the ‘real world’ rather than sheltered employment or lengthy job preparation. Employment specialists within mental health agencies work directly with clients with mental health disorders to explore jobs that they are interested in doing and then provide support, coaching, CV development, interview training and on-the-job support.

The study involved developing and implementing IPS in Community Mental Health Teams (CMHTs) and Early Intervention Psychosis teams (EIP teams) in Nottingham and will go on to compare the outcomes for service users who received IPS with those who also received additional tailored work-focused, psycho-social support to explore whether this increases the rate of employment even further.

They found that more than half of those who received the IPS and additional support — 42 out of 74 — were successful in achieving a vocational aim. From that group, 23 (31 per cent) started a new job, 11 (15 per cent) achieved voluntary work and eight (11 per cent) began studying for a long-term professional qualification.

Professor Schneider added: “It’s fair to say that the service users involved in this study were already highly-motivated to work. However, given that these are largely young people aged between 18 to 35 with little or no work experience and a serious stigmatised mental illness, these are encouraging results, consistent with what has been found in Canada and the USA.”

Additionally, the study has changed professionals’ attitudes towards employment support — care coordinators have begun referring to the study team directly because they can see the real benefits that study participants in terms of employment outcomes.

Michael Osborne, Service User Consultant (Voluntary) with Nottinghamshire Healthcare NHS Trust, said: “The IPS Scheme has been a really great success and many service users have gone on to have meaningful employment. I believe that this will give them a sense of importance and contentment for the forthcoming future. They hopefully will go further on to achieve good things. IPS has been a boon to those who wanted to gain work and has shown other schemes how to approach the service user.

“This scheme and the empathy and understanding that staff have shown to the service users has made an impact on employers. However the desire and effort of the service user must not be overlooked. A combination of staff skill, service user desire and commitment and the Individual Placement Support scheme has achieved beneficial success to the lives of the service users and to their employers and the country at large.”

Erica Bore, a vocational specialist in the Early Intervention in Psychosis team at Nottinghamshire Healthcare NHS Trust, said: “IPS made a real difference to the clients within our EIP service. By having a non-clinical member of staff based with the team and having a pure focus on employment, clients’ employment aspirations were placed highly on the team’s agenda. Clients actively engaged with the employment specialists and positive results were seen by all involved. IPS fitted the EIP model entirely and strengthened the service already on offer.

“It was a real shame when IPS was no longer able to be sustained within the team due to staff costs. The biggest difficulty encountered by our EIP service when implementing the IPS model was the high volume of clients who wished to access the service and the staffing time from the employment specialists involved. This showed a real need for IPS within the service as a direct result from the clients’ wishes. IPS would be welcomed back into our EIP team without question.”

The final analysis of the project, which is still to be completed, may also indicate that this is a more cost effective way of getting people into work, which is made even more important because the participants are drawn from a population who under normal circumstances would not be expected to be in employment.