Importance of occupational support for NHS patients with mental illness (original) (raw)
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Occupational Medicine, 2023
Background: Unemployment is a structural inequality which raises the risk of premature deaths among people with mental illness. Aims: This study examined whether NHS patients with mental illness get support to find or keep a job because reducing unemployment rates can reduce the risk of premature mortality. Methods: This study analysed recently released data from 54 NHS trusts which randomly sampled patients for a Care Quality Commission survey. This study assessed 11,001 working-age patients with mental illness, of whom 50% are long-term service users (6+ years). Results: Perceived access to occupational support was poor with 46% of patients who wanted the support saying that they did not get help finding or returning to work. Perceived occupational support for physical comorbidities needed improvement because 40% of patients with physical comorbidities did not receive support for physical health needs. 25% said that medication side effects were not discussed, and 24% lacked medication follow-up although 87% of patients found medication beneficial to their mental health. Occupational support significantly benefited overall patient satisfaction to an equivalent extent as main treatment (that is, receiving medication and talking therapies), and it was a more consistent predictor of patient satisfaction than talking therapies. Conclusions: Improved access to schemes which reduce unemployment among NHS patients with mental illness is needed (e.g., individual placement and support programmes), although limited availability might be due to funding constraints. As well as addressing unemployment, occupational support should address other risk factors for premature mortality e.g., poverty, stigma, discrimination, and social exclusion.
Research Briefing 38: mental health, employment and the social care workforce
• Mental health problems are widespread in the working-age population. • Mental health stigma and discrimination remain common in the workplace. • Employers are largely unaware of the levels of mental health need among employees, line managers lack confidence in supporting people with mental health problems and co-workers have mixed views about mental health. • Policy on mental health and employment does not provide a coherent framework to support the recruitment and retention of people with mental health problems. • People with mental health problems do not have to be completely recovered to remain in or return to work. • Good practice means collaboration between professionals, practitioners and employees. • There is sufficient evidence to inform the development of services and interventions so that people with mental health problems can find and keep work in social care.
Helping people with severe mental illness to obtain work: systematic review
British Medical Journal, 2001
Objective To determine the most effective way of helping people with severe mental illness to obtain competitive employment-that is, a job paid at the market rate, and for which anyone can apply. Design Systematic review. Participants Eligible studies were randomised controlled trials comparing prevocational training or supported employment (for people with severe mental illness) with each other or with standard community care. Outcome measures The primary outcome was number of subjects in competitive employment. Secondary outcomes were other employment outcomes, clinical outcomes, and costs. Results Eleven trials met the inclusion criteria. Five (1204 subjects) compared prevocational training with standard community care, one (256 subjects) compared supported employment with standard community care, and five (484 subjects) compared supported employment with prevocational training. Subjects in supported employment were more likely to be in competitive employment than those who received prevocational training at 4, 6, 9, 12, 15, and 18 months (for example, 34% v 12% at 12 months; number needed to treat 4.45, 95% confidence interval 3.37 to 6.59). This effect was still present, although at a reduced level, after a sensitivity analysis that retained only the highest quality trials (31% v 12%; 5.3, 3.6 to 10.4). People in supported employment earned more and worked more hours per month than those who had had prevocational training. Conclusion Supported employment is more effective than prevocational training at helping people with severe mental illness obtain competitive employment. Papers School of Psychiatry and Behavioural Sciences, University of Manchester, Manchester PR2 9HT Ruth E Crowther research fellow Max Marshall reader in community psychiatry
European Psychiatry
Background Employment is intrinsic to recovery from mental health conditions, helping people live independently. Systematic reviews indicate supported employment (SE) focused on competitive employment, including individual placement and support (IPS), is effective in helping people with mental health conditions into work. Evidence is limited on cost-effectiveness. We comprehensively reviewed evidence on the economic case for SE/IPS programmes. Methods We searched PubMed/MEDLINE, EMBASE, PsycINFO, CINAHL, IBSS, Business Source Complete, and EconLit for economic and return on investment analyses of SE/IPS programmes for mental health conditions. Traditional vocational rehabilitation, sheltered work, and return to work initiatives after sickness absence of less than 1 year were excluded. Studies were independently screened by two reviewers. We assessed quality using the Consolidate Health Economic Evaluation Reporting Standards checklist. The protocol was preregistered with PROSPERO-CR...
Scandinavian Journal of Caring Sciences, 2011
Individual placement and support-a model to get employed for people with mental illness-the first Swedish report of outcomes Lack of participation in the open labour market is highly prevalent for people with a mental illness across countries, and the proportion of people who get some kind of sickness benefit because of mental illness is steadily growing in Europe. Vocational rehabilitation through individual placement and support (IPS) has been shown to be effective and is evidence-based for people with severe mental illness. In Sweden, the method is used but not scientifically evaluated. The aim was to investigate vocational and nonvocational outcomes at a 1-year follow-up and the relationships between these outcomes, at two different sites in the north of Sweden. The participants were 65 men and women, mostly younger than 30 years of age and with a mental illness. Occupational situation, psychiatric symptoms, self-esteem, quality of life and psychosocial functioning were assessed. The vocational outcome during 1 year was that 25% of the participants were employed, and 14% were in education. Most of the participants moved from unemployment to work practice for a prolonged time. Participants in employment, education or work practice at follow-up showed higher satisfaction with their occupational situation than those without regular activities outside home. Among the participants in work practice, improvements in psychiatric symptoms and global functioning were identified. This attempt is the first to evaluate supported employment according to the IPS model for persons with mental illness applied in the Swedish welfare system. There is a need for a longer follow-up period to evaluate whether interventions such as further education and work practice actually will lead to real work.
The employment of people with mental illness
Advances in Mental Health
People with a mental illness are among the most socially and economically marginalised members of the community. They experience high levels of unemployment and nonparticipation in the labour force. Unemployment has a number of negative effects including the loss of purpose, structure, roles and status and a sense of identity which employment brings. Employment enables social inclusion in the wider community and is an important way that people with a mental illness can meaningfully participate in the wider community. Australia has a mental health strategy, which guides the ongoing reform of mental health services. However, specific strategies to address the social and economic marginalisation of people with a mental illness have not been addressed. A recovery-oriented approach is recommended, which integrates the key sectors involved. To date there has been little intersectoral collaboration between the various sectors such as mental health services, housing, and vocational services...