Working Your Way Through Recovery

1
Working Your Way Through Recovery

• Maria Hilditch, Specialist OT
• Jan McGall, Lead OT

2
Objectives

• Provide an overview of current mental health
  policy and drivers for change in Northern Ireland
  and United Kingdom
• Review the link between employment and mental
  health recovery
• Provide an overview of the supported employment
  initiatives within the Belfast Health and Social
  Care (BHSCT) for mental health service users

3
Outcomes

• Gain a greater understanding of
• the impact of mental ill-health on the worker
  role
• Recognise the necessary change in policy and
• service provision in supporting employment
• Gain an understanding of mental health care
  priorities in Belfast in ensuring employment is a
  realistic recovery goal for service users

4
Where are we now?

• 32 of people with a disability are in employment
  in Northern Ireland
• Mental and behavioural disorders make up the
  largest diagnostic category for Employment
  Support Allowance
• Long term unemployment and increased risk of
  mental health problems
• Unemployment increased risk of suicide

5
Drivers for Change

• Research shows that those in paid employment are
  5 times more likely to achieve functional
  remission than those who are unemployed or in
  unpaid employment
• Recovery and Work
• Recovery an ethos to guide practice and also a
  personal journey for individuals
• Benefits of work in recovery

6
Policy Perspective

• Dame Carol Black Working for a Healthier
  Tomorrow 2008
• The Review of Mental Health and Learning
  Disability (Northern Ireland) June 2005 The
  Bamford Report
• Recovering Ordinary Lives, The Strategy for
  Occupational Therapy in Mental Health Services
  2007-2017

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Key Service Changes

• Where have we come from?
• Principle that work is important in in everyones
  life has always been there
• 50 years ago, large psychiatric institutions on
  the outskirts of city which were self sustaining
  in many ways but with many issues around
  individual rights
• Move towards community care and reintegration and
  need to develop real employment initiatives
  reflective of individual skills

8
Key Service Changes

• How has this developed
• Recovery focused
• Individualised
• No ceiling on what you can and cannot do
• Continuum of options voluntary work, paid work,
  part-time etc with a value on productive roles,
  including homemaking

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Overview of Supported Employment Initiatives in
BHSCT

• Individual Placement and Support (IPS)
• Exemplar Employer
• Acute Care Job Clinic

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Where we started from

• Images supplied courtesy of www.belfast-murals.co.
  uk

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Video
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Why IPS

• Zero exclusion
• Competitive employment is the goal
• Specialist integrated within the mental health
  team
• Rapid job search
• Individual job preferences
• Employment specialists develop relationships with
  employers based upon a persons work preferences
• Ongoing time-unlimited support
• Personalised benefits counselling

13
Barriers to employment

• Stigma (3 components ignorance, prejudice and
  discriminatory practices)
• Over protective families/professionals
• Self stigma (negative past experience, low self
  efficacy)
• Benefits trap
• Resources for employability
• Side effects of medication

14
IPS Process and Implementation

• Referral received
• Initial joint meeting with client within one week
• Service explained OT role and ES role
• Job search initiated clinical needs addressed
  in parallel
• Key worker remains involved
• Ongoing support from ES and OT for client and
  employer

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Roles within IPS

• Role of Employment Specialist
• Role of Occupational Therapist

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Where are we going?

• Increase in the employment rate for our service
  users
• Work is firmly on the agenda
• Independent evaluation
• Chairmans Award
• Implementation across Recovery and Early
  Intervention Teams

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Exemplar Employer

• Rationale BHSCT
• Process
• Ring fenced posts
• Support of Workable and other partnership working
• Outcomes

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Acute Care Job Clinic

• Ethos
• Location
• Outcomes / Formative Evaluation

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Summary