Case study

Mental health: improving employment and health outcomes

PHE facilitating closer collaboration across work, public health and mental health systems to improve employment and health outcomes in mental health.

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Summary

Public Health England (PHE) East of England is brokering and facilitating closer collaboration across the work, public health and mental health systems to improve employment and health outcomes for those with mental health conditions.

Background

The Five Year Forward View for Mental Health was published in 2016 and says ‘Stable employment and housing are both factors contributing to someone being able to maintain good mental health and are important outcomes for their recovery if they have developed a mental health problem’.

The report recommended up to 29,000 more people per year living with mental health problems should be supported to find or stay in work.

The Improving Lives: The Work, Health and Disability Green Paper, published in October 2016 asked ‘what would it take to transform the employment prospects of disabled people and people with long-term health conditions?’. Only 32% of people with mental illness were in work compared with 48% of people with physical disabilities and 80% of people who do not have physical or mental health conditions.

In the East of England, there are around 180,000 people in receipt of Employment and Support Allowance (ESA), 49% of those was due to mental and behavioural disorders. Within the age bracket 18 to 24 year olds, the percentage due to mental health rises to 65 to 70% in some localities.

What was involved

An existing Health and Work Network of Local Authority workplace health leads was expanded in 2016 to include ‘worklessness’ within its remit and representation from Department of Work and Pensions (DWP) Districts in the East of England. The terms of reference of the Network were extended to include the ambitions and objectives of the ‘Improving Lives’ Green and White Papers.

Initial meetings focused on improving mutual understanding of DWP and public health within Local Authorities (LAs).

With regard to DWP:

  • what they do and how they do it
  • the benefits they administer
  • developments relating to a greater focus on health and work as a result of ‘Improving Lives’

With regard to public health:

  • the services that they commission
  • their focus on addressing health inequalities
  • how that might support health improvement of those on DWP benefits

This has resulted in a range of activities such as:

  • delivery of ‘making every contact count’ to frontline Jobcentre Plus staff
  • opening referral pathways into healthy lifestyle services
  • delivery of sessions and NHS Health Checks to customers and staff in Jobcentres

Public Health England East of England (PHEEoE) has also supported training of Jobcentre staff with ‘Connect 5’ mental health training.

By early 2018, relationships between DWP and LAs had developed well, and the timing was considered right to introduce the mental health system into the picture.

The areas of interest were developments relating to Improving Access to Psychological Therapies (IAPT) and wellbeing services set out in the Five Year Forward View for Mental Health.

Specifically, these were:

  • the trajectories for, and increase in, access to IAPT and wellbeing services
  • (re)introduction of employment support roles in IAPT
  • extending IAPT services to include treatment of long-term conditions
  • expansion of Individual Placement Support (IPS) models

In November 2018, 60 representatives from IAPT, wellbeing services and Clinical Commissioning Groups (CCGs), DWP and LAs from across the East of England met to consider ‘Improving Employment and Health Outcomes for those with Mental Health Conditions’.

Representatives from the Work and Health Joint Delivery Unit set out the national context and ambitions. PHEEoE set out the work to date to translate national ambitions into local action, the position regarding young people and those ‘not in employment, education or training’ (NEETs).

Delegates were asked to consider how they might:

  • create a more integrated and supportive individual journey through the work and health systems
  • use the resources currently expended by the employment and health and care systems where they make the most difference
  • develop delivery models that support and incentivise the outcomes we want
  • encourage work to be seen and embedded as a health outcome within the health and care system

What went well

Those closer to the frontline and involved in the delivery of services are seldom aware of the wider context of national strategies and command papers and how they might relate to each other.

DWP and the NHS are not obvious partners and there is little understanding of how and where to access either system to develop partnership working or what sits behind each logo.

Delegates appreciated bringing the work, public health and mental health systems together from their localities, drawing together the parts of a wider picture, setting out the areas of mutual interest and the potential opportunities, with all the key local partners around a single table to broker and facilitate discussion.

DWP and Mental Health Clinical Network representatives delivered brief presentations to refute myths and ‘fake news’, to get beyond adverse media coverage, anecdotal and negative feedback relating to accessing services, waiting times and the support that is available. This helped to raise awareness of the need to better understand DWP and IAPT services in order to identify where the opportunities are, and recognition that both services have more in common than might be apparent.

What could be improved

It is extremely difficult to translate national ambitions to local activity. There needs to be a catalyst somewhere in the wider systems that draw together strategies and command papers, identifies where they overlap and how it might work locally.

Since 2014, PHEEoE has worked with the Clinical Networks and NHS England’s Directors of Commissioning Operations (DCO) across a number of policy areas to be the catalyst in the system. In the absence of PHEEoE’s leadership, it is unlikely that the work, public health and mental health systems would find each other locally.

Next steps

Public Health England East of England has extended an open offer to support the local discussions that will follow on from the November 2018 meeting and agreed to bring people together again in April or May 2019.

PHEEoE will also discuss with the Mental Health Clinical Network and NHS England DCO how it best progresses and co-ordinates activity moving forward through both the Worklessness, Health and Work Network and the Clinical Network and DCO’s support of service improvement in IAPT services and expansion of IPS services.

Lastly, Public Health England East of England will explore how it can best bring local skills and employability leads from LAs and local IAPT services to support the mental health of young people and NEETs whilst supporting efforts to secure employment.

Further information

Neil Wood, Health and Wellbeing Programme Manager, Public Health England – East of England.

Published 18 December 2018