7. Employment support
Employment support is an important part of recovery planning. Good links between treatment providers and employment services can help people navigate complex systems and make informed decisions about employment opportunities.
Dame Carol Black’s 2016 independent review into the effects on employment outcomes of drug or alcohol addiction (England) highlighted the mutually reinforcing benefits of employment and recovery.
Employment and accessing employment support can and should be part of the recovery planning process. Autonomy is central to this, although treatment providers should be aware that some people accessing alcohol treatment may be subject to welfare benefit conditionality and be required by Jobcentre Plus (or Jobs and Benefits office in Northern Ireland) to look for work.
Good links between treatment providers and employment support providers can help people in alcohol treatment navigate potentially complex systems and rules. Providers include Jobcentre Plus and, where available, Individual Placement and Support (IPS) services. A case management approach can help with this.
Access to welfare benefits advice can help people to make informed decisions about employment and particular roles.
This chapter outlines things that services can do to improve employment opportunities for people with problem alcohol use. There is strong evidence that being in good quality employment supports a person’s health and wellbeing. Alcohol treatment staff should ensure that people in treatment can make informed choices about employment and accessing employment support.
7.3.1 Engaging people in alcohol treatment to support employment
Alcohol treatment services should develop and sustain links to employment support. Dame Carol Black’s 2016 independent review recommended that employment should be addressed at the same time as treatment and recovery support, rather than at the end of structured treatment. This could include IPS, which is integrated in community drug and alcohol treatment across most of England and in some areas in Wales, or targeted employment services in Scotland, Wales and Northern Ireland (see section 7.3.4).
As well as being a barrier to employment, problem alcohol use can cause and be a consequence of:
- workplace stress
- difficulties at work
- job loss
Alcohol treatment staff should discuss the person’s attitudes towards and expectations about employment as part of comprehensive assessment when they first access the service. They should also discuss this at each review, in a non-directive way. If alcohol treatment staff discuss employment and access to employment support early in the person’s treatment, and review it regularly, this will enable the person to make an informed decision about their options. Practitioners should also discuss job insecurity and retention with people who are currently employed, and they should know where to refer people who are at risk of losing their job.
The period around starting a job can be stressful, as can transitioning to a new environment and adopting workplace routines. The treatment provider or an employment support provider should make extra support available to people starting work particularly those who have not worked before or not worked for some time. If possible, they should offer to contact them more often, as well as offering to go with the person to work on the first days and offering to support them with managing their first wages and any changes to their benefit claims.
7.3.2 Respecting the person’s autonomy in employment support
For people who are not already in employment, or receiving employment support, or have not been referred to a mandatory programme, it is important that they decide when (or if) they are referred to employment support.
There are some circumstances where a person may be the subject of conditions where this may not be possible. For example, where a person:
- is on job-ready social security benefits and is expected to undertake particular activities to remain eligible for those benefits (conditionality)
- has been the subject of a mandatory referral to a Department for Work and Pensions (DWP) commissioned or co-commissioned programme, or a programme commissioned by a devolved government
Services should ensure that there is a single point of contact (SPOC) and regular, effective communication between the local Jobcentre Plus or Jobs and Benefits office. This will ensure that employment support and benefit conditionality supports treatment and recovery rather than working separately to it (see section 7.3.5 on benefit conditionality and support options below).
Jobcentre Plus work coaches and managers have access to the Flexible Support Fund. This is a discretionary fund that they can use for costs related to a person starting work, such as buying clothing or tools, or covering travel expenses. The Flexible Support Fund is also sometimes used by DWP to commission specialist services to meet local priorities and unmet local need. This could include specialist employment support for people accessing alcohol or drug community treatment. You can find more information on available national and local employment services and schemes, including the Flexible Support Fund, on the Getting into work page on the Turn2Us website (UK-wide).
7.3.3 Understanding the role of employment
Services should promote access to employment and employment support to all who attend their service. This should take place at or shortly after comprehensive assessment, and then regularly throughout treatment.
While employment is generally associated with recovery and wellbeing, not all employment will help with this. A review on the relationship between work, health and wellbeing found that sometimes employment does not result in improved health and wellbeing. For example, the beneficial health effects depend on the nature and quality of work a person does.
The jobs that are often the most accessible to people with limited experience include jobs that are low paid, insecure and with limited autonomy and routes for progression.
Where services provide or help people access employment support, they should try to support them into stable and secure work that matches what the person wants to do, while being realistic about the sorts of jobs that might be initially available to them. An entry-level job can provide a direct or indirect route to a better one following the ABC path: any job, better job, career.
7.3.4 Expansion of access to Individual Placement and Support and targeted employment support schemes
Commissioners and alcohol treatment providers should consider making IPS available. IPS is a highly personalised form of employment support with evidence that it is effective for people experiencing alcohol dependence, mental health conditions and related conditions. There are several important differences between IPS and conventional employment support. For example, IPS employment specialists engage employers directly to explore opportunities for their clients. IPS also provides in-work support, including supporting the person in their new workplace while they adjust to their new role.
The IPS programme is now integrated in alcohol and drug treatment and is available in most areas in England and in some areas in Wales. This mirrors a significant expansion of IPS in mental health services backed by NHS England. You can find a range of IPS resources at the Centre for Mental Health and at IPS Grow, a website funded by NHS England and DWP to support the national roll-out of IPS in mental health services.
The following employment support schemes are tailored to the needs of people experiencing problem alcohol or drug use, or the needs of several groups with specific needs including people with problem alcohol use:
- No One Left Behind from Employability in Scotland
- Out of Work Service offers support from peer mentors in Wales
- Community Family Support Programme in Northern Ireland
7.3.5 Benefit conditionality and support options
Jobcentre Plus requires people who are on out-of-work benefits (such as Jobseeker’s Allowance or the Universal Credit all work-related requirements) to fulfil the requirements of their Claimant Commitment or face a sanction (a temporary reduction or suspension of payments). People on these benefits who are accessing structured alcohol (or drug) treatment can have their Claimant Commitment temporarily suspended under current legislation. This is to allow the person to focus on engaging in treatment and recovery for a period of up to 6 months.
People in treatment who are receiving other benefits (for example, Employment and Support Allowance or Universal Credit no work-related requirements, work-focused interview requirement or work preparation requirement groups) may have little or no contact with Jobcentre Plus or the Jobs and Benefits office. However, they may still be able to access some Jobcentre Plus or Jobs and Benefits office services and can also ask to discuss referral to specialist employment support programmes. Specialist programmes can be national in scope, although many local or combined authorities also design and commission their own employment programmes.
7.3.6 Facilitating access to welfare benefits advice
The welfare benefits system is complex, and keyworkers, clinicians and claimants themselves are unlikely to fully understand it. In-work benefits are among the most complex aspects of the system. Alcohol treatment services should ensure that people have access to high-quality welfare benefits advice throughout treatment, including about benefit conditionality and financial planning, to help them make informed decisions about work.
Citizens Advice offers welfare benefits advice among other services. There are several charities that provide information and support for people wanting to access welfare benefits, including Turn2Us.
Ensuring that people in treatment have access to welfare benefits advice can help them to maximise their income, avoid problems and make informed decisions about the financial implications of taking a particular job. This includes whether they will be financially better off in work, and if so, by how much. As well as mainstream DWP benefits (and legacy tax credits administered by HM Revenue and Customs), services should be able to signpost people to local authority schemes, including:
- local welfare assistance schemes
- Council Tax Reduction
- Discretionary Housing Payments
7.4.1 Employment support agency links
Treatment services should develop links with Jobcentre Plus, or Jobs and Benefits offices in Northern Ireland, and other relevant local employment support providers. This is made easier with designated, named points of contact at each service.
Good and regular communication between the treatment service and the local Jobcentre Plus or Jobs and Benefits office should mean that:
- there is an effective referral pathway between Jobcentre Plus or the Jobs and Benefits office and alcohol treatment services and lines of communication from treatment to employment services to support effective co-ordination
- people feel that they can disclose problem alcohol or drug use to employment services and that the response of those services will be appropriately supportive
- Jobcentre Plus or Jobs and Benefits office can apply conditionality easements when needed
- services can better co-ordinate treatment and employment support around the person and adjust these to take account of changing circumstances (including referral to specialist employment support programmes)
In areas where IPS employment support is available, the IPS team should work closely with Jobcentre Plus staff and managers. They should work to ensure that:
- support is aligned and co-ordinated
- expectations of people receiving employment support are reasonable, realistic and support health and treatment goals
- there are stronger working relationships between treatment services and Jobcentre Plus
Co-locating Jobcentre Plus or Jobs and Benefits office work coaches in treatment services may be an effective way of providing employment support and resolving welfare benefits queries. Peer mentors or other staff from treatment services based in Jobcentre Plus or Jobs and Benefits offices may help people to navigate sometimes complex and potentially intimidating Jobcentre Plus processes.
While it is appropriate for staff at treatment services and Jobcentre Plus or Jobs and Benefits offices to work together, a SPOC approach can be an effective way of ensuring continuity. The points of contact at either end could be a service manager, team leader or IPS team leader on the treatment side, and a partnership manager or disability employment adviser on the Jobcentre Plus side, and equivalent positions in Jobs and Benefits offices in Northern Ireland. Individual services and Jobcentre Plus offices or Jobs and Benefits offices could establish a simple service level agreement, although this is not essential.
7.4.2 Case management approach
A case management approach means that there is co-ordination between the alcohol treatment service and the person’s Jobcentre Plus or Jobs and Benefits office work coach (or their adviser if they have been referred to an external specialist programme). This approach can ensure that people can access conditionality easements (reducing or removing work-related requirements) when appropriate and their progress with treatment and recovery can inform any referrals to further employment support.
When an alcohol treatment service refers someone to employment support, or they are already accessing employment support, the keyworker and employment support provider should adopt a case management approach to help co-ordinate treatment and other support. It is important to avoid a situation where treatment support and employment support have conflicting requirements. For example, a person in alcohol treatment may find it difficult to manage a claimant commitment requiring a large part of each week be spent on work search activities alongside attending a structured day programme.
7.4.3 Engagement with primary care
Many people accessing treatment for alcohol use experience poor health and often comorbidities. Treatment services should work with local GPs to ensure that they are aware of local employment support options, and that support is co-ordinated, including access to employment support.
Doctors issue fit notes to people to provide evidence of the advice they have given about their fitness for work. This is based on their knowledge of their patients’ health status and, where applicable, treatment need. The fit note is intended to be a positive process that looks at people’s strengths as well as their health conditions.
GPs will be aware that patients may have different priorities at different stages in their treatment and recovery when requesting a fit note. For example, people often need access to health-related benefits and may be too unwell to work early in their treatment journey but are likely to benefit from appropriate work or employment support as they progress, including support to make work part of their recovery journey. GPs need to know where to signpost patients for appropriate employment advice and support.
7.4.4 Recognising other health and wellbeing needs
People in treatment for problem alcohol use are likely to experience poor overall health and may have accumulated health harms because of their alcohol use. Ongoing support and access to treatment and medical care, including flexibility around appointment times, is essential to support employment and wellbeing. Treatment services offering flexible opening times, or at least flexible appointments, can be a good way of ensuring that working people in treatment can continue to access support.
The workplace is a setting where alcohol (and drug) related harms can be identified, and steps initiated to meet needs. So, treatment providers should engage with employers in their local community. The primary aim of engaging with employers should be to reach people with treatment needs and to support employers to be more informed about alcohol use, harms, treatment, recovery and employment.
Engaging with employers can:
- help to support people in treatment to remain in work
- help reach under-served parts of the community
- build relationships that could support future employment opportunities for people in treatment
- offer a way to contact employees who might need advice or treatment but feel reluctant to engage with alcohol treatment services
- offer an opportunity to help employers improve their workplace alcohol policies
Treatment services should have policies to guide responses to concerns about people in treatment working in safety-critical roles. Some safety-critical roles are defined in legislation, but more broadly this means any role where health and safety would be unacceptably compromised by someone being impaired due to alcohol (or drug) use. Risk assessment processes and any safeguarding matters relating to work should be:
- comprehensive
- transparent
- involve the person at the earliest stage
Services will be aware that ongoing alcohol (and drug) use may pose risks in safety-critical occupations, and that this could pose a range of issues depending on the circumstances, including ethical, legal and reputational. Risk assessments should take employment into consideration and should always be done with the person. Where a workplace risk is identified, services will need to carefully consider the details of each case.