The featured article is by the Department of Health, was published in 2006 and is titled ‘Vocational Services for People with Severe Mental Health Problems: Commissioning Guidance’ freely available here. There is a joint introduction by Rosie Winterton MP, Minister of State for Health Services and Margaret Hodge MP, Minister of State for Employment and Welfare Reform in which the low employment of rates of people with severe mental health conditions is discussed and the benefits that employment bring including promotion of independence. The article is aimed at commissioners.
In the introduction, the document is identified as being useful in the implementation of a number of other documents including the National Service Framework for Mental Health. The authors reference the Choosing Health White Paper (reviewed here) in which returning people to good health includes a return to employment. The authors argue that employment can facilitate recovery. The guidance is described as helping commissioners to utilise evidence in choosing vocational services, ensure access to employment advisers, embedding vocational/social support in CPA and provide according to needs in both primary and secondary care for people with severe mental health problems.
There is then a section on Context and Evidence. The authors cite the Labour Force Survey (Office for National Statistics, 2003) when stating that people with severe mental health problems have the lowest level of employment in ‘any of the main groups of disabled people’. The authors explain how they define the term ‘work’ and also gives some case vignettes. They then go on to discuss education referencing the White Paper ’21st Century Skills: Realising our potential’ and also cite research showing that 1/3 of people with ‘mental health problems’ have no qualifications (Social Exclusion Unit Report, Mental Health and Social Exclusion, 2004). The authors identify a number of papers looking at helping people with severe mental health problems to gain activities (’employment, education or voluntary work’) including a Cochrane Review. They then reference the Individual Placement and Support Approach providing supporting evidence. The authors provide evidence for factors that determine success in vocational rehabilitation including a focus on paid emplyment, accessibility according to an individual’s preferences, minimal pre-vocational training, ‘integration into the work of the clinical team’, maximising in work welfare benefits with benefits counselling. In discussing the current situation, the authors cite the Mental Health and Social Exclusion report and also note that strategic direction facilitates people with severe mental health problems gaining the activities described above.
In the Commissioning Guidance, the objectives, principles and framework are outlined. The principles are clearly outlined:- clinical employment leads in secondary services, employment specialists in clinical teams (plural), public service employer examplars, ‘supported work opportunities’ and local partnerships between specialist and mainstream providers. A number of case studies are given. Thus there is the South West London and St George’s Mental Health Trust which developed a vocational services strategy as well as Sheffield Care Trust which has developed the User Support and Employment Service. The commissioning framework is described in some detail including the use of a table.
In the section on Commissioning guidance: Co-ordination, leadership and monitoring there is a more detailed exploration of vocational pathways and the role of mental health professionals in the pathways. In this section, process-mapping is suggested as a method for allowing commissioners a better understanding of an individual’s pathway through the service. In the section on the role of the mental health professional, the distributed responsibility amongst all team members is emphasised. The North East London Mental Health NHS Trust is given as a case example, where the trust has been working with Jobcentre plus to facilitate access to employment for mental health service users on Incapacity Benefit. In the section on coordination and leadership of vocational services the example of Hampshire County Council is given which has partnered with the Voluntary Community Sector and Hampshire Partnership Trust. In the final section on monitoring vocational services, a number of outcome measures are suggested including gaining and retaining paid employment as examples. The example of the South West London and St George’s Mental Health NHS Trust is given which has incorporated vocational outcomes into its Key Performance Indicators.
While this document is specifically aimed at Commissioners, it provides a valuable look at some of the factors influencing the development of services.
Steps To Treatment = 2 (Guidance that can be incorporated into local policy)
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