Job Retention Case Management in Mental Health

1. Job Retention Case Managementin Mental Health Welcome!

2. Learning objectives for the Day To understand the broad value of job retention and gain an overview of the contextual skills and knowledge identified as being of most use to the job retention case manager To understand the principles & practice of the case management approach. To learn how a healthy work environment is essential for successful job retention. To become familiar with a practical set of tools which you can apply in your service

3. The why, what when & how of job retention WHY? Looking at the evidence: The economic costs The human cost WHAT? Linking retention with prevention & vocational rehab. HOW? The case management approach Holistic Assessment WHEN? Early Intervention Working with the GP

4. Prevention, retention & rehabilitation Primary: workplace health promotion, stress reduction, prevention of illness/injury wherever possible. Secondary: early intervention job retention, managing sickness & absence, workplace support. Tertiary: Finding a new career path – with continuity of support.

5. The economic argument 47% of IB/ESA claimants claim on grounds of mental illness (ONS May 2011) Mental health & stress related problems are now the leading cause of absence from work Estimated cost of mental ill health in England in 2009/10 was £105.2bn, with highest cost £53.6bn relating to human suffering, followed by lost economic output £30.3bn, and health & social care costs £21.3bn. Employers costs: sick leave, lost production, recruitment & training, litigation/insurance etc

6. The hidden cost of conflict • *Lowered job motivation • * Lost work time – damage to morale and productivity • Health costs and legal expenses • Unnecessary re-structuring • Lost staff • Sabotage, theft and damage

7. CIPD ‘Managing conflict & work survey -2007 • Organisations devoted, on average, 12 days of per year in dealing with grievances/disciplinary issues per 100 staff • Employers’ annual cost of £20k in dealing with ET claims and hearings • Workplace mediation help as an early intervention rather than a last resort

8. U.K. playing catch up! Scandinavia – 50% return to work after major injury. U.S.A. – One in Three U.K. – One in Six! As many as 4 people in 10 return to benefits after 6 months back at work – low paid jobs; unsuitable employment; lack of support & lack of external agency support once back at work. Australia: for every dollar spent on rehabilitation, 33 dollars are saved.

9. The Human Cost The breakdown of marriages Falling into debt and poverty Loss of friends and social identity /roles Social exclusion / economic exclusion Dependency on professional services

10. I belong, therefore I am People living alone has doubled in Europe since 1947 Loneliness as bad for you as smoking 15 a day Review of studies shows people had 50% better survival rate if they belonged to a wider social group (Holt-Lundstad) 1 in 10 adults often felt lonely - 1 in 3 would like to move closer to their family – Mental Health Foundation – May 2010

11. Why early intervention? 6 months off work? - only 50% chance of returning to work; 1 year – 25%; 2 years – nil! Presenteeism? – people get depressed before they go sick. Grievances, disciplinary issues work place conflict are the result So early involvement avoids interventions which are often about damage limitation.

12. The GP Picture The Facts Background 35% of consultations involve a mental health problem. 90% of mental health care provided by primary care. Unemployment increases workload of G.P. – strong links between unemployment & health problems Signing off - a protective strategy often at the expense of the patients health. They do not have the time and often the skill or knowledge to deal effectively work absence issues. Access to talking therapies has been patchy

13. And most important: the HOW A service based on individual need – not service led. Solutions Focussed. Transparent Process Recovery based practice Facilitating Healthy Relationships – bridge building. Holistic Assessment

14. Recovery based practice Based on individual need not service led Diagnosis not a good indicator of workability. Gestating hope A time to get well - not a time to be sick! Support is better than care. Health professionals no substitute for friends. Supporting the naturally occurring support. Recovery is a process not an event

15. The Employer needs your services too! Workplace assessment linked to client assessment will identify where the employer needs to ‘get well’ too. Employers’ need help and advice on mental health issues. “We knew she had a nurse but they never included us……The job retention worker made some useful suggestions and the support they gave her made all the difference. We'd have had to let her go – things couldn’t have carried on the way things were” (Avon Pilot)

16. Summing up the ‘how’ of job retention Mental Health - it’s all about relationships If I don’t know what’s happening to me, how can I tell my wife? Saving the job –saving the marriage Canaries! It’s bridge building, detective work, problem solving, resolving conflict and diplomacy.

17. Singing from the same hymn sheet Many Agencies involved: Human Resources, Occupational Health, Line Manager, work colleagues, G.P./clinical support, trade union reps. etc. Different players – different agendas. Who stands alongside the client in their vulnerability? Case Managers provides: advocacy, coordination, support, negotiates & provides information.

18. Fit Note v Sick Note “Employers tell us that managing sickness absence can be challenging. This is compounded by the sick note system that makes sickness a black and white issue, either you’re fit for work or you’re not. We recognise how important it is to get people back to work quickly – the new fit note will do just that” Lord McKenzie, Work & Pension Minister

19. Action on the Fitness Note Launched originally in April 2010 with national training programme for G.P. Practice – but fit notes still being used as a sick note! Jan 2013 Second Fit Note Review - Independent Fit for Work Assessment & Advisory Service announced for 2014 The job case manager will provide the assessment information to advise both G.P. and Occupational Health. AHP Advisory Fitness for Work Report – March 2013 – establishing the AHP expertise. South Staffs Fit for Work pilot has produced a referral ‘stamp’ for GPs so that employers can seek help from FfW Service job retention case managers

20. Action on the Fitness NoteChallenges Fit for Work Assessment and Advisory Service – • Some employers want to use non compliance with fit note as opportunities to bring disciplinary measures. • Will new system be another way of FORCING people back to work? • Need for meaningful performance targets that encourage support rather than punitive approaches. • GPs remain in control and consulted as gatekeepers of Fit Note, or hand over control to FFW Service?

21. Employment Outcomes as Indicators “NHS professionals and their organisations – along with their regulators – should recognise retention in or return to work as a key indicator of their successful treatment of working age people and appropriate data should be collected to monitor it.” Working for a Healthier Tomorrow In future, performance on mental health and employment will be one of the criteria used to assess the quality of the NHS, social services and public health partnerships, Public Health Outcomes Framework for England 2013-16

22. Challenges for IAPT Employment Advisers To work in an integrated fashion with therapists. Immediate referral to address workplace issues. To ensure there is sufficient time for complex cases – particularly regarding advocacy with the employer prior to return to work. Recommended ratio of 1:8 , EA’s: Therapists Creativity with the monitoring – which currently is biased towards the individual getting well with less regard to environmental change. Need for meaningful performance measures – current KP17 only records whether client has come off benefits/sick pay – remained in work should be a successful outcome.

23. Delphi Study – Sainsbury Centre for Mental Health & Nottingham University 80 ‘experts’ throughout the U.K. consulted to establish the priority skills & knowledge set for the delivery of job retention services Acknowledged that the specialist skills and knowledge required, cross traditional professional boundaries. Skills such as negotiation, advocacy & conflict resolution. Knowledge of Employment Law: Equality Act , and Health & Safety legislation

24. Job Retention Team (the trainers!) Activity Establishment of regional networks for peer support; training & development – in London & South East; East of England; Yorkshire; Lancashire; Cheshire & West Midlands Training events: 2 Day Mediation Skills “When Work Relationships Break Down” (www.centrevents.co.uk) Principles & Practice paper & The What ifs of Job Retention. MIND Best Practice Handbook endorsed by Dame Carol Black published Autumn 2011

25. Useful Links & References http.//www.workingforhealth.gov.uk/Initiative/mental-health-and-employment-strategy/Default.aspx Working for a Healthier Tomorrow – Dame Carol Black’s Review, 2008 – www.workingforhealth.gov.uk Work Place Interventions for People with Common Mental Health Problems – BOHRF Report, 2005 – www.bohrf.org.uk Mental Health & the U.K. Economy, 2007 – www.oxfordeconomics.com ‘Back before Christmas’ – The Avon Pilot – Thomas, Secker, Grove, 2002 – from www.scmh.org.uk Work & Wellbeing – Briefing Paper 34/Sainsbury Centre – also ‘Delivering Job Retention Services’ - www.centreformentalhealth.org.uk You can also sign up for the monthly Centre for Mental Health email bulletin ‘Working our Way to Better Mental Health’ – 1st nationwide strategy for mental health & employment ‘New Horizons’ – improving quality of life/wellbeing & accessibility of services for people with poor mental health