Beyond the Gate: Securing Employment for Offenders with Mental Health Problems

1. Beyond the gate:securing employment for offenders with mental health problems Dr Graham Durcan Associate Director, Criminal Justice Programme

2. Introduction • The Centre for Mental Health • Research & policy = improvement • Criminal Justice Programme • Diversion – all stages (prevention to re-entry) • Youth Justice • Employment of offenders • Employment Programme • Individual placement support

3. prevelance

4. Context: criminal justice • Multiple and complex needs • Nearly half of offenders serving community sentences and up to 90% of prisoners have a mental health problem; 70% have two or more such problems • Combined mental illness and substance misuse is common • Other needs including unemployment, homelessness, poverty, relationship breakdown, history of trauma, domestic violence and abuse • Importance of integrated working widely recognised but challenges in delivery • Resettlement & employment initiatives – excluded from

5. today • Context (offenders) • Introduction to an employment methodology from the mental health ‘world’ • Individual Placement and Support • Evidence base • Our scoping exercise in criminal justice settings: Beyond the gate • Adapting the IPS for criminal justice settings

6. Research evidence The IPS approach to supported employment

7. English anti-stigma campaign Time to Change

8. A bit of history… • 1980s - closure of large hospitals, moved ‘industrial therapy’ units into the community and renamed them ‘sheltered workshops’. • Philosophy: TRAIN then PLACE • vocational services after clinical treatment and care is completed • extensive pre-vocational training to help prepare people for work • work readiness assessments

9. Growth of Supported Employment Models • During late 1980s PLACE then TRAIN approach – supported employment • Research studies published, mainly from the States on the employment outcomes from these approaches • Increasing number of supported employment services in the UK; patchy and poorly funded

10. Evidence for what works best • 16 published and qualifying RCTs* 12 in USA • 1 in Hong Kong • 1 in Canada • 1 in Europe (six European countries) • 1 in Australia • 11 RCTs involve services with high fidelity to IPS. *See 2008 edition of Psychiatric Rehabilitation Journal

11. IPS is a type of supported employment • US studies – ‘individual placement and support’ approach to supported employment (Drake & Becker supported employment model) • Far superior outcome rates (50 – 70% real employment, i.e. salaried / competitive position • Bespoke jobs vs advertised jobs

12. The Individual Placement and Support approach 7 evidence-based* principles: 1. Eligibility is based on individual choice; 2. Supported employment is integrated with treatment; 3. Competitive employment is the goal; 4. Rapid job search (within 4 weeks); 5. Job finding, and all assistance, is individualised; 6. Follow-along supports are continuous; 7. Financial planning is provided. *Evidence for each principle as well as for the model as a whole (Bond, 2004; Bond et al, 2008; Psychiatric Rehabilitation Journal).

13. Who should use the services? Grove & Membrey, 2005 review of the literature: • Individual factors such as diagnosis, length of illness, age, severity of symptoms are not predictors of whether people will achieve successful vocational outcomes’ • Best individual predictors are motivation and self-belief • What is important is the availability of high quality employment support services • “If you think work is bad for people with mental illness, try poverty, unemployment, and social isolation”. Marone & Golowka (2000) Psychiatric Rehabilitation Journal

14. Our Centres of Excellence Programme • Tools for commissioners • Information and Resources • Implementation and dissemination – IPS centres of excellence • Facilitating national learning network

15. Beyond the gate (1) • 18 months • Visits to employment of offender projects • In prison, in other secure settings, in probation • Interviews • Key stakeholder: providers, CJ staff, offender, ex-offenders, etc. • In-depth • Consultation with expert panel • International literature review

16. Beyond the gate (2) Key finding those with sig’ MH problems excluded • Employers – creating and developing opportunities • Pragmatic recruitment – attitude over qualifications/health status • Support for employer & employee – ongoing • Opportunities for pre employment….BUT linked to real work world • Criminal justice agencies facilitation role

17. Centre for Mental Health: next steps • Adapting the IPS model • 3 year study • 3 prison sites (?) Male Sentenced, Young Adults, Women • Involvement of prison, mental health inreach, an expert IPS service, community services, a mentoring service, housing expertise • Outcomes: jobs+++, mental health and social stability

18. Thank you for listening Graham.durcan@centreformentalhealth.org.uk