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Helping people with mental health problems to find and remain in work
Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board Bwrdd Iechyd Prifysgol Hywel Dda University Health Board
Bwrdd Iechyd Addysgu Powys Powys Teaching Health Board
Helping people with mental health problems to find and remain in work Iechyd Cyhoeddus Cymru Public Health Wales
Ymddiriedolaeth GIG Prifysgol Felindre Velindre University NHS Trust
I CAN Work is the first large-scale Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru pilot in Wales to test the integration of Welsh Ambulance Services employment support with health support NHS Trust in order to help people into employment. The service is led by Betsi Cadwaladr University Health Board and delivered across North Wales by voluntary sector partners RCS and Adferiad Recovery, in partnership with Welsh Government and DWP. The pilot ran from June 2019 to June 2021, during which time it engaged and supported over 800 people, with nearly a third of these securing employment, despite the challenges presented by COVID-19. The service is now moving into its second phase following confirmation of continuation funding. I CAN Work is based on the principles of the internationally recognised Individual Placement and Support (IPS) employment programme. The model has been shown to help people find work more quickly than traditional employment support, with those involved in the programme enjoying better health, staying in work for longer, and earning more per hour. Working to these same overarching principles, the I CAN Work pilot looked to adapt and test the IPS model in a locally relevant context and in line with the approach set out in the Together for Mental Health national strategy. The service was quickly and successfully integrated under the Health Board’s ‘I CAN’ brand, which describes and promotes a person-centred approach to mental health provision across health and community settings in the locality cluster. The service eligibility was also broadened to include people living with mild-to-moderate mental health challenges, which meant that people were able to access the service from a range of community settings. This embedding of I CAN Work within a whole-system-approach to mental health support across community, primary care and specialist services created a framework for effective joint working and provided a highly receptive environment for the pilot. The positioning of I CAN Work as a clinical routeway has been pivotal for its success and has led to proactive engagement from BCUHB staff. The evidence indicates that good work is beneficial to health and wellbeing, and lack of work is detrimental to health and wellbeing. Unemployed people consult their GPs more often than the general population, and those unemployed for more than 12 weeks show between four and ten times the prevalence of depression and anxiety. For many with mental health needs, a job is an important part of recovery, but few receive tailored support to seek paid work. The I CAN Work project ensures that patients with mental health Daniel, a 27 year old trained chef from Prestatyn, experienced anxiety and low mood from spending five months out of work, after bullying in a previous job affected his mental health. His life took a new turn when the jobcentre referred him to support through RCS, where a dedicated I CAN Work employment specialist helped him to find work with the catering team at Glan Clwyd Hospital. Daniel said:
The key elements of IPS are:
l Competitive employment is the primary goal l Integration of employment and health support l Zero exclusion – eligibility is based on patient choice l Employment is promoted as a core part of recovery and wellbeing l Job search is rapid and not determined by work-readiness or illness l Job search is guided by individual preferences l There is systematic job development l Personalised planning/counselling l Support provided is time-unlimited including in work support
“My confidence and anxiety were shot after receiving a number of knock backs and I felt like giving up. But my I CAN Work employment specialist was amazing and helped to boost my self-esteem by sending me on a confidence boosting course. She was very proactive and understood what type of work would suit me, rather than pushing me towards any old job.”
needs can access quality, work-focussed support as part of their care plan, thereby reducing pressure on primary care services.
The service evaluation conducted by Bangor University concluded that the I CAN Work programme was successful in integrating mental health support with employability support, providing personalised and tailored support at the interface between the areas of wellbeing and employability. Participants have given consistently positive feedback about the benefits of receiving continued, tailored, focussed support, which many viewed as distinct from the more traditional employment support programmes that they had experienced. In particular, they highlight the vital role of the ‘Employment Specialists’, who provide person-centred support and use a range of skills to support, encourage and empower clients to address areas of difficulty in their mental health and wellbeing in order to build opportunities for employment. Participants also report the importance of I CAN Work in terms of alleviating their mental health issues. Many present to the service with issues of anxiety, depression or low confidence, which can act as barriers to gaining work. The programme was seen as providing valuable support to help them move forward, with some participants identifying the need for less visits to GPs as a result.
