Evidence-based supported employment
Think global, act local
Any supported employment consultant will tell you that people who experience mental illness want to work, and can work.
Furthermore, international evidence is now demonstrating that having a paid job is a key part of getting well and staying well.
Research from across the world, including the United States, Australia, Europe, Canada, and Hong Kong has focused on an evidence-based supported employment approach called individual placement and support (IPS). Evidence-based supported employment (EBSE) is three times more effective at helping people who experience mental illness get a job than any other form of vocational rehabilitation (Bond et al, 2008).
Helping people with mental illness find a job, and keep a job, is also an exceptionally good use of public funds. A growing body of knowledge, including analysis currently underway in New Zealand, shows that people are less dependent on health and welfare services when working.
Employment the key goal
Under EBSE, competitive paid employment is the key goal and focus, as opposed to training or lengthy ready-to-work preparation. Under EBSE, people are supported to look for jobs and to take up jobs within weeks of making contact with employment consultants, such as those from Workwise.
Significantly, under EBSE, the employment consultant becomes a member of the clinical mental health or equivalent support team, meaning employment plans are integrated with goal plans and treatment plans. It also means the mental health team is available as the person starts work and can provide input if needed, ensuring a coordinated team approach. No-one is excluded from EBSE. Providing the person wants a job, they can be referred to an employment consultant. Help to get a job isn’t something that happens after treatment; it is part of a person’s treatment. This is a key difference to the way employment support services within the mental health and addiction sector in New Zealand have been delivered in the past.
World Psychiatry Congress in Argentina
In September 2011 Warren Elwin, chief executive Workwise and Helen Lockett, strategic development for Wise Group (which Te Pou is part of) attended the World Congress of Psychiatry in Buenos Aires, Argentina.
This event is organized by the World Psychiatric Association every three years, and is the main international scientific event in the field of psychiatry. The congress aims ‘to provide an overview of the most promising current trends in the various areas of psychiatric research and practice, with the contribution of prominent experts of the various topics’.
The congress attracts researchers, psychiatrists and other clinicians, government and world health policy makers and others who provide mental health services. This year saw one of the largest turnouts for the conference with around 13,000 delegates in attendance.
For the first time ever at this event there was a keynote presentation on evidence-based supported employment given by renowned psychiatrist Professor Bob Drake from Dartmouth Psychiatric Research Centre, in the USA. This was a historic address and other leading international experts in the field of evidence-based supported employment and recovery were present for this moment, and to be involved with symposia and other presentations throughout the conference.
A selection of presentations from the congress are available for download from the Te Pou library.
Opportunity
Delegates at the World Psychiatry Conference were impressed with how far evidence-based supported employment has come over the last decade within mental health, and at the same time with how far it has yet to go to be available for all those who need it. Many countries are where New Zealand is now, with some good examples of the approach occurring, but we will need to work out how to achieve robust and sustained implementation of it within mental health services. Thus far implementation has been led by a handful of passionate and influential researchers, clinicians and providers who have been keen to find out what works and to implement it for the benefit of people and communities. There is clearly a worldwide spirit of collaboration and determination to reduce unemployment (and so poverty) for people with mental health conditions, and to develop better understandings of how to do this effectively.
From a New Zealand context the conference provides a real opportunity for us to build a learning collaborative of people from across the mental health and employment sectors who can work together to provide the cross-sector leadership needed to support the systematic implementation of evidence-based supported employment in New Zealand.
EBSE works, but it is not yet widely used across New Zealand. As a country we need to do much better. People who experience mental illness have the lowest employment rate of any disabled or disadvantaged group – only one in five people with mental illness have a paid job.
A growing number of health professionals would like to see EBSE as an integral part of all mental health and addiction services in New Zealand. This would mean that:
- all mental health and addiction workers, in clinical and non-clinical settings, will know that having a paid job is a key part of getting well and staying well
- all mental health and addiction workers will actively encourage and support individuals they work with to pursue and achieve their job aspirations
- all mental health and addiction workers will understand their role is to use their expertise to help people continue and build ordinary lives – having a job, a home and a social life.
Just as importantly, poor employment rates among people who experience mental illness are of concern to government, policy-makers and planners, and work is occurring to encourage the development of policies that require EBSE to be funded, provided and monitored.
