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.

The development of employment-focused health care

Evidence-based supported employment (Individual Placement and Support [IPS]) is effective because employment support services are integrated with health treatment. Research has shown that as the Employment Consultant (EC) becomes part of the clinical team, they increase health professionals’ awareness of the importance of employment for recovery and improved well-being. Integrating ECs:

• facilitates an earlier referral to the employment services,
• encourages joint planning of treatment and vocational goals and,
• can lead to health professionals initiating more conversations about employment directly with patients/service users.

This coordination of care is crucial to ensuring the patient/service user doesn’t have to navigate two service systems. In New Zealand, as in other countries like Australia and the UK, health services are provided separately to employment services. This doesn’t promote returning to employment or prevent people falling out of employment.

Te Pou supports a number of projects designed to improve our understanding of how IPS can be applied in other contexts to secondary mental health care. In particular, the integration of employment support with GP practices and the Employment and Mental Health Option Grid.

Integrating employment support with GP practices

In 2012, Workwise in partnership with Midlands Health Network and Waikato Work and Income, established an integrated employment support programme in a number of GP practices. Te Pou has completed a formative evaluation of the programme which assesses its feasibility and early impacts.

Workwise extended this approach with primary care at the end of 2012 to include a demonstration delivered with Compass Health PHO in the Wellington region. ECs work in two general practices based in Newtown and Porirua/Waitangirua. The programme is supported by Work and Income in the Wellington region by co-ordinating wrap-around employment and welfare services where possible.

Related resources

• Te Pou has released a formative evaluation report and briefing paper following a demonstration of integrated employment support
• The Employment and mental health Option Grid has been published to stimulate evidence-informed conversations about the benefits and risks of returning to employment with the help of an employment advisor
• Presentations on EBSE from the World Psychiatry Congress are available to download from the Te Pou library

Employment as a health intervention - the role of psychiatry in bridging the evidence to practice gap

An article published in the Australian and New Zealand Journal of Psychiatry (ANZJP) provides a summary of the international research on the effectiveness of Individual Placement and Support (IPS), an approach to supported employment for people with a mental illness also referred to as evidence-based supported employment (EBSE).

It describes the intervention and explores methods for its successful implementation. It argues that to address this evidence to practice gap a systematic implementation programme is needed across New Zealand and that psychiatrists and their professional bodies are well placed to influence and accelerate this implementation in publically funded mental health services.

Psychiatrists can lead the development and delivery of employment-focused health services and influence public
policy, funding and community expectations.

Subscribers to the ANZJP can access the full article online.