Job Retention and Vocational Rehabilitation for People with Mental Health Problems.

1. Job Retention and Vocational Rehabilitation for People with Mental Health Problems. Fife Pilot

2. Aims of this Presentation • To give a description of the Job retention Pilot Study. • To introduce participants to a process applicable to job retention for mental health issues, illustrated through “composite” case studies • To describe some of the learning encountered during intervention. • To give an overview of the interim results from the evaluation

3. The Context • Average length of time taken off work for mental health related problems is estimated at 29 days compared to 19 days for musculoskeletal disorders.( Jones et al. 2001/2002: Self Reported Work Related Illness in 2001/2002: Results from a household Survey. SW 101/102 – www.hse.gov/statistics/causdis/swi0102pdf ) • As many as 117,000 people with mental health problems, aged between 18 and 65 years currently registered unemployed are capable of work and want to work. ( Scottish Executive Health Department (1997) A Framework for mental health services in Scotland 1997) • Constructive Employment can have a positive impact on mental health and well-being. (Schneider J. (1998) Work interventions in Mental Care, Some Arguments and recent evidence. Journal of Mental Health, 7: 81-94)

4. Drivers for the Project • The National Programme for Improving Mental Health and Well- Being. • The Framework for Mental Health Services in Scotland • The Mental Health and Employment Policy for Scotland • The Mental Health (Care and Treatment) (Scotland) Act 2003 • Fife’s Multi-agency Mental Health Strategy Group-Employment Strategy Group

5. Support into Work Anyone who applies to Fife Council or NHS Fife. Application packs contain a flyer offering confidential service. FEAT offer support through application process and into employment Job Retention Workplace assessment Meet with Employee and manager Short term assistance for mental health issues Referral on to specialist services. 2 Strands to the Project

6. Rehabilitation Consultant’s Role • Workplace assessment. • Meet with employee and manager to identify what changes might be made to assist the employee in returning to or remaining at work. • Formulate a plan to overcome identified problems.

7. Inclusion/ Exclusion Criteria Participants must : • Have work-related issues that are affecting their mental health or mental health issues affecting their work. • Have reduced performance or increased sickness absence. • Have worked for their organisation longer than six months, usually. If involved with the support into work strand this may indicate earlier inclusion. • Have consented and be willing and able to co-operate with the rehabilitation consultant.

8. Referral from OHSAS Self Referral Eligibility Screening Participant Consent Obtained Pre-intervention Assessement CORE, GHQ12,EQ-5D Pre-intervention Assessment COPM Allocation to Rehabilitation Consultant Assessment and workplace visit Action Plan agreed with client Intervention as agreed in plan Post-Intervention Assessement Client’s/Manager’s Perceptions Objectively derived data Post –Intervention Assessment (OT) Exit

9. Structure of the model • Aim of the project is to develop and evaluate a model which can be rolled out across Scotland. • Need for a structured approach which allows the model to be accepted and applied to the context of other areas.

10. 3 “models”- Kortman • Professional Model- a wide description of role and practice across many client groups and situations. • Delineation- The favoured approach to be used with a particular client or group. • Application- Specific intervention techniques used during client contact. Kortman B (1995):The Eye of the Beholder, Models in Occupational Therapy. British Journal of Occupational Therapy.58, 532-536

11. Model of preference- Professional Model • Model of Human Occupation- Considers the individual in terms of Motivation, Roles and Habits, Skills and the environment the individual moves in.

12. Model of Preference- Delineation Approach Specific to the client’s needs e.g. • Cognitive approach • Behavioural approach • Rehabilitative approach • Symptom management

13. Application The specific activities and techniques used in the intervention e.g. • Relapse prevention plans. • Target setting. • Support in positively reframing client situation.

14. Job Retention Pilot Intervention • Personal contact with the employee and manager. • Workplace assessment. • Formulate an action plan. • Liaison with employee and manager. • Short term interventions and referral on

15. The Model. Schematic

16. Learning.

17. Referrals • The majority of referrals are for individuals with Anxiety and depression. • The demand for assistance with job retention issues appears to outweigh supply. • People presenting with major mental illnesses usually require a more rehabilitative approach.

18. Each Case a Minimum of 4 People • The index client. • The manager. • The HR officer. • The OH physician or nurse. • Other (e.g.CPN)

19. The Index Client Each case is unique and the rehab agent should consider the following: • The mental health problem the client is presenting with. • The client’s personality. • The client’s motivation, roles and habits and skills associated with their worker role.

20. The Manager is Key • Their sensitivity to mental health issues. • Their specialist knowledge of the job e.g. what might be a reasonable adjustment. • Their power to implement a plan. • Their knowledge of the client. • The possibility of their being a contributing factor in the client’s difficulties.

21. HR, OH and Other Agents. • HR are remote from the process of the intervention but are central to the case in terms of attendance management and organisational policy. • OH may have continued contact with the client and require some level of communication. • Existing services already giving support should be factored into planning as they may be doing work pertinent to the return to work programme.

22. The Job Task Components • Physical • Cognitive • Social • Emotional • Environmental

23. Case Study Mrs C’Studie 44 yrs old Class and Admin assistant 3 year history of Anxiety, including panic Still attending work but performance much diminished. Supportive manager has accommodated difficulties but needs action taken

24. Worker Role Interview • Showed clients level of motivation supported a return to her role • Continued reporting for work carrying out reduced duties had maintained her work routines • Client was able to engage with the children in her care on a one to one basis • Client perceived her work environment as supportive.

25. Job site visit • Although client continued to attend work she was not fulfilling her role, concerns within the organisation that this was unsustainable. • Manager was sensitive to mental health issues, had made adjustments already and was keen to see a return to full capacity

26. Job Task Analysis • Used Valpar Profile Analysis Guide to describe the level of demands in a variety of component areas e.g. temperaments, aptitudes, educational development • Identified what tasks had been lost and level of perceived difficulty in re-engagement.

27. Meeting with both Manager and Client • Facilitated communication between the two parties • Agreed the plan together- identified tasks not being carried out, in order of ease and set time scales and targets to re-introduce these. • Agreed need for specialist help and time to utilise this to ensure maintenance of progress in future. • Agreed Review date.

28. Result • Client returned to almost full working capacity by review date. Discharged at this point.

29. Case Study • Anne Awnimuss • 35 years old • Technical Officer, Science Department • 15 year history of Schizophrenia • 11 month sickness absence • Fractured relationships within department

30. Worker Role Interview • Showed client had a strong identification with her worker role and specialised skills. • Illustrated an absence of routines in work role and during period of sickness absence. • High lighted symptoms of the illness impacting on ability to fulfill role.

31. Job Site Visit and meeting with manager • Reinforced that client was considered to have specialist skills valuable to the organisation. • Changes had occurred during clients absence introducing increased level of IT equipment • Organisation willing to accommodate issues around symptoms and medication.

32. Plan included: • Phased return over 6 week period. • Hours altered to accommodate hours of daylight throughout the seasons. • Break times organised to accommodate onset of drowsiness caused by medication. • Client provided with work space to minimise contact with IT equipment.

33. Result • Client did not cope well with the early stages of the phased return. • Client resigned but this was declined by the organisation. Resigned whilst ill. • Same plan implemented at a lower key site. • Client resigned.

34. Some Unsolicited Comments • “…advice was helpful and we put several things in place to change his routine. The transformation in him has been quite remarkable.”- G’s manager. • “….it has been very stressful for me but I have been able to make decisions where needed.” – A (a client)

35. Evaluation Overview • Pre and post intervention assessments conducted independently of intervention. • Range of measures covering: • Occupational performance and satisfaction • Psychological distress • Quality of life and general functioning • Client and manager’s perspectives

36. Evaluation Overview – Pre & Post Intervention Measures • Non-standardised measures: • Client’s Perception Questionnaire • Manager’s perception Questionnaire • Standardised measures: • Canadian Occupational Performance Measure • CORE • GHQ-12 • European Quality of Life 5D

37. Interim Findings – Group overview • Subgroup of 11 completed cases. • Analysis of pre and post-intervention scoring on standardised measures using non-parametric statistics (Wilcoxen Signed Ranks tests). • Demographic Information • Gender – 6 males and 5 females • Age – mean= 42.09, range 28 to 56

38. Interim Findings – Employment Status • Pre-intervention employment status • Absent from work and receiving sick pay =8 • Absent from work – no sick pay =1 • Length of absence mean=26.2 weeks (range 1-72 weeks) • At work performing restricted duties =2 • Post-intervention employment status • All 11 individuals were at work at the point of discharge (some restricted duties).

39. Interim Findings- Occupational Group

40. Interim Findings – Diagnostic group

41. The Canadian Occupational Performance Measure (COPM)Law et al (2000) • Designed for use by Occupational Therapists to detect self-perceived change in occupational performance problems over time. • Performance and satisfaction scores based on ratings for 5 individually relevant occupational performance problems.

42. COPM findings – Performance scores This difference was statistically significant (T(11)=0, p<.01)

43. COPM findings – Satisfaction scores This difference was statistically significant (T(11)=0, p<.05)

44. Evaluation Overview • Pre and post intervention assessments conducted independently of intervention. • Range of measures covering: • Occupational performance and satisfaction • Psychological distress • Quality of life and general functioning • Client and manager’s perspectives

45. Evaluation Overview – Pre & Post Intervention Measures • Non-standardised measures: • Client’s Perception Questionnaire • Manager’s perception Questionnaire • Standardised measures: • Canadian Occupational Performance Measure • CORE • GHQ-12 • European Quality of Life 5D

46. Interim Findings – Group overview • Subgroup of 11 completed cases. • Analysis of pre and post-intervention scoring on standardised measures using non-parametric statistics (Wilcoxen Signed Ranks tests). • Demographic Information • Gender – 6 males and 5 females • Age – mean= 42.09, range 28 to 56

47. Interim Findings – Employment Status • Pre-intervention employment status • Absent from work and receiving sick pay =8 • Absent from work – no sick pay =1 • Length of absence mean=26.2 weeks (range 1-72 weeks) • At work performing restricted duties =2 • Post-intervention employment status • All 11 individuals were at work at the point of discharge (some restricted duties).

48. Interim Findings- Occupational Group

49. Interim Findings – Diagnostic group

50. The Canadian Occupational Performance Measure (COPM)Law et al (2000) • Designed for use by Occupational Therapists to detect self-perceived change in occupational performance problems over time. • Performance and satisfaction scores based on ratings for 5 individually relevant occupational performance problems.