Evaluating Social Firms' Role in Supporting Vocational Recovery for Individuals with Mental Health Challenges

1. SoFarr Study An investigation of the usefulness of Social Firms in promoting vocational recovery for people with mental health problems Eleanor Gilbert & Alyssa Milton Coventry and Warwickshire Partnership Trust

2. Overview Background – Mental Health and Employment Phase 1 of Research: Results from a National Survey Phase 2 of Research: Current interviews with employees Phase 3 of Research: In-depth peer interviews with employees and focus groups with Social Firm managers & Health Professionals Coventry and Warwickshire Partnership Trust

3. Work and Mental Health – the benefits • In the UK most people with severe mental illness (SMI) State that they wish to work (Secker et al 2001). • Employment is associated with: • Better QoL and well being (Marwaha et al 2008). • Improved mental health (Social Exclusion Unit 2004). • Social identity and status • Social contacts and support • A means of structuring and occupying time • Activity and involvement • A sense of personal achievement (Shepherd 1989). Coventry and Warwickshire Partnership Trust

4. Unemployment and Mental Health – the costs • In the UK there are high rates of unemployment (80-90%) for people with SMI (Marwaha & Johnson 2004). • Lack of work is a core part of the social exclusion people with mental illness (Social Exclusion Unit 2004). • Unemployment is associated with earlier death and greater levels of psychological illness (Moser et al 1987, McKee-Ryan e al 2005). • The financial costs of SMI are approximately £3.4 billion (2005) for those with schizophrenia (Managalore & Knapp 2006). Coventry and Warwickshire Partnership Trust

5. Work & Mental Health on the agenda • Policy reports have highlighted that health services need to focus on maintaining and promoting economic activity in those with SMI (Black 2008) • No one model of service is right for everyone, and each approach may help different people at different times in their recovery (Boardman 2003). • Vocational schemes targeting mental health have had limited evaluation in the UK (Boardman 2003). Coventry and Warwickshire Partnership Trust

6. Part 1: National survey • Aim: to understand • How many Social Firms employ people with a history of mental ill health • Distribution of these firms • What types of employment Social Firms offer this group • How employment of people with MH problems affects business

7. Part 2: Interviews with employees • Cross sectional design used to survey 120 participants. • Aim is to compare the data gathered from workers in Social Firms to secondary mental health service users. • Additionally, gain an understanding of: • Types of work social firms offer. • The range of age, gender and ethnicity of Social Firms workers. • Current levels of symptoms and contact with mental health services. • Levels of income received through work and the impact on their finances. • Levels of satisfaction with life in general and in particular with their working lives. Coventry and Warwickshire Partnership Trust

8. Part 3a: Peer interviews with Social Firm employees • In depth qualitative semi-structured interviews completed by Peer Interviewers with approximately 30 employees. • Sampling considerations (e.g. age, position, MH, job tenure). • Questions will probe areas such as: • Pathways into and through Social Firms. • The benefits and challenges of working in Social Firms. • The perceived impact of working in Social Firms on areas of life such as symptoms, social networks, self concept and QoL. • Stigma experiences. • Support mechanisms in Social Firms. Coventry and Warwickshire Partnership Trust

9. Part 3b: Focus groups – Social Firm Managers • Explore Social Firm managers' views of the employment of people with MH in their organisations. Such as: • The benefits and problems for people with MH working in Social Firms. • Challenges experienced in managing staff and support processes • Social Firms suitability for people with range of MH problems • Typical accommodations made in the workplace • Exploring the balance between supporting workers and running a business • The types of business experience of successful Social Firms and markers of success. Coventry and Warwickshire Partnership Trust

10. Part 3c: Focus groups – Health Professionals • Explore the views of mental health professionals on the benefits and difficulties of Social Firms for people with mental health problems. • Levels of awareness and experience of Social Firms • The perceived benefits and problems of this type of work for people with MH • How the Social Firms model compares to IPS • Their views on types of people suitable for Social Firms • Whether developing links with Social Firms would be seen as beneficial including the methods in which this would occur. Coventry and Warwickshire Partnership Trust

11. National Survey - method • A UK national survey was completed of Social Firms and other types of social enterprise or supported business • Only included those providing paid employment for people with history of mental ill health. • Membership lists: • Social Firms UK, • Enterprise UK, • Social Social Traders, • British Association for Supported Employment • The International Centre for Clubhouse Development Coventry and Warwickshire Partnership Trust

12. Method • Snowballing technique • Local authorities • Job Centre Plus offices • Lead Occupational Therapists in Mental Health Trusts • Mental health charities and academics asked to provide details of any relevant businesses they were aware of • An internet search Coventry and Warwickshire Partnership Trust

13. Questionnaire • Questionnaire was developed and piloted with Social Firm managers. • Employers asked about: • goods or services supplied • finances • sickness management • recruitment of workers with mental illness • liaison with mental health services. • information about employees with a history of mental illness Coventry and Warwickshire Partnership Trust

14. Results • 67 Social Firms and 82 social enterprises or supported businesses (149 total) identified as potentially employing people with a history of MH problems. • Responses from 145 employers -83 confirmed they currently employed at least one person with mental illness. • Questionnaire were completed by 74 of the eligible businesses • Represented 550 employees with history of mental ill health Coventry and Warwickshire Partnership Trust

15. Mapping • The organisations surveyed were located throughout the UK. • 40% south of England, • 27% north and the midlands, • 22% Scotland • 11% Wales. • Mainly manufacturing and services/catering. • Average number of years of operation was 6.8 for Social Firms and 24 for social enterprises /supported businesses Coventry and Warwickshire Partnership Trust

16. Coventry and Warwickshire Partnership Trust

17. Conclusions from National Survey • Employment of people with a history of mental ill health in Social Firms and social enterprises is currently on a very small scale. • People with wide ranging mental ill health are employed • Social Firms tend to have been developed in the last decade • Increasing awareness may lead to expansion of employment for this group of people in Social Firms • May provide a viable alternative to individual placement and support (IPS). Coventry and Warwickshire Partnership Trust

18. What next? Currently carrying out interviews with employees – data gathering In-depth peer interviews with employees in the autumn Focus groups with Social Firm managers Focus groups with clinicians Results next year Coventry and Warwickshire Partnership Trust

19. Thank you Contact details: Eleanor Gilbert (Warwick University) Eleanor.Gilbert@covwarkpt.nhs.uk Alyssa Milton (UCL) a.milton@ucl.ac.uk Dr Steven Marwaha (Chief Investigator: Warwick University) S.Marwaha@warwick.ac.uk Professor Sonia Johnson (UCL) s.johnson@ucl.ac.uk Coventry and Warwickshire Partnership Trust