How we helped 1,000 people with mental health conditions find a job

In the middle of a global jobs crisis, what chance does someone with a serious mental health condition have of getting a good quality job?

At the best of times, just one in 14 people who suffer with this type of condition enjoy the financial independence, sense of purpose and fulfilment, and social dignity that comes with paid work. Not to mention that employment is one of the best ways to help people recover from mental ill health.

We set up Mental Health and Employment Partnership (MHEP) in 2015 to tackle this deep social injustice.

MHEP was built upon the abundant evidence that, with the right kind of support, it is possible to help people with serious mental illness find work. The approach we adopted, called Individual Placement and Support (IPS), has been tried with great success all around the world.

Armed with this knowledge, we set about persuading local councils, NHS funders, and others to try a new way of paying for services. And that by doing so, we could unlock funding for mental health and employment support at scale.

Five years, 25 local partnerships, and £2 million of ground-breaking social investment later, we are celebrating our 1,000th client getting a job. Here’s what we’ve learnt from the process.

Some of the most transformational services fall between government silos

Our programme was by no means the first attempt to help people with mental illness into work. But previous central government programmes have had limited success. That’s partly because the way government delivers most employment support, via DWP, is disconnected to the way it delivers mental health treatment, via the NHS.

For the people on the receiving end, they may be told by their job coach to look for work at pain of cuts to their benefits — while being told by their psychologist that work is stressful and should be avoided at all costs!

The IPS model that we adopted brings those two systems together, putting employment specialists directly into mental health teams. Employment support is closely tied to medical treatment and the client gets joined-up messages from all the professionals they’re working with.

The problem? Until recently, the NHS expected DWP to fund employment support, while DWP would not pay for employment specialists based in mental health teams.

The MHEP solution was to combine both sources of funding into one pot on a payment-by-results basis. That meant that each funder, whether local or national, health or employment-focused, could link their payments to the outcomes they’re most interested in.

Now bringing together lots of different funders all paying in a different way can get complicated quickly. The role MHEP plays is to manage that complexity away from stretched council officials and small charitable employment providers.

We do that in two ways.

1. We raised social investment from Big Issue Invest. Over time, that’s amounted to £2 million of flexible capital that we could use to pay for services. When those services clocked up job and health outcomes, our investor started getting repaid.
2. We set up a performance team at Social Finance whose role is to manage the web of contracts, funding flows, provider relationships, and outcomes data that makes the whole structure work.

It hasn’t been easy – but without an intermediary managing a complicated set of government, provider, and investor partners, we would never have helped 1,000 people into life-changing employment.

Delivering quality is hard – dedicated expertise and a focus on outcomes can help

The IPS employment model works. It helps people find jobs, including people with serious mental health conditions who have been out of work sometimes for decades.

But delivering it in practice is easier said than done. It requires strong service leadership; a capable, motivated, trained staff team with low levels of churn; and a supportive environment, especially among the mental health clinicians who we rely on to refer their patients and to offer them positive messages about the benefits of work.

Once we had services operating on the ground, we quickly found that achieving all of this consistently was going to be harder than we imagined. Some teams lost experienced staff while others struggled with effective leadership. Even getting basic data, like how many people got a job each month, proved tricky.

Often when local councils or NHS bodies fund services, the contract managers responsible for them are generalists who are stretched over dozens of projects and initiatives. They end up focusing on getting strategies and funding approved and procurements completed, with almost no time to sort out operational issues once the service is up and running.

The MHEP programme brought three innovations to tackle this challenge and drive a focus on quality.

• First, by putting outside investors’ money on the line, getting outcomes wasn’t a nice-to-have — it was make-or-break. We built a performance team that was dedicated to tracking outcomes monthly and working with providers to resolve issues quickly.
• Second, we brought in a specialist operational adviser with decades of experience managing health and employment services. Our adviser was able to get under the skin of delivery problems and provide direct coaching, training and support to frontline staff.
• Finally, by specialising in one specific model — IPS — and working with a whole range of different government agencies in different geographic areas, we have brought a level of expertise to the table that no one funder would otherwise have available.

That means that we can identify issues quickly and apply solutions that have been proven to work elsewhere. For example, we now have standardised performance metrics with a rich set of benchmarks that tell us what kind of cost per user and cost per outcome we should be able to expect. These have been published for anyone to review as part of a recent evaluation of the model.

Walking the tightrope — how we’ve balanced local ownership and national accountability

National government has the money and resources to fund services at scale, drawing on international expertise and a well-oiled machine to drive accountability and performance.

Local government has deep understanding of its local ecosystem and a rich web of relationships between state, charity, and community actors.

Both are critical if we are ever going to solve hard social problems — like tackling the chasm in employment rates between people without long-term health problems and people with complex barriers like a serious mental illness, a drug and alcohol addictions, or a learning disability.

Over the past five years, we have found our position as an intermediary body pivotal in bridging this gap.

Take, for example, recording and reporting on outcomes. National reporting standards are burdensome, bureaucratic and rigid. Local standards are too often flimsy, inconsistent and lack independent validation.

The MHEP approach has been to develop a consistent but adaptable set of performance metrics, a flexible but rigorous approach to validating outcomes, and a set of benchmarks that prove what can realistically be achieved by services.

So while IPS services have typically been classed as ​“too expensive”, we have shown that you can deliver them at comparable costs to the government’s national Work and Health Programme with better outcomes for those with the most complex needs.

Managing national and local needs is a balancing act. But it’s also the right way to get outstanding outcomes for those who need them most.

Where next?

Since our launch, there has been a revolution in mental health and employment services. The NHS in England has made an astounding commitment to make IPS employment support a core part of mental health services across the nation.

That’s given MHEP the opportunity to move into yet more innovative — and complicated! — territory.

In 2019, we launched the largest employment programme in the UK for people with drug and alcohol addictions, bringing together 19 national and local funders to commission a pioneering service in West London. And this year, we launched our first partnership to help people with learning disabilities into work.

IPS employment support works for these different groups. It helps them find jobs in a way that is fundamentally life-changing.

Looking forward, we realise the funding will get ever more complex with each new group we help. Different types of funders; different outcomes; different interests.

But we’ve learnt over five years that dealing with this complexity is worth it. It’s worth it for those thousand people who we’ve helped to find a new job, a new hope, and a new life. And while there are more people to help, we’ll keep going.

Want to find out more? To learn about commissioning and delivering IPS, visit www.ipsgrow.org.uk, and to learn more about MHEP, contact Bex at bex.spencer@socialfinance.org.uk.