beyond the gate: securing employment for offenders with mental health problems dr graham durcan...
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Beyond the gate:securing employment for offenders with mental health problems
Dr Graham DurcanAssociate Director, Criminal Justice Programme
Introduction
The Centre for Mental HealthResearch & policy = improvement
Criminal Justice ProgrammeDiversion – all stages (prevention to re-entry)Youth JusticeEmployment of offenders
Employment ProgrammeIndividual placement support
prevelance
prisoners general population
schizophrenia and delusional disorder
8% 0.5%
personality disorder 66% 5.3%
neurotic disorder (e.g. depression)
45% 13.8%
drug dependency 45% 5.2%
alcohol dependency 30% 11.5%
Context: criminal justice
Multiple and complex needsNearly half of offenders serving community sentences and up to 90% of prisoners have a mental health problem; 70% have two or more such problemsCombined mental illness and substance misuse is commonOther needs including unemployment, homelessness, poverty, relationship breakdown, history of trauma, domestic violence and abuse
Importance of integrated working widely recognised but challenges in delivery Resettlement & employment initiatives – excluded from
today
Context (offenders)Introduction to an employment methodology from the mental health ‘world’
Individual Placement and SupportEvidence base
Our scoping exercise in criminal justice settings: Beyond the gateAdapting the IPS for criminal justice settings
Research evidence The IPS approach to supported employment
English anti-stigma campaign
Time to Change
A bit of history…
1980s - closure of large hospitals, moved ‘industrial therapy’ units into the community and renamed them ‘sheltered workshops’.
Philosophy: TRAIN then PLACE
vocational services after clinical treatment and care is completed
extensive pre-vocational training to help prepare people for work
work readiness assessments
Growth of Supported Employment Models
During late 1980s PLACE then TRAIN approach – supported employment
Research studies published, mainly from the States on the employment outcomes from these approaches
Increasing number of supported employment services in the UK; patchy and poorly funded
Evidence for what works best
16 published and qualifying RCTs*
12 in USA1 in Hong Kong 1 in Canada 1 in Europe (six European countries) 1 in Australia
11 RCTs involve services with high fidelity to IPS.
*See 2008 edition of Psychiatric Rehabilitation Journal
IPS is a type of supported employment
US studies – ‘individual placement and support’ approach to supported employment
(Drake & Becker supported employment model)
Far superior outcome rates (50 – 70% real employment, i.e. salaried / competitive position
Bespoke jobs vs advertised jobs
The Individual Placement and Support approach
7 evidence-based* principles:
1. Eligibility is based on individual choice;
2. Supported employment is integrated with treatment;
3. Competitive employment is the goal;
4. Rapid job search (within 4 weeks);
5. Job finding, and all assistance, is individualised;
6. Follow-along supports are continuous;
7. Financial planning is provided.
*Evidence for each principle as well as for the model as a whole (Bond, 2004; Bond et al, 2008; Psychiatric Rehabilitation Journal).
Who should use the services?
Grove & Membrey, 2005 review of the literature:
Individual factors such as diagnosis, length of illness, age, severity of symptoms are not predictors of whether people will achieve successful vocational outcomes’
Best individual predictors are motivation and self-belief
What is important is the availability of high quality employment support services
“If you think work is bad for people with mental illness, try poverty, unemployment, and social isolation”. Marone & Golowka (2000) Psychiatric Rehabilitation Journal
Our Centres of Excellence Programme
Tools for commissioners
Information and Resources
Implementation and dissemination – IPS
centres of excellence
Facilitating national learning network
Beyond the gate (1)
18 monthsVisits to employment of offender projects
In prison, in other secure settings, in probation
InterviewsKey stakeholder: providers, CJ staff, offender, ex-offenders, etc.In-depth
Consultation with expert panelInternational literature review
Beyond the gate (2)
Key finding those with sig’ MH problems excluded
Employers – creating and developing opportunitiesPragmatic recruitment – attitude over qualifications/health statusSupport for employer & employee – ongoingOpportunities for pre employment….BUT linked to real work worldCriminal justice agencies facilitation role
Centre for Mental Health: next steps
Adapting the IPS model3 year study3 prison sites (?) Male Sentenced, Young Adults, WomenInvolvement of prison, mental health inreach, an expert IPS service, community services, a mentoring service, housing expertiseOutcomes: jobs+++, mental health and social stability
