Supported employment of persons with mental health problems, integration into regular workplace environment ŠENTPRIMA – Institute for rehabilitation and education Ksenija Bratuš Albreht, EUMASS, June, 2016

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Introduction The percentage of people with disabilities among the long-term unemployed is higher than the percentage of people with disabilities in the entire category of unemployed people. (Source: Employment Service of Slovenia, May 2015). Persons with mental health problems take a special place in this category, because they are the most excluded individuals among all. Šentprima will present practical experiences (good practice) with IPS method (Individual Placement and Support) in the work integration of people with severe mental health disorders in the regular market. 3

Work integration Persons with severe mental health problems face specific needs during their work integration. These needs can be addressed only with a comprehensive individualized program of rehabilitation and team-based approach in the field of medicine, psychology, social work and occupational therapy. Team of experts offers and ensures support for both, employer and person with disability, as it varies according to the type of disability, level of impairment and obstacles that each disabled individual faces. Such support is enabled as a supported employment and it refers to the employment of person with disability in the regular workplace environment. 4

‘Place and Train’ not ‘Train and Place’ Individual Placement and Support is a form of supported employment and differs from other types of vocational rehabilitation which have traditionally taken a ‘train and place’ approach. Traditional vocational services typically focus time and resources on training and supporting people to develop new skills in segregated and sheltered environments. In contrast, the primary goal of the IPS approach is to directly find a job and then provide continued support - a ‘place and train’ approach (Appendix). Adhering to the principles of IPS (fidelity to the model) is a key factor in ensuring success of the programs and the skills of vocational workers and the quality of their relationship with clients is crucial. 5

Individual placement and support (IPS) model IPS stands for Individual Placement and Support, the evidence-based approach to supported employment which is designed for persons with serious mental illness. Individual placement and support model is based on close adherence to seven key principles (Mueser 2004): 1.the goal is competitive employment in work settings integrated into a community’s economy; 2.services are based on clients’ choices; 3.clients are expected to obtain jobs directly, rather than following lengthy pre-employment training (rapid job search, job searching commences directly on entry into the program); 6

Individual placement and support (IPS) model 4.attention to client preference in the job search; 5.integration between employment services and mental health treatment teams; 6.ongoing individual support (the support provided in the program is time-unlimited, continuing after employment is obtained, and is adapted to the needs of the individual); 7.systematic benefits counselling (Bond 2008a). 7

Individual placement and support (IPS) model In IPS, employment specialists serve on clients’ treatment teams alongside other staff, such as case managers and psychiatrists. Each employment specialist provides the full range of vocational services to each client, including engagement in services, identifying job interests and vocational assessment, job finding, and job support. IPS uses assertive outreach (Stein 1998) to deliver vocational services in the community rather than at mental health or rehabilitation agencies (Bond 1997b). 8

Example: Employment of long-term unemployed person with severe mental health problems using IPS model. 44 year old male high-school graduate during the study of economy he was diagnosed with schizophrenia because of many hospitalisation he never concluded his study 5 years of work experience in marketing he was 10 years unemployed when he enter the vocational rehabilitation program low self esteem and confidence, fear of changes 9

Example: Employment of long-term unemployed person with severe mental health problems using IPS model. medical restriction: without norms of work production, without night shifts, without the use of machines, part- time work in the early training due to: reduced capacity for long-term mental effort, to solve social situations, reduced maintenance attention, problems with concentration, psychomotor slowdown; difficulty in work with people, difficulty with social interactions. 10

Example: Employment of long-term unemployed person with severe mental health problems using IPS model. He started to train within a short time ( due to fatigue ) in the context of administrative tasks: 5 working hours per day. The support was providing to both employer and employees. Adaptations during the training: part time work for 2 months (5 hours per day), the third month was able to work 8 hours per day; the work was well organise; monitoring for the whole time of training was provided; psychosocial support for the whole time of training like motivational interviewing, stress managment, individual counselling... 11

Example: Employment of long-term unemployed person with severe mental health problems using IPS model. SERVICE FOR THE EMPLOYERS AND THE EMPLOYEES that are long term provided: information, advice and training facilities (on employment rights, expectations of the employer, job tasks, responsibilities...); monitoring at Work (the changes in the workplace, health or personal life); development of individual work methods (coaching the change, conflict...); providing support in the wider environment (engage in activities to improve the well-being, working with the family, the environment in order to facilitate integration); advice on changes; employer support services (to advice, give support for the changes, to assist employers in modifying the work and work environment); 12

Example: Employment of long-term unemployed person with severe mental health problems using IPS model. Employer support services: screening programs to detect risk factors or early signs of disease. He is employed in the context of supported employment for 1,5 year in an competitive work environment. The vocational team provides on an average base 5 hours of counselling per month, the support is based on clients needs. Support is equally provided for the employers. 13

Summary People with severe mental illness can work in competitive employment. Programs following evidence-based principles of supported employment have better outcomes. Programs must address financial and organizational barriers to be successful. 14

ŠENTPRIMA – Institute for rehabilitation and education Joe Marrone, an employment trainer: “If you think work is stressful, try unemployment.” Thank you for your attention! Ksenija Bratuš Albreht, ŠENTPRIMA – Institute for rehabilitation and education 15