The health and wellbeing impacts of Active Labour Market Programmes (ALMPs) Dr Adam Coutts Public Policy Unit Department of Politics and International Studies University of Cambridge

Why focus on ALMPs, health and wellbeing?

What are ALMPs? ALMPs and back-to-work interventions form core components in the delivery of social protection, welfare-to-work policy (UK’s Work Programme, One Euro Jobs programme - Germany) and broader policies of social mobility and poverty alleviation. ALMPs and associated interventions are used to increase employability and reduce the risk of unemployment. Include job search assistance, basic skills training. Have become more important since 2008 given high unemployment (youth) across OECD but also within development contexts – Middle East (Highest youth unemployment in the World). Quasi labour market status between unemployment and employment.

Policy importance Mental ill health costs the UK economy c£70bn per year - 4.5% of GDP. People with mental health conditions run a much higher risk of living in poverty and social marginalisation. The economic cost of a completed suicide for someone of working age in the UK exceeds £1.6m. Co-morbidity of mental and physical health conditions is common; of the 15 million people in England with a long-term (physical) condition, 30% also have a mental health condition. Mental health conditions are common and rising amongst the unemployed and those claiming benefits.

Policy / academic importance Since 2008 increasing political and economic imperatives to generate maximum value from public services – do more / same with less. Social Impact Bonds (SIB) – public services paid according to the results, including on wider health and wellbeing measures. Concept of Health in All Policies - the scope for non-health sector public policy interventions to improve health and wellbeing. Developing policy and academic agenda on What Works, Behaviourial insights, policy effects on happiness and wellbeing and impact evaluations / RCTs of social policies. Social Determinants of Health field: Evidence gap - need for research on how non-health sector policies and interventions affect health and may help reduce health inequalities. Also new area of ‘psychology of poverty’ research – World Development report.

Evidence base Lots of evidence showing redundancy, unemployment and ‘bad’ work have negative impacts on health and wellbeing. Policy belief that interventions designed to move unemployed people into work as quickly as possible offset negative impacts on health and wellbeing. Increasing aggregate level evidence that ALMPs can protect the mental health of the unemployed during economic downturns / recession (Stuckler, McKee et al) BUT - Why do these interventions work? Evidence is limited in explaining causal mechanisms at individual level. Only two UK studies. Most evaluations of such ALMPs focus on outcomes such as earnings and employment.

Social Protections Help… Each 100 USD greater social spending reduced the effect on suicides by: %, active labour market programmes %, family support %, healthcare %,unemployment benefits Spending> 190 USD no effect of unemployment on suicide Source: From Stuckler et al 2009 Lancet

Lack of evidence on ALMPs, health and causal mechanisms Evidence on the effects of ALMPs and training programmes exclusively about labour market outcomes - earnings, job outcomes and the cost- effectiveness. Evidence on labour market status and health has focussed on the health damaging effects of working conditions or of unemployment. Less evidence available on what happens to health within quasi-employment condition of ALMPs Policy makers assume that mechanisms designed to move people from unemployment to employment are the key factors in tackling poverty and improving health.

Evidence on ALMPs, health and wellbeing Generally positive where evidence exists Best available evidence is from RCT studies - Työhön job search training Programme, Finland) and the Institute of Social Research (Michigan) JOBS shows: –Reductions in psychological distress and depression. –Increased subjective well-being (SWB). –Higher levels of control/mastery. –Improvements in motivation and self-esteem. Some negative / mixed findings Health / WB benefits disappear after participation. Where intervention is poorly delivered by instructors. Some participants more responsive – work best for those suffering from poor psychological health.

Jobs II – Does it work? Trialled in the US, Finland, Ireland and China. Participants were tracked at various stages following completion of the programme and compared against a control group. Findings: Participants found re-employment more quickly. (In Michigan 53% of participants found work within 4 months of completing the programme compared to 29% in the control group. In Galway 47.7% were employed at the one year follow up stage compared to 16.8% in the control group.) The quality of the employment was better and employment was sustained. Participants rated the quality of their working life as significantly higher than the control group and were higher earners. Participants who were still unemployed had higher levels of motivation and self confidence and consistently lower levels of depression than the control group.

Why do they work? Models of Jahoda (1982), Warr (1987), Fryer (1986) and Bandura’s (1997) self-efficacy model, Suggests ALMPs and interventions used to deliver them have the potential to improve psychological health and psychosocial functioning, through the provision of the latent functions/vitamins. May mimic the psychological experience of work – represent a ‘psychological holiday from unemployment’ despite being in ‘labour market limbo’ and financially no better off.

Why do they work? Possible active elements of interventions: Provision of social support from fellow participants and instructors reduces feelings of isolation and loneliness. Provision of time structure – daily routine. Work experience / vocational components combined with intensive job search and psychological support (basic CBT) seem to work best for health and reemployment.

Need for UK evidence BUT we don’t know which interventions will work most effectively to improve health, wellbeing and get people into work in UK context. Don’t know which groups of claimants are most effectively supported by interventions. THEREFORE! Establishment of JOBS II / Group work RCT intervention by the DWP Health and Work Team. To be implemented in mid 2016 across a number of JCP districts targeted at JSA claimants.

JOBS II / Group Work Evaluation Aim is to answer two key questions: – In the UK context, does the JOBS II support have an impact on employment and wellbeing outcomes? – For whom does this type of support work for? We also want to know how we can reduce drop out between referral and take up of the support. Methodology – National RCT Outcomes tracked for up to 12 months post programme.

JOBS II / Group Work trial The objective of this trial is to test the Jobs II model at scale and build the evidence base around what works in supporting those at risk of developing common mental health conditions (and those with common mental health conditions) in their return to work. Jobs II is a 5 day programme for job seekers which aims to: Enhance self esteem. Provide the social skills necessary for networking, contacting employers and successful interviewing. Inoculates against setback in the job search process.

Jobs II – How does it work?

Jobs II – Course Content The course is delivered by pairs of trainers in 5 four hour sessions over a week. Activities include: Dealing with obstacles to reemployment Identifying marketable skills Identifying sources of job leads Finding job leads in social networks Conducting the information interview Handling emotions related to unemployment Practicing and rehearsing interviews Thinking like an employer Evaluating a job offer

Evaluation component Aim is to answer two key questions: – In the UK context, does the JOBS II support have an impact on employment and wellbeing outcomes? – For whom does this type of support work? We also want to know how we can reduce drop out between referral and take up of the support. Methodology – National RCT Outcomes tracked for up to 12 months post programme.

Discussion Can health and wellbeing impacts on ALMPs and B2W be monetised? To demonstrate cost-benefit and savings to health services and treasury generated by ALMPs – what is the social value of ALMPs to government and individual? Are health / SWB impacts more important than job outcomes in areas where there are no jobs?

Thank you For further information on the evidence and the JOBS II / Group work trial