1. Newham Primary Psychological Services
Neelam Dosanjh
Head of Service
Monton Jienpetivate
Deputy Head
Newham’s Model

2. Newham Profile Population 308, 800 High transient population
4th most deprived borough in London
Diversity
Young population - 60% aged between 25 and 45
70% are from different ethnic backgrounds, 130 languages
Employment
- Approximately 10% are unemployed double London’s average, no change post 2012
Second highest in benefit claims
60% of ESA claimants report having mental health issues
Health Inequalities

3. Service Profile
Extended IAPT with specialist provision for LTC and MUS, Peri- Natal MH, Eating Disorders, Trauma
Stepped Care Model – 0 to step 4a
7000 Referrals per year
Approx into treatment
Therapy choice is a priority but can’t always deliver due to capacity - CBT, DIT, IPT, Systemic, Integrative
Sub contract to Third sector for counselling, a service for DV and welfare and employment

4. Drivers
Mental ill-health is prevalent in the working age population and is associated with high economic and social costs to individuals and society at large.
Improving  the wellbeing of people with mental health problems and helping them find and sustained employment remains a challenge to health and employment services alike.
Unemployment and being out of work are seen as key drivers behind mental ill-health (Pevalin and Goldberg, 2003; Paul and Moser, 2009). Employability and returning to work helps to improve mental wellbeing (Paul and Moser, 2009; McManus et al., 2012.

5. Profile of Service Users accessing Employment Service
Length of depression and anxiety – 2 to 5 years
Social isolation and exclusion
Poor motivation and self esteem – extrinsically driven
Low educational attainment
Workless-ness in the family
Co – morbidities – substance misuse, poverty, safeguarding issues, poor social stability (welfare), physical ill health

6. Integrated Model Barriers: Integrated Provision: Cultural shift :
To employment for people with mental health problems is the stigma and discrimination (Centre for Mental Health, 2013)
Is the ‘benefit-trap’ when benefits create stronger incentives to remain in the system rather than return to work ( Lelliott et al., 2008)
Integrated Provision:
The integrated employment service within Newham IAPT offers opportunities to overcome these barriers
Cultural shift :
Therapists to assist the engagement
SUs – suspicious, disengagement

7. Integrated Model - Benefits
Provides social stability to better engage with the therapeutic process
Ease of access for Service Users
Learning , having a shared language and tailoring service provision
Improves the Service User’s overall experience of care, engagement, quality, retention in employment and provides a longitudinal approach to improved well being

8. Integrated Model - Benefits
Collaboration and close working ensures employment and wellbeing goals are aligned and realistic
Employment service has excellent links with national and local employers and employer support services such as Access to Work
The in work support provided by the employment service ensures early intervention for Service Users who are in work, and need additional mental health support to successfully retain their job.

9. Work of employment advisors
Forming relationships with Service Users
Assessing literacy and skills
Employment steps - identifying competencies
Coaching on motivation and confidence building
Job searches – matching competencies
Assisting with CV writing and application forms
Preparing for interviews
Employer engagement
Liaising with educational and welfare agencies

10. Data for a year period- July 2013 to July 2014
Number of people referred for employment support
517
100%
Number of people moving off sick pay and benefits
218
42%
Total number moving from unemployment to paid work ( 15 self employment ) 40 8%
Number moving from unemployment to part time or full time student 99
19%
Number retaining full time work
124
24%
Number retaining part time work 36 7%

11. IAPT Employment Initiative
Newham IAPT and local partnership
Letwin pilot project: Newham IAPT engagement

12. IAPT Employment Initiative: existing partnership
Local initiatives between Newham IAPT and Work Programmes set up in 2012
Initial meeting with all local main providers
CDG and A4e signed up

13. IAPT Employment Initiative: Existing partnership
Planning and pre-referral stage
Establishing relationships with advisors and fostering engagement
Training provided by IAPT
Ongoing contact, consultation, follow-up and engagement
Pathway mapping and Referral and infrastructure configuration
Evaluation: Joined by UCL Partners

14. IAPT Employment Initiative: Existing partnership
Success
Relationship
Commitment from staff from both sides
Support and accessibility of IAPT staff to advisors
Advisors increased confidence in their role and engagement with customers
Challenges
Learning each other’s “language” and system
Governance, information sharing and data sharing
Keeping on the task, and maintaining enthusiasm

15. Letwin Pilot Project: Aims
“The purpose of the pilot is to test the impact on benefit off-flows of a client receiving support from the NHS (provided by IAPT). The focus will be Employment and Support Allowance (ESA) claimants in the Work Related Activity Group (WRAG) who report a common mental health condition that may impact on their ability to job search. These claimants will be engaged with the Work Programme.”

16. Letwin Pilot Project: Scope
“Advisers to address job search and employment and establish if progress may be restricted by a common Mental Health Condition – advisers are not expected (nor should attempt to) to diagnose mental health conditions, but to identify where it impacts on Job search activities and employment and refer those who consent to the support.”

17. Letwin Pilot Project: Scope
One thousand claimants
Eight providers across the course of four months from September 14.
The referrals will be voluntary and no sanctions can be applied for non-participation. Both existing claimants and new claimants of ESA.

18. Letwin Pilot Project: Newham IAPT engagement
Preparation stage
Being “introduced” to selected partners – Seetec and CDG (Shaw Trust)
Process mapping, information sheets, data sharing, referral form and process
Weekly conference call/ feedback with the pilot team

19. Letwin Pilot Project: Newham IAPT engagement
Local implementation
Active engagement “at the top” - Three-way meeting – IAPT, Primes and the project team
Negotiating a model, establishing contact points and referral route with management
Establishing and maintaining relationships
Information session with advisors
One-to-one, team consultation
Maintaining contact
In-house communication, configuring IAPTus, referral pathway, tracking and engaging booking and clinical staff

20. Letwin Pilot Project: Newham IAPT engagement
Two models
A dedicated advisor as a link person
Meeting with local manager and the advisor to clarify aim of the project, criteria and secure commitment
Individual meeting with the advisor to help identify appropriate referrals
Regular contact
All advisors make referrals
A half-day information session, including “refreshers” session of previous training and referral route
Establish referral handling, feedback and information sharing
Regular contact via dedicated team leader and individually about outcomes of referrals

21. 31 Referrals received Dec 14 – Jan 15

22. Initial engagement outcomes

23. Current status 53% made it through to assessment completion; 47% dropped out at booking and pre-assessment

24. IAPT Employment Initiative: Letwin Pilot Project
Learning points
Engagement and relationship is the key.
Commitment from the top is vital.
Be adaptive and understand our partners’ organisation needs and pressure, e.g. avoid training at the end of the month, multiple sessions as needed to ensure enough advisors on the ground to keep the business open.
Keep it simple. Advisors are busy and have a high caseload.
If plan A does not work, have a plan B in place.
Communication of outcomes – no-one would like to refer to a “black hole”.
Ensure a robust and referral handling and tracking system.
Engage and communicate with your own staff – clinical and booking team.

25. Neelam Dosanjh
Monton Jienpetivate