1. Beyond the gate: securing employment for offenders with mental health problems Dr Graham Durcan Associate Director, Criminal Justice Programme

2. Introduction The Centre for Mental Health Research & policy = improvement Criminal Justice Programme Diversion – all stages (prevention to re-entry) Youth Justice Employment of offenders Employment Programme Individual placement support

3. prevelance prisonersgeneral 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%

4. Context: criminal justice Multiple and complex needs Nearly half of offenders serving community sentences and up to 90% of prisoners have a mental health problem; 70% have two or more such problems Combined mental illness and substance misuse is common Other 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

5. today Context (offenders) Introduction to an employment methodology from the mental health ‘world’ Individual Placement and Support Evidence base Our scoping exercise in criminal justice settings: Beyond the gate Adapting the IPS for criminal justice settings

6. Research evidence The IPS approach to supported employment

7. English anti-stigma campaign Time to Change

8. 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

9. 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

10. Evidence for what works best 16 published and qualifying RCTs* 12 in USA 1 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

11. 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

12. 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).

13. 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

14. Our Centres of Excellence Programme Tools for commissioners Information and Resources Implementation and dissemination – IPS centres of excellence Facilitating national learning network

15. Beyond the gate (1) 18 months Visits to employment of offender projects In prison, in other secure settings, in probation Interviews Key stakeholder: providers, CJ staff, offender, ex- offenders, etc. In-depth Consultation with expert panel International literature review

16. Beyond the gate (2) Key finding those with sig’ MH problems excluded Employers – creating and developing opportunities Pragmatic recruitment – attitude over qualifications/health status Support for employer & employee – ongoing Opportunities for pre employment….BUT linked to real work world Criminal justice agencies facilitation role

17. Centre for Mental Health: next steps Adapting the IPS model 3 year study 3 prison sites (?) Male Sentenced, Young Adults, Women Involvement of prison, mental health inreach, an expert IPS service, community services, a mentoring service, housing expertise Outcomes: jobs+++, mental health and social stability

18. Thank you for listening Graham.durcan@centreformentalhealth.org.uk