Title
Contents
Acknowledgements 8
The Authors 9
Summary 10
1 Introduction 15
1.1 Background to the research 15
1.2 Evaluation findings to date 16
1.2.1 IBPA perspectives on clients with mental health issues 16
1.2.2 Client perspectives on Pathways to Work 17
1.2.3 Evidence on what works for clients with mental health issues 18
1.2.4 Achieving sustainable job outcomes for clients with mental health issues 19
1.3 The research aims and questions 20
1.4 The research design 20
1.5 Outline of the report 22
2 Jobcentre Plus and non-Jobcentre Plus staff perceptions and experiences of working with people with mental health conditions and Pathways to Work 24
2.1 Introduction 24
2.2 Mental health clients: a distinctive client group for Jobcentre Plus Pathways? 25
2.3 Working with mental health clients 26
2.3.1 The compatibility of NHS treatment and Pathways engagement 26
2.3.2 Supporting an isolated client group often lacking in confidence 27
2.4 The value of work in promoting well being and Jobcentre Plus Pathways to Work 28
2.5 Constraints on support for mental health clients 29
2.5.1 Partnership working between Jobcentre Plus staff and non-Jobcentre Plus people and organisations 29
2.5.2 Training and support for Jobcentre Plus staff 31
2.5.3 Jobcentre Plus performance targets 32
2.5.4 The stigma society attaches to mental health conditions and the underestimation of capabilities 33
3 Mental health client attitudes to and beliefs about work 34
3.1 Introduction 34
3.2 The circumstances of Incapacity Benefit claims 34
3.2.1 Secondary mental health conditions 35
3.2.2 Bereavement leading to depression 35
3.2.3 Workplace issues and pressures 35
3.2.4 Family and relationship breakdown 36
3.2.5 Refugee resettlement and transition 36
3.2.6 Childhood mental health condition which continued into adulthood 36
3.2.7 Substance misuse 36
3.3 Client perceptions of job readiness 37
3.3.1 Perceptions of mental health conditions as a barrier to working 38
3.3.2 Financial insecurity 40
3.3.3 Client views on suitable work and work arrangements 41
3.3.4 Lack of qualifications 43
3.3.5 Perceptions of discrimination 43
3.3.6 Local labour market conditions 44
4 Client experiences and perceptions of Work Focused Interviews 45
4.1 Participating in Work Focused Interviews 45
4.1.1 First contact 45
4.1.2 Scheduling subsequent meetings 47
4.1.3 The Jobcentre Plus environment 48
4.2 Patterns of contact 49
4.2.1 Meetings deferred 49
4.2.2 Mandatory WFIs only 50
4.2.3 Long-term contact 51
4.2.4 Brief, focused contact 51
4.3 Content of Work Focused Interviews 52
4.3.1 Range of services 52
4.3.2 Adviser referrals 54
4.3.3 Action planning 54
4.4 Client views about Work Focused Interviews 55
4.4.1 Positive and negative client experiences 55
4.4.2 Factors influencing WFI interactions 56
5 Client experiences and perceptions of referrals and other services 62
5.1 Introduction 62
5.2 Condition Management Programme 62
5.2.1 Group sessions 63
5.2.2 Service discontinuity and setbacks 64
5.2.3 Experience of inappropriate referrals to CMP 64
5.2.4 Stigma attached to Jobcentre Plus 65
5.3 Job broker services. 65
5.3.1 Appropriateness of job matching 66
5.4 Work opportunities 67
5.4.1 Volunteer work 67
5.4.2 Permitted Work 68
5.5 Other services accessed 69
5.5.1 Coordination of Pathways and other services 69
6 Issues in entering and sustaining paid work 72
6.1 Introduction 72
6.2 Nature of employment 72
6.3 Clients feelings and expectations in entering employment 73
6.4 Discrimination and disclosure 74
6.5 In-work support and reasonable adjustments 76
6.5.1 Reasonable adjustments 76
6.5.2 Financial support 76
6.5.3 In-work advisory support 77
6.5.4 Other supports 77
6.6 Gaps in support and suggestions for improvement 77
6.6.1 Employer compassion and flexibility 77
6.6.2 Reinforcing information on services 78
6.6.3 Wider awareness of mental illness 78
7 Understanding people's trajectories 79
7.1 Introduction 79
7.2 Client journeys and the importance of taking small steps -signs of progression 79
7.3 Mapping client trajectories and outcomes 80
7.3.1 An initial interview followed by a deferral of further meetings 81
7.3.2 Series of six mandatory WFIs, with or without additional voluntary contact 83
7.3.3 Brief, focused contact with an IBPA prior to referral to other services or entering work 85
7.4 Facilitators of positive outcomes: Pathways support 87
7.4.1 The importance of getting the timing right for the intervention 87
7.4.2 The importance of long-term support and case management 88
7.4.3 The importance of the right combination of support 89
7.5 Facilitators of positive outcomes: Support outside Pathways 89
7.5.1 Counselling and talking therapies 90
7.5.2 Group interaction 90
7.5.3 Support workers 91
7.5.4 GPs 92
7.5.5 Informal social networks 93
8 Conclusions and policy implications 94
8.1 Summary of research findings 94
8.2 The adequacy of Jobcentre Plus Pathways support 97
8.2.1 Service gaps 97
8.2.2 Suggestions for improvement to service delivery 98
Appendix A Research instruments 102
Appendix B Overview of sample characteristics 120
Appendix C Interviewing people with mental health conditions 123
Appendix D Initial letter to mandatory clients 126
References 130
Figure 7.1: Client trajectories and outcomes 81
Boxes
Box 7.1: Client 36: WFIs deferred, no movement towards work 82
Box 7.2: Client 38: Soft outcomes from Pathways but journey towards work stalled 83
Box 7.3: Client 33: Soft outcomes from Pathways and journey progressing 84
Box 7.4: Client 11: Journeyed to work readiness but not yet experienced a successful transition into work 85
Box 7.5: Client 4: Transition into sustained work with Pathways help 86
Box 7.6: Client 12: Transition into sustained work with limited role of Pathways 87