Re-Working specialist mental health employment provision in Bristol
Introduction & Background
The MH Partnership (MHP) is the primary local vehicle for implementing the Bristol Vision for Mental Health Services. The Partnership reviews changes to local services, monitors service plans and is used as a consultative body to inform commissioners of mental health services in Bristol. The Bristol Mental Health Employment Working Group is a sub-group of the MH Partnership, with a remit to:
 
          Improve paid employment outcomes for people using primary and secondary mental health services
          Improve levels of job retention for people with mental health issues who are in work
          Promote equality and good employment practices and with local employers, in relation to mental health
          Work strategically and at an operational level, reporting back to the MH Partnership
 
The Bristol MH Employment Working Group reviewed the Modernising Mental Health Services Stakeholder Engagement Report in October 2011 and contacted the project team to offer our expertise to the re-design process. We were subsequently asked to hold an employment specific public consultation event on Wednesday 5th September 2012 and to submit a comprehensive report to the Modernisation team, including the public consultation feedback and our expert group recommendations.
 
Employment Working Group critique of the proposed model
          Specifies that ‘Employment and Training’ should appear on all Recovery Action Plans
          Indicates an ‘Employment Lead’ within each Primary Care Mental Health Service
          Embedding Employment Lead’s closer to primary care can enable greater early intervention and clinical integration, whilst reducing gaps and increasing co-ordination with other local services
          Does not detail the Employment Lead role (e.g. Specialist vs Champion) or how it operates
          Does not specify how attention to patients’ employment needs will run throughout all pathways
          Stand alone workers are at greater risk of being pulled away from specialist work and becoming internalised by their teams
          Individual workers could all operate in different ways (not necessarily following best practice), and create weaker, duplicated partnerships with the employment support sector
          One single team, centrally managed, with a worker allocated to each Primary Care Mental Health Service, would enable the team to be far greater than the sum of its parts
          Capacity needs to be built in to allow for work to address mental health with local employers and mainstream employment services
 
Public Consultation Summary
 
At the public consultation event on 5th September we asked nine questions relating to the proposed model and future design of specialist mental health employment provision in Bristol. This elicited a wealth of feedback in the form of issues to be addressed and proposed solutions; a brief summary of which is presented below.
 
Service Structure:
          A single hub and spoke model team of specialist workers, operating across what was primary and secondary care
          Workers embedded within clinical teams, but crucially also firmly and formally integrated to deliver in partnership  with mainstream employment services
          Within future services: employ people with lived experience, facilitate peer support mechanisms, and ensure service development is driven by client experience feedback
 
Access and Outcomes:
          Rather than simple ‘paid work’ or ‘off benefits’ outcomes, future services should report on individually tailored goals of ‘independence’ and ‘employability’; both for job seeking clients and those aiming to retain work
          Ensure the service is accessible via self-referral and through multiple, community based access points
          Deliver time-limited interventions, allowing people to self-direct discharge and re-access the same service
 
The Bristol Offer:
          The main required culture shifts for mental health services center on employment goals as a essential part of recovery planning with a presumption of patient employability
          Commission to allow the service to take clients from outside of the mental health system and to enable the service to provide appropriate support to mainstream services
          Don’t duplicate what clinical teams or mainstream employment services deliver, but work in a way which overlaps and adds value, to support an individual’s employment journey
 
Conclusions
 
Through undertaking this piece of work we found from the outset that there was considerable desire to redesign specialist mental health employment provision to make the best use of available resources. The main focus of the resultant proposed modernisation has been to improve access and individualisation, increase local accountability and integration, reduce duplication and promote supportive overlap between mental health and employment services.
 
Many findings from the wider public consultation echoed the expert view of the EWG and mirrored key principles and design elements proposed by the Modernisation Programme. The EWG therefore feels confident that through the continuation of this work, more effective specialist mental health employment support provision can be implemented to meet Bristol’s diverse needs.
 
Full feedback from the consultation event, along with the findings from an online ‘personal experience’ survey, will appear in a public report to be presented to the Modernisation Board on 10th October 2012. This report will include a review of current services, national policy context and the recommendations made by the EWG on future service design.