The government's contention that employment is positive for those with mental illness is strongly supported by the evidence, write Philip Mitchell and Geoffrey Waghorn.
“A job is a prescription for a young person with mental health issues.” – Minister for Social Services, Scott Morrison, speech to ACOSS National Conference, Friday June 26, 2015.
OPINION: Social Services minister, Scott Morrison, ruffled a few feathers when he said last week that a job is a prescription for a young person with mental health issues, with some opining this reflected a simplistic view of mental health treatment.
But as it happens, there is quite a bit of research supporting what the Minister said.
The full quote, in context, was:
$19.4m will be provided for young people with mental health conditions. I particularly want to thank Headspace and Orygen’s Patrick McGorry for their very strong investment in the development of these initiatives when they brought them to me earlier this year. In this trial we are helping young people enter the work force and treat their conditions at the same time, through an individualised placement and support programme. A job is a prescription for a young person with mental health issues – that’s what was put to me by Pat and we are very pleased to be able to respond in this way and we are very invested in seeing this programme work and understanding its broader implications and applications.
It is clear that the “a job is a prescription” line was not intended literally. Employment was not claimed to be a substitute for good mental health care. Rather, Mr Morrison’s comment is a reference to, and recommendation of, the Individual Placement and Support (IPS) approach.
The IPS program helps overcome barriers that many people with mental health conditions face in obtaining paid employment. The program matches employers with suitable jobs to employees who have mental illness, and helps support both employers and employees over time.
The (IPS) program is a relatively new response to the problem of high unemploymentamong young people with mental health conditions in Australia. The government’s support of such a program is good news for Australia because this is what independent scientists have been recommending for over ten years.
The IPS approach has consistently proven to be two to three times more effective than any other methods for adults with severe and persistent mental illnesses (such as schizophrenia and bipolar affective disorder) who have employment goals.
Studies have shown it also works well for young people with mental health conditions, such as generalised anxiety disorder, major depression, and first episode psychosis, provided they have employment goals.
Those who don’t have employment goals are not usually invited to participate. Two studiesconducted in Australia confirm that IPS can be implemented successfully within the existing systems even though there are important challenges.
When implemented successfully, the results for IPS are significantly better than the national average results for Disability Employment Services.
Under the IPS approach, better forms of mental health treatment and care also need to be provided in support of high quality employment assistance. Employment services also need to be better tailored to individuals than in existing services.
The employment assistance is also more intensive when needed, to ensure that each person’s own employment preferences are respected and attained.
Mental health care for people employed under the IPS program is also intended to continue longer than is usual in Australia, to the point where both the person’s mental health and their employment become manageable.
Even after the program is successful, rapid re-entry pathways need to be established to ensure that “graduates” of IPS programs can maintain employment and good mental health.
Australia, like most developed countries, has been slow to respond to this evidence. IPS services are not yet widely available, even though the IPS approach is now over 20 years old.
The current DES funding framework does not yet fully support the IPS services needed by young people with early psychosis and other emerging mental health conditions.
It remains unclear to what extent Australia’s existing mental health services accept that restoring employment and education is part of recovery oriented treatment. While many mental health services are moving in this direction, most remain very health outcome focused.
In other countries, such as the United States, vocational rehabilitation is considered the core business of mental health services because it contributes to the overall recovery of the people it aims to help. So the way that the term “recovery” is defined by mental health services determines the range of services that can be provided.
In principle, Mr Morrison is on the right track and the government’s support of such programs could be an exciting step forward, but it all depends on how well the new contracts are specified, and how well any new IPS programs for young people are actually implemented.
For adults with severe mental illnesses, for instance, an employment specialist’s caseload should be limited to 20 active cases at any time. For youth with less severe mental health conditions, a slightly higher active caseload may be warranted, but probably not more than 30 (depending on how many service users actually need one-to-one assistance).
Another risk concerns the quality of existing mental health services, which need to be of sufficient quality, frequency, and duration for the health service to work in partnership with an employment service.
Success is likely if the principles of IPS are built into the contracts that govern how the new programs are delivered.
Mr Morrison’s comment is supported by research that shows a well-managed employment program, such as IPS, can contribute significantly to improved employment outcomes, and this often improves mental health outcomes (in combination with good mental health care) for people with employment goals.
Effective assistance to get a job can be an important option for young people with employment goals, as long as basic conditions for delivering that assistance are met. Namely, that the employment assistance is integrated with good quality ongoing mental health care, is sufficiently intensive and individualised, and is implemented in accord with the other IPS principles and practices that have proven so effective over the past 20 years.
This review is spot on. The contention that employment is positive for those with mental illness is strongly supported by the evidence and is consistent with best practice internationally. This is more than just a motherhood statement.
There have been scientifically strong Australian randomised controlled trials indicating the benefit of the Individualised Placement and Support approach to employment for the mentally ill. These findings are consistent with many international studies reporting that being employed leads to greater autonomy, status and acceptance within society, opportunities for personal development and a sense of well-being.
Further, these reports indicate that employment is able to facilitate recovery from mental illness. An effective modern mental health program needs to incorporate such approaches to employment and vocational training in addition to medications and psychosocial assistance. –– Philip Mitchell
Geoffrey Waghorn is Adjunct Senior Lecturer, The School of Population Health at The University of Queensland
Philip Mitchell is Scientia Professor & Head of the School of Psychiatry at UNSW.
This opinion piece was first published in The Conversation.