Mental health: what works to support people to find and stay in work?

Naomi Clayton, Deputy Director, Learning and Work Institute


18 05 2023


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Mental ill health can be a substantial barrier to employment: 51% of people with a mental illness are in work, compared to 75% among the general population. And with 1 in 6 people experiencing a common mental health problem, such as anxiety and depression, in any given week in England, it’s perhaps not a surprise that many young people report poor mental health as a common reason for finding it difficult to find a job or why they are not currently looking for work. For people in work, each year an estimated 18.5 million days are lost through sickness absence due to mental health conditions, a 40% increase since 2009.

But we know that, with the right support, people can overcome the challenges they face in finding and staying in work when they have a mental health condition – and there’s a fair amount of high-quality evidence on what works.

Individual placement and support (IPS) stands out as one of the most effective models. The model integrates employment and health support, and focuses on competitive employment outcomes, rapid job search, and client preferences in services and job searches. The most effective IPS programmes have led to significant employment gains – and are cost-effective.

The Health-led Employment Trials (HLTs) were one of the most recent attempts to replicate these successes and test whether the model, traditionally designed for jobseekers with severe and enduring mental health conditions, would work for people experiencing mild/moderate mental and/or physical health conditions. Led by the Government’s Work and Health Unit, the HLTs tested the IPS model in Sheffield City Region (SCR) and the West Midlands (WMCA).

The large-scale randomised control trial and process evaluation, which we partnered with IES, RAND and NatCen to deliver, showed the HLTs made a significant difference to employment and health outcomes. The trials also built people’s capability and self-belief through the model’s strength-based approach, and employers became more confident in employing people with long-term health conditions. But the impacts were more mixed than some of the most effective programmes. In Sheffield, the impact was on health and well-being (rather than employment) but it was relatively small. In the West Midlands, the impact was on employment but there was no discernible impact on health and well-being.

Why? The evaluation showed that, like early trials of IPS in the UK, the model was not implemented in a way that fully adheres to the principles of the evidenced model. While the process evaluation found better join up between the health system and trial in SCR, higher and more complex caseloads meant that employment specialists had less time to spend with participants and there was less focus on employer engagement compared to WMCA. Across the trials, there were shortcomings in employer engagement, discussions of workplace adjustments, job development and integration with health professionals compared to the evidenced IPS model.

The evaluation also highlighted the importance of responding the different support needs of those in work and out of work. Employment specialists in SCR, who had a mixed caseload of people in and out of work, found it challenging to cater for the differing preferences and needs of the two groups. A separate evaluation which we undertook for Welsh Government of its in-work support service highlighted the need for a flexible delivery model, effective support for smaller businesses, and engaging relevant stakeholders to promote the service.

Trials like the HLTs are crucial in better understanding what works to support the increasing number of people who face health barriers to work. Addressing the issues highlighted by the evaluation in the design and implementation of future IPS programmes is likely to lead to better outcomes for more people.

Good progress has been made on building the evidence on supporting people into employment but arguably less is known about what works to create more accessible employment opportunities and to support people to stay in work.

With the prevalence of mental health conditions increasing and more people reporting that work is more intense and stressful, it’s vital we look at how we can effectively join up work and health to support more people to access and stay in work, and that we look at the role of employers and job quality too. As part of our work in this area, we’re leading a spotlight campaign for Health Equals on the connections between good work, good health, and inclusion – more on this to follow!