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Solace blog

26th March 2015

Writing the next chapter of health and employment

Up until fifty years ago, if you experienced a severe mental illness like schizophrenia, bipolar disorder, or severe depression, there’s a good chance you would be kept in hospital or in an asylum for long periods of time.

Today, society rejects that approach as inhumane and counterproductive. Indeed, it is now recognised that one of the most profound ways that people with any type of health condition or disability can improve their wellbeing is by achieving fulfilling, paid and sustained employment.

Yet despite this shift in aspiration, reality lags the rhetoric. Less than half the disabled population is in employment. For those with mental health issues, the proportion falls to 37%. Taking only those with severe mental health issues, just 8% are in paid employment.

Successive UK governments have identified this as a critical challenge. Not only do these high rates of unemployment represent a huge human loss – helping someone into work can save £5-10k per year.

We believe there could be a different way to tackle this problem by bringing together more closely two very different, but critically interlinked services – healthcare and employment advice – and their associated funding streams.

Today, an individual suffering from mental illness is still unlikely to have a treatment plan that is linked up to their employment support. As a patient, they may have a trusted relationship with their clinician; but their relationship with their employment adviser carries the burden of sanctions threats and mandatory activity.

To help solve this conundrum, Social Finance has, together with service users, developed a new model: Health and Employment Partnerships. This model will bring health and employment services together, pooling resources and capabilities, and making employment support a core, but voluntary part of an individual’s care pathway.

As a first step, we are launching a Social Impact Bond (SIB) to invest in health-based employment support services for those with severe mental illness. A SIB is a financial mechanism in which investors pay for a set of interventions to improve a social outcome that is of interest to a government commissioner. If the social outcome improves, the commissioner repays the investors for their initial investment with a small return. If the outcome does not improve, the commissioner does not pay and the investors lose their capital. This Social Impact Bond is being supported by the Cabinet Office, with outcomes payments funded by six partner CCGs and Local Authorities.

We’ll be using a model called Individual Placement and Support (IPS), which has achieved outstanding results across many countries and settings. IPS adopts a personalised, intensive “place then train” approach. Advisers take the time to understand people’s aspirations and skills, help them to achieve employment as quickly as possible, and then provide ongoing, long-term support.

Over time, we hope to expand our impact, launching other programmes along these lines. That could include, for example, supporting people with Learning Disabilities into work, or providing employment advice in GP surgeries.

We’ve come a long way from the attitudes and approaches of the 1950s. We hope this will be one more step along the right path.

Adam Swersky, Associate Director, Social Finance