VOCATIONAL OPPORTUNITIES IN FORENSIC MENTAL HEALTH

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VOCATIONAL OPPORTUNITIESINFORENSIC MENTAL
HEALTH

• Sarah Hill

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Vocational Opportunities

• National Social Inclusion Programme
• Why it matters
• Forensic Mental Health
• North London Forensic Service

• Developing Education, Training work
  Partnerships The Project
• Education Provision
• Challenges for Tutors
• Discussion

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Social exclusion defined

• What can happen when people or areas suffer from
  a combination of linked problems unemployment,
  poor skills, low incomes, poor housing, high
  crime, bad health and family breakdown.
• Characterised by the inter relatedness of
  problems that are mutually reinforcing combined
  they create a fast moving, complex and vicious
  cycle
• (Social Exclusion Unit 2004)

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Mental health and social exclusionthe problem

• Less than 1 in 4 adults with mental health
  problems work
• almost twice as many people claim Incapacity
  Benefit for mental health conditions as in 1995
• more than double the risk of losing their job
• 3 times more likely to be in debt
• Homelessness for this group has almost doubled
  since 1997
• Overall costs of mental health problems estimated
  at 77bn

unemployment social isolation
worsening mental health suicide
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People are excluded in many different ways
low levels of participation in FE/leisure
activities
serious illness overlooked
not eligible to be juror or school governor
harassment complaint not taken seriously
financial services hard to access
1 in 4 tenants with serious arrears/at risk of
eviction
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People can become very isolated
Services
Employment
?
?
?
Sport exercise
?
?
Education
?
?
Family neighbourhood
Volunteering
Faith communities
Arts and Culture
Sue attends the day centre and the clinic. She
has 5 friends she sees at outpatients or the day
centre.
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ACTION PLAN SUMMARY
Stigma and discrimination strengthened programme
co-ordinated across government and voluntary
sector

• Role of health and social care
• advice/support on vocational social issues
• implement evidence based practice for people with
  severe mental health problems (Individual
  Placement Support)
• address inequalities in access poor physical
  health

• Employment
• Pathways to Work
• transition from benefits to work
• enterprise
• job retention

• Social participation
• education, volunteering, arts, leisure
• supporting parents
• community roles

Getting the basics right - stable housing,
transport, advice
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EDUCATION Key Deliverables 05/06

• PROMOTE ACCESS TO ADULT LEARNING, FURTHER, AND
  HIGHER EDUCATION
• Decrease in N. proportion of people within each
  region with MH problems without qualification.
• Increase in N. with NVQ 2 equivalent within each
  region
• Increase in N. accessing mainstream courses
  within each region

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Some Specifics for Health

• Exercise, arts and learning on prescription
• Vocational and social support embedded in CPA
  with full service user involvement.
• Monitoring vocational outcomes for people on CPA.
• Establish employment and educational status on
  admission to hospital, and support job retention
• Develop lead contact on vocational and social
  issues
• Strengthen links to local partners e.g. Jobcentre
  Plus and education

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What are Forensic Services?

• Tertiary service
• High
• Medium
• Low
• Hostels
• Forensic outreach/Community
• Prison in-reach
• Links with general mental health services

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Brief History

• Old institutions
• Asylum closures
• Community Care
• NHS/Private sector
• Closure of high secure provision

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Who are forensic services for?

• Mental Health Act 1983
• Civil sections
• Other sections
• Diagnosed mental illness
• Offending behaviour
• Treatment

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Admission

• Through the courts
• Through diversion schemes
• From prison
• From general mental health
• From high security
• From lower security
• Medical and social care assessment

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Treatment

• Staffing MDT teams
• Treatment/CPA
• Therapy, education and training
• Support
• Insight related work
• Risk assessment, management and taking

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North London Forensic Service
Ten wards 1 LSU, 2 Hostels plus outreach
services and prison in-reach

• 6 Rehab wards
• 2 long-term
• 1 Learning Disabilities
• 1 mid-term female
• 2 mid-term male
• 1 low secure male

• 4 Acute wards
• 1 female
• 3 male (1picu/ficu)

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EDUCATION TRAINING WORKPARTNERSHIPS
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Project Abstract

• The vocational project gives individuals the
  opportunity to obtain or regain valuable work and
  education experience. It can help maintain or
  develop skills/knowledge, whilst providing the
  opportunity to take an increasing level of
  responsibility for their rehabilitation. This
  can also increase the opportunities available to
  them as they progress through their rehab
  programme and move to less secure environments or
  back into the community with an improved chance
  of integration into the wider community beyond
  services.

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Work, Education Training

• Offers people the opportunity to develop skills,
  knowledge increase employability.
• Maintains skills previous work roles.
• Supportive/graded environment.
• Courses can be done independently or lead to an
  NVQ
• Limited prevocational training

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Funding

• Educomm partnership - European Social
  Fund/Learning Skills Council.
• Hospital Estates.
• Local College, North London Forensic Service and
  LSC.

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Developing Partnerships

• Local College
• Learn Direct
• Private Education Providers
• General Hospital Volunteering
• Hospital Estates
• Local employers

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The Application Process

• Application form completed or educational need
  identified by OT
• Service User and staff identify
• Skills
• Relevant course
• Interests

• Risk assessment
• MDT clearance
• Interview/Enrolment

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Pathways to Education, Training work
EDUCATION
WORK EXPERIENCE
MDT Referral
MDT Referral
MDT Referral
MDT Referral
External College Based Courses
Local College Tutors
Work Projects
MDT Referral
Liase report to MDT
General Hospital Work Experience
LEARN DIRECT COURSES
MDT Referral
Liase with MDT
ECDL
Basic Skills
Social Enterprise
Community Based Work
Enrolment to NVQs
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Interview Process

• What the project will offer
• Hard and soft skills
• Educational opportunities
• What the project expects of the individual
• Commitment
• Responsibility
• Punctuality
• Good standard of work

• Questions
• Personal goal setting

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Identified Skills

• Painting decorating
• Warehouse/factory work
• Shop assistant
• Vehicle valeting
• Gardening
• Driver/delivery
• Office work
• Engineering

• Carpentry
• Security
• Kitchen porter
• Upholstery
• Ground maintenance/caretaker
• Catering
• Hairdressing
• Vehicle maintenance

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Work Skills Learn Direct in Partnership

• Health Safety.
• First Aid.
• Lifting Handling.
• Office Administration.

• Food Hygiene.
• Customer Care.
• Landscaping.
• Developing CVs/Portfolios.

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Three monthly appraisals

• Adapted standardised tool Sheltered Employment,
  Rehabilitation and Training Service
• Grading scale
• 0 1 2 3 4
• On 5 criteria
• Task competence
• Work enthusiasm
• Response to supervision
• Confidence and initiative
• Social relationships
• Lower scores indicate higher competence at task
  or skill

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Limitations

• Type of jobs available
• Impact of secure environment
• Attitudes

• Funding
• Patient payment
• Minimum wage issues
• Benefits trap

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Local College

• Visiting tutors work with small groups on the
  wards and provide
• English for Speakers of an Other Language (ESOL).
• Basic Skills.
• Literacy
• Numeracy.
• Yoga

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Learn Direct

• Paper based and Computer-based courses
• Range of courses ECDL etc
• Additional Tutor support
• Internet Access
• Course limitations

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Challenges for Tutors

• Health vs. Education language
• Forensic hoops
• Managing anxieties
• Understanding risks
• Part time
• Different targets and outcomes
• Liaison with health MDT

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Challenges for TutorsShared language

• Health vs. Education language
• Patients/service users vs. students
• Diagnosis vs. symptom description
• Clinical Process vs. course/module completion
• What are core barriers/challenges?
• How can we develop a shared language?

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Challenges for TutorsRisk

• PROBABILITY OF A NEGATIVE OUTCOME
• X
• SEVERITY OF OUTCOME
• Can be negative or positive
• Risk Assessment likelihood of harm occurring in
  different situations and should look at balancing
  harm and benefits
• Risk Management process of reducing the
  likelihood of a specific harm occurring

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Challenges for TutorsThe Myths

• Myths about people with mental health problems
• Theyre dangerous
• Theyre incompetent, unintelligent, poorly
  qualified, capable only of low level jobs if they
  can work at all
• Theyre unable to cope with stress
• Theyre unpredictable and unreliable
• Negative stereotypes and discrimination more
  disabling that mental health problems themselves

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Challenges for TutorsHow do clinicians assess
risk

• Clinical - Based on subjective judgement and
  reports
• Actuarial - Standardised instruments that have an
  empirical basis
• Very few validated instruments specifically for
  mentally disordered offender population
• No substitute for knowing the person

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Challenges for TutorsRisk Assessment

• What risk is being assessed?
• What is relevant to the situation?
• Document the known risks and their context
• Triggers and context
• Dynamic and static factors
• Most of the risk is managed by the clinical teams
  but how well is this communicated to tutors?

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Challenges for TutorsManaging Risk

• What would your anxieties be?
• What do you feel you need to know?
• Why?
• Who needs to know it?
• How can you balance confidentiality with
  reasonable information sharing?
• What links are needed between education and
  health?

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The Future

• Partnerships and sustainable relationships
• Shared understanding
• Accessibility and inclusion
• Joint funding
• Graded supported pathways

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Sarah.Hill_at_beh-mht.nhs.uk