David Gilbert, a service user and Director of InHealth Associates which carried out an evaluation of IPS implementation, provides his professional and personal view.
25 years ago, I was recovering from mental health problems. With my confidence shot, I needed support to get a job to help my healing and rebuild my life. I never got that support.
How life turns.
Rachel and I have been evaluating a ‘return to work’ scheme for people with mental health problems – the IPS model that ensures dedicated support from ‘employment specialists’ to get people into paid work.
We looked at what helps and gets in the way of implementing IPS across six mental health trusts. 300 interviews later…
We heard about the immense benefits of IPS – helping people find jobs and kickstarting lives. This had a knock on effect on staff morale and professional pride. The dedicated Employment Specialists were seen as kind, professional and people-centred. Where people’s trust had been broken, IPS went some way to repairing it.
We heard about the immense benefits of IPS – helping people find jobs and kickstarting lives. This had a knock on effect on staff morale and professional pride.
An early flood of referrals from mental health teams showed how ripe services are for this approach. The one thing we expected to find – health professional resistance – was uncommon. And client success stories overcame a few reservations about the model (IPS is all about finding proper paid jobs – not about volunteering, or accessing education).
The employment specialist teams had to cope with success and hard wire systems quickly (referral processes, record sharing, reporting). They were located alongside health professionals wherever possible, attended community mental health team meetings and developed beneficial informal relationships – which cannot be over-estimated – over coffee.
There were problems – feelings of admin overload, confusion over reporting lines, clarity of roles across operational and strategic roles, difficulties engaging with employers, etc. Like any innovation, IPS is exciting and disruptive. Managing change requires communication, business implementation and influencing skills.
The voluntary sector did not always embrace IPS. Did this new kid in town threaten their hard work? Was their own funding at risk? Once again, it was the building of understanding (that IPS is one part of a spectrum of support) that enabled joint working. Relationships with staff at local DWP and jobs/benefits support agencies were hard too – and bureaucracy caused a few tears. But even in such arid partnership territory, strong alliances developed.
Like any innovation, IPS is exciting and disruptive. Managing change requires communication, business implementation and influencing skills.
At corporate level, there seemed a genuine passion for the work, sometimes arising from personal experience: “once you have that emotional connection, the penny drops and you see the need for a sustainable package that reduces reliance on services”.
IPS seems a no-brainer: Happy clients, happy staff. But as projects edged forward, hope became tinged with uncertainty. “Just because it works… no guarantee of funding” said one interviewee. We were left scratching our heads as to why. Different teams in different sites in different ways made huge efforts – with mixed success garnering continued funding.
Was 18 months too short a time both to establish the service and seek new monies? Was it a failure to sell the benefits? Were projects too complacent that ‘evidence’ would win the day? Were champions sidelined during corporate decision making? Is the NHS risk averse? Is ‘outcome-based’ commissioning not yet for real? These were some of the interpretations we heard.
Whatever the answer, success followed in sites where commissioners had ring-fenced recovery-type approaches. This allowed space for IPS to be part of over-arching strategies. And where trusts themselves were shifting towards less biomedical approaches across the board, sustainability was better built in from the off. The next wave of IPS pioneers need to take a long hard look at the rapidly evolving commissioning landscape.
The next wave of IPS pioneers need to take a long hard look at the rapidly evolving commissioning landscape.
IPS is not perfect. Its singular scope of support into paid work comes with a flip side. There needs to be wider focus on preventing people at work getting ill in the first place (otherwise IPS is merely picking up the pieces) and IPS must be part of more integrated support across a spectrum of support needs: training and education, voluntary work and paid employment. Ironically, IPS can also risk skewing delivery. It is so good, that gaps in other provision can look bad!
And disappointments? Personally, I was surprised that early rhetoric about linking IPS to service user involvement did not happen. And few users got jobs in host trusts, perhaps showing the need to engage better with HR teams. Or illustrating perhaps a residue of a stigmatising staff culture.
With my service user hat on, I would advocate more of a focus across systems on ‘what matters’ and ensuring users and carers are part of senior decision making. If service users had power to influence commissioning intentions, my guess is that this would augment the case for such an impressive psycho-social intervention.
Overall, I became persuaded just how good IPS can be, if implementation is done well. I wish it had been around when I needed it! The system has always under-estimated our capabilities. Just because minds are knocked off kilter and our trust damaged, this does not make us unable – with a little help – to work, to be paid, to be valued. I hope IPS becomes the norm. I hope our report helps.