Improving Access to Work for disabled people - Work and Pensions Committee Contents


3  The AtW Workplace Mental Health Support Service

50. DWP launched an AtW Workplace Mental Health Support Service (WMHSS) in late 2011. The service is currently the only element of AtW which aims specifically to help people overcome mental health-related difficulties at work. Below we examine the design of the WMHSS; its effectiveness; and the adequacy of its current reach.

Contractual arrangements and service design

51. Remploy won the contract to deliver the WMHSS to DWP's specifications following an open tender process. The service is designed to support people in work who are off sick or encountering difficulties due to mental health problems. Support is delivered by Vocational Rehabilitation Consultants—multi-disciplinary specialists, including occupational therapists, psychologists and specially trained employment advisers—subcontracted to Remploy. People must refer themselves to the service, initially by telephoning the DWP call centre. They are not required to disclose their participation in the scheme to their employer, but the employer's engagement is sought if the participant consents.

52. Support is delivered both face-to-face and over the telephone. The types of help offered include:

·  Workplace adjustments, including the potential for flexible hours, home working or a workplace mentor or buddy to provide additional support;

·  Coping strategies related to working practices such as time management and planning;

·  Condition management, with resources and information to support anxiety, stress or fatigue management, relaxation techniques, and many other conditions. This may also involve signposting to provision available through the NHS or leading mental health organisations;

·  Support with disclosure in the workplace, and potential mediation between the employer and individual if their relationship has broken down;

·  Employer education and advice on mental health in the workplace, increasing understanding of the impact of mental health conditions and how they can be managed; and

·  If the individual is already on sick leave, suggestions on a return to work strategy, particularly around timing, nature of tasks upon return, and any adjustments required beforehand.

Remploy receives around £900 from DWP to support each participant in the scheme for six months. To date the service has supported around 3,000 people. The current annual cost of the scheme is approximately £1.6 million, which is around 1.5% of total AtW programme expenditure.[55]

Effectiveness and scope

53. The WMHSS appears to be highly effective; Remploy reported that more than 90% of people referred to the service remained in work after six months of support.[56] However, while expert witnesses were supportive of the establishment of a specific AtW scheme to address mental health issues, they believed that its focus was currently too narrow. Some were also concerned that it was the only AtW-funded support option available to people experiencing mental health problems and that this implied an unacceptable lack of choice. Liz Sayce believed that there would be "nothing wrong" with the WMHSS if it were one of a number of employment support options for people with mental health issues.[57]

54. Nicola Oliver, a specialist working with the Centre for Mental Health, was concerned that the WMHSS support options described above appeared to be primarily designed to address relatively mild conditions, including work-related stress and anxiety. Her view was that they were unlikely to be adequate for people experiencing more severe problems, including depression and bi-polar disorder. She agreed with Liz Sayce that a broader range of support options was required, including through specialist organisations such as Mind, Rethink and Bi-polar UK.[58]

55. Tom McAlpine OBE, a mental health professional specialising in employment support, told us that alternative providers had previously offered effective support, funded by AtW, for people with "severe enduring mental health conditions", but that they been prevented from doing so since the establishment of the WMHSS contract. His view, supported by a number of mental health organisations, was that people with mental health problems should have a range of options to choose from, as is the case for people with other types of disability.[59]

Pre-employment eligibility letter

56. In 2010 DWP introduced a pre-employment eligibility letter which is available to download and print from the GOV.UK website. The letter is intended to allow people with a pre-existing disability or long-term health condition to indicate to a prospective employer that they are likely to be eligible for AtW support. The intention is to "reassure employers that they will not incur excessive costs as a result of taking on a disabled person" and also increase the confidence of disabled people to apply for jobs, knowing that they were likely to be eligible for support.[60] A number of witnesses pointed out that, because the WMHSS is designed to support people already in work, this option did not appear to be available to people with a pre-existing mental health issue.[61]

Reach

57. The over-riding concern expressed about the WMHSS was that its current reach was insufficient given the scale of mental health issues in the UK. A joint submission from the mental health sector emphasised that:

·  One in six workers will experience mental ill health at some point in their working life;

·  Stress and mental health problems are the second biggest cause of work absence; and

·  Between 2011 and 2012 employers saw a 44% increase in reported mental health problems.[62]

A recent report by Dame Sally Davies, the Government's Chief Medical Officer, concluded that "Mental illness is the largest single cause of disability" in the UK and that "it is the leading cause of sickness absence in the UK, accounting for 70 million sick days in 2013."[63]

58. Remploy acknowledged that "the WMHSS can only reach a tiny proportion of those requiring workplace mental health support." However, Gareth Parry stressed that the scheme had "significant capacity to grow". He told us that the caseload was "not limited by ability to deliver"; the issue was primarily one of "promotion of the service."[64]

Self-referral process and the call centre

59. The relatively small number of referrals to date may be partly due to the current scope of the scheme, as described above. Remploy believed that aspects of the scheme's design and administration were also holding back referrals. In particular, it believed that the system of self-referral by telephone was inappropriate for many people experiencing a mental health issue. Gareth Parry of Remploy explained that;

    In many walks of life, that might be a perfectly normal, acceptable thing to do, but for somebody experiencing high levels of stress or anxiety or, particularly, depression, making that phone call to an anonymous person can be quite a difficult experience.[65]

Remploy noted that a more flexible system, which allowed initial referrals from employers or other third parties, had existed until about a year ago; it argued that this system should be reinstated.[66]

60. Gareth Parry reported that referrals to the WMHSS were down by around 50% compared to a year ago. He believed that this was at least partly related to changes made to the way AtW applicants can contact DWP—from May 2014 all AtW calls have been routed through the main DWP call centre rather than more local DWP staff. Mr Parry reported incidents in which people seeking referral to mental health support had phoned the call centre only to find that staff were unaware of the existence of the WMHSS (we consider the central call centre system in more detail in chapter 6).[67]

Integration with health services and the Fit for Work service

61. Witnesses highlighted a lack of awareness of the WMHSS, and AtW more generally, within health services. Nicola Oliver argued that DWP should do much more to make health services aware of the employment support available to people with mental health problems, and others, through AtW. Remploy told us that it had "done lots of work" to raise awareness of the WMHSS with disability organisations, employers and health services, particularly GPs; but it agreed that DWP should do more at a "strategic level", including coordinated work with the Department of Health and the Department for Business, Innovation and Skills.[68]

62. The Minister indicated that DWP had noted these concerns and was considering them as part of its internal review. He was clear that:

    […] if we are going to make a big impact on the disability employment gap […] we are going to have to make a big impression on people with mental health problems, only half of whom are at work, and those with learning disabilities. We absolutely need to do better on the mental health side of things.[69]

He said that he "could not explain" the recent drop in referrals which Remploy had identified, but assured us that he would "look into it".[70] He noted that DWP's Fit For Work service, which was launched in November 2014, in which employees who have been off sick from work for four weeks are referred for an occupational health assessment, had the potential to boost referrals to the WMHSS, and AtW provision generally, if the two services could be successfully coordinated.[71]

63. While the Department has made some progress in broadening the emphasis of Access to Work to include support for people with mental health problems as well as physical and sensory impairments, there is clearly a very long way to go in this regard. We agree with the Minister that addressing mental health needs has a big part to play in closing the employment gap between disabled people and the rest of the population. While its introduction is welcome, the current Access to Work provision for mental health, the Workplace Mental Health Support Service, is far from sufficient, given the scale of mental health problems in the UK and their impact on employment.

64. In scaling up Access to Work, priority should be given to supporting people with mental health problems, and other more hidden intellectual, cognitive and behavioural impairments, and learning disabilities, to gain and continue in employment. We recommend that DWP take steps to publicise the Access to Work Workplace Mental Health Support Service (WMHSS) to mental health service providers. It should also ensure that the provider of the new Fit for Work service is fully aware of the WMHSS and refers people where appropriate.

65. To increase the reach of the service, we recommend that DWP change its practice and begin to accept initial referrals to the WMHSS from employees' advocates and employers, where the employee's consent has been given. DWP also needs to take immediate steps to ensure that all of its call centre staff are aware of the WMHSS and that they refer callers appropriately. DWP should publish case studies on the Access to Work webpages to illustrate to potential service users and employers how the programme can support people with mental ill health; learning disabilities; and other cognitive, intellectual and developmental impairments.

66. People with physical and sensory impairments have an element of choice in how their Access to Work support is provided; there is currently a lack of choice in Access to Work mental health support. We recommend that DWP develop a range of mental health provision, in additional to the WMHSS, with a broader focus and which is better able to address difficulties faced by people with more severe and enduring mental health conditions. Once this additional provision is in place, we further recommend that DWP make clear that the Access to Work pre-employment eligibility letter is available to all disabled job applicants, including those with pre-existing mental health problems.


55   Remploy (ATW0083) Back

56   IbidBack

57   Q37 Back

58   Q138 Back

59   Tom McAlpine OBE (ATW0199); Joint submission from mental health sector (ATW0250) Back

60   Sayce Review, p 15 Back

61   Joint submission from mental health sector (ATW0250); Remploy (ATW0083) Back

62   Joint submission from mental health sector (ATW0250) Back

63   Annual Report of the Chief Medical Officer 2013, Public Mental Health Priorities: Investing in the Evidence, September 2014 Back

64   Q195 Back

65   Q200 Back

66   Remploy (ATW0083) Back

67   Q200 Back

68   IbidBack

69   Q320 Back

70   IbidBack

71   Q316 Back


 
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© Parliamentary copyright 2014
Prepared 19 December 2014