Developing an integrated approach across various government departments’ for service users with First Episode Psychosis to achieve employment and educational goals using Individual Placement Support model

摘要

In Ireland it is estimated that 1,500 people develop psychosis annually, two thirds of whom are under 35 years of age. The development of a first episode of psychosis affects young people at a critical stage and routinely interrupts schooling and/or work leading to poor employment rates or high dropout rates from school or college. Early Intervention in Psychosis has been identified as making a critical difference to the outcome for those who develop a psychotic illness and over the last twenty five years has been extensively researched and adopted internationally. The National Clinical Programme for Early Intervention in Psychosis currently being developed has identified return to work or education as a key outcome measure. Individual Placement Support has been identified internationally as evidence based approach for all individuals who present to mental health services with first episode of psychosis. Historically mental health services in Ireland have availed of a separate sheltered supported employment model in relation to employment often with low expectations of service users to progress beyond this point. This new approach will benefit the individual’s functional and personal recovery and facilitating social inclusion. There are also wider economic benefits to society as well as for the individual. The Government mental health policy document A Vision for Change -Report of the Expert Group on Mental Health (2006) and The Comprehensive Strategy for People with Disabilities (2015 – 2024) identity the importance of a recovery ethos which includes the benefits of employment for the individual and society in general. Individual Placement and Support (IPS) has been proven as an effective model for supported employment and studies have demonstrated increased rates of competitive employment. IPS is an evidence based intervention that enables people find and keep competitive employment. The application of this model to service users with first episode of psychosis (FEP) is growing across the world and has been adapted to include education. It is based on key principles of competitive employment, rapid job search, ongoing support to employers and employees and benefits counselling. The aim of this IPS programme is to ensure that all service users with FEP are supported to seek competitive work, remain in work or are supported to complete education. Implementing this integrated policy crosses mental health, department of social protection and the education sectors. Within mental health services occupational therapists have been identified as key enablers within community mental health teams to ensure that service users who present with FEP receive timely access to vocational assessment and rapid transfer to employment/educational specialist and be supported to achieve their work or educational goals. New IPS posts have been funded to commence delivery of this programme. The IPS specialist will be embedded in both a funded employment service and the mental health service. Joint working between mental health workers and employment specialist will promote a model of integrated care across government departments with the service user at the centre of their plan of care. We are developing an integrated pathway across traditional service lines which entails developing an agreed standard operating procedure for this new pathway with a developed training plan to ensure that the agreed pathway is implemented in mental health services in Ireland. This innovative cross departmental work is outside the normal pathway but has the potential as a template for other areas. As this entails innovative work practises ongoing detailed planning is required to ensure its successful implementation. Internationally IPS has proved to be more effective than other standard vocational services in gaining and maintaining open employment. The programme will be evaluated using an agreed data set, similar to international studies. Qualitative feedback from service users, mental health service employees and employment specialists will all form part of the evaluation.