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Improving the labour market participation of people with
histories of substance misuseand offending
Benefits, obstacles and interventions.
Paul Anders, Senior Policy Officer
Background- DrugScope – c.450 member organisations
- Policy, good practice, research, campaigning,
national & regional forums
- England (pop. 53m):
- 300,000 crack cocaine/opiate users (England)
- 200,000 adults in drug treatment
- c.1,600 adult drug/alcohol services
- c.£900m (€1.2bn) spent on treatment
- £15.4bn (€21bn) cost of drug addiction, of which
£13.9bn (€19bn) is drug-related crime
- Cost-benefit ratio estimated at 1:2.5
Recovery capital – whole person approach
Changing presentation
• 80s & 90s heroin spike appears to be over
• Fewer entrants to system and less opiate/crack cocaine
presentation – although adult drug services still c.70% OCU
• Ageing population in treatment
• Need to reconfigure services to reflect need
Prisons- 23rd Jan 2015: 84,865 in prison (inc. 3,811 women)
- Jan-March 2014
- 26,151 people sent to prison in total, of whom:
- 11,196 people were sent to prison to serve a short
sentence (below 12 months)
- 47% of all adults reoffend within 12 months
- 58% of short sentence prisoners reoffend in 12
months
- Highest per capita in Western Europe at 148 per
100,000
- £3bn (€4bn) cost of prisons per year
Montenegro & the UKMontenegro UK/England
Unemployment 15% (2014) 5.8% (UK, Q3 2014)
LT as % of unemployed 80% (2011) 39% (UK, Q2 2014)
18-24 unemployment 45% (2010, 33% to 30, 2013) 15.1% (UK, Q3 2014)
Industry 20% (2011) 18.2% (UK, 2013)
Services 73.9% (2011) 80.4% (UK, 2013)
Agriculture 6.2% (2011) 1.4% (UK, 2013)
Self employed 16% (2011) 15% (UK, 2014)
Seasonal Yes Somewhat
Regional disparity Yes (16%-48% - 2010)) Yes (4.4%-8.5% - 2013))
Poverty rate (income) 8.6% (2013 – Gini 26.7%) 23.2% (2013 – Gini 34%)
Employment service ZZCG/EAM Jobcentre Plus
Labour market programmes ZZCG/EAM Private, NGO, public (excluding
JCP), social enterprise
Jobseeker profiling Intermediate Limited
Wage incentives Yes (various) No (but £ to some disabled to
facilitate employment)
Complex needs
• SMD = severe & multiple disadvantage – substance use, offending,
homelessness (mental health excluded due to data quality)
• Treatment population – 75-85% mental health problems
• Prisons – 25% (women) & 15% (men) mental health problems; 57% &
62% personality disorder
• Mental health treatment – 40% illicit drugs and/or harmful alcohol
consumption
• Rough sleepers – 45% mental health problems
Employment & drug treatment
Finding work
• 50% JSA off-flow = <3 months
• 50% LDAN cohort job entry = c.12 months
N=115
Labour market interventions in the UK
• Supply side measures
• Deficit based
• Limited integration with skills & training
• Demanding conditionality
Eurostat 2011
Conditionality
• 2m sanctions in 2 years – up to 3 years withdrawal of benefits
• Disproportionate impact on people with mental health
problems, the young & socially excluded
Conditionality - consequences
• C.500k unemployed/inactive disengaged from main
employment service
Labour market programmes - UK
• DWP Work Programme – long term unemployed: 3, 9, 12
months
• Non-prescriptive ‘black box’
• Payment by results: £0 to £14,000 (€ 18,700) plus £5,000
(€6,700) drug/alcohol premium in pilot areas
• £2.8bn (€ 3.7bn) 5 year programme cost at £2,100 (€2,800)per
job
Dotted line = minimum
performance level
Employment - benefits• Drugs & alcohol
• >90% heroin & crack cocaine users unemployed
• Improved treatment outcomes
• Less frequent relapse
• Less severe relapse
• Direct savings (e.g. treatment, health, social security)
• Indirect savings (e.g. offending, social care)
• Potential savings up to c.£40,000 (€53,000) per person
• Offending
• 67% unemployed at time of arrest
• 27% enter employment on release
• Cost of prison place £37,000 (€49,000) p.a.
• Can reduce low level, persistent offending
• Complex interplay and causal relationship between
offending, reoffending and employment
• Employment improves health and wellbeing – but less clear
with poor jobs – low status, low paid, insecure, unsociable,
unpleasant etc.
Barriers to employmentPersonal barriers:
• Drug and alcohol addiction
• History of offending
• Low self-confidence, self-esteem & motivation -
discouraged workers
• Physical and mental health problems
• Poor employment histories,
• Low skill and qualification levels,
• Learning disabilities
• Behavioural problems
• Poor access to information
Structural barriers:
• Cost of labour market participation
• Employer attitudes – stigma & discrimination
• Absence of a compelling competing narrative despite
positive employer experiences
• Labour market conditions
• Inadequate macro measures
• Scarcity of effective interventions
• Silos – activity, policy and funding
Towards a solutionSeven interventions:
• Individual placement and support
• Counselling approaches
• Social enterprise
• Employer initiatives and corporate social responsibility
• Job subsidies
• Campaigns
• Toolkits and information for universal services
• An evidence-based model of employment support
• Originally developed in the US to support people with
• mental health problems
• IPS only used once before in the UK with an addictions client
group
• CNWL is a Centre of Excellence in IPS services
Measurable Outcomes:
• Job entry & sustainment
• Earnings
• Likelihood of dropping out of service/rehospitalisation
• Percentage of service users entering competitive employment
Individual placement & support
IPS key principles• Aims to get people into competitive
employment
• Open to all those who want to work
• Tries to find jobs consistent with people's
preferences
• Works quickly
• Brings employment specialists into clinical
teams
• Employment specialists develop
relationships with employers based upon a
person's work preferences
• Provides time unlimited, individualised
support for the person and their employer
• Includes benefits counselling.
IPS compared to generic interventions
Drake, Robert; Bond,
Gary (2011). "IPS
Supported Employment:
A 20-YearUpdate".
American Journal of
Psychiatric
Rehabilitation 14 (3):
155–164.
CNWL mental health IPS
service compared to
Work Choice (main UK
disability employment
programme), 2011-12.
Mental health – severe &
mild to moderate
IPS – diversity of job entry at CNWL
IPS strengths & weaknesses
• Evidence based – proven in mental health,
promising in substance use and elsewhere
• Off the shelf and replicable
• Intermediate skills required
• Inherently joins health care and employment
support
• Perceived as high cost (but arguably
comparable to traditional interventions for
equivalent client group)
• Culture, attitude and values essential
• Dependent on job market and economy
• Scalability untested
NEXT
Psychosocial approach including:
• Learning styles and reflective practice
• Active listening skills
• Models of substance misuse
• Psychology of prejudice & working with difference
• Understanding your emotional world
• Intro to cognitive behavioural therapy
• Communication skills and understanding family dynamics
• Career action planning
• Understanding and working with schemas
• Advanced listening skills & understanding personal responsibility
• Understanding group work
• Giving & receiving feedback
• Interpersonal boundaries and co-dependency
• Improving assertiveness
• Fight, flight or freeze? Understanding the response to trauma
• Working with anxiety
• Voluntary work placement
NEXT strengths & weaknesses
• Offers a consistent approach between
treatment and employment support
• Proven track record – 9 out of 10 participants
go on to employment, education, training or
volunteering
• Prepares people for work but not job
brokerage
• Requires experienced and skilled staff to
deliver
• Time limited
• Homelessness, substance use, socially excluded;
• Activities include:
• Job readiness training
• Job brokerage (Social Value Act readiness)
• Direct employment – Work Champions, distribution & The Handy
Help Co
• With Lambeth Jobcentre Plus:
• Engage: 480
• Employ: 36
• Support into mainstream employment: 51
• Cost to JCP: £28,500 – or £559 per person into competitive
employment
• Work Programme equivalent cost – c.£3,300 per job
Social enterprise
Social enterprise strengths & weaknesses
• Creates employment, supports targeted local &
regional economic activity
• Can actively engage and target particular cohorts
• Can leverage public spending and investment for
positive social gains
• Emerging practice - e.g. Social Value Act in UK,
Europe 2020
• Socially excluded employee premium
• Employer concern & customer risk aversion
• Cost implications of ethical employment
• Small base in Montenegro, limited infrastructure &
legislative support
Job subsidy/guarantee strengths & weaknesses
• Can stimulate employer engagement
• Existing framework in Montenegro
• Intermediate labour market can be more effective
than job coaching approaches – e.g. Future Jobs
Fund in UK
• Can be precisely targeted
• Can be costly
• Open to gaming and creaming
• Risk of displacement & excessive deadweight
• Competing priorities & groups
• EU State Aid rules
• Employer attitudes towards different cohorts have
cost implications
Employer initiatives
Timpson – 1400 high street
Shops
• Corporate social responsibility
• Backed by business case
• 5 prison academies
• Academies resemble shops & replicate shop
environment including corporate uniforms
• All attendees who complete skills training
offered paid work
• 300 ex-prisoners recruited in 4 years
• 16 shop managers recruited from prison
• 7 employees known to have reoffended
Employer initiatives strengths & weaknesses
• Demonstrates the business case
• Halo effect – for firm and employee cohort
• Scalable
• Public support progressive recruitment approaches
• Very limited employer take-up so far: Timpson is almost
unique. No equivalent for substance use clients
• Public supportive, but stigma still an issue
• Limits on what can be achieved: “for lots of people having a
job would be the least useful thing for them in their life. A
third of people in prison are right for employment, a third
have significant health problems and a third are people I
would not want to have in my business” – James Timpson
Campaigns• Ban the Box – Business in
the Community
• Launched in 2013
• Evidence from USA:
• Improved employment
rates
• Social & economic
benefits
• Time to Change – Mind &
Rethink Mental Illness
• Major national campaign to
tackle stigma and
discrimination
• 3% increase in the number of
people who say they face no
discrimination,
• 11.5% reduction in average
discrimination
• 2.4% improvement in public
attitudes.
Campaigns strengths & weaknesses
• Can utilise existing communication channels
• Impacts permeate beyond employment
• Turning the oil tanker – perceptions are
persistent
• Require public buy in
• Risk of competing messages
• Difficult to demonstrate direct effect on
employment – e.g. suggestion that Time to
Change has had limited effect on recruitment,
although it may have changed employer
attitudes to people they already employ.
Information products
DWP mental health toolkit
• Universal guidance for
non-specialists
• Aims to use a new
approach to getting more
suitable and sustained job
outcomes for people with
mental wellbeing needs
• Developed by
psychologists, Work
Programme providers and
mental health experts
• Comparatively quick and
cheap
• Offers few guarantees of
consistency, access and
efficacy
• Works best as part of a
coordinated strategy
including training, quality
assurance & user satisfaction
Co-locate services & improve practitioner skills;
Approaches from mental health appear to transfer well, e.g. Individual Placement
and Support – but pilot and learn from a range of interventions;
Introduce and assess early – part of the journey, not the destination, although
introduction should be planned, staged and build from a stable foundation;
Structured and intensive, but flexible – provision should reflect changing
circumstances and fluctuating ability to engage;
Skilled, motivated and experienced staff – not necessarily within the treatment
sector, but people who are able to understand and work with the client group;
Long-term planning – a career or pathway, not just a job. Understanding and
planning for the individual’s aspirations and motivation is important;
Include basic / functional skills alongside employability;
Addresses lack of recent/any work experience;
Include intermediate labour market approach;
Engage with employers locally and individually, and make the case nationally to
address negative preconceptions and stigma – negative preconceptions are the
norm, even among employers who are signed up to the agenda.
10 points to conclude:
Contact
Paul AndersDrugScopepaul.anders@drugscope.org.ukTel: +44 (020) 7234 9799
http://www.drugscope.org.uk/http://www.ldan.org.uk/employment.htmlhttp://www.nta.nhs.uk/uploads/employmentandrecovery.final.pdf
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