RAND Solution
Challenge
Mental illness is increasing among the working-age population in the United Kingdom and is associated with high economic and social costs; it is one of the leading reasons that people claim sickness benefits.
Context
At any one time, 18 percent of the working-age population in the UK—some 6 million individuals—has a mental health problem, and over 40 percent of sickness claims include a mental or behavioral disorder as a primary condition. The UK government is seeking new approaches to improve employment outcomes for affected individuals, reduce substantial costs to the Treasury of providing services, and contribute to improving the general health and wellbeing of the population.
Employment is known to lead to lower societal and economic costs and to better subjective wellbeing for the individual. The government is therefore looking for evidence-based practices to help those with mental health problems to remain employed. Likewise, the government wants to encourage unemployed people with mental health conditions to seek employment rather than remain on government benefits.
“Improving the employment outcomes of those with common mental health problems is a complex issue. There is no one-size-fits-all solution.”
Joanna Hofman, senior analyst
Project Description
The Department for Work and Pensions and the Department of Health jointly commissioned RAND Europe to determine the best approach to improve employment outcomes for people with common mental health problems, both diagnosed and undiagnosed.
The research team reviewed existing evidence on the effectiveness of current interventions and consulted with a wide range of experts in mental health and employment. They then compiled a list of evidence-based and innovative policy options most likely to improve employment outcomes for people with the sort of mental health problems that most commonly occur in welfare benefit claimants—principally anxiety and depression.
Researcher Spotlight
Research Questions
- How can the UK government encourage employed people with mental health problems to remain employed?
- How can the UK government encourage unemployed people with mental health problems to find employment?
Key Findings & Recommendations
Key Findings
Researchers identified several challenges in the current provision of public services to help people with common mental health problems either retain or find employment.
- Early interventions are important to prevent people from falling out of work.
- Poor integration of health and employment services lengthens the amount of time people must spend seeking treatment.
- Services are often not integrated; they tackle either the mental health problem or the employment need as a discrete issue.
- Services are often delayed, even though the original problems can grow and worsen over time.
- Gatekeepers—doctors, employment advisers, and employers—report feeling unsupported in providing services to people with mental health problems.
- One of the key barriers to employment for people with mental health problems is the stigma and discrimination embodied in the reluctance of employers to take on an individual with a mental health problem.
- Another barrier is the "benefit trap," when the incentives to remain in the system are stronger than those to return to work.
Recommendations
RAND made five major recommendations:
- Embed vocational support into primary care settings through Individual Placement and Support (IPS).
- Enhance support (e.g., group therapy) to those out of work to build resilience against setbacks faced when seeking employment.
- Provide access to online mental health and work assessments and support—for example, building on computerized cognitive behavioral therapy interventions.
- Offer telephone assessments and support to people with common mental health problems who are out of work.
- Test and evaluate these innovative approaches to develop an evidence base on better ways to support people with common mental health problems.
“The [RAND Europe] report and its proposals will contribute to a better evidence base for action. It will enable both departments to take forward our exploration into better mental health and employment provision—providing better approaches to help people with mental health problems to work.”
Lord Freud, Parliamentary Under-Secretary of State, Department for Work and Pensions
Impact
In 2014, the UK government conducted a number of feasibility studies to explore three of the evidence-based approaches outlined in the report:
- An IPS feasibility study took place across four Jobcentre districts: Durham & Tees Valley, Surrey & Sussex, Midland Shires, and Black Country.
- A six-week, peer-led group-therapy program known as JOBS II was initiated in August across two Jobcentre districts: Thames Valley and Gloucestershire & West of England.
- The telephone-based support was implemented across two Jobcentre districts: North East Yorkshire & Humber and South Yorkshire.
The government commissioned independent evaluations of these studies and found them each to have promise. For example, the independent evaluation of the IPS study showed “positive feedback from service providers and participants.”
Based on the lessons learned from the evaluations of the feasibility studies, the government is conducting randomized control trials in 2016 and 2017 to explore the impact of the interventions.
RAND Europe is continuing to work in this area, with a current study evaluating IPS Grow, a national implementation support initiative which aims to drive the delivery of high-quality IPS services within secondary mental health care.
“[The report] sets out some exciting recommendations for change, including making sure that our health and employment services work more closely together.”
Nick Clegg, then–Deputy Prime Minister of the UK
