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Time for better day and vocational services in mental health

Preview: ‘About time: commissioning to transform day and vocational services’

by Helen Lockett, Linda Seymour and Adam Pozner, Sainsburys Centre for Mental Health

Having social contacts and being in work are good for health. They play an especially important part in recovery from mental ill health. Yet people with severe mental health problems experience high levels of social isolation and unemployment.

Research has consistently shown both that most people who have periods of mental ill health would like to work and that diagnosis or severity of illness are not predictors of employability. Anyone with a mental health problem can work if they have the belief in themselves and they get effective, ongoing support.

Adult mental health day and vocational services are crucial to give people a realistic chance of achieving their hopes and aspirations and of participating fully in their communities. Yet too often they are under-achieving in that regard, sheltering and segregating people with severe mental health problems rather than helping them to achieve their potential.

What day and vocational services should look like is clear. There is a readily available international evidence base that the individual placement and support (IPS) approach is the most effective method of employment support (see http://www.scmh.org.uk/employment/services.aspx). For proponents of evidence-based health care, it should be noted that IPS is in fact the most effective mental health intervention in existence, with much better results than either medication or psychological therapy.

Health and social care commissioners hold the key to reforming day and vocational services in line with the evidence of what works and what people want. But modernising these services is not easy. It means making radical changes to, or even de-commissioning, services that have been in existence for a long time as well as creating new types of service that offer individuals personalised support to pursue their own vision of recovery.

Sainsbury Centre has worked with PCTs and local authorities in different parts of the country to help them to re-commission day and vocational services. The lessons of that experience are brought together in a new guide, About Time , which will be available for download from 12th June (www.scmh.org.uk/employment/commissioning.aspx).  

That experience shows, for example, that people who use services (and some of those who don’t) should be involved actively, as equals, at all stages of the commissioning process: for example in setting out specifications for what services are needed, in reviewing how well existing services are performing and in choosing new providers.  

Our experience also shows the importance of good communication with all of those who are affected by the changes throughout the re-commissioning process and of ensuring that new services are put in place before old services are de-commissioned.

The lessons learned from this process will have resonance beyond day and vocational services. They could inform much of the forthcoming process for implementing the Darzi review, for example.

About Time is available from Sainsbury Centre, price £25, on 020 7827 8300 or at www.scmh.org.uk/employment.