Wellbeing & life issues
.Good mental health is integral to human health and well being. It is known that a person’s mental health and many common mental health disorders, are influenced both positively and negatively by various social, economic, and physical environments operating at different stages of life. Improving these ‘social determinants of health’ will provide opportunities for both improving population mental health and for reducing risk of those mental disorders such as anxiety and depression that are associated with social inequalities.
Many IAPT services have worked in collaboration with various partners to tackle some of these social determinants of health, providing advice and support on wellbeing and life issues such as employment, housing and debt. These collaborations are broadly classified into the following:
- Wellbeing initiatives
- Employment support – either integrated with or on referral from the IAPT service
We believe that by collaborating with partners to tackle some of these life issues, IAPT services can adapt their services to better address the needs of these individuals swiftly thus saving clinical time to address the needs of those with common mental disorders. We therefore recommend that services consider these partnerships and examples below.
Kensington & Chelsea – Community Living Well [please see case study] is a service where IAPT is integrated with other local partners to support patients’ mental health and wellbeing needs. Services are co-located and there is a single-point of access for all services offered, including wellbeing services which comprise an employment service, housing support, peer support and facilitated meet-ups, a training programme for people who want to be peer support workers for co-facilitated groups and 1:1 support [See job description – Kensington and Chelsea – Employment services – Community Living Well JD]
Merton, Sutton and Wandsworth Uplift services offer wellbeing step 1 care in their respective boroughs, offering a range of workshops, groups and courses around the themes of employment, staying fit and well during Covid, coping with stress, managing anger and improving self-confidence, in collaboration with other partners. As well as offering an introduction to ‘5 ways to wellbeing’ sessions, since Covid, the services have developed wellbeing videos hosted on social media platforms or NextDoor. For more information, please see case study.
Brent are offering Step 2 virtual workshops around sleep issues, mindfulness and managing worries. These are delivered via Zoom fortnightly (max 15). The team are also running 4-week therapy programmes for managing worries for max 10 attendees per group.
Bexley – IAPT Bexley are seeing a ‘revolving door’ of clients who have 3-4 episodes of IAPT treatments. Often these clients have a housing problem or have lost their job and ideally need some peer mentoring or befriending. Such clients are usually referred to the recovery college, called Community Connect. Community Connect is funded by Bexley CCG, managed by Bexley Council and staff are employed by Mind in Bexley. The Recovery College is broader than IAPT, it also supports social inclusion, personalisation, housing, Healthwatch and a carers service. There is a wellbeing phone line that clients can call. For example, if a client needed help mowing their lawn, Community Connect would find services locally to help them do that.
Hammersmith & Fulham IAPT noticed low referral and access from some deprived areas with well-known poor health outcomes in the borough. On further engagement with the residents, the service learnt that they would want services offered closer to home as the IAPT was too far for them to travel. In response, the IAPT service partnered with GP surgeries, local health centres and community centres in the local area to provide individual therapy and workshop session closer to home.
Lewisham Community Wellbeing run weekly workshops as a zoom call, and do a poll at the end of it for participants to ask them how it helped them (rather than filling in the IAPT outcome forms, which the patients don’t want to do).
Other wellbeing resources which service users can be referred to can be found on the Thrive London and Good Thinking links below.
- Sleep – https://good-thinking.s3.amazonaws.com/documents/Sleep_Information_Sheet.pdf
- Anxiety – https://www.good-thinking.uk/resources/centre-clinical-interventions-anxiety-workbook/
- Health anxiety – https://www.good-thinking.uk/resources/cci-health-anxiety-workbook/
- Depression – https://www.good-thinking.uk/resources/cci-depression-workbook/
- Self – compassion – https://www.good-thinking.uk/resources/cci-depression-workbook/
- Mindfulness –https://good-thinking.s3.amazonaws.com/documents/Generalised_Anxiety_Workbook_-_Mindfulness.pdf
- Panic – https://www.good-thinking.uk/resources/cci-panic-workbook/
Healthy London Partnership’s Coping Well During Covid Webinar series, on Managing Financial Anxiety
Some IAPT services are in receipt of funding from the government’s Joint Work and Health Unit for the integration of IAPT, healthcare and employment support. The principal aim of this integrated approach is to create a culture of prevention and early intervention to make sure people get timely access to health support and suitable employment support, so they avoid long-term unemployment. To ensure employment support is available in all IAPT services across England, the Department of Health and Social Care/Work and Pensions Joint Work and Health Unit is evaluating the impact of the investment with a view to a possible bid for further investment in Employment Advisors in IAPT services. You can find out more about the evaluation here.
Below, we share an example from one London IAPT service (City & Hackney) that has benefitted from this funding and other examples of employment support offer from some other services.
City & Hackney
- Have 8 employment advisors (EA) integrated with the IAPT service as part of the DWP pilot project. This has grown to become a core component of the IAPT service. The EAs help to keep people in work and help people find work.
- Working in partnership with Legal Advice Centre (University House) to support clients in accessing free legal advice around employment related issues, EAs work closely with the employment law solicitor in identifying suitable cases and supporting clients to receive legal advice, often around reasonable adjustment and re-deployment, and providing mediation.
- Pre-COVID, EAs were based at Hackney Job Centre Plus (JCP) one afternoon a week to provide one-to-one sessions with JCP customers who might benefit from IAPT support. This has now shifted to remote support and partnership working since COVID.
- The service has received very good feedback on job retention from employers who found the input of the EA helpful.
- A positive impact on client wellbeing and recovery has been reported. Research carried out by the service showed a more consistent reduction in clinical scores, compared to those without EA support, especially for the depressed group. These findings were statistically significant.
- Summary of EA achievements in City & Hackney IAPT
Bexley have an IAPT employment advisory service, funded by DWP.
Westminster IAPT provide employment support funded by the council. An employment support worker is embedded within the IAPT team with supervision by the team. The collaboration has worked well.
Haringey and Enfield IAPT have a long-standing working relationship with the Shaw Trust, who attend IAPT team meetings. The IAPT team refer to the Shaw Trust, and vice versa. The Shaw Trust have employment workers, and the IAPT team have a psychologist, to support job applications and manage anxiety.
Barnet, Ealing and Hounslow IAPT partner with Twining Enterprise to support individuals to find their purpose, overcome obstacles, take action to move forward with their goals and thrive in their lives through healthy and meaningful employment alongside active engagement with others in their community. It achieves this through 1-2-1 and group interventions, individually tailored support and coaching and mentoring.
Kensington & Chelsea – Community Living Well [please see case study] is a service where IAPT is integrated with other local partners to support patients’ mental health and wellbeing needs. Services are co-located and there is a single point of access for all services offered, including an Employment service and Housing support.
Merton IAPT have developed employment workshops. There has been large demand and long waiting lists to attend these workshops. With 12 people max per workshop, team have run 4 times over autumn.
Barking & Dagenham has agreed a co-location of the IAPT service with Barking & Dagenham borough council. This will support the Trust and local authority to better deliver care in the community and increase access to IAPT service. The partnership will begin with a 3-month pilot at 2 borough sites. The aim is to direct attention away from GP healthcare settings and meet service users where they would normally access help such as employment, housing, debt advice, etc. which usually have a MH link. Further information on the co-location can be found here.
Lewisham are working with the King’s College Institute of Psychiatry, Psychology and Neuroscience (IOPPN) to pilot a social care hub, that will include debt advisors, employment advisors (via DWP) and also IAPT. The service works closely with Lewisham Community Wellbeing, which is organised by Bromley and Greenwich Mind, and offers peer support regarding broader life issues and social needs of residents.
Bromley IAPT have their own employment support workers (1.8WTE).