Allied Health Professions: disclosure guidance

10 Positive Disclosure

The disclosure process must be individualised. Information provided in relation to PVG, disclosures or dates of employment via an application form will only provide factual information about offences, illness, dates and gaps in employment and it will not put them in context. The use of written personal statements, letters, pre-rehearsed phrases are all useful to set offences in context and/or explain gaps in employment history. Agencies should look to safeguarding the personal information shared.

10.1 Personal Information Plan

This form can be worked on collaboratively by the individual and therapist, and then adapted into a letter of disclosure to be used for interview preparation, applications, referrals, supporting statements etc.

The plan should include:

• Name
• Placement interested in (if known)
• Strengths and skills
• Identifying sensitive information
• Identifying what is needed to stay well

Please see Annex C for Personal Information Plan Template.

10.2 Personal Statement overview

A personal statement or letter to supplement the interview or application can be helpful to address areas the person feels might disadvantage them and can be helpful to promote their skills. A supporting letter from the client ensures the applicant is in control of how information is released, what is communicated, how they want to disclose and to whom.

For example, it may include:

Transferable and job specific skills

Address employers concerns regarding the applicant:

• Fitting into the workforce
• Being reliable

Within such documents:

• Avoid the word disclosure and use 'information sharing' or 'personal information' instead.
• Keep as short as possible.
• Be able to be communicate verbally if requested at interview.
• Use a strengths based approach, highlighting positive strengths and skills, personal attributes and interests.
• Focus on characteristics an employer may value
• Focus on functional abilities in relation to the job, including relevant experience to the post and relevant knowledge and skills.
• Discuss mental health issues / learning disability rather than diagnosis.
• Any mention of an offence should be put in context of past and current lifestyle

10.3 Covering Letter

A covering letter for an application form can serve the same purpose if the applicant has concerns that their mental health / learning disability or offending history will be a barrier at the application stage.

10.4 Written Character References

A written character reference in the form of a supporting letter from an individual known to the applicant can be useful to highlight strengths, achievements and transferable skills.

10.5 Portfolio of achievement

A portfolio of achievement can be another means of sharing relevant experience and skills. It can also be used to enable applicants to discuss in an open and positive way, issues around their mental health and offending history. The portfolio of achievement can include evidence of work experience, formal and informal learning, supported by personal statements, CV and testimonials from staff who have observed their progress. Evidence of commitment to a leisure activity, building structure and routines and any certificates obtained can also be used. The portfolio of achievement can be used as a basis for interview preparation.

10.6 Disclosure In Action – Case Studies

The below case studies are based off real life scenarios which individuals have consented to being used. For data protection purposes, these have been edited and anonymised so that there is no identifiable information present.

10.6.1 Person 1's Story

Person 1 is an individual who is managed under a CORO (Compulsion Order with Restriction Order), with a history of violent offences, currently living in the community. Person 1 is keen to undertake a college course, however, due to their status as a Restricted Patient, history of violence, prior convictions and severe mental health issues, some consideration is required regarding the sharing of personal information.

Key points considered in their care;

Assessment and documentation of risks through MAPPA

Consideration of what needs to be disclosed and to whom

Potential triggers of mental health relapse

Liaison with education provider

Key phrases for Person 1 to use when managing personal information

10.6.2 Information Sharing

The Occupational Therapy Service had previously established a single point of contact with this College through the safeguarding liaison officer who works with students and external agencies to safeguard students and the public. Initial contact was made through this established route with Person 1's consent.

Discussions held during Person 1's recent MAPPA meeting concluded that there were minimal risks to public safety associated with Person 1's previous conviction and accessing community facilities. The college requested a letter from Patient 1's Responsible Medical Officer (RMO) confirming this and the decision was taken by the college and clinical team that there was no further need to disclose specific details relating to Patient 1's offences. It was agreed however by all parties, including Person 1, that information sharing would be beneficial around potential triggers, which may increase the risk of mental health relapse. It had been identified that the college environment in itself may be a trigger.

Person 1 and their Occupational Therapist discussed the benefits and purpose of meeting with college staff to share such information and discussed how and what information would be shared. A meeting was then arranged with Person 1, the Occupational Therapist, the safeguarding liaison officer and the sector lead for the course. Person 1 took the lead in this information sharing meeting presenting information on early warning signs and trigger factors. A written crisis management plan which had previously been devised by the multi-disciplinary team and Person 1, for use by staff, third party carers and friends involved with Person 1 was shared. This set out guidance on early warning signs, potential trigger factors, how to respond and who to contact should concerns be noted.

This meeting served to reassure college staff who reported it was helpful to know what was important to feedback and allowed them to ensure a thorough risk assessment of Person 1 and the safety of those attending the course.

Through meeting with the college and sharing such information, Person 1 and the Occupational Therapist were able to have a deeper understanding of aspects of the course which could cause relapse. Person 1 was then supported by their Occupational Therapist to prepare for such scenarios. One example is that Person 1's offending history could easily be found online with the potential for fellow students to access this information. Through discussing such scenarios and supporting Person 1 to prepare responses and coping strategies they became more confident in managing their personal information should the need arise.

10.6.3 Person 2's Story

Person 2 was an inpatient within a secure hospital when they were asked about their aspirations for work. During their time as inpatient, Person 2 worked in the patient cafe undertaking back of house duties initially such as washing the dishes and preparing the salad before progressing to serving customers. Person 2 has numerous convictions and a long standing history of severe health issues linked to a long-term severe mental illness. Since leaving hospital Person 2 has shown interest in hospitality work and enquires about a post advertised in the window of a local restaurant. Through their work with the employment specialist and community Occupational Therapist they have chosen to apply for positions that do not require them to work early in the morning and do not require PVG registration.

Key points considered in this case

• Use of time limited voluntary work
• Early preparation i.e. CV, Portfolio of achievement
• Use of Subject Access Request (SAR)
• Patient empowered to manage their personal information
• Pre-rehearsed phrase to put convictions into context
• Use of a letter to the employer

Staff in the restaurant ask Person 2 to come back with their CV and to meet with the manager and restaurant owner. Person 2 and their Occupational Therapist previously applied for a SAR which detailed the information the police currently hold about their convictions. Although Person 2 knows they do not need to reveal their criminal convictions (this job does not fall under the category of regulated work) they would be required to reveal convictions if employers ask. Person 2 is anxious about what they should do. Person 2 plans to apply for work are discussed and supported by the mental health team treating them in the community. The Occupational Therapist and Person 2 review Person 2's CV and quickly prepare for them for meeting with the restaurant owner. Person 2 has references from voluntary work and portfolio of achievement complete with photographs of food they prepared in the cafe.

Following Person 2's meeting they are offered the job on a 3 month trial basis and is keen to prove themself. The employer did not ask about their criminal convictions or severe mental health condition and Person 2 reported that they had simply mentioned they had some health issues previously though these were no longer an issue. Person 2 therefore has a dilemma on whether to disclose or not. Legally Person 2 is not required to disclose either the mental health condition or convictions. Person 2 chooses only to disclose their mental health condition to the manager in a letter following their 3 month trial. Person 2 writes about how their voluntary work at the cafe helped in their mental health recovery and what this job has meant to them personally. Although Person 2 has not disclosed their criminal convictions, they have been supported to rehearse a personal statement putting their offences into context and highlighting how they have progressed to enable Person 2 to be better prepared for future questions.

10.6.4 Person 3's Story

Person 3 was being supported by the forensic community learning disability service when they were asked about their vocational goals. An occupational therapy vocational assessment was completed with Person 3 where they identified an aspiration to undertake a volunteer role. The Occupational Therapist and Person 3 identified their strengths as being friendly, enjoys meeting new people, follows verbal instructions well. Person 3 and their Occupational Therapist attended a local volunteer open day where they could explore options for volunteer roles. Person 3 identified that they would like to work in a charity shop. Person 3 was tasked with visiting a local charity shop to obtain an application form. Due to Person 3 being illiterate, the Occupational Therapist completed the form on their behalf. A time was agreed for Person 3 and the Occupational Therapist to meet with the shop manager to discuss potential roles for Person 3 within the shop. In advance of the meeting, Person 3 and the Occupational Therapist met to create a summary of information to pass on to the shop manager. This included that Person 3 has a learning disability and is supported by a team of healthcare professionals. It detailed potential roles which would meet Person 3's needs and ways they would like information relayed to them i.e. verbal instructions with Person 3 repeating back, visual demonstration of new tasks. Contact details of the Occupational Therapist were included so that any issues could be raised by the manager. This information was agreed by Person 3 and the clinical team before being shared with the shop manager. No PVG was required for this role.

Person 3 has difficulty tolerating behaviours such as lateness and can take dislikes to people. Person 3 met regularly with their Occupational Therapist to review this volunteer placement and any issues which arose. A review period of 4 weeks was agreed with Person 3 and the shop manager to ensure that the expectations of Person 3 and the shop manager were being met.

Key points considered in this case

• Clear instructions re role expectations
• Documentation of best ways to communicate
• Use of a letter to the service manager
• Regular review of the volunteer placement.

10.6.5 Person 4's Story

Person 4 was a nursing student when they were convicted of a serious driving offence. They received a fine and a suspended sentence. They knew they would be unable to practise as a nurse because of their criminal record. They were devastated by this realisation. They were now unemployed, and began to lose contact with their friends, many of whom were now practising as nurses. Person 4 was diagnosed with a severe mental health condition and spent long periods of time alone. Although in general their concentration was poor, they found reading was one of the only things they were interested in, finding it a form of escapism.

Key points considered in this case

• Use of self-employment
• Patient empowered to manage their personal information
• Pre-rehearsed phrase to put convictions into context
• Use of a letter to the employer

Person 4 was prescribed a course of medication which helped to some extent but were still spending the majority of their time alone and began to relapse. With their negative thoughts re-emerging, Person 4 was referred to an Occupational Therapist where they discussed how they were spending their time. They were asked about their aspirations for the future which included discussions about work. Person 4 shared their passion for reading and literature.

The Occupational Therapist asked if this was an area that they could see themself working in. Person 4 agreed that their interest lay in this area and with support began to apply for jobs. They passed an online test with a freelance proof reading company and began to take on assignments. As Person 4 was self-employed, they were not required to disclose their convictions or their mental health condition. Person 4 then decided to apply for positions with national newspapers, a marketing firm and copy editors. When completing application forms they were supported to explain in a covering letter the nature of their offence, about their regret and subsequent journey. They began to be offered interviews and were eventually offered a job within a small marketing company. Person 4 described the process as challenging with a few set-backs along the way but the employers were sympathetic to Person 4's explanation of the offence and welcomed the opportunity to prepare in advance. As 5 years have now passed, the offence is now considered spent, however Person 4's driving licence will be endorsed for 11 years. They decided to apply for a SAR as a means to confirm the date of their driving conviction, confirmed with reference to the rehabilitation period. Person 4 also wished to share the fact that they are now no longer on any anti-depressants and feel hopeful for the future.

10.6.6 Case Example Of Personal Information Plan And Covering Letter

Employers assert that covering letters have more impact when the content is individualised by the applicant, written in their own words, reflecting their experiences and personal responsibility for their circumstances.

Detailed below is an example of a personal information plan (PIP) that was completed early in Person 5's recovery journey whilst an in-patient in a medium secure setting.

The PIP was then used and adapted by the person to develop a covering letter when they applied for a post in the community. Person 5 coped well with managing their sensitive personal information effectively and benefitted from preparing for this early on in their recovery journey. The Occupational Therapist and Community Occupational Therapist supported this person to consider the process throughout. They were considering their future work role. They worked alongside the Occupational Therapist to consider sensitive personal information and how best to convey this. At this point the person was considering this in a broad sense, thinking around how they would answer questions at interview or from people they knew regarding their history. They then used this preparatory work to assist them in answering questions at interview for courses and projects.

The PIP is detailed below:

"Due to a difficult period in my life I fell mentally ill and resorted to drugs and drink to cope. This led to an offence and I was then admitted to hospital for several years. Since then I have turned my life around. I have now recovered from mental illness and have not touched drugs or alcohol in over six years. I am now looking to further my recovery through education and work. I now have a positive view for the future".

Covering Letter

The person was discharged from hospital and worked alongside the Community Occupational Therapist to further develop their work role. At this time the person had engaged in a variety of skill development courses and projects and was looking to apply for food related jobs. The person adapted the PIP into a personal letter which accompanied application. The covering letter is detailed below:

To whom it may concern,

I am really interested in the position within your restaurant. I have relevant experience in a similar post and would welcome to opportunity to meet with you and share my skills.

Due to a period of ill health I spent some time in hospital, hence the gap in my CV. I'm now in good health and keen to get back to work. I am keen to continue turning my life around and give something back to society and the community.

I have a passion for cooking and believe I am good at it. I have been working voluntary at the a café keeping my skills up to date and am now looking to move into paid work.

Thank you for reading this letter and considering me for the post. I hope we can work together in the future.

Yours sincerely,

Mr Anonymous

10.6.7 When things don't go so well

Person 6 has a history of severe mental illness, substance misuse and offending behaviour. They are living in the community supported by the Forensic Community Mental Health Team following several years as an in-patient. They have been supported by their Occupational Therapist to apply for a new volunteer post (non-clinical) within a local hospice. Person 6 was supported to produce a CV and personal statement which highlighted their extensive work experience including their present post in a hospice shop, as well as gaps in employment. Person 6 was supported by their Occupational Therapist to disclose their offending history giving the background of severe mental illness and substance misuse. Within occupational therapy sessions, Person 6 practiced scenarios to prepare themselves for interview. They attended the interview, where they disclosed some of their offences and severe mental health diagnosis. They asserted their work goals as essential in their recovery from mental ill health. Person 6 was offered this post which they held for several months.

Person 6 benefitted from this experience and wished to gain further work experience. They applied for a post involving direct patient contact which required enhanced disclosure. The Occupational Therapist explained the process and reality of their offence history being revealed. Person expressed their wish to continue with the application. The enhanced disclosure highlighted in detail Person 6's extensive offending. The hospice chose to decline the application and terminate their current roles within the hospice. With Person 6's permission, the Occupational Therapist attempted to meet with the hospice manager to give background to Person 6's journey and the positive progress they have made. This offer was declined.

10.7 Service users' personal experiences of the disclosure process

"For me the process of giving over disclosure and dealing with the situation has been more comfortable than I imagined it would have. I have done it on 3 separate occasions, twice out with the hospital with mainstream opportunities and on all occasions, I have been treated with respect, understanding and acceptance. For me, my index offence was very serious so giving disclosure initially felt very daunting, with fear of the experience being completely negative and catastrophising about the scenario, but thankfully so far each occasion has gone well, with one person commenting when asking me about my disclosure that she believed in second chances and wished me one also."

"At first I was nervous about giving my personal information to the employer. But once I did and got accepted I felt relieved and now I feel more confident about having a job in the future."