Transitional employment services - phase 2: evaluation

3. 'Non-user' experience and attitudes to health and employment

3.1 Introduction

A key finding in phase 1 of the evaluation was that those who were referred and started the service are only a proportion of the total number who might benefit from such support. An issue for both services, therefore, has been why do people who are in apparently similar circumstances to those who have engaged with the services decide not to participate and what might be done to better engage with this group?

Undertaking research with this wider group is not straightforward. Access to the customers' contact details is only available for those who signed the release forms during their induction interview. Therefore, the research has engaged with groups of individuals working with two specialist Providers who were part of the WFS and WAS supply chain. Further details are included in Appendix 2.

A condition of undertaking this research was that the individuals would remain anonymous and we would not seek to catalogue anything more than the age group. It is clear from the discussions, however, that many individuals had mental health issues which affect the 68% of WAS customers and represents a major barrier to participation.

A total of 47 people attended four group discussions at the organisations' premises in Glasgow, Edinburgh, Falkirk and Kirkcaldy covering their employment experiences, aspirations and how their disabilities or health conditions impact on these and the other barriers they face in moving into work and possible routes to overcoming these. Below are the key findings from this aspect of the research project. For an expanded discussion on these please see Appendix 3.

3.2 Key findings

• All participants expressed a strong desire to work, but often only when they felt well enough to be able to sustain their participation. Around 40% of the participants had been in employment in the past three years. Many reported past experiences of taking jobs that did not suit their circumstances and these ending badly.
• A minority had been asked by JCP work coaches whether they would be interested in engaging with an employability service but had declined this offer because even the 18 month timeframe placed too much pressure on them.
• Handling new and stressful situations was a challenge for many. This can be exacerbated in a system where frontline advisors in health services and employment support are themselves often stressed, and many in the groups felt that this sent out the wrong message, whatever the assurances that were provided over voluntary participation.
• A surprisingly high proportion of attendees did not have any formal diagnosis of their health problem despite engaging with health services over an extended period – some for decades. A key distinction was made between physical disability and mental health conditions where the latter are not easy to assess. A diagnosis provides legitimacy and sometimes access to more structured support with a timeline towards recovery or more stable circumstances.
• This concern is perhaps most acute among young people who feel that they are not being taken seriously by professionals and have more significant barriers to access other support – e.g. alternative accomodation if they are not getting on with their family at home.
• All participants highlighted the difficulty in getting specialist support. Many recognised that NHS services were simply not geared up to diagnose their problems, particularly as all parts of the service were very busy with waiting times of up to a year for relatively short period of support. This affects peoples' ability to plan and so commit to employability services.
• All participants felt that peer support was really helpful to get through this process. Most felt that group work was too much when they first engaged with the service, but recognsied that as they start to recover, peer support is very helpful to progress further. Some conditions isolate and being with others who have had a similar experience is really important.
• A number highlighted other barriers to work – accomodation costs, home life (younger age groups), access to learning to improve their prospects of securing better quality (full time) jobs, especially in local labour markets where these are in short supply.
• Future employability services will need to work very closely with frontline health services. This is going to be a challenge with waiting times to access support services and no guarantee that interventions to address the individual's mental health will provide results. A more open-ended approach to defining participation in employability services will be required to provide the necessary flexibility to accommodate the needs of such clients.
• Support needs to be timed carefully in order to build on the recovery phase. Initial access to support can lead to a deterioration in their mental health before support and treatment helps recovery.