Beck Charlotte, Wernham Connie
John Howard Centre, East london NHS Foundation Trust.
BMJ Qual Improv Rep. 2014 May 2;3(1). doi: 10.1136/bmjquality.u204182.w1821. eCollection 2014.
Employment has been proven to be an effective recovery tool and therapeutic intervention for those with severe and enduring mental health conditions. Aside from monetary reward, employment is a means of structuring time and provides a sense of worth and achievement, which enhances self-esteem and confidence. A social identity is developed through employment, encouraging social support and increasing social networks. Securing employment can bring about improved quality of life and positive change in one's social circumstances; therefore it can reduce symptoms associated with mental illness and potentially prevent re-offending, as the individual develops a sense of independence, self-efficacy, and value. Barriers to employment exist for forensic mental health service users and therefore it is imperative that employment needs are addressed at the earliest possible stage in recovery. An evaluation of employment activities across two forensic mental health units revealed a lack of appropriate employment opportunities for service users, and those roles available were not implemented in line with recommended best practice. In response to this issue several enterprises were established to offer opportunities for service users to engage in meaningful employment and develop skills that a future employer would value. Each enterprise responds to a business need within the units to ensure sustainability of services. The enterprises are essentially micro-businesses with social objectives whose surpluses are reinvested for the purpose of increasing opportunities for service users. The enterprises are underpinned by the philosophy of the Individual Placement and Support (IPS) model; empirical evidence suggests that the IPS model is the most effective intervention, based on the 'place then train' philosophy. The model recommends a focus upon rapid job search to achieve competitive employment for those who want to work; opportunities sourced should be consistent with individual preference and benefits counselling offered. Support should be time unlimited and integrated with mental health treatment. A person-centred and strengths-based approach is also adopted to support people to build on their strengths, establish goals, and encourage motivation.
就业已被证明是一种有效的康复工具，对于患有严重且持久心理健康问题的人来说也是一种治疗性干预措施。除了金钱回报，就业是一种安排时间的方式，能带来价值感和成就感，从而增强自尊和自信。通过就业可以形成社会身份认同，促进社会支持并扩大社交网络。获得就业能够改善生活质量，带来社会境遇的积极变化；因此，随着个人形成独立感、自我效能感和价值感，它可以减轻与精神疾病相关的症状，并有可能预防再次犯罪。法医精神卫生服务使用者在就业方面存在障碍，因此在康复的最早阶段就解决就业需求至关重要。对两个法医精神卫生单位的就业活动进行评估后发现，服务使用者缺乏合适的就业机会，而且现有的岗位也未按照推荐的最佳实践来实施。针对这一问题，设立了几家企业，为服务使用者提供从事有意义工作的机会，并培养未来雇主看重的技能。每个企业都满足单位内部的业务需求，以确保服务的可持续性。这些企业本质上是具有社会目标的微型企业，其盈余会再投资，目的是为服务使用者增加机会。这些企业以个人安置与支持（IPS）模式的理念为支撑；实证证据表明，基于“先安置后培训”理念的IPS模式是最有效的干预措施。该模式建议重点关注快速求职，为那些想工作的人实现竞争性就业；所获取的机会应符合个人偏好并提供福利咨询。支持应不受时间限制，并与心理健康治疗相结合。还采用以个人为中心、基于优势的方法来支持人们发挥自身优势、设定目标并激发动力。
