The Mental Health Education and Employment Service

London Borough of Hackney has a high prevalence of mental health conditions in the population.  There are also significant pockets of multiple deprivation.

The aim of the service is to recruit and support students with mental health conditions through further education and beyond. The service advocates on behalf of students and is student led, the students set their own goals and support is tailored towards each on a case by case basis.  Examples of support include, referring students to the college’s Additional Learning Support & Inclusion Team for in class support,  the college’s Student Welfare & Advice Team for benefit and housing related issues,  and helping  university or job applications. The service advocates and refers to appropriate services. It is not a mental health service, but an education service, there is no clinical role.

To raise awareness about mental health and well-being in the organisation producing policy and procedures for tutors.

Students are recruited through community mental health teams. Also there is tailored recruitment from mental health wards (people with severe and enduring mental health conditions) to specifically designed short courses based in hospital to give confidence. Discrete Mental Health literacy and numeracy courses have been designed as a stepping stone available on campus. Specific Mental Health Cookery Course is co-facilitated between the East London Foundation Trust (Mental Health) and Hackney Community College with the longer term aim of getting them off the ward and into mainstream college courses.

In the past two years the service has seen an increase in demand from younger students referred through Children and Adolescent Mental Health services and those from the mainstream student population under increased pressure from social disadvantage that impacts on mental health as low mood or self- harming.

The intervention is in partnership with a mental health trust so it is part of a more holistic approach.

The key aims and objectives are:

• To identify and address barriers to learning for people with mental health needs.

• To facilitate access, support and progression to mental health service users who are currently studying or thinking about returning to education and training or employment.

• To provide in-depth one-to-one advice, guidance, and support to mental health service users to engage in education, training and employment.

• To challenge stigma. To support, advise and raise awareness around mental health issues among college staff.

• To liaise with key College staff to ensure appropriate, flexible provision is developed and delivered to meet the needs of mental health service users at college and within community and NHS venues.

The key driver is local need.  It is recognised that people with mental health support needs are excluded from many services and aspects of society, including further education. In this college's local area, the most common reasons for being in receipt of incapacity benefits for both genders is mental, emotional and behavioural health with almost half (46%) of claimants suffering from these illnesses. This is 11% higher than the neighbouring boroughs’ average.

The diagram below illustrates the three main stages in stages in a learner’s journey, access to education, success and progression and notes some specific barriers experienced by this group of people.

A key additional barrier at each stage is that a learner or prospective learner may be staying within a hospital or secure unit. This is addressed and supported by professionals through the learner journey. 

  95% of learners referred from mental health services have long term enduring mental health conditions.

There are strong partnership arrangements and risk assessment procedures in place for forensic referrals.

Current  2013 Equalities monitoring data:

There is high political support in that the benefit claimant count for people with mental health conditions is very high.  This initiative aims to support people into training and then work and thus can reduce the benefits dependency of people with mental health conditions.

The college management had identified the unmet mental health needs of the existing student population as a priority.

The key factor to the success of this initiative has been the partnership.  There is a steering group of senior managers from the Mental Health Trust, the Public Health Department of the Council and two from the College.

A particular characteristic of the excellence of the Service is the collaborative working partnership approach of the funders, the College and key organisations working with mental health service users in the borough. Trust and strong partnerships have increased the number of referrals from clinical and community organisations over the duration of the project.

The work has developed to include the following range of activities in place to reach and support the target group, combining the factors of health and education – another characteristic of the excellence of the Service:

a.    Individuals have access to the Service through a range of activities:

·         One-to-one advice and support appointments, and weekly drop-in

·         Weekly advice surgeries at the Therapy & Life Skills Service and at the local hospital

·         Monthly advice surgeries with Community Mental Health Teams

·         Monthly Advice surgeries at the Early Intervention Service

·         Forensic Advice surgery as and when required

b.    Assessments and plans

The Service works with learners and potential learners with mental health needs ranging from mild to moderate to severe and enduring. The Service consequently offers a number of assessments to meet the different needs of the client group.

Each individual is offered impartial information, advice and guidance on education, training and employment opportunities to meet their unique needs and goals.

Forensic service assessments. People referred to the service by the local forensic mental health team have detailed assessments due to the complex needs of the individuals and their situation. The current process includes a multi-disciplinary and multi-agency team agreeing to the College referral, which often includes security clearance.

Education Success Plan. This maximises the wellbeing of service users entering College and supports the College in engaging with the service users. It is a consistent system for holding and sharing information about Forensic Service users attending course at the College.

Skills action plan. This is negotiated and completed with each individual to identify previous experience, future goals and support needs (including self esteem, confidence, time keeping, staff/student interactions and travel) and possible impacts of their health and medication on attendance and learning. The plan is updated as goals are met and needs change throughout the learning journey. The purpose of this assessment is to establish what risk factors may influence this learner’s success in getting the most out of the experience at College and to put in place controls to minimise these risks.

Disclosure

Service users are asked to consent to this information being recorded and shared with their College tutor and relevant lecturers.

If during or after these processes a learner needs more time to consider accessing education, future meetings are arranged.

After the initial assessment of learners, ongoing guidance and support is in place throughout their college experience, involving ongoing liaison between the tutor and clinical team to ensure appropriate support remains place for the learner.

c.    Support in the case of hospitalisation

It is not uncommon for a mental health service user to relapse and be admitted to hospital during their course of study. In cases of hospitalisation:

·         an appointment is arranged for an adviser to see the learner on the ward

·         needs and support are discussed around work load, return to class, submitting assignments etc.

·         adviser liaises with tutor to action decisions made by the learner

·         adviser updates learner with feedback from tutor or pass on course work where appropriate

·         adviser facilitates post-discharge meetings with learner and tutor to discuss and action continuing support needs

·         meetings with the learner if required on a weekly basis during first few weeks of re-engagement with the course.

d.    Course offer

·         Courses provide an opportunity for inpatients to leave hospital wards and have another focus in their lives. Inpatients are escorted to classes and supported by an occupational therapist.

·         Specialist, discrete courses for mental health service users are offered on campus and in the community. These provide stepping stones to mainstream provision:

-       Pottery classes at the Centre for Mental Health at the local hospital for inpatients and outpatients, and at a local rehabilitation centre. The tutor also teaches classes at the College which enables a smooth progression route for learners.

-       Computers for Beginners, ESOL, Read, Write & Spell at a local rehabilitation centre.

-       Cookery course, funded by the local Foundation Trust NHS, delivered on campus three times a year.

-       BTEC Workskills Return to Learn course, taught on campus (three times a year) by a College mental health adviser who is a qualified teacher. This is also funded by the local Foundation Trust NHS.

-       Employability Workshops on campus.

·         Mental health service users are also encouraged to join mainstream courses, with support, where this is appropriate to their individual circumstances and needs. The Service currently supports learners on courses across mainstream curriculum: ESOL, Art & Design, Construction, IT, Sports & Leisure, Adult Recreation, Teacher Training, Literacy & Numeracy and Catering.

e.    Where Service users attend mainstream college courses, we offer this additional support:

·         Help with filling in forms and support through the enrolment process

·         Support from staff with mental health experience and understanding throughout a learner's time at College

·         An agreed action plan detailing education and employment goals

·         Support with work preparation, CV writing and  job search

·         Advice on progression to higher education

·         A safe place to talk about education and training issues

·         One-to-one confidential advice/counselling service

·         Referral to specialist external agencies

·         Holistic approach to support in collaboration with mental health agencies.

f.     We make sure that all College staff working with mental health service users have the following support:

·         Advice and guidance to tutors in supporting students with mental health needs

·         Support for part-time staff teaching mental health classes in the community

·         Cross-College Mental Health awareness sessions delivered in partnership with the local Foundation Trust

·         Mental Health policy

·         Mental Health Guidelines and Crisis Procedure developed in partnership with external partners

·         Mental Health tool-kit for teachers

The service is growing continually and there is an increasing focus on student knowledge with a Student Voice Forum coproducing elements of the service.

We commissioned the development of a tool kit ‘recipe for success’  to share our knowledge  http://shop.niace.org.uk/recipe-for-success.html

A threat to the sustainability of the service is education funding cuts and benefits generally.  If students cannot afford the fees or are not entitled or have benefits problems then we cannot support them.

The service costs £85,000 per annum which funds two posts and on costs.

There are no volunteers.

The service is funded jointly by East London Foundation Trust and Hackney Council (public health) and Hackney Community College

In 2008 the service was externally evaluated by NIACE http://www.niace.org.uk/.  Key

Findings of this evaluation were:

·         "Participants identified different entry routes to the project and gave favourable comments about the support they received"

·         Learners "appreciated support and encouragement and a familiar face at college" and "college tutors and other learners were also described as helpful and supportive."

·         "Improved social functioning"

·         "As a result of the support (the learner) had received and his educational experience, he has been discharged and now has an occupational role".

·         A refugee with severe mental health problems "was able to enter the college and develop occupational skills"

·         "(The College) is phenomenal in its thinking around this project". (Head of Occupational Therapy)

·         The College is described as "an essential cornerstone of community services for mental health service users"

In 2008-09, 197 clients of the service undertook courses at the college:

The retention rate was 88%, against the College's retention rate of 87%.

The achievement rate was 72% against the College's achievement rate of 73%.

These figures show a great success in a group that was previously under-represented and would otherwise be at great risk of underachieving.

Achievement of goals

Learners who were clients of the service in 2009-10 were surveyed about what they wanted to achieve from the education experience, and at the end of the course, whether they met their goals:

·         45 wanted to progress to the next level; 59 actually progressed

·         110 wanted to feel more confident; 112 reported feeling more confident

·         112 wanted to learn new skills; 119 reported having learnt new skills

·         96 wanted to meet new people; 105 were pleased to have met new people

·         5 wanted to progress to voluntary work; 4 actually progressed to voluntary work

·         18 wanted to progress to work; when surveyed, 12 had already found work.

Overall:

38% over-achieved their goals

32% achieved their goals

18% partly-achieved their goals

11% didn’t achieve their goals

1% unknown.

The table below shows the most recent monitoring data available:

Matrix 2013: “Supporting students to achieve their employability action plan, mental health care plan or individual learning plan (via E-Tracker) was particularly impressive across a range of services”  Matrix Report 2013

Current data on the gap between students who were supported by the Mental Health Support Services :

2013- Mental Health Students on HCC courses n = 294

Retention 87% (whole college population = 93%)

Achievement 84% (whole college population = 89%)

Success 73% (83%)

Attendance 72% (79%)