Shared learning database
Type and Title of Submission
De-medicalising long term sickness absence, human solutions to 'stress' and common mental health problemsDescription:
Data from 948 referrals to the Leicestershire The Fit for Work Team reveal that while 61% of referrals are for people with mental health problems, only 5% of people who have returned to work cite mental health therapy as the most important intervention. 71 % report that more practical and human interventions at the workplace are the most important intervention.Does the submission relate to the general implementation of all NICE guidance?
NoDoes the submission relate to the implementation of a specific piece of NICE guidance?
YesFull title of NICE guidance:
PH19 - PH19 - Managing long-term sickness absence and incapacity for workIs the submission industry-sponsored in any way?
Description of submission
Aims and objectives
The Leicestershire Fit for Work service (FFWS) is on of six DWP funded pilots in the UK that aim to reduce long term sickness absence by providing case managed early intervention that overcome the barriers to a successful return to work for employed people receiving fit notes. The Leicestershire service is run by The Fit for Work Team, (FFWT) a 'not for profit' GP led Social Enterprise and subject to independent evaluation by the Institute of Employment Studies. Our focus is specifically on GP referrals.Context
Data from DWP and employers organisations in 2011 revealed the most common cause of long term (> 6weeks) sickness absence in the UK is now 'stress'. 'The medical sickness certificate is one of the most powerful and potentially dangerous treatments in the GP armamentarium'. These are the words of Professor Waddell when introducing the evidence review, Is Work Good for Your Health and Well-being' This statement reflects the growing consensus that any national approach to reducing sickness absence levels needs to engage with mainstream primary care. 'Vocational Rehabilitation: What Works, for Whom, and When' is a systematic review of 450 scientific reviews and reports. The findings support the principle of a co-ordinated return to work plan, the importance of identifying people at risk of long term sickness absence from primary care and de-medicalising the reasons for absence. The split between mainstream primary care and vocational rehabilitation is well recognised but hitherto, has never been addressed in a systematic way. Our Fit for Work Service pilot was designed to bring these worlds closer together. Analysis of the Leicestershire Joint Strategic Needs Assessments in 2010 revealed that while the number of people moving off Incapacity Benefits was increasing, the flow of people onto such benefits was also increasing, particularly for mental health disorders. NICE PH19 provides a framework for managing long term sickness absence. The conventional approach in primary care and by employers (with access to employee assistance schemes) towards people off work with common mental health problems is usually to arrange counseling or other talking therapies as the default intervention to facilitate a return to work. There is emerging evidence that alternative solutions may be better targeted to the rising number of people off work with stress and other common mental health problemsMethods
At discharge from the service, we record a variety of data that includes a reflection by the person referred and the Case Manager who has coordinated their journey through our interventions. Each is asked to record the 'most important intervention that has helped them return to work from a list of options. The client records this in an anonymised questionnaire that is received and sent by post via the admin team not the Case Manager. 1). Musculoskeletal treatment (physiotherapy, chiropractor, osteopathy etc) 2). Mental Health therapy (counselling or talking therapy such as CBT) 3). Mediation/Negotiation with employer 4). Learning or new skills 5). Debt/Legal/Housing or other problem with personal life 6). Personal support/confidence building from FFWS 7). Help with leaving job/new employment 8). Better treatment or understanding of my pain. The results are recorded and comparedResults and evaluation
The data from 325 clients discharged up to October 2011 reveal that 61% of referrals were for mental health problems and 27% for musculoskeletal (msk) problems. The 'most important intervention that has helped them return to work was reported by Intervention as -MSK treatment (Client: 24% Case Manager: 15%) -Mental health therapy (Client: 5% Case Manager: 1%) -Mediation/negotiation (Client: 19% Case Manager: 21%) -Learning/new skills (Client: 5% Case Manager: 1%) -Debt/legal/housing/personal (Client: 5% Case Manager: 2%) -Support/confidence building (Client: 24% Case Manager: 52%) -Help to leave job/new work (Client: 10% Case Manager: 2%) -Better treatment/ -understanding of my pain (Client: 10% Case Manager: 6%) While Case Managers and clients disagree on the detail, both would seem to suggest that 'human interventions' (support, mediation, help with alternative employment) are far more important than mental health therapy.Key learning points
While 61% of referrals to our service are for people with mental health problems, only 7% of people who have returned to work cite mental health therapy as the most important intervention. Human interventions (support, mediation, help with alternative employment) are reported as being more important. The feedback suggests that a bespoke case managed return to work service can provide success to people off work with stress and other common mental health problems. Conflict resolution and personalised support are the key interventions towards a successful outcome. The data reveals that Case Managers, with no medical or formal mental health training also recognise that the unmet needs of these clients were human rather than therapeutic. The pilot supports the notion that de-medicalising long term sickness absence is appropriate for the majority of people receiving fit notes for > 6 weeks and supports the proposal in the recent 'Sickness Absence Review' commissioned by the DWP that an independent advisory service to assess sickness absence at 4 weeks would be more appropriate than the health intervention routes typically chosen by GPs and employers to date.
|Name:||Dr Robert H Hampton|
|Job Title:||General Practitioner, Occupational Physician & Clinical Lead for Leicestershire Fit for Work Service|
|Organisation:||Leicestershire Fit for Work Service|
|Address:||Voluntary Action Leicester, 9 Newarke Street|
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This page was last updated: 30 January 2012