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If they are to influence mental health outcomes in the general population, public health officials know they need help. This is why there is so much interest in a trial that has started in the West Midlands region of the UK.
The West Midlands Combined Authority (WMCA), which covers a population of more than 4m and is centred around the city of Birmingham, is running Thrive West Midlands, a programme aimed at giving employers incentives to introduce wellbeing initiatives and at improving employment prospects for those with mental health difficulties.
Thrive at Work, the part of the programme that is aimed at employers, has enrolled 152 small and medium-sized businesses on a randomised controlled trial, funded by central government, to see whether a financial incentive — in this case grants of up to £10,000 to spend on health and wellbeing — can persuade companies to make good their commitments to mental health. The intervention period will run until this October and final reports on the success of the programme are due in March 2020.
In an era of severely squeezed budgets for local authorities, economics underpins the approach. “We lose 4.1m working days in the West Midlands for mental health per year,” says Sean Russell, director of implementation for the Thrive programme.
He describes the scheme as “future-proofing”. “Ultimately, what we want to do is make our region resilient, responsive and restorative.” Benefits include reduced absenteeism, improved staff retention and savings on agency costs, he says.
The scheme offers a toolkit for employers to fill what Russell says is a gap in guidance. The programme also aims to train half a million people over the next 10 years in mental health first aid as well as enabling small businesses to access occupational health services for a minimal fee. Companies will assess evidence through the trial and be awarded bronze, silver or gold status based on their level of commitment.
Separately, central government has pledged £8.4m to fund Thrive into Work, the job-finding arm of the scheme that is running concurrently, to test the effectiveness of Individual Placement and Support (IPS), a method of providing ongoing support for people with mental health problems to secure and keep a job. Anita Hallbrook, the combined authority’s lead on IPS, says the intensive, individualised service is far more likely to sustain employment than other models. “This is the largest trial of its kind,” she says.
Job candidates are normally referred from local medical practices, so success demands a real “culture change” from the National Health Service, says Hallbrook. “We really need to push doctors to recognise employment as a health outcome. We need them to refer into this service in exactly the same way that they refer into an outpatient appointment or to see a consultant.
“If we put the person at the centre and focus on the health outcome, then inevitably the economic impact will follow, and we think that’s going to have a bigger impact than the kind of adversarial ‘you must work’ approach.”
Tracy Elsdon, an employment adviser at Prospects, one of the groups that find jobs for candidates, says “a lot of organisations are concerned or scared about taking on someone with a health condition”. She says the groups sit down with an employer and a new employee and go through the best support options, giving advice and guidance. “We can signpost other organisations to support the employer as well,” The result? “Local business is tapping into a workforce that they didn’t think was possible for them.”
These workers are also highly motivated, says George Farmer, Thrive area manager at Dudley and Walsall Mental Health Partnership NHS Trust. “If you employ somebody and give them an opportunity that they never thought they were going to have, because they’ve had a disability, then they’re going to be the most loyal, dedicated member of staff that you’ve got.”
Tender Years Day Nursery in Solihull, on the south-eastern outskirts of Birmingham, is one of the participants in the trial. Lisa Whitehouse, the nursery’s owner, stresses the importance of tackling mental health problems early — crucial when you consider that her staff are influencing the early development of children. “In the environment we work in, if people are struggling with their own mental health, they can typically become quite vacant and withdrawn.”
Thrive West Midlands is loosely modelled on Thrive NYC, a programme launched in New York three years ago on the basic premise that mental health is a public health issue and that local authorities are best placed to deal with it.
“This is not something that can be driven from the national level or even US state level, the traditional power over care delivery in public health,” says Gary Belkin, a deputy commissioner in New York’s department of health.
Some 185 US administrations are now part of the Cities Thrive Coalition. Thrive acts local but thinks global, says Belkin, citing innovative approaches from countries such as Haiti and Zimbabwe. “As the former head of mental health at the World Health Organization once said, when it comes to mental health, every country is a developing country. Except that the real developing countries are actually changing things, and the rest of us have to take notice,” Belkin says.