An evaluation of an employment project for mentally ill people

This thesis is concerned with the rehabilitation and employment of mentally ill people. It focusses on a Community Programme which offers a year's employment to people with a mental illness. Fifty -three people recruited to the Sprout project were interviewed at various stages during their career on the project. The study sets out to evaluate the project's impact on participants, both during their employment there and subsequently. Participants' views on employment in general and on Sprout were obtained, along with details of their employment and psychiatric histories and of their social circumstances.At a time of high general unemployment, there is much debate about the emphasis work should be given in rehabilitation. In the thesis, I rehearse some of the arguments and counterarguments and consider what light the views of service -users can throw on the issue. It emerges that many mentally ill people believe that they benefit from being in work. They want to work and, given a supportive setting, are capable of doing so. However, there were few opportunities for those leaving Sprout to take up either sheltered or open employment elsewhere.The outcomes for Sprout participants were highly diverse and it seems imperative that such diversity should be reflected in a range of provision which catered for variations in ability and interest. To polarise discussion and debate whether or not work has a place in rehabilitation seems unhelpful.The project had, on the whole, disappointingly little long -term effect on the abilities and quality of life of participants. However, when viewed in the context of other research findings, these results are not surprising as rehabilitation rarely succeeds in bringing about lasting improvements in ability. Moreover, it was evident that Sprout participants often faced substantial difficulties in their lives outside work and yet received little or no support from health or welfare services. This may have affected outcome.The thesis points up deficiencies in current services for mentally ill people and suggests ways in which the employment opportunities of this group might be enhanced. It is insufficient to look only at the employability of the individuals concerned, without also considering the wider social factors which influence access to and retention of employment

Progress in the development of integrated mental health care in Scotland

The development of integrated care through the promotion of ‘partnership working’ is a key policy objective of the Scottish Executive, the administration responsible for health services in Scotland. This paper considers the extent to which this goal is being achieved in mental health services, particularly those for people with severe and enduring mental illness. Distinguishing between the horizontal and vertical integration of services, exploratory research was conducted to assess progress towards this objective by examining how far a range of functional activities in Primary Care Trusts (PCTs) and their constituent Local Health Care Co-operatives (LHCCs) were themselves becoming increasingly integrated. All PCTs in Scotland were surveyed by postal questionnaire, and followed up by detailed telephone interviews. Six LHCC areas were selected for detailed case study analysis. A Reference Group was used to discuss and review emerging themes from the fieldwork. The report suggests that faster progress is being made in the horizontal integration of services between health and social care organisations than is the case for vertical integration between primary health care and specialist mental health care services; and that there are significant gaps in the extent to which functional activities within Trusts are changing to support the development of integrated care. A number of models are briefly considered, including the idea of ‘intermediate care’ that might speed the process of integration

"We're not short of people telling us what the problems are. We're short of people telling us what to do": An appraisal of public policy and mental health

Background: There is sustained interest in public health circles in assessing the effects of policies on health and health inequalities. We report on the theory, methods and findings of a project which involved an appraisal of current Scottish policy with respect to its potential impacts on mental health and wellbeing. Methods: We developed a method of assessing the degree of alignment between Government policies and the 'evidence base', involving: reviewing theoretical frameworks; analysis of policy documents, and nineteen in-depth interviews with policymakers which explored influences on, and barriers to cross-cutting policymaking and the use of research evidence in decisionmaking. Results: Most policy documents did not refer to mental health; however most referred indirectly to the determinants of mental health and well-being. Unsurprisingly research evidence was rarely cited; this was more common in health policy documents. The interviews highlighted the barriers to intersectoral policy making, and pointed to the relative value of qualitative and quantitative research, as well as to the imbalance of evidence between "what is known" and "what is to be done". Conclusion: Healthy public policy depends on effective intersectoral working between government departments, along with better use of research evidence to identify policy impacts. This study identified barriers to both these. We also demonstrated an approach to rapidly appraising the mental health effects of mainly non-health sector policies, drawing on theoretical understandings of mental health and its determinants, research evidence and policy documents. In the case of the social determinants of health, we conclude that an evidence-based approach to policymaking and to policy appraisal requires drawing strongly upon existing theoretical frameworks, as well as upon research evidence, but that there are significant practical barriers and disincentives

With mental health and wellbeing in mind

This paper is based on work undertaken on behalf of the Scottish Development Centre for Mental Health and it explores key challenges in addressing the mental health needs of children and young people who are looked after away from home. It considers some models of working that show promise in building bridges between activities to promote good mental health for all such children, as well as highlighting activities that focus on assessment, care and treatment for those who require such intervention

Mental health officer services Structures and supports

Includes bibliographical referencesAvailable from British Library Document Supply Centre- DSC:m03/36441 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Measuring the tail of the dog that doesn't bark in the night: the case of the national evaluation of Choose Life (the national strategy and action plan to prevent suicide in Scotland)

Background Learning about the impact of public health policy presents significant challenges for evaluators. These include the nebulous and organic nature of interventions ensuing from policy directives, the tension between long-term goals and short-term interventions, the appropriateness of establishing control groups, and the problems of providing an economic perspective. An example of contemporary policy that has recently been subject to evaluation is the first phase of the innovative Scottish strategy for suicide prevention (Choose Life). Discussion and summary This paper discusses how challenges, such as those above, were made manifest within this programme. After a brief summary of the overarching approach taken to evaluating the first phase of Choose Life, this paper then offers a set of recommendations for policymakers and evaluators on how learning from a second phase might be augmented. These recommendations are likely to have general resonance across a range of policy evaluations as they move from early planning and implementation to more mature phases