'Disability and employment' in mental healthcare

Considering the scale of (mental) disability and associated economic burdens for multiple stakeholders, there is a need for better ways to integrate people with disabilities into the society. In the Netherlands the average employment rate is over 80%, but for people with a depression or other significant (mental) disorders this percentage can drop to 40%¹. One of the primary areas to focus on is employment, since not only does having stable jobs ensure participation in society, but also helps lower the need for continuous care, ensures better quality of life and leads to less costs for many stakeholders involved (i.e. a reduction in financial aid by the governments).

_{¹Government of the Netherlands; Figures and initiatives Collaboration GGZ-Work & Income}

Background

The project was executed as an interdisciplinary collaboration between the Social Services Drechtsteden, the UWV, Randstad, a healthcare insurer and the GGZ organisation Yulius. Yulius is a healthcare institution that specialises in helping children, adolescents and adults with psychological problems. Having worked specifically in the area of mental healthcare and special education, Yulius recognises that a suitable job is important for people with psychological problems who want to participate in society. It is well known that work can contribute to the recovery of psychological problems, and Yulius wanted to gain insight on this more broad and social approach to caring for people with psychological problems or related disabilities.

Initiative 'Werk als beste zorg'

The initiative ‘Werk als beste Zorg’, which started in October 2017 had one goal: to place twenty GGZ clients with a regular employer. Clients with long-term psychological problems or disabilities who were being treated for their complaints with Yulius and who were motivated to work were eligible for ‘Werk als beste zorg’. Werk als beste zorg focuses on active matching between client and employer, whereby work activities are deployed with mutual understanding between the two.

The aim of this project was to gain insight into the added value of ‘Werk als beste zorg’ in promoting sustainable labour participation and improving the health of clients with long-term psychological problems. However, the project was expected to have its own challenges. There are multiple stakeholders and they are not always aware of each other’s areas of work, which makes coordination inherently difficult. We found that municipalities have relatively little knowledge about mental health disorders and psychological vulnerability. Conversely, mental healthcare institutions are not always familiar with the support instruments and the possibilities for their clients on the municipality level. This in some cases lacking connection to broader areas of care is a lost opportunity – since for example a normal job can give clients a role, rhythm and meaning. In addition, labour participation can possibly reduce their healthcare consumptions and thereby healthcare costs with up to 45% and reduce their dependency on governmental support with up to 100%.

The six-month pilot set a target for these parties to jointly try to get 40 GGZ clients to work sustainably with regular employers. The pilot would be considered successful if it succeeded for half of the participants. The pilot has proven to be a success and at this moment in time over 80 clients have been involved in 2020. The participants had a wide range of disabilities with some serious psychological problems, such as psychoses and schizophrenia. Consequently, the type of work they did also varied widely, focussing mainly on the lower educated work section.

The approach that we took for this project was very collaborative and focused on good supervision. We recognised that starting work is a life event that can cause stress and a temporary relapse into the psychological problems. At the start, a staff member was appointed who was specifically involved in the collaboration at both the municipal organisation and the GGZ institution level. Having a job coach was helpful in addressing issues during the pilot, and we are still investigating the possibility of using a Yulius counsellor as a job coach for such cases.

Delivering a tailored solution ensured the match between the target population with specific mental disorders and the employers in a sustainable way – step 4

There were also other challenges. In the beginning, communication between the social service and Yulius was rather difficult. The turning point came when both authorities appointed a subsidy from the Ministry of Social Affairs and a so-called key figure: a special officer who had to establish the connection. Once these key figures were appointed and knew how to find each other easily, it promoted a better understanding throughout the organisations. Professionals from both agencies now regularly put their heads together to go through the cases. The collaboration offers opportunities for individual tailor-made solutions - something that is especially necessary for GGZ clients.

Various organisations have been involved in this project apart from Yulius, including several municipalities (Alblasserdam, Dordrecht, Hardinxveld-Giessendam, Hendrik-Ido-Ambacht, Papendrecht, Sliedrecht and Zwijndrecht), Erasmus MC, Social Services Drechtsteden, Entrepreneurs and Employers Network 'De Normaalste Zaak' and 'Baanbrekend Drechtsteden'. Ultimately, the aim of the cooperating parties is to demonstrate that labour participation does indeed lead to a higher quality of life and lower social costs, and so far, the project demonstrates this well.