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Around 90 per cent of offenders have a mental health problem, personality disorder or addiction, and most have two or more such problems. One of the most effective ways of preventing reoffending and improving the life chances of an offender is through achieving and maintaining employment, however very few people leaving prison will have employment on release from prison. This paper aims to focus on these issues.

The paper describes an investigation conducted by the Centre for Mental Health into employment opportunities for offenders with mental health problems on release from prison.

The investigation revealed that, although offenders with mental health problems are less likely than other prisoners to be included in employment programmes, evidenced‐based approaches such as individual placement and support offer huge potential. The investigation identified five principles for employment programmes supporting this group: employers should play an instrumental role in creating opportunities; recruitment should be pragmatic, based on attitude and “character” rather than qualifications or health status; support should be offered to employees and their employers/managers for as long as they need it; opportunities for “pre‐ employment” and “in work” skills development should be linked to real employment opportunities; and criminal justice and other statutory agencies should facilitate effective pathways to real work and skills development.

There is a need to develop more employment programmes for offenders with mental health problems that incorporate evidenced‐based approaches such as individual placement and support, and a number of key principles identified in this investigation.

The investigation that this paper describes is the first to consider as its main focus evidence‐based employment interventions for people with mental health problems leaving prison or engaged with other parts of the criminal justice system.

The relationship between employment services and employment outcomes has been the subject of research for a number of years (Bond et al., 2001; Drake et al., 1996). More recently, the competitive employment of service recipients has become an important indicator of community mental health program and service system performance. The National Association of State Mental Health Program Directors’ President’s Task Force on Performance Measures, for instance, recognized the importance of monitoring employment rates for adults with serious mental illness: “For payers, this is the payoff…Monitoring this outcome for populations with mental illness…is critical. This was considered a critical outcome to track.” For similar reasons, the new federal Performance Partnership (Block) Grant program (Federal Register, 2002) requires annual reporting by all states of employment rates for recipients of publicly funded mental health services.

The User Employment Programme at South West London & St George's Mental Health Trust pioneered user employment in mental health trusts. Eight years on, Miles Rinaldi and colleagues review the lessons learned to date and highlight some pitfalls to avoid and useful pointers for others embarking on this course. Key to its success has been the ongoing support and involvement of senior management, listening to and learning from users, and an incremental approach to breaking down the barriers between ‘them’ and ‘us’.

This paper reports on the implementation and evaluation of the JOBS programme in Ireland. This is a training intervention to promote re‐employment and improve mental health among unemployed people that was implemented on a pilot basis in the border region of the Republic and Northern Ireland. Programme participants were unemployed people recruited from local training and employment offices and health agencies. The evaluation indicated that the programme was implemented successfully and led to improved psychological and re‐employment outcomes for the intervention group, lasting up to 12 months post‐intervention. This paper reflects on the implementation issues that arose in adapting an international evidence‐based programme to the local setting and considers the implications of the evaluation findings for the roll out of the programme on a larger scale.

This paper brings together findings from current research into mental health and employment from an economic perspective. The economic impact of reduced employment and productivity for people with mental health problems is described from both individual and societal viewpoints. Interventions reported to have an impact on employment are considered, looking at both clinical interventions that have reported employment outcomes and interventions that have as their primary target the improvement of employment outcomes. The paper also describes the impact of common mental health problems on employment and productivity and reports the findings of some studies in this area. However, the quantity and quality of economic information in this area are limited.

Recovery principles have been central to debates in both the government and the mental health field, when thinking about the best way to support people who have experienced mental health distress into employment and education. The purpose of this paper is to review how this principle has been employed within the most effective approaches. This information will contribute to the development of the South London and Maudsley (SLaM) NHS Foundation Trust apprenticeship/return-to-work scheme for people who have experienced mental health distress.

NHS evidence was used to undertake searches journals on CINAHL, EMBASE, PsycINFO, MEDLINE, HMIC, AMED, BNI, HEALTH BUSINESS ELITE and the Cochrane Library. Common search terms used were as follows: apprentice*; mental illness*; mental disorder*; psychiatric; psychosis; chronic mental disorder*; patient*; service user*; client*; return to work schemes; work; employment; unemployment; peer worker*; supported employment; vocational rehabilitation; peer training*; outcome measure*; recovery.

Although the available literature writing about these employment schemes were not explicit in using Recovery as its guiding principle (i.e. Hope, Control and Opportunity), many of the participants in studies about a particular type of supported employment called Individual Placement Support (IPS) referred to recovery concepts in their narrative accounts, i.e. doing work that is meaningful, building self-esteem. This particular type of employment scheme was shown to have better outcomes for people who have experienced mental health difficulties then others schemes. The importance of employers having systems in place to support people’s control/self-management of their mental health condition was a key factor in helping them retain jobs once they have got them.

The SLaM education and training service plans to develop a return to work programme for people who have had lived experience of mental health distress, through a workforce skills apprenticeships scheme. This is first apprenticeship scheme of this type in London. Therefore, this paper will review the literature on previous and current employment programmes for people who have experienced mental health distress, specifically highlighting what has worked well and what could be improved. This paper will also draw on the literature presented in this review and conclude on key points, which will contribute to the development of SLaM’s apprenticeships scheme. This literature review will form the basis of further research about the outcome/evaluation of the actual apprenticeship scheme after the first year.

Although work has a fundamental role in the individual’s psychological well-being, the vast majority of mental health service users are not in employment. This is the result of various barriers that impede their work re-integration process despite their desire to work. Apart from the illness’ symptoms, these barriers are strongly associated with the negative effects of long-term unemployment, the negative stereotypes and attitudes towards mental health service users and the fear of losing disability benefits. There are several occupational intervention models aiming at vocational rehabilitation of mental health service users. Arguably, the Individual Placement and Support (IPS) model of supported employment has proved to be more effective compared to other models. This chapter presents an innovative career counselling approach that combines elements from the IPS model and from the newly emerged career theories that have been developed to address today’s world of work challenges. This model was developed by the Pan-Hellenic Association for Psychosocial Rehabilitation and Work Integration (PEPSAEE) in Greece during the recent major economic crisis. Further implications of the model’s implementation regarding vocational rehabilitation of mental health users as means for social inclusion are discussed.

A proportion of the working age population in the UK experience mental health conditions, with this group often facing significant challenges to retain their employment. As part of a broader political commitment to health and well-being at work, the use of job retention services have become part of a suite of interventions designed to support both employers and employees. While rigorous assessment of job retention programmes are lacking, the purpose of this paper is to examine the success of, and distils learning from, a job retention service in England.

A qualitative methodology was adopted for this research with semi-structured interviews considered an appropriate method to illuminate key issues. In total, 28 individuals were interviewed, including current and former service users, referrers, employers and job retention staff.

Without the support of the job retention service, employees with mental health conditions were reported unlikely to have been maintained their employment status. Additional benefits were also reported, including improved mental health outcomes and impacts on individuals’ personal life. Employers also reported positive benefits in engaging with the job retention service, including feeling better while being able to offer appropriate solutions that were mutually acceptable to the employee and the organisation.

Job retention programmes are under researched and little is known about their effectiveness and the mechanisms that support individuals at work with mental health conditions. This study adds to the existing evidence and suggests that such interventions are promising in supporting employees and employers.

There is an established international evidence base on supported employment for people with severe and enduring mental health problems, and now a growing evidence base on how to successfully implement this into practice. The process involves substantial organisational development and change, and therefore effective leadership is critical. This article outlines some of the challenges to implementing supported employment services and explores what recent leadership theory could contribute to this process, as the Sainsbury Centre embarks on its Centres of Excellence Programme in England and seeks to build a wider learning community from our partnerships formed through the International Initiative for Mental Health Leadership (IIMHL).