Presentation for drug and alcohol treatment providers, social workers and officials, given in Podgorica, Feb 2015.

1. Improving the labour market
participation of people with
histories of substance misuse
and offending
Benefits, obstacles and
interventions.
Paul Anders, Senior Policy Officer

2. Background
- DrugScope – c.450 member organisations
- Policy, good practice, research, campaigning,
national & regional forums
- England (pop. 53m):
- 300,000 crack cocaine/opiate users (England)
- 200,000 adults in drug treatment
- c.1,600 adult drug/alcohol services
- c.£900m (€1.2bn) spent on treatment
- £15.4bn (€21bn) cost of drug addiction, of which
£13.9bn (€19bn) is drug-related crime
- Cost-benefit ratio estimated at 1:2.5

3. Recovery capital – whole person
approach

4. Changing presentation
• 80s & 90s heroin spike appears to be over
• Fewer entrants to system and less opiate/crack cocaine
presentation – although adult drug services still c.70% OCU
• Ageing population in treatment
• Need to reconfigure services to reflect need

5. Prisons
- 23rd Jan 2015: 84,865 in prison (inc. 3,811 women)
- Jan-March 2014
- 26,151 people sent to prison in total, of whom:
- 11,196 people were sent to prison to serve a short
sentence (below 12 months)
- 47% of all adults reoffend within 12 months
- 58% of short sentence prisoners reoffend in 12
months
- Highest per capita in Western Europe at 148 per
100,000
- £3bn (€4bn) cost of prisons per year

6. Montenegro & the UK
Montenegro UK/England
Unemployment 15% (2014) 5.8% (UK, Q3 2014)
LT as % of unemployed 80% (2011) 39% (UK, Q2 2014)
18-24 unemployment 45% (2010, 33% to 30, 2013) 15.1% (UK, Q3 2014)
Industry 20% (2011) 18.2% (UK, 2013)
Services 73.9% (2011) 80.4% (UK, 2013)
Agriculture 6.2% (2011) 1.4% (UK, 2013)
Self employed 16% (2011) 15% (UK, 2014)
Seasonal Yes Somewhat
Regional disparity Yes (16%-48% - 2010)) Yes (4.4%-8.5% - 2013))
Poverty rate (income) 8.6% (2013 – Gini 26.7%) 23.2% (2013 – Gini 34%)
Employment service ZZCG/EAM Jobcentre Plus
Labour market programmes ZZCG/EAM Private, NGO, public (excluding
JCP), social enterprise
Jobseeker profiling Intermediate Limited
Wage incentives Yes (various) No (but £ to some disabled to
facilitate employment)

7. Complex needs
• SMD = severe & multiple disadvantage – substance use, offending,
homelessness (mental health excluded due to data quality)
• Treatment population – 75-85% mental health problems
• Prisons – 25% (women) & 15% (men) mental health problems; 57% &
62% personality disorder
• Mental health treatment – 40% illicit drugs and/or harmful alcohol
consumption
• Rough sleepers – 45% mental health problems

8. Employment & drug treatment

9. Finding work
• 50% JSA off-flow = <3 months
• 50% LDAN cohort job entry = c.12 months
N=115

10. Labour market interventions in the UK
• Supply side measures
• Deficit based
• Limited integration with skills & training
• Demanding conditionality
Eurostat 2011

11. Conditionality
• 2m sanctions in 2 years – up to 3 years withdrawal of benefits
• Disproportionate impact on people with mental health
problems, the young & socially excluded

12. Conditionality - consequences
• C.500k unemployed/inactive disengaged from main
employment service

13. Labour market programmes - UK
• DWP Work Programme – long term unemployed: 3, 9, 12
months
• Non-prescriptive ‘black box’
• Payment by results: £0 to £14,000 (€ 18,700) plus £5,000
(€6,700) drug/alcohol premium in pilot areas
• £2.8bn (€ 3.7bn) 5 year programme cost at £2,100 (€2,800)per
job
Dotted line = minimum
performance level

14. Employment - benefits
• Drugs & alcohol
• >90% heroin & crack cocaine users unemployed
• Improved treatment outcomes
• Less frequent relapse
• Less severe relapse
• Direct savings (e.g. treatment, health, social security)
• Indirect savings (e.g. offending, social care)
• Potential savings up to c.£40,000 (€53,000) per person
• Offending
• 67% unemployed at time of arrest
• 27% enter employment on release
• Cost of prison place £37,000 (€49,000) p.a.
• Can reduce low level, persistent offending
• Complex interplay and causal relationship between
offending, reoffending and employment
• Employment improves health and wellbeing – but less clear
with poor jobs – low status, low paid, insecure, unsociable,
unpleasant etc.

15. Barriers to employment
Personal barriers:
• Drug and alcohol addiction
• History of offending
• Low self-confidence, self-esteem & motivation -
discouraged workers
• Physical and mental health problems
• Poor employment histories,
• Low skill and qualification levels,
• Learning disabilities
• Behavioural problems
• Poor access to information
Structural barriers:
• Cost of labour market participation
• Employer attitudes – stigma & discrimination
• Absence of a compelling competing narrative despite
positive employer experiences
• Labour market conditions
• Inadequate macro measures
• Scarcity of effective interventions
• Silos – activity, policy and funding

16. Towards a solution
Seven interventions:
• Individual placement and support
• Counselling approaches
• Social enterprise
• Employer initiatives and corporate social responsibility
• Job subsidies
• Campaigns
• Toolkits and information for universal services

17. • An evidence-based model of employment support
• Originally developed in the US to support people with
• mental health problems
• IPS only used once before in the UK with an addictions client
group
• CNWL is a Centre of Excellence in IPS services
Measurable Outcomes:
• Job entry & sustainment
• Earnings
• Likelihood of dropping out of service/rehospitalisation
• Percentage of service users entering competitive employment
Individual placement & support

18. IPS key principles
• Aims to get people into competitive
employment
• Open to all those who want to work
• Tries to find jobs consistent with people's
preferences
• Works quickly
• Brings employment specialists into clinical
teams
• Employment specialists develop
relationships with employers based upon a
person's work preferences
• Provides time unlimited, individualised
support for the person and their employer
• Includes benefits counselling.

19. IPS compared to generic interventions
Drake, Robert; Bond,
Gary (2011). "IPS
Supported Employment:
A 20-YearUpdate".
American Journal of
Psychiatric
Rehabilitation 14 (3):
155–164.
CNWL mental health IPS
service compared to
Work Choice (main UK
disability employment
programme), 2011-12.
Mental health – severe &
mild to moderate

20. IPS – diversity of job entry at CNWL

21. IPS strengths & weaknesses
• Evidence based – proven in mental health,
promising in substance use and elsewhere
• Off the shelf and replicable
• Intermediate skills required
• Inherently joins health care and employment
support
• Perceived as high cost (but arguably
comparable to traditional interventions for
equivalent client group)
• Culture, attitude and values essential
• Dependent on job market and economy
• Scalability untested

22. NEXT
Psychosocial approach including:
• Learning styles and reflective practice
• Active listening skills
• Models of substance misuse
• Psychology of prejudice & working with difference
• Understanding your emotional world
• Intro to cognitive behavioural therapy
• Communication skills and understanding family dynamics
• Career action planning
• Understanding and working with schemas
• Advanced listening skills & understanding personal responsibility
• Understanding group work
• Giving & receiving feedback
• Interpersonal boundaries and co-dependency
• Improving assertiveness
• Fight, flight or freeze? Understanding the response to trauma
• Working with anxiety
• Voluntary work placement

23. NEXT strengths & weaknesses
• Offers a consistent approach between
treatment and employment support
• Proven track record – 9 out of 10 participants
go on to employment, education, training or
volunteering
• Prepares people for work but not job
brokerage
• Requires experienced and skilled staff to
deliver
• Time limited

24. • Homelessness, substance use, socially excluded;
• Activities include:
• Job readiness training
• Job brokerage (Social Value Act readiness)
• Direct employment – Work Champions, distribution & The Handy
Help Co
• With Lambeth Jobcentre Plus:
• Engage: 480
• Employ: 36
• Support into mainstream employment: 51
• Cost to JCP: £28,500 – or £559 per person into competitive
employment
• Work Programme equivalent cost – c.£3,300 per job
Social enterprise

25. Social enterprise strengths &
weaknesses
• Creates employment, supports targeted local &
regional economic activity
• Can actively engage and target particular cohorts
• Can leverage public spending and investment for
positive social gains
• Emerging practice - e.g. Social Value Act in UK,
Europe 2020
• Socially excluded employee premium
• Employer concern & customer risk aversion
• Cost implications of ethical employment
• Small base in Montenegro, limited infrastructure &
legislative support

26. Job subsidy/guarantee strengths &
weaknesses
• Can stimulate employer engagement
• Existing framework in Montenegro
• Intermediate labour market can be more effective
than job coaching approaches – e.g. Future Jobs
Fund in UK
• Can be precisely targeted
• Can be costly
• Open to gaming and creaming
• Risk of displacement & excessive deadweight
• Competing priorities & groups
• EU State Aid rules
• Employer attitudes towards different cohorts have
cost implications

27. Employer initiatives
Timpson – 1400 high street
Shops
• Corporate social responsibility
• Backed by business case
• 5 prison academies
• Academies resemble shops & replicate shop
environment including corporate uniforms
• All attendees who complete skills training
offered paid work
• 300 ex-prisoners recruited in 4 years
• 16 shop managers recruited from prison
• 7 employees known to have reoffended

28. Employer initiatives strengths &
weaknesses
• Demonstrates the business case
• Halo effect – for firm and employee cohort
• Scalable
• Public support progressive recruitment approaches
• Very limited employer take-up so far: Timpson is almost
unique. No equivalent for substance use clients
• Public supportive, but stigma still an issue
• Limits on what can be achieved: “for lots of people having a
job would be the least useful thing for them in their life. A
third of people in prison are right for employment, a third
have significant health problems and a third are people I
would not want to have in my business” – James Timpson

29. Campaigns
• Ban the Box – Business in
the Community
• Launched in 2013
• Evidence from USA:
• Improved employment
rates
• Social & economic
benefits
• Time to Change – Mind &
Rethink Mental Illness
• Major national campaign to
tackle stigma and
discrimination
• 3% increase in the number of
people who say they face no
discrimination,
• 11.5% reduction in average
discrimination
• 2.4% improvement in public
attitudes.

30. Campaigns strengths & weaknesses
• Can utilise existing communication channels
• Impacts permeate beyond employment
• Turning the oil tanker – perceptions are
persistent
• Require public buy in
• Risk of competing messages
• Difficult to demonstrate direct effect on
employment – e.g. suggestion that Time to
Change has had limited effect on recruitment,
although it may have changed employer
attitudes to people they already employ.

31. Information products
DWP mental health toolkit
• Universal guidance for
non-specialists
• Aims to use a new
approach to getting more
suitable and sustained job
outcomes for people with
mental wellbeing needs
• Developed by
psychologists, Work
Programme providers and
mental health experts
• Comparatively quick and
cheap
• Offers few guarantees of
consistency, access and
efficacy
• Works best as part of a
coordinated strategy
including training, quality
assurance & user satisfaction

32.  Co-locate services & improve practitioner skills;
 Approaches from mental health appear to transfer well, e.g. Individual Placement
and Support – but pilot and learn from a range of interventions;
 Introduce and assess early – part of the journey, not the destination, although
introduction should be planned, staged and build from a stable foundation;
 Structured and intensive, but flexible – provision should reflect changing
circumstances and fluctuating ability to engage;
 Skilled, motivated and experienced staff – not necessarily within the treatment
sector, but people who are able to understand and work with the client group;
 Long-term planning – a career or pathway, not just a job. Understanding and
planning for the individual’s aspirations and motivation is important;
 Include basic / functional skills alongside employability;
 Addresses lack of recent/any work experience;
 Include intermediate labour market approach;
 Engage with employers locally and individually, and make the case nationally to
address negative preconceptions and stigma – negative preconceptions are the
norm, even among employers who are signed up to the agenda.
10 points to conclude:

33. Contact
Paul Anders
DrugScope
paul.anders@drugscope.org.uk
Tel: +44 (020) 7234 9799
http://www.drugscope.org.uk/
http://www.ldan.org.uk/employment.html
http://www.nta.nhs.uk/uploads/employmentandrecovery.final.pdf