Mental health policy and practice across Europe: an overview

302 Mental health policy and practice
when looking at the length of time that individuals kept their jobs (Drake et al.
1996; Lehman et al. 2002). There is also some evidence suggesting that the
quality of support for individuals while in the workplace can make a difference
to long-term retention of employment. One evaluation of a workplace fundamental
skills module which provided training in social and workplace skills for
people with mental health problems that had obtained employment reported a
lower level of job turnover compared with those individuals who received
standard IPS-type support alone (Wallace and Tauber 2004).
While the evidence on effectiveness for supported employment interventions
seems strong, it is difficult to generalize any findings on their cost-effectiveness
in comparison to other types of intervention because these are highly contextspecific
and most analyses have focused on individuals with learning disabilities
(Schneider 2003). Indeed the costs of IPS interventions may often outweigh the
gains in terms of benefit payments avoided, or income tax payments made, as
for instance shown in one recent study in Australia (Chalamat et al. 2005). It is
important however to consider broader measures of outcome as well as narrow
measures such as rate of return to employment. In comparison to other interventions
higher rates of employment can be associated with other benefits such
as increased levels of social inclusion and improved quality of life.
Although the evidence on most sheltered workplaces suggests that they are
not effective in getting individuals into mainstream employment, one emerging
area where further careful evaluation is required is that of social firms or social
cooperatives (Schneider 2005). These companies are created for the employment
of disabled people, and typically at least 30 per cent of the workforce has
some disability. Some qualitative analysis suggests that important factors in the
success of social firms in ultimately improving the chances of open employment
include the participation of employees in the firm’s development, wages above
the minimum wage rate, genuine opportunities for employees to develop their
potential and the involvement of local agencies in firm development (Secker
et al. 2003). Certainly there has been some growth in social firms across Europe.
Most are to be found in Italy, with more than 8000 employing in total 60,000
people and Germany where there are 520 firms employing 16,500 people
(Seyfried and Ziomas 2005). The Confederation of European Social Firms,
Employer Initiatives and Social Cooperatives (CEFEC) now has organizational
members in 14 countries in both western and eastern Europe. One mapping in
the United Kingdom suggested there were 118 full or emerging social firms with
more than 1500 employees of which more than 900 places were filled by people
with disabilities. People with mental health problems formed the largest single
group accounting for more than 30 per cent of these 900 jobs (Baker 2005).
Financial disincentives to employment
We have already noted that many studies have been undertaken in the United
States where the welfare system is somewhat different to that found in most
European countries. This makes it difficult to generalize findings to a European
context where disability benefits appear to act as a significant disincentive to a
return to work in many countries. This is in contrast to the situation in the US