News

At last, it looks as though some real efforts are being made to support the employment of mental health service users in local authority social services. This is in sharp contrast to many survivors' experience of health and social care services, which have often been less accepting than mainstream employers. Social care workers who have had breakdowns frequently talk of unsupportive agencies, colleagues who no longer know how to relate to them and managers who sideline them. These are grim messages about the underlying value base of social work and social care.

It is important to build on the positive new developments now under way in social services to support mental health service users as workers. This is especially so at a time when a new Social Exclusion Unit report has highlighted the importance of positive employment in challenging the marginalisation and stigma faced by many mental health service users. (Sadly, the report has largely ignored the excluding effects of the present benefits system and of proposed mental health legislation extending compulsion.)

Arguing for the recruitment and retention of people with experience of mental distress to local authority social services can hardly be dismissed as special pleading. Over and again in recent research, one clear and simple message has been emerging about what service users want from social care workers. Whether children interviewed by the Department of Health, peer research by homeless teenagers in The Netherlands or service user research about what adult service users want in the UK, the message has been the same. Service users want workers who listen, treat them with equality and respect and have empathy and warmth. Who is more likely to be able to offer this than people with shared experience, as well as the essential skills?

But there are still some fundamental barriers to be dealt with before this can become a routine possibility. Social care must stop talking about working with "vulnerable" people, as though there are two classes of humans: the "together us" and the "hapless them". There are no invulnerable care workers and it is time that practice and thinking were more determinedly based on understanding of our shared humanity and interdependency. We have a reminder of the consequences of not doing this: the move towards a more technical approach to care management has been one of the biggest social work disasters of the past 20 years.

It is doubtful, however, whether people with experience of distress and the psychiatric system will ever be accepted fully and equally as co-workers, while mad and bad are treated as the same. This is likely to happen as long as abuse and violence are explained away in terms of "mental disorder" without independent evidence. This is a situation perpetuated by defence lawyers seeking to get their clients off criminal charges on medical grounds and by psychiatrists expanding their diagnostic empires by medicalising people's behaviour and experience. Until this arbitrary association is challenged, there will always be fear and uncertainty about how predictable, how reliable, how safe mental health service users are.


Equally, it is not enough for social services just to open their doors to mental health service users or survivors as workers. They must also ensure that the working conditions they offer are positive and supportive. Yet there can be little doubt that terms and conditions of employment in local authorities have deteriorated over recent years. This creates problems for all workers. For staff with experience of distress it may impose insuperable obstacles. The positive negotiation of reasonable adjustments under the Disability Discrimination Act 1995 to meet the individual needs of survivor workers should be seen as a priority by employers. But it should never be treated as an alternative to ensuring good quality employment is ensured for all. And, for survivor workers, such standards must also mean that there are no "glass ceilings", but instead truly equal opportunities in employment, real career structures and no ghettoisation in mental health or user involvement - unless that is what the worker really wants to do.

There is one beacon to guide us here. A key senior manager who has successfully taken forward the employment of mental health service users in NHS trusts is Rachel Perkins, herself a survivor. Our hope must now be that we can look forward to seeing many similar champions emerging in local authority social care.

Peter Beresford is professor of social policy, Brunel University, and is involved in the psychiatric system survivor movement.