Hard climb ahead

“And what do you do?” is one of the first questions you are
asked when meeting someone new, and for most of us it’s an easy one
to answer. But for people who are out of work because of mental
health problems, what they “do” is the last thing they want to
explain.

Work gives us a sense of purpose and provides a path to new
relationships. “Work is central for all of us. It offers a way of
gaining self-esteem and a sense of identity. Why would it be any
different for service users?” asks Jenny Secker, professor of
mental health at Anglia Polytechnic University and the South Essex
Partnership NHS Trust.

She says there is “absolutely no doubt” that people with mental
health problems are able to hold down a proper job. So why are only
18 per cent of people with psychiatric problems in employment, when
studies suggest that between 30 and 40 per cent are capable of
doing paid work?

The benefits system is one of the biggest barriers, as coming off
incapacity benefit to go back to work can feel risky. Some people
may need to build up their hours at work slowly, but because of
lack of money, find themselves having to take on more hours than
they are ready for, says Secker.

Of course this only applies if a person is able to find a job.
Ignorance about mental health problems among employers still
prevails despite the fact that at any one time, one adult in six
has a mental health problem of some sort.

And willingness to employ people with mental health problems has
been slow to improve, with only a small increase over the past
decade in the numbers of adults with neurotic or psychotic
disorders who work, compared with the figures for people with
physical disabilities.

If employers see gaps in people’s work histories that are due to
mental illness then they worry that a person is not capable of
doing the job, says Toby Williamson, head of the Mental Health
Foundation’s Strategies for Living project, which examines people’s
experiences of mental distress.

This is in contrast to the way that employers see gaps in CVs for
physical health problems, and willingly accept that treatment is
complete, he says.

“The stigma, discrimination and prejudice around mental health
issues is an added factor in preventing people returning to work,”
he says.

But the government is making a concerted effort to change things.
Last month the social exclusion unit launched a consultation to
look at ways of reducing the social exclusion of adults with mental
health problems.

That the government is taking the issue seriously is welcome news,
but Williamson says he would be concerned if the main driver was to
get people back into work and off benefits. He explains that people
with mental health problems already feel under pressure to go back
to work and that this pressure can add to their difficulties,
sometimes making it necessary for them to take more time off or
give up work altogether.

The SEU’s consultation is being sent out to more than 5,000
organisations across health and social care, the voluntary sector
and local authorities. But will employers be sufficiently
involved?

“If employers are to be brought on board and made aware of the
sensitivities then this exercise must involve them,” stresses
Williamson.

The attitudes of mental health services can also have a major
influence on whether or not a person is in work. Some mental health
professionals discourage clients from working out of fear that it
could be detrimental to their well-being. But Bob Grove, director
of the employment programme at the Sainsbury Centre for Mental
Health, believes that mental health services should recognise the
importance of employment.”If the mental health team believes that
all clients are unemployable then what is the incentive for anyone
else to give them a job? It is important that mental health teams
recognise that clients want to work,” he insists.

The time to act is when a person shows an interest in working, he
explains, as the longer a person is out of the labour market, the
harder it is to get back in. However this stance would mean a move
away from the medical model. “You don’t need people to be cured or
to have no symptoms before they work again,” he says.

There is one area where the experience of mental health service
users is invaluable – within mental health services
themselves.

“People who have had mental health problems have a lot of empathy,
insight and optimism about mental health issues. They know what a
good service looks like and feels like and are able to provide that
to other people,” says Emma Harding, senior project worker at the
User Employment Programme at Springfield Hospital, which falls
within the South West London and St George’s Mental Health NHS
Trust.

The trust actively encourages the employment of people with mental
health problems and has a written charter that states “personal
experience of mental health problems among staff can actively
enhance the quality of mental health care provided”. As a result,
personal experience is identified as a desirable – but not
essential – part of the selection criteria for all clinical posts
within the trust, in addition to the other qualifications and
experience necessary. Estimates suggest that as many as a quarter
of new recruits in recent years are people who have disclosed their
experience of mental health problems.

Many people with mental health problems want to work and have
useful skills and experience to offer employers. But there are also
supporting health and economic arguments. More than a third of
people receiving incapacity benefit have a mental health disorder,
while the total cost of mental illness in England has recently been
estimated at more than £77bn.

Meanwhile, people with mental health problems who have a job are
healthier, and use fewer support services. Helping such people back
into employment is surely a win-win situation.

– More at
www.socialexclusionunit.gov.uk/mental_health/mental_health.htm

Writing therapy

“At an interview in the City I was asked to explain the gaps on
my CV. I said that I had manic depression. The interviewer asked if
this was a problem. I said it had been in the past but it was OK
now,” says Jason Pegler. He never heard from the interviewer
again.

He would not recommend people with mental health problems tell
employers about their condition because of discrimination. Pegler
was 17 when he began to suffer from manic depression. After
graduating from university he went to work in a bank, but he was
too embarrassed to tell anyone about his diagnosis.

After receiving a Mind Millennium award in July 2001 Pegler
finished writing A Can Of Madness, a book about his
experiences, and went on to set up his own company,
Chipmunkapublishing, which publishes books about people’s
experiences of mental health problems.

“Writing saved my life. I needed a creative outlet and otherwise I
wouldn’t be here now. I don’t know how it works but it works,” he
says. “People need to work, rest and play. You can’t do just one or
two.”

For more information go to www.chipmunkapublishing.com/