On the way to work

The government says it is committed to tackling barriers to work
for people with mental health problems. Peter Beresford says this
must include an overhaul of the benefits system and support at

Something exciting may be happening. The government may be
heralding a new age in employment opportunities for mental health
service users. Barbara Roche’s announcement that tackling
barriers to their employment is to be a new priority for the social
exclusion unit could mark a genuine breakthrough.

Not before time. I have seen mental health service users
debarred from employment; facing discrimination because of problems
dating from years before. I have seen them harried by benefits
organisations, despite following all the rules to the letter, when
they have obtained some small-scale paid work, which has increased
their confidence, skills and self-esteem.

I have watched service users wait in dread for the results of
occupational health interviews after successful job applications.
I’ve seen them routinely sidelined, denied promotion and
confined to jobs far below their capabilities. I have been told
dismissively by a psychiatrist that I might one day be able to get
a job as a clerk. Most of all, we know about the grim association
between poverty and mental health service use, related to the
disproportionately high rates of unemployment among mental health
service users – the highest for any group of disabled people.

If life, as Freud is supposed to have said, is about work and
love, then at a stroke, many mental health service users have been
cut off from one of the essentials for

giving existence meaning. Challenging this, though, must mean a
lot more than dragooning service users into low pay, low value, no
hope jobs. This is why an integrated employment strategy for mental
health service users, is especially needed now. This must have at
least three components.

First, the benefits system must get real. The government says it
wants people to move from welfare to work; from benefits to paid
employment. Yet we have a benefits system of frightening
inflexibility and tortuous complexity that is a minefield for any
service user seeking to begin the process of reintegrating
themselves into the world of work. Put one foot wrong – such as
failing to include travelling expenses within the overall limit of
£20 permitted earnings – and you could put your incapacity
benefits at real risk. How can such a draconian and
incomprehensible system be allowed to coexist with government
strictures for service users to get involved in policy and
provision and to be paid accordingly?

Second, policy makers have got to stop seeing people’s
ability to work as a personal characteristic. It actually depends
on the quality of the fit between jobs and people. That’s why
it is so important to start auditing employment for the access and
support it offers mental health service users.

Many mental health service users want to get back into paid
work, but as a right, not an obligation. They want flexible
employment, decent employment conditions, safeguards against
discrimination, access to proper education, training and recognised
qualifications and for their experience to be valued.

They also want flexibility between benefits and work. This is
the third crucial point. Policy makers have got to stop thinking in
crude binary terms of can work, can’t work. The reality is
that many more survivors would be able to stay in employment if
they were ensured the continuous and crisis support they may

A social model approach and a focus on barriers to employment is
helpful. More importantly, some of the structures needed to break
down such barriers are already in place. The Disability Rights
Commission has begun to establish precedents to counter the job
discrimination facing mental health service users. The extended
Disability Discrimination Act 1995, despite its weaknesses,
provides a basis for more accessible and supportive workplaces,
with its requirements for “reasonable adjustments” to be made in
working conditions. Perhaps most important for the future, direct
payments, which are now mandatory, offer real possibilities for
ensuring that service users can have the support they need when
they are studying or in work.

There’s still a bigger issue to be tackled though – the
overall quality of working conditions. With one in five of all
workers reporting high stress levels, reform of work conditions is
long overdue. Otherwise, instead of adding to the sum of human
well-being, it will all too clearly continue to feature as a major
cause of mental and emotional distress.

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

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