Employment

• Employment
• Vocational specialists and occupational therapists
• Individual Placement and Support
• Disclosure
• Government initiatives
• Volunteering

Employment

Working in paid employment can improve people’s mental health and well-being. Yet many people with a diagnosis of psychosis are without work: research has shown, for example, that 80 per cent of people with schizophrenia are unemployed, leading to a loss of confidence and self-esteem, poverty and isolation.

Surveys have illustrated that many employers are reluctant to hire someone with a history of mental illness. Low expectations of people with mental health problems, prejudice, stereotypical views and lack of knowledge often combine to deny people the chance to get a job.

Research has also shown that people with a diagnosis of schizophrenia sometimes do not apply for paid work because they anticipate discrimination and think there is no point.

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Vocational specialists and occupational therapists

Many community-based teams offering mental health care include an occupational therapist. Their role is to offer practical support to help people get on with their daily lives – help with managing money, help to develop strategies to arrive somewhere on time or to increase their confidence, for example. Occupational therapists are concerned with people’s personal recovery, and this includes helping people look for and gain employment or voluntary work, if they so wish.

Vocational specialists or vocational practitioners are also sometimes based within community teams. Their role is to work with people to help them either keep their jobs, or get back to work. They are often based in Early Intervention teams when people are experiencing symptoms that may herald an episode of psychosis, and may be worried about losing their job. Vocational specialists can negotiate with employers on behalf of an individual – about initially working reduced hours, for example. Employers are required by law to make ‘reasonable adjustments’ if they know about a diagnosis of a mental health problem. These could be things like changing working hours to avoid the rush hour, or being allowed to take 10 minutes away from their desk if they are feeling particularly anxious.

Sometimes people may want to start their journey back to work by signing up for a training scheme, or getting work experience to help them develop new skills or practice old ones before returning to a paid job.

Vocational specialists and occupational therapists can help people do this: they will work with an individual to support their personal goals.

Some voluntary organisations also run schemes and programmes to help people get back to work, often offering training and preparation, and sometimes work experience.

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Individual Placement and Support

Individual Placement and Support (you may see this called ‘supported employment’)  is about helping someone get a job straightaway with a minimal preparation period, and then supporting them while they are at work, for as long as they need. Employment specialists (also called job coaches or employment consultants) will help someone get a job – including coaching them for an interview, for example – and then support both the individual and the employer for as long as is necessary. They meet people regularly or offer advice on the phone, and family members and friends might be part of a team that supports people in their working lives.

Individual Placement and Support – or IPS – has been tested in America and proven to help people who need more intensive support return to work, increasing people’s chances of getting and keeping a job.

Realising ambitions: Better employment support for people with a mental health condition is a report on mental health and employment commissioned by the UK government’s Department for Work and Pensions in December 2009. It sets out recommendations, including introducing IPS in this country.

The report says employment specialists should be part of all community-based mental health teams. They could be employed directly by health authorities or local authority social services departments, or employed by voluntary organisations. The report recommends at least one employment specialist be based in every community-based mental health team to offer people Individual Placement and Support.

Sainsbury Centre for Mental Health is also supporting Individual Placement and Support for all those who want to work. Mental health services in central and north west London, Essex, Shropshire, Somerset and south west London are partners in the Sainsbury Centre’s Centres of Excellence programme which will pioneer Individual Placement and Support. The idea is to share what they learn with services in other areas of England.

Existing vocational specialists working in community-based mental health teams may already be offering Individual Placement and Support to people they work with.

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Disclosure

Should people tell potential employers about their mental health problems? The decision about whether to ‘disclose’ experience of mental illness can be a hard one, and is up to each individual. Vocational specialists and occupational therapists can talk through the pros and cons and help people come to a decision.

Because of discrimination and stereotyping by employers, disclosure may mean people are less likely to get a job, or secure promotion. Colleagues may treat people differently and presume mental health difficulties play a part in every request for help. People may feel they have to ‘prove’ themselves, and colleagues may blame mental health problems on ordinary everyday moods.

On the other hand, if people don’t tell employers about their mental health problems, they may open themselves up to potential dismissal for lying. Disability discrimination laws says employers should make ‘reasonable adjustments’ that someone with a mental health problem may need to do the job – eg changing hours or working conditions. Employers are only required to make reasonable adjustments, however, if they know about people’s experience of mental illness. People who ‘disclose’ may find it easier to ask for help and time off to go to doctors’ appointments for example, and it may be difficult and stressful to keep that part of their life secret. ‘Disclosing’ to colleagues at work may also help break down some of the prejudice and discrimination about mental ill health.

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Government initiatives

There are a number of government initiatives to support people with mental health problems who want to get a job.

Working our way to better mental health: a framework for action (December 2009) is the first nationwide mental health and employment strategy, which includes proposals to help people get and keep jobs, to challenge stigma and to support employers who hire people with experience of mental health problems.

The proposals include a new network of mental health coordinators in every JobCentre Plus district, and nine trial occupational health advice lines to give support to small businesses to help them keep people in work.

The government is also look at ways of extending and changing its Access to Work programme (run by JobCentre Plus) to offer more practical support to people with mental health problems.

Work, Recovery and Inclusion is another government strategy focusing on employment for people with mental health problems that was also launched in December 2009.

The Sainsbury Centre for Mental Health has produced a short leaflet that explains how these different government documents fit together, and sit alongside New Horizons, the government’s 10-year strategy for mental health services and promoting everyone’s mental health and wellbeing. You can download the leaflet as a pdf.

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Volunteering

Some people may choose voluntary work to help them to get back into the world of work and vocational specialists and occupational therapists can help people find out about volunteering opportunities.

Volunteering can help people learn new skills and improve their self-esteem and confidence, even though it may not necessarily lead to a full-time job.

Capital Volunteering was a London-based project that offered volunteering opportunities to people with mental health problems (from 2005 to 2008). When researchers at the Institute of Psychiatry evaluated its success, they found that although the majority of the 5,000 people who volunteered continued to be out of work and on benefits, the scheme had enabled them to make friends and develop a social life, often for the first time in years. Volunteering had helped them gain confidence and given structure to their lives. Capital Volunteering was run by Community Service Volunteers and the London Development Centre for Mental Health and funded by the Treasury’s Invest to Save Budget.