Mental Health and Supported Employment. Rachel Perkins BA , MPhil (Clinical Psychology) PhD, OBE. A view from 4 perspectives. 33 years working in mental health services ... from clinical psychologist to director
BA, MPhil (Clinical Psychology) PhD, OBE
“Out of the blue your job has gone, with it any financial security you may have had. At a stroke, you have no purpose in life, and no contact with other people. You find yourself totally isolated from the rest of the world. No one telephones you. Much less writes. No-one seems to care if you’re alive or dead .” (Bird, 2001)
or “... the early onset of distress will mean social exclusion throughout our adult lives, with no prospect of ...a job or hope of a futures in meaningful employment. Loneliness and loss of self-worth lead us to believe we are useless, and so we live with this sense of hopelessness, or far too often choose to end our lives.” (cited by SEU,2003)
Too often people with mental health conditions become
‘I used to be ...’ people ....
Helping people to gain/regain/retain employment is critical in enabling people to become more than a ‘mental patient’, a person with a present and a future ...
Employment ... a human right e.g.
“Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment.”
Most people with a mental health condition want to work – highest want to work rate of all disabled people (SEU, 2003)
But in the UK
(Department of Work and Pensions, 2013)
But often the biggest challenges are fear and low expectations ...
Fear on the part of the person, mental health professionals, employment advisers, employers
Nicola Oliver (2011) a woman with bipolar disorder
“My first obstacle was my employer. Ten days after I disclosed my disability I was sacked.
“My second obstacle was my community psychiatric nurse. He was lovely but recommended I consider only low stress jobs and part time hours; maybe I could stack shelves in a supermarket! I hadn’t studied for three degrees to stack shelves.
“My third obstacle was my psychiatrist. She told me that it was unlikely that I would ever work again.”
Is it any wonder that with these messages from the ‘experts ...
“My fourth obstacle became my-self. I became ‘Nicola the bipolar person’: incompetent, inadequate and worthless.”
“I was offered cognitive behavioural therapy to overcome my low self-esteem, but the psychologist became my fifth obstacle. She was adamant that I should stop yearning to return to work.”
Many would have given up at this point ... but Nicola was determineddespite all the negative messages she continued to try to get work ....
“I contacted a recruitment agent who told me I had a great CV ... but she quickly became my sixth obstacle. When I explained the gap on my CV was due to bipolar disorder I never heard from her again.”
“The seventh obstacle was the charity I approached to help me get into work ... I was told ‘maybe we should wait until you are a bit better’.
“My final obstacle was a disability employment advisor who was supposed to help me find work. She wanted to send me on a confidence building course! I didn’t want training, I wanted a job.”
Frequently we ask questions like
These are the wrong questions – research shows:
The most important variable determining whether people can work is the type of support and adjustments provided
The 8 principles of ‘Individual Placement with Support’ evidence based supported employment for people with mental health conditions ....
1. Focus on open employment - real jobs – and a ‘can do’ approach
2. Do not select people on the basis of ‘employability’ or ‘work readiness’ – help everyone who wants to have a go
3. Integrate employment support with treatment – treatment and employment support must be done in parallel and Employment Specialists must be part of clinical teams – sitting in the same office, working together
4. Rapid job search (start within 4 weeks) rather than stepping stones first. If training/experience are necessary, these should be in parallel with job search.
5. Job search must be personalised and based on client preferences - a person is more likely to get and keep a job that is in line with their interests/preferences - and may involve active, individualised, work with employers
6. Employers are approached with the needs of individuals in mind – not just passive applications for jobs, but pro-active job finding - an emphasis on building relationships with employers in order to access the ‘hidden labour market’.
7. Time-unlimited , personalised support to both employee and employer: Employment involves a relationship between employee and employer and both parties may need support
8. High quality assistance with in and out of work welfare benefits and financial planning
Need to do all of these things to be effective – outcomes related to fidelity
16 ‘randomised controlled trials’: at least 60% of people with serious mental health problems to successfully get and keep open employment (see Bond et al, 2008, SCMH, 2009)
55% receiving IPS vs. 28% in existing service
13% receiving IPS vs. 45% in existing service
20% readmitted in IPS vs. 31% in traditional service
IPS is effective in regular day to day practice
The experience of South West London Mental Health NHS Trust
Employment Specialists in 11 Community Mental Health Teams including the Community Drug Team (2007/8):1984 people received vocational support
1155 people successful in working/studying in mainstream integrated settings:
(Rinaldi and Perkins 2007)
Employment not seen as a priority for health and social care services- not part of their ‘core business’
Common assumption: people need to be fully ‘better’ before they can return to work:
treatment then rehabilitation then then work
The reality: You don’t have to be fully ‘better’ to work and
the longer they are out of work the less likely they are to return (without special support): 6 months absence – 50% return; 12 months absence – 25% return; 2 years absence – 2% return
(British Society of Rehabilitation Medicine)
Common assumption: ‘stepping stones’ - people need to build up their qualifications , skills and confidence in a safe, sheltered setting they will be able to move on to open employment
The reality: people learn that they can only work in a safe, sheltered setting and never move into work
Peer support – often people who have faced similar challenges are the best ones to provide support AND seeing what others have achieved can increase motivation and self-confidence. For example:
Managing symptoms and problems in a work context – a work health and well-being plan “Having your own plan about how to cope and what you need is good for employer and employee.”
(see ‘Surviving and Thriving at Work, Disability Rights UK - sarah.cosby@disabilityrightsUK.org)
And remember that:
“The greater danger for most of us lies not in setting our aim too high and falling short, but in setting our aim too low and achieving our mark.”
“... grant that I may always desire more than I can accomplish.”
“There’s a better life out there ... If you just sit back, then you won’t make it – but you can make it if you want to. You’ve got to be real with yourself. The power is you.”
(Nash Momori, 2008)
“I have re-entered full-time employment. Over a year later I am still working. I now focus more on opportunities in life and less on my condition. I regularly socialise with my colleagues after work and actually feel content to be a taxpayer again … The support has been immeasurably important …[it] has enabled me to make the journey towards recovery and realise my aim of contributing to society again through fulfilling employment.”
“My passion for my career is immense. A job defines you, provides money, personal fulfilment and a sense of achievement. This is what I am, this is what I do, I am no longer a mental health condition.”
“Now I’m a contributing member of society because of my employment. It’s worth is altering the life of someone with a mental illness … helping me to change direction from hopelessness to being worthwhile.”