Employment Support for People with Mental Health Problems INTRODUCTION Returning to full time employment is often seen as the ultimate objective of people suffering from mental health problems. This paper explores the issues involved, describing the path back to employment, and explains some of the challenges and opportunities which may be encountered. Background Work is seen by many people as essential to show that they have recovered from mental illness.(1) There have been a number of government initiatives to assist in helping people get back to employment. These include: Government initiatives focussing on social inclusion. Mental Health Service user groups and professionals calling for action on provision in the community. Changes to the Disability Discrimination Act mean discriminatory practice by employers can now be penalised. European Social Fund providing money for innovative schemes and follow up projects to address exclusion. Barriers continue to be raised by those seeking to re-establish themselves in the workforce such as - The benefits system and the interaction between the minimum wage and therapeutic earnings. The structure of the "New Deal" programmes. Getting back into work can be seen in terms of a ladder which has to be climbed, starting with social skills and building up through training, sheltered employment, sympathetic employment to full employment. Social skills To gain the best out of any training or work opportunity, everyone needs to be able to communicate well and with confidence. For those who have had a period of mental illness, it is particularly hard to regain the confidence to speak to others. Meeting with others with similar experience and joining in social activities and making new friends is an essential basic step. For those who are not naturally social beings, volunteering to undertake some tasks is a useful way of regaining the ability to talk to a range of people During this time, opportunities should be taken to discuss training and work options with Personal Advisers at the Department of Social Security, or Job Brokers through the New Deal for the Disabled. Training There are a number of training schemes throughout Scotland for those with mental illness. Two are run by NSF (Scotland): one in Dumfries and one in Edinburgh. Anyone undertaking training should insist on working towards recognised qualifications (e.g. SVQs; Hygiene certificates) which will be of use in mainstream employment. Open learning opportunities (linked to the Government's Lifelong Learning proposals) can also be explored, where, as in NSF (Scotland) Dumfries projects, people register with local colleges to gain SVQs. Examples of training opportunities include: Local college - usually free to those on benefits. Distance learning, using email. This requires computer equipment, but financial help may also be available. University breakthrough courses such as provided by the University of Aberdeen. Sheltered Employment A number of charities run employment schemes for those recovering from mental illness. Different opportunities exist in each area and you should talk to local projects of NSF (Scotland), or the National Office if none locally, Turning Point,(2) Rehab Scotland,(3) your local Association for Mental Health and local Health Board to discover the opportunities in your area. There is also the Scottish Union of Supported Employment.(4) Here are two types of schemes which exist in various parts of Scotland. Clubhouse This model uses a 'Transitional Employment Programme', where the disabled person is offered a paid short term work placement as part of a work preparation programme. More than one person is trained for each post, so that if the first worker cannot make it, another worker is substituted. Thus the employer does not have to cover the costs of staff sickness or holidays, but the clubhouse worker is not a member of the workforce with the same rights and responsibilities as other workers. Social Firm This is a viable business set up in fair competition within the local market. Pay to workers complies with minimum wage requirements. The business is staffed by a mix of people with and without disabilities. In general, the staff without disabilities have extra responsibilities, such as providing support and supervision, and are salaried, whilst the majority of other workers remain on benefits and are paid under therapeutic earnings regulations. 'Therapeutic Earnings' describes the earned income of a person who is in receipt of a disability benefit and who does part time therapeutic work. The work must be recommended by the person's GP or Consultant and allowed by the Decision Maker at the Benefits Agency before the work starts. A system should be set up between the support agency, the Psychiatric Service and the local Benefits Agency to make this process stress free for the supported worker. The work can take place in any setting - open market, day centre, rehabilitation unit, sheltered workshop, clubhouse, social firm - the maximum allowed earnings rules are the same. National Minimum Wage: There is no legal exemption to the payment of the minimum wage for any work. Many projects offering supported work at a lower wage rate prior to the minimum wage being introduced have compromised by putting up the hourly rate to comply with the minimum wage and cutting back the number of hours per week done by each worker. Sympathetic Employment This is real work in an integrated setting, that is, a typical workplace, with ongoing appropriate support provided by an agency with expertise in employment support and with the employer actively managing the work scope so that the employee is capable of undertaking it. Real work refers to work that needs to be done, and excludes work that has been artificially created for the worker with a disability to do. This can be offered by good employers, creating real opportunities. As recently quoted, 'People used to talk the three F's: filing, filth and food. Those were the career options�realistically a mental illness meant you were out of the game'.(5) The Employment Service of the Benefits Agency run a Supported Employment Scheme in which the supported worker is assessed as being a certain percentage disabled, and the employer is subsidised by a related amount to take the person on to the payroll. Numerous studies, including an NSF questionnaire in 1998,(6) have shown that on top of the typical barriers faced by people who are long term unemployed, people with mental health problems are further disadvantaged in the following specific areas when trying to access mainstream education, work or training: Lack of flexibility in the employment and benefits system. The benefits system is complicated and needs to be simplified, ensuring that people do not lose out on benefits if they take on employment but find they cannot sustain it. Stress at work. Stress does not discriminate between the "well" and "unwell", but means must be found to involve people in work that supports, rather than damages their mental health. This includes developing a broader range of work opportunities in which people can contribute, creating employment in social firms, and working with employers and employees to adapt and support opportunities in open employment. Prejudicial attitudes of employers and society in general. There is no simple solution to this problem. NSF (Scotland) along with other voluntary and professional organisations are working continuously to reduce the discrimination and educate the public in general and employers in particular. Employment Ideally the experience of mental illness should be no barrier to undertaking work when the person is fully recovered. The Disability Discrimination Act 1995 has been successfully used to fight for employment in the case of a manager who had recovered from schizophrenia.(7) The Act states that "employers have a duty to take any reasonable steps they can to reduce or remove any substantial disadvantage caused to a disabled employee or job applicant by any of the employment arrangement". This is the duty to make 'reasonable adjustments'.(8) Most people, however, do not want to get into a legal fight. There are two key problems people face when applying for a mainstream job: What do I say on the form, or in my CV? Time spent not working or training needs to be explained and giving false information will endanger employment rights and could lead to dismissal. What happens when I provide medical information? This is often required to be provided, but should not lead to discrimination if all other requirements of the job are met by the applicant. Discrimination because of medical history is difficult to prove, but widely believed to be the case. A large study undertaken by MIND uncovered an overwhelming amount of discrimination experienced by people with mental health problems including in employment(9). References, Further Reading and Organisations Edward Peck and Peter Bates. Vocational Rehabilitation and Employment in Mental Health Review 1997 Turning Point 121 West Street, Glasgow, G5 8BA, UK-Scotland Rehab Scotland, 1650 London Road, Glasgow, G31 4QF. SUSE Scottish Union of Supported Employment, 32 Redhall Crescent, Edinburgh EH14 2HU Dennis Moore. Press and Journal 29 September 2000 NSF Benefits Questionnaire 1998. NSF 30 Tabernacle St. London EC2A 4DD Andrew Watkiss v John Laing plc. Jilly Welsh Mental Block in People Management 20 January 2000 Disability Discrimination Act 1995, see any Department for Education and Employment (DfEE) guidelines. Creating Accepting Communities. Mind. November 1999 Organisations The Next Step. Guide to User-led Evaluations of Supported Employment Services, NSF (Scotland) 2000 A-Z..... Employment and Mental Health, Mind Publications 1997 Disability Rights Commission www.drc- gb.org 1st Floor, Riverside House, Gorgie Road, Edinburgh, EH11 3AF Employment, Highland Users Group March 1997 National Clubhouse Association U.K. c/o Old Fox House 1 Old Fox Yard Ipswich St. Stowmarket Suffolk IP14 1AB Pathways to Work, Sheila Durie October 1999 (Associate Consultant, Scottish Development Centre for Mental Health Services) The Social Firms Handbook, Grove et al 1997. Pavilion Working it Out: Creating work opportunities for people with mental illness health problems - A Development Handbook, Pozner et al 1996. Pavilion

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