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