Introduction

K240_1 Work and mental health About this free course This free course is an adapted extract from the Open University course K240 Mental health and community http://www.open.ac.uk/courses/modules/k240. This version of the content may include video, images and interactive content that may not be optimised for your device. You can experience this free course as it was originally designed on OpenLearn, the home of free learning from The Open University - http://www.open.edu/openlearn/health-sports-psychology/health/work-and-mental-health/content-section-0 There you’ll also be able to track your progress via your activity record, which you can use to demonstrate your learning.

Copyright © 2016 The Open University Intellectual property Unless otherwise stated, this resource is released under the terms of the Creative Commons Licence v4.0 http://creativecommons.org/licenses/by-nc-sa/4.0/deed.en_GB. Within that The Open University interprets this licence in the following way: www.open.edu/openlearn/about-openlearn/frequently-asked-questions-on-openlearn. Copyright and rights falling outside the terms of the Creative Commons Licence are retained or controlled by The Open University. Please read the full text before using any of the content. We believe the primary barrier to accessing high-quality educational experiences is cost, which is why we aim to publish as much free content as possible under an open licence. If it proves difficult to release content under our preferred Creative Commons licence (e.g. because we can’t afford or gain the clearances or find suitable alternatives), we will still release the materials for free under a personal end-user licence. This is because the learning experience will always be the same high quality offering and that should always be seen as positive – even if at times the licensing is different to Creative Commons. When using the content you must attribute us (The Open University) (the OU) and any identified author in accordance with the terms of the Creative Commons Licence. The Acknowledgements section is used to list, amongst other things, third party (Proprietary), licensed content which is not subject to Creative Commons licensing. Proprietary content must be used (retained) intact and in context to the content at all times. The Acknowledgements section is also used to bring to your attention any other Special Restrictions which may apply to the content. For example there may be times when the Creative Commons Non-Commercial Sharealike licence does not apply to any of the content even if owned by us (The Open University). In these instances, unless stated otherwise, the content may be used for personal and non-commercial use. We have also identified as Proprietary other material included in the content which is not subject to Creative Commons Licence. These are OU logos, trading names and may extend to certain photographic and video images and sound recordings and any other material as may be brought to your attention. Unauthorised use of any of the content may constitute a breach of the terms and conditions and/or intellectual property laws. We reserve the right to alter, amend or bring to an end any terms and conditions provided here without notice. All rights falling outside the terms of the Creative Commons licence are retained or controlled by The Open University. Head of Intellectual Property, The Open University 978-1-4730-2091-7 (.kdl) 978-1-4730-2090-0 (.epub) Introduction In this free course, Work and mental health, you will explore how employment affects mental health and consider the way in which people can be supported back to work. This OpenLearn course is an adapted extract from the Open University course K240 Mental health and community. Learning outcomes After studying this course, you should be able to: explain how the experience of mental health problems affect, and are affected by, employment understand how the recovery model can be used to support people with mental problems to return to work explain what can be done to reduce the barriers to employment for people with mental health problems. 1 Rewards and challenges … ‘an endless significance lies in Work’; a man perfects himself by working. Foul jungles are cleared away, fair seed fields rise instead, and stately cities; and withal the man himself first ceases to be a jungle and foul unwholesome desert thereby. Thomas Carlyle, Scottish Philosopher (1844, p. 137)

Thomas Carlyle advocates work not because of its material rewards or the benefits to the economy but because it develops us as people. Work builds our skills and our mental wellbeing. However, many people with mental health problems can’t access employment opportunities. While being at work during periods of mental illness can be difficult for those with mental health problems, most people with these difficulties could take paid employment if it were not for numerous barriers in the workplace and the wider community (Centre for Mental Health, 2013). Although employment can be stressful, difficult and exhausting, many people find it a great source of satisfaction too. The first activity in this course invites you to examine your own experience in order to develop an understanding of the rewards and troubling aspects of employment. Activity 1 ‘… an endless significance lies in Work’ Allow about 30 minutes Think about the work that you do. This might be paid employment, volunteer work or as a homemaker or a carer. In the text boxes below, make notes of: some benefits of employment some difficulties of employment. Benefits Difficulties Employment is significant in terms of who we are, self-esteem, confidence and personal development. Work builds relationships and our skills set. The financial rewards are helpful too. Although employment plays a powerful role in our mental wellbeing, stress, difficulties and problems with co-workers can cause particular mental distress. It is clear that work has both positive and negative impacts on our mental state, so perhaps Carlyle was a little optimistic when he said we are ‘perfected’ through work. What happens when work gets too much? 2 Employment and mental health problems Nick and Louis both have mental health problems and could not continue with full-time employment. They both attend the mental health charity Restore, an organisation that supports mental health recovery. For many, recovery includes work of some kind with an ultimate goal of finding paid employment. This goal may be very challenging to achieve and some people may require a lot of support. You will learn about this support later but first you need to get to know Nick and Louis. Activity 2 ‘… and I sorta lost everything really.’ Allow about 30 minutes Watch the video of Nick and Louis. Identify: what benefits Nick and Louis gain from working what factors contributed to Nick and Louis becoming unwell. Video 1 Nick and Louis LOUIS: I was a head chef. I sort of worked with children. I had my own business and stuff, a house down by the sea as well. Yeah, that I renovated. I had my family and everything. And then I just got ill. Yeah, so I lost everything, really. Three years ago Louis developed serious mental health problems and had to give up work. LOUIS: I was diagnosed with anxiety, depression. And I sort of … sorry. Anxiety, depression, and post-traumatic stress with a personality disorder also, as well. NICK: After 10 years of being a self-employed piano player, I think the fact I’ve been in quite a difficult relationship which had caused a lot of anxiety, and also the stresses of looking for work and not knowing how much work you’re going to get, how often, and when, I think those two things combined to overload my nervous system. And I woke up one morning feeling absolutely terrible, in a very bad place, and went straight to the doctor and got prescribed antidepressants. It was certainly a totally different experience to episodes of melancholy or unhappiness that I’d had before. I had been to therapists in the past because of anxiety and depression. This was a totally different experience, waking up with clinical depression. I’d clearly been pushed over the brink by the nature of my lifestyle, the difficulties of surviving as a jazz musician in this society. And so those things compacted to essentially push me over the edge. INTERVIEWER: How stressful is it, being a professional chef? LOUIS: Really quite stressful, especially when you’re a perfectionist. Because you put too much pressure on yourself, which doesn’t work very well with mental health issues. Mainly because you’re constantly … like I used to do roughly 70, 74 hours a week, and sort of go in on my day off to do paperwork and stuff. NICK: I did try to carry on working. I took antidepressants, which you were hoping would kick in all the time. But my sleep was reduced to a virtual two or three hours if I was lucky. The musical engagements I had were pretty traumatic. I was inwardly sort of shaking and terrified, just about managing to get onto the scene of the engagement, driving probably precariously at times, I think. It was a case of sort of toughing it out. I thought I might get better. But of course, if you keep piling on the pressure, you don’t get better. INTERVIEWER: What were the good parts about cooking? LOUIS: Good parts were, I suppose … well, yeah. It used to make me feel really happy, really accomplished, really passionate about it, very willing to teach others and stuff. I used to teach kids how to cook as well as drama and stuff. And I was a proper foodie who just loved growing stuff and cooking stuff and, like, putting myself on a plate, really. So that was sort of one of my nicest achievements really to cooking. NICK: This was the first experience of clinical depression. There was a gradual improvement. And I started working again about six months later. But it certainly took six months before I was in a place where I could work again. And this, I would have to say, has been pretty much the pattern with three subsequent episodes of depression that I’ve had over the last 10 years. So it’s disrupted my musical career. I think it’s made a lot of people that I probably would have been working for, and with, wary of my reliability because it’s happened now on four occasions. But having said that, I now feel in a better place than I was before. I feel I have a lot more self-knowledge as a result of those experiences. And hopefully, my career will now proceed, if not at a meteoric rate, it will slowly progress, I would hope. The main thing is to avoid another clinical depression. And then all should be reasonably smooth. INTERVIEWER: Could you go back to cooking as a career? LOUIS: No, never. INTERVIEWER: Why not? LOUIS: Because I don’t want to. I don’t want to. Basically, I’ve achieved so much in my career, and I’ve done everything I wanted to do. Now I want to do something for me. So that’s what I’m going to do because I’m worth it at the end of the day. But it’s taken me years to realise that. So I’ve done what I wanted to do, so now I’m going to do it. I have to again. What job I really want to do is be a train driver, because that was an ambition I had when I was a child. But whether that’s going to be possible, now I’ve been labelled, I don’t know, but I don’t see why I can’t do it. NICK: You have to take it easy to start with. I mean, you need to, sort of, in my case, I needed to do just the very lightest musical engagements, playing in nice community environments. And that sort of helped me to ease my way back into it and to look at myself again as a professional musician. I think it’s difficult to change your image from somebody who’s mentally ill, who has a serious problem with depression, anxiety. Changing that perspective to one of being a creative, dynamic, and useful member of society, you need to change your self-image back to being somebody who can make a real contribution. LOUIS: I’m a bit scared I’m going to break again. But then I’m putting in the hard work here and group therapy. So hopefully, so that will stand me in good stead hopefully. I’m nervous, but I think everybody gets nervous going back into society, so to speak.

What benefits do Nick and Louis gain from working? For Louis, working was extremely beneficial. It not only brought him the material benefits of a ‘renovated house by the sea’ but also was important to his identity and self-esteem. He loved being ‘a real foodie’ and gained considerable self-esteem from doing a job well. In Nick’s case, he gained the satisfaction of using his musical skills in a job which gave others a lot of pleasure. He had the opportunity to socialise with people. For many, being a working musician is a valued social position. What factors contributed to Nick and Louis becoming unwell? You need to pay attention to both what Nick and Louis say and what they imply. Louis’ lifestyle as a chef – long hours, little time off, the need for perfectionism – undermined his mental health. For Nick the uncertainties of living as a jazz musician ‘overloaded his nervous system’ and he became unwell. For both, ‘keeping going’ piled on pressure, which made things worse. This is where the Centre for Mental Health’s (2013) claim that most people with mental health problems can work becomes quite provocative. You might ask, and only Nick and Louis would be able to answer, what kind of work situation would accommodate their mental health needs? What kind of support do they need? You will come back to these questions later. Nick and Louis’ mental health problems are not simply a reflection of their employment circumstances. For example, a difficult relationship was a significant contributor to Nick’s decline. Employment is only one factor influencing their experience of mental health problems. However, employment is often seen as a significant part of mental health recovery. 3 Employment and recovery The connection between employment and mental wellbeing means that even if work were a significant factor in the development of mental health problems, the mental health recovery process often involves work of some kind. Nick and Louis’ return to employment at Restore starts with a ‘recovery group’ in which they can work at carpentry, gardening, crafts or in a café. These groups offer Nick and Louis a work-like environment where they follow the structure of a regular working day. This work matters commercially too – their services and products are for sale to the local community.

Recovery groups are successful because they follow ‘recovery principles’ (see below). How might these be enacted in practice to meet Nick and Louis’ needs? The principles of recovery Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems. Recovery represents a movement away from pathology, illness and symptoms to health, strengths and wellness. Hope is central to recovery and can be enhanced by each person seeing how they can have more active control over their lives (‘agency’) and by seeing how others have found a way forward. Self-management is encouraged and facilitated. The processes of self-management are similar, but what works may be very different for each individual. No ‘one size fits all’. The helping relationship between clinicians and patients moves away from being expert/patient to being ‘coaches’ or ‘partners’ on a journey of discovery. Clinicians are there to be ‘on tap, not on top’. People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services. Recovery is about discovering – or re-discovering – a sense of personal identity, separate from illness or disability. The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process. These shared meanings either support a sense of hope and possibility, or invite pessimism and chronicity. The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications. It seeks to cultivate their capacity for hope, creativity, care, compassion, realism and resilience. Family and other supporters are often crucial to recovery and they should be included as partners wherever possible. However, peer support is central for many people in their recovery. (Davidson, 2008, cited in Shepherd et al., 2008) Activity 3 Recovery groups for employment Allow about 1 hour 10 minutes There are two tasks in this activity. You’ll start by thinking through how you could put recovery principles into action to meet Nick and Louis’ needs before looking at a real-life example of a recovery group. Part A Allow about 30 minutes Working from the recovery principles listed above, identify at least three recommendations for an effective recovery group. Make sure that these recommendations are suitable for Nick and Louis’ needs. Here is an example to get you thinking: Recruit caring and optimistic staff who value working in partnership with those attending the recovery group. Part B Allow about 40 minutes In the video below Nick and Louis describe their experience of a recovery work group. Which experiences reflect your suggestions and guidelines? Do they mention any features that were not on your list but which you think were effective? Video 2 Recovery group at Restore NARRATOR: Restore was set up to help people with mental health problems recover and return to employment. But when some people first arrive at this Oxfordshire-based charity, they’re highly vulnerable. LOUIS: I came here and I was shaking, jittery, and just really paranoid, quite ill. It got me back into a family atmosphere, sat around a table, which was good, which started to build my confidence. NICK: I remember attending this place and for the first few months needing to just go off behind one of these buildings and have a good cry until I felt able to go back into the social setting. It’s a slow process and you need to be really just gently coaxed back into a more balanced way of living. NARRATOR: Restore’s approach is to encourage recovery through participation in practical activities, such as gardening, cooking and crafts, within a supportive social environment. LOUIS: I’ve done stuff like building paths and making pens and turning bits of wood on lathes and building block work and putting the roof on the gazebo outside, and just real manual labour jobs. But also I could do stuff like cards and artwork and stuff, which if I wasn’t feeling up to do that then I could do something. But just basically take the time that I needed and give myself the space that I needed. KATIE ROWELL: Restore is a really incredible therapeutic environment. The recovery work happens through those activities, but it also happens around them. Often, they just may be working with a group of people in the kitchen, chopping some vegetables ready for lunch. That might allow a conversation to happen about maybe an issue that someone is struggling with or a kind of difficulty they’re having. Working on something together can be a lot less threatening than just trying to have a conversation together. It’s something outside of themselves to focus on. It also gives people the chance to build their confidence again. To get that sense of achievement that, hey, I did that really well. NICK: It seems to me very natural that if you did some gardening, you started relating to the earth and the plants around you. It seems to me quite natural that that would help with your feeling of connection to the universe. LUCY HILL: It gives them time to focus and relax through what they’re doing. They may have a goal and they may want to get it done but they can take their time, there’s no limits on how long they’ve got to work in these practical skills. And I find people, they start smiling, they’re enjoying it so if they are feeling anxious or a bit depressed, it takes them away from that for a bit, which is so important. LOUIS: There’s a lot of empathy here so people understand and it helps you figure out how to get better. And it gives you a routine. You need a routine every now and then and it just keeps you level. And so if you have problems, you can talk about it. So if you have bad days – everybody has bad days – but you learn to pick yourself up. NARRATOR: Many people with serious mental health problems experience unemployment, and this can create further issues. LUCY HILL: This leads to a lot of problems with finances and if they have a family, it could be their family life. All other types of organisations have to get involved, maybe social services, the doctors, and it does have a massive downfall on people because of their self-esteem as well. If they become unemployed – from my experience of speaking to people – they find it hard to get the self-esteem to get back into what they want to do again. And they lose a lot of confidence. KATIE ROWELL: Also, sometimes long-term unemployment can just be very discouraging and really demoralising if someone feels that actually they’re able to work and they’ve got a lot to offer, but perhaps because they’ve been out of work for a long time and maybe because they have a mental health issue there’s more barriers maybe that they feel they have to overcome in order to get work. NARRATOR: The people who take part in Restore’s programmes are called members and once they start to recover, they’re encouraged to think about work. One programme, The Beehive, is a recovery group, which offers members a structured day and tasks they can volunteer to take on. MARTIN REALEY: The Beehive is one of our six recovery groups; it has a recovery coordinator, recovery worker, and ranging between about 15 and 22 members on any one day. They arrive in the morning, post an initial staff meeting, and agree to buy the staff and some volunteers. They then sit down and have a meeting about what they’re going to do that day. That’s both looking at individuals and their recovery goals, and the activities which are taking place that day. NARRATOR: There’s also an on-site café open to the public that members can work in. MARTIN REALEY: The café is significantly different because it has such a large interface with the general public. So the interaction just with normal, everyday people, especially for individuals who don’t have a huge amount of interaction and struggle in open and public environments, that's a place to do it in a bubble of protection … CUSTOMER: Hi. Can I have a single cappuccino, please? RESTORE MEMBER: Single cappuccino. MARTIN REALEY: … where if necessary they can take a step back. So it can be a gradual introduction back into either an environment with other people or a workplace or a structured day. KATIE ROWELL: It can boost people’s confidence. It can also give them the evidence that they can manage their mental health issues in a work-like environment. I think that’s what we are. We’re not a work environment, but we’re work-like. And the environment here might be more supportive but perhaps it helps people to see that now actually I can, just as I manage things here, I could manage things and really have a lot to offer in a work environment. NARRATOR: As members recover, they’re offered one-to-one coaching to help them plan their personal journeys back to work. COACH: All you can do is discourage the bad coping. NARRATOR: Last year, Restore’s combination of recovery, support and coaching helped nearly 200 people return to paid or voluntary work. MARTIN REALEY: I think one of the common themes amongst the majority of people that go through the recovery process and coaching is understanding themselves. That’s understanding what they wish to achieve as individuals, what their barriers are, how to cope with those barriers. NICK: Human beings are pretty fragile. We can really go off the deep end sometimes, and that’s generally because life has just got too much for people. And it just gets too heavy. And it’s a slow journey back. And once you’ve regained your inner stability, it’s very important to maintain it. LOUIS: It’s like I’m not there yet because I’m not through my therapy. But in the next year, I’ll be back to work, hopefully. I’m quite determined to do that. I’m going to be sad to say goodbye to this place, but I need it as a sense of achievement as well because it’s been a long slog to get to this point.

The video depicts several things in line with recovery principles. Your recommendations will be your own, but here are four that you may have spotted in the video. Recommendation 1: Group activities should help people access peer support. At Restore, group activities provided plenty of opportunities to receive empathic support from others. Louis valued the way the family atmosphere built confidence. Recommendation 2: Individuals should be able to choose what best suits their needs and interests. At Restore, the day started with a meeting in which people chose an activity from tasks that needed doing. Louis valued being able to do tasks he ‘felt up to doing’. Recommendation 3: Group activities should support community inclusion. Restore’s café was open to the public. Louis may not want to return to catering but Nick might value the café as a place to perform music. Recommendation 4: Make sure that participants find the activities meaningful. Nick felt a strong (and almost spiritual) sense of personal connection to gardening work. The recovery groups are one step toward returning to paid employment. For many people though, their ultimate aim is a return to paid employment. What support is necessary to enable people to find and keep work? 4 Finding and keeping paid work Both Nick and Louis eventually want to return to full work and a career. Research from Mind (2017/2018) has reported that 48 per cent of all the people surveyed said that they had experienced a mental health problem in their current employment. This staff survey included 43,892 workers across 74 organisations. Importantly, of the 48 per cent who had experienced a mental health problem in their current work, only half of them had disclosed this to their employer. These statistics show how common it is to experience a mental health problem while in employment. They also demonstrate that many people find it challenging to disclose this information to employers. How do we ensure that people with mental health problems can find and keep employment? Mind (2016) reports many barriers to keeping and finding work for individuals with a mental health problem. These include: limited employment support employer stigma benefits system constraints low self-esteem and low aspirations as a result difficult economic conditions (housing issues, debts) fear that job will cause a relapse gaps in CV and lack of recent references. Mind’s (2016) report makes recommendations aimed at a wide range of stakeholders, including the government, employers and those providing mental health services. For example, local agencies can assist individuals by offering job clubs, employment workshops and offering mock interviews. They also recommend support to build up an individual’s weekly routine so that they can gradually build up to the working hours they are aiming for. Employers can develop trust with individuals with mental health problems by being aware of the current staff with lived experience who can provide knowledge and support for others, particularly applicants and new recruits dealing with mental health problems. In the next activities, you will have the opportunity to make recommendations to the government, employers and mental health service providers that might improve the employment chances of people with mental health problems. Since your recommendations should reflect the reality of people’s lives, you will start by considering the experience of two people who have returned to paid employment. Activity 4 Sarah and Julie Allow about 1 hour Watch the video where Sarah and Julie discuss returning to work and, using the table below, identify the challenges they faced. Then note any recommendations of necessary actions you would make to mental health service providers, employers and the government that might improve the employment chances of people with mental health problems. Be creative. Video 3 Returning to work NARRATOR: People who’ve experienced serious mental health problems have many barriers to overcome before they can return to employment. SARAH: There’s a lot of fear about going back to work. It’s a big step when you’ve been off for a long time and you’ve been unwell to go back into work, and that was a bit frightening. Also having an interview is quite scary. JULIE: I wouldn’t have even gone for an interview, because of the thought of how to explain a gap to somebody, what you disclose, what you tell people, the fear of all that – that would’ve just stopped me even looking for jobs, let alone applying. CAROLINE: Also a lot of people haven’t worked for a very long time, so there’s a real fear about going back into the workplace and how they’re going to cope with that. And a lot of our people are in receipt of benefits, so that can be a big worry, because a lot of people are worried that if they get into work, and then it doesn’t work out, then they’re going to lose all their benefits, and then they’ve got to start all over again. NARRATOR: People also need to learn to manage their mental health problems. Sarah had a job in the care sector, but she left work for two years because of depression and anxiety. SARAH: I think the thing with depression is you never really know if you’re better or not, because you’re always using different ways of dealing with it, and you’re never really sure if you’re better or not. So I think I have to work on overcoming the fear that I was feeling and finding the confidence. I think that was the main things I had to deal with myself. NARRATOR: Medication and cognitive behaviour therapy helped Sarah manage her depression, but it was a recovery programme at Restore where she participated in practical activities, such as gardening and pottery, with other people that really made the difference. SARAH: I think when you have mental health problems, you spend a lot of time unsure what to do, but actually, if you’ve got something constructive like if you’re making a clay pot, then you’ve got something else to concentrate on, and it takes your mind off the worries you’ve got. I think Restore offered me something to get up for in the morning, somewhere to come and meet people and do constructive activities and feel more like I was living rather than struggling at home. Restore helped me gain my confidence back, and because I got confident again, I felt I could go back to work. I didn’t want to stay off work for a long time. MAN: Even though the loved ones are always going to be there by their side … NARRATOR: Julie had a long break from work following a number of suicide attempts. After two years of therapy, she was offered one-to-one help with Restore’s coaching service, but she didn’t feel ready for work. JULIE: Well, I didn’t realise how low I suppose I still really was when I came to see the coach who’s here, because he was talking to them, going back through the history, all the work I’d done. And we hadn’t really started a CV, and the coach came in one day, and he said, I think a job’s come up here you should apply for. And honestly, I looked at him, and I laughed. And I said, you’re joking, because if I’d seen that job advertised, I wouldn’t have even looked twice at it. And I think over the course of the next few weeks, he obviously didn’t let go of that, but what he did without me even realising, throughout my CV and the things we’d already started doing, he said, “But you were class leader in a preschool. You were this. You were that. Why? Why can’t you?” And I think it took him probably two or three weeks to get a definite no to a maybe, but I doubt that’s the bit people don’t see ... the confidence that they’re giving you, and they’re building you up to think, yes, maybe I can do this. CAROLINE: It’s very much a case of going on a journey with that person. I mean, I think it’s really important to recognise every little step as you go along and to make that person realise when they’ve actually achieved something, however small. And it’s surprising that within a couple of months of sort of working with people how much their confidence does grow. JULIE: OK. So we’re just going to look at substance misuse and suicide. It says 9 per cent of people moderately dependent on alcohol will … NARRATOR: In fact, Julie secured a paid job as a mental health trainer for Restore, giving presentations to raise awareness. Her employer has been very supportive, but she’s also drawn on her own resources. JULIE: I think it’s down to you to start believing in yourself. I think I had to acknowledge what happened and be happy talking about it. But I think once I started to value myself as a person again, and the confidence grew, I was happy. And for me, there were certain things I put in place that I know if this starts happening, it’s time to stop and start maybe looking after yourself at that point and not letting things dip. NARRATOR: Sarah also benefited from coaching and secured a job in a care home for elderly people. But a key factor in her successful return to work has been the positive and flexible attitude of her employer. SARAH: I did tell them about my issues. I went for the interview, and I actually explained that I’ve been off for a long time with depression, and I was struggling, and I wanted to go back to work just for a few hours. I chose about 10 hours so that I was working at least a small bit and could get me back into the routine. And they were very helpful. They said to me if I would struggle with the care work, they could take me on in the cleaning department and help there so that I was feeling I was back at work in a care role, but still not caring if that was too difficult. NARRATOR: After six months, Sarah was able to work 30 hours a week, but she and her employer have built in some safeguards. SARAH: I don’t work night shift, which helps. If I’ve got a problem, I go and face it. I’ll speak to the manager or a colleague and deal with the problem rather than let it get worse and fester. CAROLINE: Employers need to have a greater understanding about how to manage employees with mental health problems. People with mental health problems are perfectly capable of holding down work, but they perhaps need to have a little bit more consideration and a lot more flexibility as well. Obviously with different mental health problems, then the sort of conditions can sort of go up and down. And it’s just, I think, being aware of that and the sorts of signs to look out for and how people can support others in the workplace. SARAH: I think mostly it’s positive. Going back to work when you’ve had depression makes you feel able again instead of disabled. JULIE: All you can do is be there, listen, giving the encouragement … I say sometimes it takes a person to get to a level before they’re ready to hear that. I, for me, I haven’t had a disadvantage from returning to work, and that’s me. I think working here as well, anything going on, we’re always encouraged to talk. There’s always somewhere to go to talk, but for me, the advantages have been massive. It’s just … they say it’s completed. For me, I know I need structure. I need to get up. I need to go out and do something. It’s that feeling of self-worth that, I think, this job in particular, you’re doing something that’s really making a difference.

Interactive table 1 Supporting people with mental health problems in employment: challenges and recommendations Interactive table 1 Supporting people with mental health problems in employment: challenges and recommendations

Area under consideration	Challenges	Recommendations
Mental health services
Employers
Government

Here are some things you may have observed. Example table 1 Supporting people with mental health problems in employment: challenges and recommendations

	Challenges	Recommendations
Mental health services	People with mental health problems often lack self-confidence.	Employ coaches who can sensitively but assertively provide encouragement to apply for work.
Employers	Mental health problems can fluctuate.	Employers accommodate flexible working patterns such as reduced hours or phased return.
Government	People fear that if they return to work but cannot cope, it will take a long time to reinstate their benefits. This may prevent them from seeking work.	Improve the flexibility and responsiveness of the benefits system.

Grounding your analysis in lived experience is a good place to start. 5 A vision for employment support In the next activity, you will examine how we as a society might need to reconsider work. This is especially important following the COVID-19 lockdowns, in which many people had to work from home and others, particularly in the health care sector, endured a very stressful work environment.

Activity 5 How working might change after COVID-19 Allow about 1 hour Read the following article by the NHS Confederation about how employment can be reconsidered in the aftermath of the COVID-19 pandemic: Five key principles to guide us through the COVID-19 aftermath. Note the recommendations they propose and the challenges they address in your table, adding to your existing notes. Interactive table 2 Supporting people with mental health problems in employment: challenges and recommendations Interactive table 2 Supporting people with mental health problems in employment: challenges and recommendations

Area under consideration	Challenges	Recommendations
Mental health services
Employers
Government

The blog from NHS Confederation identifies several things that need to happen. Three are noted below to give you an idea, but your list of recommendations may be longer. Example table 2 Supporting people with mental health problems in employment: challenges and recommendations (continued)

	Challenges	Recommendations
Mental health services	Mental health support is patchy and fragmented.	Work together with communities and civil society to support individuals.
Employers	The seasonal economy suffered during the pandemic, affecting unemployment rates.	Individual placement support (IPS) would support people with mental health problems to attain and retain employment. Invest in employment support with a therapeutic element.
Government	The pandemic had economic and social impacts and increased economic inequality.	A long-term plan for the nation’s health must focus on mental health. Increase investment in employment services.

Conclusion Finding and keeping paid employment can be daunting and presents several challenges. However, as Carlyle (1844) suggests, for many ‘an endless significance lies in Work’. As you have seen in this course, despite the demands, it can be hugely beneficial for our mental health. That is, if we have the right job with the right employer. This OpenLearn course is an adapted extract from the Open University course K240 Mental health and community. References Carlyle, T. (1844) Past and Present, New York, William H Colyer. Centre for Mental Health (2013) Briefing 47: Barriers to Employment , London, Centre for Mental Health. Available at: https://www.centreformentalhealth.org.uk/publications/briefing-47-barriers-employment (Accessed: 24 October 2023). Davidson, L. (2008) Recovery – Concepts and Application, Devon Recovery Group. Available at: https://recoverydevon.co.uk/wp-content/uploads/2010/01/Recovery_Concepts_Laurie_Davidson.pdf (Accessed: 24 October 2023). Mind (2014) We’ve Got Work To Do: Transforming Employment and Back-to-work Support for People with Mental Health Problems, London, Mind. Available at: https://www.mind.org.uk/media-a/4291/weve_got_work_to_do.pdf (Accessed: 24 October 2023). Mind (2016) Supporting people with mental health problems into sustainable employment. Available at: https://www.mind.org.uk/media-a/4283/supporting-people-with-mental-health-problems-into-sustainable-employment-2016.pdf (Accessed: 24 October 2023). Mind (2017/2018) Mind’s Workplace Wellbeing Index 2017/18: Key insights. Available at: https://www.mind.org.uk/media-a/4784/workplace-wellbeing-index-insights-report-2017-18.pdf (Accessed: 24 October 2023). Organisation for Economic Co-operation and Development (OECD) (2014) Mental Health and Work: United Kingdom, Paris, OECD Publishing. Available at: http://www.keepeek.com/Digital-Asset-Management/oecd/employment/mental-health-and-work-united-kingdom_9789264204997-en#page3 (Accessed: 24 October 2023). Shepherd, G., Boardman, J. and Slade, M. (2008) Making Recovery a Reality, London, Sainsbury Centre for Mental Health. Available at: https://www.centreformentalhealth.org.uk/publications/making-recovery-reality (Accessed: 24 October 2023). Thomas, J. R. and Fraser, V. V. (2009) ‘Implementing evidence-based supported employment in a recovery-oriented mental health agency’, American Journal of Psychiatric Rehabilitation, vol. 12, pp. 143–60. Acknowledgements This free course was written by Chris Kubiak. It was first published in March 2016 and updated in October 2023. Credit is due to Jeanne Humber from Restore, who contributed to this course. Except for third party materials and otherwise stated (see terms and conditions), this content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licence. The material acknowledged below is Proprietary and used under licence (not subject to Creative Commons Licence). Grateful acknowledgement is made to the following sources for permission to reproduce material in this free course: Text 3. Employment and recovery: Extract from The Principles of Recovery: Adapted from ‘Recovery – Concepts and application’ by Laurie Davidson, reproduced by kind permission of the Recovery Devon Group (http://www.recoverydevon.co.uk/download/Recovery_Concepts_Laurie_Davidson.pdf) Images Course image: © mediaphotos/iStockphotos.com Figure 2: © The Open University Section 5 image: © Prostock-Studio; Getty Images AV Videos 1, 2 and 3: With thanks to Restore. © The Open University (for use in course only) Every effort has been made to contact copyright owners. If any have been inadvertently overlooked, the publishers will be pleased to make the necessary arrangements at the first opportunity. Don't miss out If reading this text has inspired you to learn more, you may be interested in joining the millions of people who discover our free learning resources and qualifications by visiting The Open University – www.open.edu/openlearn/free-courses.

Discussion 2023053001