Work and mental health
Work and mental health

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Work and mental health

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.

Figure 2 Restore offers gardening, carpentry, craft and café work

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 enchanced 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

Timing: 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

Timing: 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

Timing: 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?
Download this video clip.Video player: Video 2 Recovery group at Restore
Skip transcript: Video 2 Recovery group at Restore

Transcript: Video 2 Recovery group at Restore

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.
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.
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.
Restore’s approach is to encourage recovery through participation in practical activities, such as gardening, cooking and crafts, within a supportive social environment.
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.
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.
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.
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.
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.
Many people with serious mental health problems experience unemployment, and this can create further issues.
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.
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.
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.
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.
There’s also an on-site café open to the public that members can work in.
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 …
Hi. Can I have a single cappuccino, please?
Single cappuccino.
… 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.
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.
As members recover, they’re offered one-to-one coaching to help them plan their personal journeys back to work.
All you can do is discourage the bad coping.
Last year, Restore’s combination of recovery, support and coaching helped nearly 200 people return to paid or voluntary work.
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.
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.
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.
End transcript: Video 2 Recovery group at Restore
Video 2 Recovery group at Restore
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The video depicts several things in line with recovery principles. Your recommendations will be your own, but here are four that we 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?


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