Work and mental health
Work and mental health

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Work and mental health

4 Finding and keeping paid work

Both Nick and Louis wanted work careers. This will be challenging, especially in times of austerity. Even in 2007, a year before the UK entered the recession, 60 per cent of people with severe mental health problems and 36 per cent with mild or moderate difficulties were unemployed (OECD, 2014). These difficulties are not surprising. Several reports have identified barriers to finding work, including:

  • limited employment support
  • benefits system constraints
  • negative community attitudes
  • limiting practitioner expectations
  • difficult economic conditions.

What does it take to ensure that people with mental health problems can find and keep employment? As suggested in the list of barriers to finding work, there is more to it than simply providing employment support. Barriers such as negative community attitudes or difficult economic conditions mean that government interventions may be called for. Improving the employment opportunities of people with mental health problems involves employment support, government support and the assistance of mental health services.

In the next activity you will explore the issue of improving the employment opportunities of people with mental health problems by examining the stories of two people in the support they need.

Activity 4 Claire and Julie

Timing: Allow about 1 hour

Watch the video where Claire and Julie discuss returning to work and, using the table below, identify the challenges they faced. Having identified the challenges, what and to who would you recommend a necessary action to improve their employment chances? Be creative.

Download this video clip.Video player: Video 3 Returning to work
Skip transcript: Video 3 Returning to work

Transcript: Video 3 Returning to work

People who’ve experienced serious mental health problems have many barriers to overcome before they can return to employment.
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.
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.
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.
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.
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.
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.
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.
Even though the loved ones are always going to be there by their side …
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.
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.
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.
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 …
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.
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.
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.
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.
After six months, Sarah was able to work 30 hours a week, but she and her employer have built in some safeguards.
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.
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.
I think mostly it’s positive. Going back to work when you’ve had depression makes you feel able again instead of disabled.
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.
End transcript: Video 3 Returning to work
Video 3 Returning to work
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Interactive table 1  Supporting people with mental health problems in employment: challenges and recommendations

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Here are some things we observed.

Example table 1  Supporting people with mental health problems in employment: challenges and 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.

This last activity highlighted the challenges faced by people with mental health problems in finding and keeping work. Research has shown that the model depicted in the last activity – Individual Placement and Support – is one of the most effective at supporting people back to work (Mind, 2014, Thomas and Fraser, 2009). Furthermore, you may have noticed that this approach operates in a way that reflects the recovery principles you saw earlier in this course.


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