In October, the British government announced plans to help people with mental health problemsto get back into work.
This would see “employment advisers” visiting people in hospital, who have been admitted with mental health problems, and giving them CV and interview advice. It was piloted at hospitals in Leicester and at the Maudsley Hospital in Camberwell, London, with “dramatic results”, though the results haven’t been published yet.
This isn’t a hundred percent altruistic, it is also an attempt to reduce the disability benefits bill, which is projected to increase by a third in the next four to five years, according to the Institute for Fiscal Studies. A jump to £63bn by 2028-29, from £48bn for 2023-24.
"There is clear evidence we are really struggling with health problems," said Work and Pensions Secretary LizKendall. She wants employers to “think different” about employees with mental health problems, offering flexibility to support and retain people.
Now this scheme is not perfect. Why are they only offering this advice and support to people in hospital, why not to people in the community? Why aren’t they working with employers to offer people, with long term mental health problems, work experience to gain skills that make them attractive to employers? And there are so many other things too. But this is a start at supporting people and is better than nothing, which is what the previous government offered, they just wanted people to repeatedly prove how ill they were.
Then, the other week, one of my relatives posted a link to this story, on Facebook, with the caption: “What absolute numpty thought this through? They get a job coach visit, why don’t they just say “get over it” because that always works doesn’t it?”
Underneath people had added to the following comments:
“I actually cringed watching this report.”
“Who would employ someone who could be ill numerous days a month? How can a business run if you don't know how many staff are going to be there?”
An ‘Oh how stupid’ emoji.
“This is what you get when you vote Labour in.” To which my relative replied, “Luckily, I didn’t.”
I wanted to scream at the post, “How can you say that? How can you be so prejudiced?”
But employment is so important to how we identify ourselves, to our self-worth. How often do we get asked “And what do you do?” How much of our identity is made up from our job/profession? Mark Tausig argued that work is the central activity whereby most adults define their identity. I retired recently and I find it is strange to no longer belong to a profession, which had been so important in my life. Robert Drake and Michael Wallach argue that unemployment worsens mental health, while employment can improve it. They said that being employed gives us self-reliance, we are valued by others, we gain the respect of others, we have an income and employment helps us to gain community integration. We can see this in our own lives.
But in the UK only 15% of people with serious mental health problems are employed. That is an extremely large number of people who haven’t got the security and value of having a job. Why aren’t we concerned about this?
The evidence shows the benefit of employment. Hoare & Machin, in their study, found that participants who found employment, had greater social contact, more structured time and therefore saw significant improvements in their mental health. Another study found that the work environment improved people’s mental health. That those with mental health problems saw an improvement in their symptoms, plus improvements in their leisure and finances from being employed. And another study found that if people with mental health problems are able to find work, then it reduces the burden on society as a whole. Those people being able to support themselves, partially or fully.
Saying all this, we can’t just give someone with mental health problems a job, then expect them to get on with it and their health get better. People will need support. Secker & Membrey identify that specific adjustments maybe required, such as flexible working hours, flexible work schedules and job tasks, especially in relation to the medication a person is taking, allowing the person to regain their stamina and confidence. Modini & Joyce found that the literature, on mental health in the workplace, focused on the negative impacts of work on mental health. But they also found that the evidence is that work can help improve a person’s mental health. Evans & Repper argue, and rightly, that mental health services and staff should also be involved in supporting people back into work, it should be a vital role because of the benefits work brings to people and communities. Drake & Wallach make the same argument, that part of treatment should emphasise the importance of work and support people into employment.
But supporting people will bare positive fruits. Castle, Crosse, and Harvey conducted a study were they provided only 20 hours of support to people in gaining employment, but their study found that 21% of those people found jobs and 43% went onto volunteering or studying. How much more could be achieved if those people had an employment coach, even for one day a week?
My own experience bears this out, too. In my early twenties, in the late 1980s and early 1990s, I suffered from severe depression. It was so bad that I was hospitalised with it, twice, and I spent a long time taking medication for it. This was a very difficult time for me. I couldn’t tell many people I was ill, the stigma of mental illness was very high, and one of the few people I trusted to tell didn’t “believe” I was ill. I was also studying for my nursing qualification at the same time. This actually helped my mental health. I had the structure of my work placements, having to be there at a certain time. Also my studies gave me structure too, having to be at lectures at certain times, having to work on assignments with specific deadlines. My mental health was poor but that structure kept me together and kept me functioning. The only person I told at college was my personal tutor, because I was afraid if others knew I would be kicked off my course, and she supported me and kept quiet about my illness.
When I qualified, I found it difficult to find my first job. As soon as prospective employers found out I had depression, they withdrew their job offers. The Occupational Health Department of the hospital I trained at told me that if they had known I had depression they would have had my training stopped. They said I was “unfit” to work as a nurse. I am so glad my personal tutor protected me from this. But all this rejection took a toll on me, my mental health deteriorated. I was being denied employment through no fault of my own. I had already proved I could safely work while having depression. It was so hopeless. I eventually found a job but I had to lie on my application. I didn’t tick the section that asked if I’d ever had any mental illness.
During this awful time, I would have loved to have access to an employment adviser who could have helped me through this. Instead I navigated it all on my own.
So why are we only just now looking at supporting people back into work, and in such a limited way? Since 2010, we have had the Equality Act, which makes it unlawful to discriminate against people with protected characteristics, including disability, and that includes mental health problems. But laws don’t change attitudes, not straight away. Frijters, Johnston & Shields found that having a mental health problem reduces your chance of getting employment by 30%.
I had hoped that attitudes to mental illness had changed since I had depression. It seems now that every Z-list celebrity is having their “struggles” with mental health problems. But my relative’s post on Facebook has made me question this. Do people still believe that mental illness is just someone faking it, using it as a way to avoid working? That a mental health problem automatically makes you unemployable?
In 2011, David Cameron’s government coined the political slogan, “strivers v shirkers”. This labelled people in work as “strivers” and those receiving benefits as “shirkers”. This simplistic ignorance appalled me back then, but have we come no further? Now I doubt we have.
Drew
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