Expert answers from
- Vocational specialists and occupational therapists
- Individual placement and support
- What the law says
- What the government says
Working in paid employment can improve people’s mental health and wellbeing. A job can give people a purpose in life and enlarge their social circles. Yet many people who have been given a diagnosis of a serious mental illness like schizophrenia are without work. Research has shown, for example, that a large majority – around 70 to 80 per cent – of people who have had a diagnosis for some time are unemployed, leading to a loss of confidence and self-esteem, poverty and isolation. Around two-thirds of people experiencing the symptoms of psychosis for the first time are also without a job.
Surveys have illustrated that many employers are reluctant to hire someone with a history of mental illness. Low expectations of people with mental health problems, prejudice, stereotypical views and lack of knowledge often combine to deny people the chance to get a job.
Research has also shown that people with a diagnosis of schizophrenia sometimes do not apply for paid work because they anticipate discrimination and think there is no point. Studies have illustrated too that mental health professionals are sometimes not as encouraging as they could be because they believe that people who have experienced psychosis may find it difficult to work.
Community-based teams of mental health professionals often include an occupational therapist. They offer practical support to help people who have mental health problems get on with their daily lives – help with managing money, help to develop strategies to arrive somewhere on time, or to increase their confidence, for example. Occupational therapists are concerned with people’s personal recovery, and this includes helping people look for and gain employment or voluntary work, if they so wish.
Community-based teams, particularly early intervention teams, may also include a vocational specialist (also called a vocational practitioner or employment specialist). They work with people who have mental health problems to help them either keep their job, or return to work.
Vocational specialists can negotiate with employers on behalf of an individual – about working reduced hours for a period of time, for example, or arranging flexible hours. Employers are required by law to consider making ‘reasonable adjustments’ if they know about a diagnosis of a mental health problem, and if an individual is 'disabled' under the Equality Act (see What the law says below).
A reasonable adjustment might be changing when a working day starts and finishes so an employee can avoid the rush hour, or being allowed to take a 10 minute break every time an employee feels particularly anxious (see What the law says below).
Sometimes, people may want to sign up for a training scheme, or get work experience to help them develop new skills or practise old ones before returning to a paid job.
Vocational specialists and occupational therapists can help people do this: they will work with an individual to support their personal goals. Even if your local NHS trust does not employ vocational specialists, there may be voluntary organisations in your neighbourhood that help people with mental health problems who want to look for jobs or prepare for work. The mental health professionals who support your relative will know about any local organisations.
'Individual placement and support' (IPS) (sometimes called ‘supported employment’) is about helping someone get a job straightaway instead of spending time preparing to return to work or training.
The idea is that everyone on a vocational specialist's caseload is offered IPS, regardless of their symptoms or their previous participation in work experience schemes, or in schemes designed to prepared them for employment.
Vocational or employment specialists then support the individual at work and the employer for as long as is necessary. Family members and friends might be part of a team that continues to support people in their working lives.
IPS has been tested in America and proven to help people who need more intensive support return to work. It has been shown there to increase people’s chances of getting and keeping a job. A report on mental health and employment commissioned by the previous UK government (Realising ambitions: better employment support for people with a mental health condition, 2009) recommended introducing IPS in this country.
The Centre for Mental Health (previously the Sainsbury Centre for Mental Health) has set up a Centres of Excellence programme to pioneer IPS schemes in England.
Mental health services at various places in England are partners in the programme. At each place, the local mental health trust is working with employment services, local authorities and other agencies to help people get paid work. The idea is to share what they learn with services in other areas of England.
There is also research going on to find out if offering people extra support (like motivational interviewing or cognitive remediation therapy) alongside IPS can give people a better chance of getting and keeping a job.
Should people tell potential employers about their mental health problems? The decision about whether to ‘disclose’ experience of mental illness can be a hard one, and is a very personal choice. Vocational specialists and occupational therapists can talk through the pros and cons and help people come to a decision.
Because of discrimination and stereotyping by employers, disclosure may mean people are less likely to get a job, or secure promotion. Colleagues may treat people differently and presume mental health difficulties play a part in every request for help. People may feel they have to ‘prove’ themselves, and colleagues may blame mental health problems on ordinary everyday moods.
On the other hand, the law says employers should consider making ‘reasonable adjustments’ that someone with a mental health problem may need to do the job – eg changing hours or working conditions (see What the law says below). Employers are only required to consider reasonable adjustments, however, if they know about people’s experience of mental illness.
People who ‘disclose’ may find it easier to ask for help and time off to go to doctors’ appointments for example, and it may be difficult and stressful to keep that part of their life secret. ‘Disclosing’ to colleagues at work may also help break down some of the prejudice and discrimination about mental ill health.
The Equality Act 2010 aims to protect people from discrimination and unfair treatment. The Act describes both physical and mental health problems as 'disabilities'. Under the Act, it is unlawful for employers to discriminate against people who have a disability.
For the purposes of the Equality Act, people who find it difficult to carry out everyday activities over a long period of time because of a health problem may be described as disabled. This may include people with mental health problems like schizophrenia or bipolar disorder.
The law says that employers are mostly not allowed to ask job applicants whether they have a disability or medical condition before deciding to invite them for an interview, or before offering someone a job (they are still allowed to ask in some cases). In the past, some employers may have decided not even to shortlist an applicant just because they have experience of mental health problems: that sort of unfair screening is now much more difficult.
People who are classed as disabled under the Equality Act have a right, under the Act, to ask for 'reasonable adjustments' during an application process, at an interview for a job, or at work. Reasonable adjustments are changes made to working arrangements or the work environment to help people with a disability, and to make sure they are not put at a disadvantage compared to their work colleagues who do not have their disability. A reasonable adjustment might include starting work a bit later if medication makes someone feel sleepy in the morning, for example. The adjustments have to be reasonable for the employer – it would not be reasonable, for example, for a small company to agree an adjustment it could not afford.
The Equality Act 2010 also seeks to stop discrimination against carers: it would be unlawful, for example, not to offer an applicant a job because an employer assumed the applicant might take a lot of time off because they were supporting someone with a mental health problem.
The government’s mental health strategy published in February 2011 has six main objectives. One of them is that ‘more people with mental health problems will recover’, and this includes ‘better employment rates’ for people with experience of mental health problems. Another objective is that fewer people will experience stigma and discrimination. The strategy is called No health without mental health and it calls on different government departments to get involved in implementing the proposals.
The government pledged to make available ‘high-quality employment support' geared towards meeting individuals’ employment needs. Visit the GOV.UK website to find out about government schemes offering support to people with disabilities, including people with mental health problems – Access to Work and Work Choice.
Government ministers have also encouraged large employers to improve the workplace support they offer to people who have mental health problems.
Some people may choose voluntary work to help them to get back into the world of work. Volunteering can help people learn new skills and improve their self-esteem and confidence, even though it may not necessarily lead to a full-time job. Volunteering can also help people make friends and develop a social life.
Vocational specialists and occupational therapists can help people find out about local volunteering opportunities.
This page was updated on 29 April 2013.
There are no plans to update the page because funding for mentalhealthcare.org.uk ended in April 2013.
We will, however, continue to regularly check that all links are working.
Links on this page last checked: 30 November 2013
Next links check due: April 2014
Other useful websites
GOV.UK: Access to work
This is a scheme that helps pay for adaptations to workplaces or support at work for people with disabilities. Access to Work might pay towards a support worker or equipment, for example, or the cost of getting to work if people cannot use public transport.
Other useful websites
GOV.UK: Work Choice – supporting disabled people in employment
The scheme aims to help people who need specialised support find and keep a job.
Centre for Mental Health
Information about Individual Placement and Support (IPS)
No health without mental health: a cross-government mental health outcomes strategy for people of all ages.
Published by the government, 2 February 2011.
Other useful websites
Information for people who want to work, want to stay in work or want to return to work, plus information for carers, mental health professionals and employers.
Other useful websites
NHS Choices: How to volunteer
with links to volunteer organisations.
- Volunteering boosts self-esteem and wellbeing and helps recovery
The results of the evaluation of Capital Volunteering. This article first appeared in Towards Mental Health published by the Health Service and Population Department at the Institute of Psychiatry.
- Click to download article
Downloadable guidance about equality at work and the Equality Act 2010.
Department of Health: Advice for employers on workplace adjustments for mental health conditions. This advice is available from the Department of Health Public Health Responsibility Deal website.
Visit the main pages to find out about the Responsibility Deal or the Mental Health Adjustment Pledge page where businesses can sign up to improve the workplace support they offer to people with a mental health problem.