Employment

• Employment
• Vocational specialists and occupational therapists
• Individual placement and support
• Disclosure
• What the law says
• What the government says
• Volunteering

Employment

Working in paid employment can improve people’s mental health and wellbeing. Yet many people with a diagnosis of psychosis are without work. Research has shown, for example, that a large majority – around 70 to 80 per cent – of people who have had psychosis for some time are unemployed, leading to a loss of confidence and self-esteem, poverty and isolation. Around two-thirds of people experiencing 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 are believe that people who have experienced psychosis may find it difficult to work.

Back to top

Vocational specialists and occupational therapists

Many community-based teams offering mental health care include an occupational therapist. Their role is to offer practical support to help people 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.

Vocational specialists or vocational practitioners are also sometimes based within community teams. Their role is to work with people to help them either keep their job, or get back to work. They are often based in early intervention teams and support people who are experiencing symptoms that may herald an episode of psychosis, and who may be worried about losing their job. Vocational specialists can negotiate with employers on behalf of an individual – about initially working reduced hours, for example. Employers are required by law to make ‘reasonable adjustments’ if they know about a diagnosis of a mental health problem. These could be things like changing working hours to avoid the rush hour, or being allowed to take 10 minutes away from their desk if they are feeling particularly anxious (see What the law says below).

Sometimes people may want to start their journey back to work by signing up for a training scheme, or getting 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. You may like to watch some of the videos on this page to find out more about the support offered by vocational specialists and occupational therapists.

Some voluntary organisations also run schemes and programmes to help people get back to work, often offering training and preparation, and sometimes work experience. The mental health professionals who support your relative will know about any such local schemes.

Back to top

Individual placement and support

'Individual placement and support' (you may see this called ‘supported employment’) is about helping someone get a job straightaway with a minimal preparation period (ie not spending a lot of time preparing to 'return to work'), and then supporting them while they are at work, for as long as they need. Employment specialists (also called job coaches or employment consultants) will help someone get a job – including coaching them for an interview, for example – and then support both the individual and the employer for as long as is necessary. They meet people regularly or offer advice on the phone, and family members and friends might be part of a team that supports people in their working lives.

Individual placement and support – or IPS – has been tested in America and proven to help people who need more intensive support return to work, increasing people’s chances of getting and keeping a job.

Researchers are currently assessing how successful individual placement and support is elsewhere.

The Centre for Mental Health (previously the Sainsbury Centre for Mental Health) has set up a Centres of Excellence programme to pioneer individual placement and support schemes in England. Mental health services in central and north west London, Essex, Shropshire, Somerset, Sussex, Leeds, Devon, Nottingham and south west London 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) with IPS can give people a better chance of getting and keeping a job.

Existing vocational specialists and occupational therapists working in community-based mental health teams may already be offering individual placement and support to people they work with.

Back to top

Disclosure

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 make ‘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 make 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.

Back to top

What the law says

The Equality Act 2010 aims to protect people from discrimination and unfair treatment. Most of it came into force in October 2010. Under the Equality Act 2010, it is unlawful for employers to discriminate against people with a disability.

The law defines people with a disability as people who have difficulty carrying out day-to-day activities. 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 medical condition or disability 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.

An employer must make ‘reasonable adjustments’ at work to help people with a disability do their job. This might include working flexibly, if medication makes people feel sleepy in the morning, for example.

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.

Back to top

What the government says

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 directgov 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.

Back to top

Volunteering

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.

Vocational specialists and occupational therapists can help people find out about volunteering opportunities.

Capital Volunteering was a London-based project that offered volunteering opportunities specifically to people with mental health problems (from 2005 to 2008). When researchers at the Institute of Psychiatry evaluated its success, they found that although the majority of the 5,000 people who volunteered continued to be out of work and on benefits, the scheme had enabled them to make friends and develop a social life, often for the first time in years. Volunteering had helped them gain confidence and given structure to their lives. Capital Volunteering was run by Community Service Volunteers (CSV) and the London Development Centre for Mental Health and funded by the Treasury’s Invest to Save Budget.

When the project ended in 2008, a Capital Volunteering Legacy Fund was set up: small grants are available to London-based volunteering projects for people who have a mental illness. You can find out more at the CSV website.