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 – as well as an income. For people who have been given a diagnosis of a serious mental illness like schizophrenia, employment can aid recovery. Yet many people who have experienced the symptoms of psychosis are without work. Research has shown that a large majority – around 70 to 80 per cent – of people who have had a diagnosis of a serious mental illness 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 therefore 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, or stressful, to work. People with a diagnosis of a serious mental illness have reported to researchers that they have not been offered help with seeking a job or volunteer position, even though they would like to have paid or unpaid employment.
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 considered to be '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) – or ‘supported employment' – is about helping someone get a job straightaway instead of spending time preparing to return to work or training. Vocational or employment specialists then support both 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. The support may include training in the skills needed to do the job.
IPS was first tested in America and has been shown to increase people’s chances of getting a job, though the long-term benefits are not known. IPS has been shown to be more effective that schemes designed to prepare people for employment. In 2009, 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') recommended introducing IPS in this country.
The National Institute for Health and Care Excellence (NICE) also favours IPS. NICE recommends mental health services offer supported employment programmes to people who have experienced the symptoms of psychosis*, or have a diagnosis of schizophrenia, who want to find or return to work. But mental health professionals should also consider offering other sorts of employment-searching support, such as training or work experience, to suit an individual's needs.
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. A number of mental health NHS trusts are partners in the programme and are working with employment services, local authorities and other agencies to help people get paid work. The idea is to share what they learn about setting up IPS schemes with other mental health trusts throughout England and there is up-to-date information about the programme on the Centre for Mental Health's website.
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.
*Psychosis and schizophrenia in adults: treatment and management was published in February 2014 and uses the term 'psychosis' to describe the symptoms of psychosis experienced by people who have a diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder or delusional disorder. The guideline does not include recommendations about treatment of psychosis experienced by people who have bipolar disorder or psychotic depression – or people who have Parkinson's disease or dementia, or another condition that causes the symptoms of psychosis. Recommendations for treatment in these circumstances are included in other NICE guidance.
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 a diagnosis of a mental illness 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 – although 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 a mental health problem: 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. So, 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.
Access to Work can help people who find it difficult to get, or stay in, work because of their disability or health condition. The scheme might help with the costs of getting to work if someone can't use public transport, for example. But only a small number of people with mental health conditions apply for help under the scheme. Between April and December 2013, Access to Work helped 31,230 people. 1,090 of them had a mental health condition.
Work Choice helps people who are considered to have a disability under the Equality Act 2010 to prepare for work by offering skills training and interview coaching.
Government ministers are also encouraging large employers to improve the workplace support they offer to people who have mental health problems – so, for example, employers can sign up to the Mental Health Adjustment Pledge (part of the government's Public Health Responsibility Deal) and thus commit to improve the workplace support they offer to people with a mental health problem.
'Closing the Gap: priorities for essential change in mental health' was published in February 2014 and follows up some of the policy statements made in the government's 2011 mental health strategy. The government says it will help employers to help more people with mental health problems to remain in work. It will also develop 'new approaches' to help people with mental health problems find work. In April 2014, Geraldine Strathdee, the national clinical director for mental health, named employment support as one of NHS England's priorities in a programme to improve services for people who have experienced the symptoms of psychosis.
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 5 May 2014
Links on this page last checked: 31 July 2014
Next links check due: December 2014
Other useful websites
Centre for Mental Health: Information about Individual Placement and Support
a 'cross-government mental health outcomes strategy for people of all ages',
published by the Department of Health, February 2011.
published by the Department of Health, February 2014.
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
with links to volunteer organisations.
Department of Health: Advice for employers on workplace adjustments for mental health conditions.
published by The Work Foundation, February 2013.
The report includes recommendations for employers, policymakers, healthcare professionals, people who have a diagnosis of schizophrenia and their family members.