Questions of Balance: Work and mental health

As the charity Mind launches “Taking Care of Business” a new campaign promoting mental health in the workplace, Kelly Mullan ponders some of the issues involved in finding ways forward for people who juggle their job and a mental health condition

Depending on the work environment and the job, employment can cause, exacerbate or ameliorate mental distress.

According to Stand to Reason’s “Glass ceiling” campaign, only 20 per cent of people with severe mental health problems are employed, compared to 65 per cent of people with physical health problems and 75 per cent for the whole adult population. Yet we have the highest “want to work rate” of any group of unemployed people with up to 90 per cent wanting to work.

Peter Beresford is a professor of social work at Brunel University and has a mental health condition. He says “Being in a job can be a great thing. It’s great for me! But employment should be a right not something used to bring people in line.

“When the Government says, ‘we’ve got to get a million people off benefits’ there is the implication that a lot of them are malingerers. There is institutionalised stigma yet anti-stigma campaigns are aimed at Mr & Mrs General Public.”

There have been more developments in mental health and employment policy in recent months than at any time in the last decade. In understanding this plethora of recent pronouncements on work and mental health, New Horizons, published in December 2009, is key. New Horizons is a cross-government programme aiming to improve the mental health and well-being of the population and improve the quality and accessibility of services. It stresses the economic benefits of getting people with mental health conditions into employment.

Many of the ideas in New Horizons come from research by Lord Layard, an economist at London School of Economics. His arguments for Increasing Access to Psychological Therapies (IAPT) are largely economic, based on the idea that greater access to therapy will take people off welfare and save the state money. Cognitive Behavioural Therapy (CBT) is seen as particularly effective.

Layard put the cost of mental illness to society at £25bn a year, over two per cent of GDP. New Horizons estimates that the full cost to the economy of mental illness is “around £77bn, mostly due to lost productivity.”

Service users are worried about conflicting goals implicit in IAPT. The aim of a good therapist is to see a person’s condition improve but the success of IAPT will be measured by whether that person comes off benefits and into work.

For the prospect of moving into work to seem like an opportunity rather than a threat, a lot still needs to change. Stigma, the disclosure dilemma, barriers to employment, and the postcode lottery of NHS mental health services must be addressed.

Professor Beresford says: “We need a rights based approach to disability and employment addressing barriers and exclusion. Is the labour market accessible or discriminatory? What helpful, sensible, sensitive, reasonable readjustments can we make? The benefits trap needs to be addressed so people can easily get back to where they were if a job doesn’t work out. Our approach needs to be methodical, down-to-earth, and legally based.

“What we need is a model of Independent Living. We should have support as a right so we can do the things others can do. It’s not about special pleading; it’s about equality and equal access. Access to Work is a realm to be developing, opening up possibilities.”

Take up of Access to Work by people with mental health conditions has been low. From April to September 2009, only one per cent of those who received support cited mental health conditions as their primary disability.

For the aims of New Horizons to be realised, investment in support services is needed but in the current climate it seems likely that funding for mental health services will be cut.

From next year, the money for IAPT going to primary care trusts will not be ring fenced. There is also the fear that the well-being agenda of New Horizons will mean a dilution of the quality of provision for people with serious mental health problems.

And just as the carrots enticing us into work are looking thin on the ground, more sticks are popping up. According to a CAB report on Work Capability Assessments (WCA) published in March, disabled people including people with severe mental health problems are being deemed fit to work and losing their benefits. Professor Beresford calls this “shocking, crude and cruel”, and says: “The mechanism for assessment is punitive.”

The WCA was revised again in April with the sections relevant to mental health cut in half. Mind’s Chief Executive Paul Farmer said: “We have seen some shocking examples of people who cannot reasonably be expected to enter any workplace being assessed as fit for work.

“People who are found fit for work will have their benefits taken away and will be forced to look for work, some without hope of an employer ever taking them on.”

Disability Now columnist, Ruth Patrick, asks: “Do we have to be so obsessed with work?” Paid work is not always a transformative experience especially if it’s minimum wage. There are different forms of involvement like parenting or voluntary work. These contributions should be valued as much as paid work.”

http://www.mind.org.uk/employment