Work and mental health

As the recession deepens in Britain, a huge rise in the number of people with mental health conditions has been predicted. Stigma and lack of support in the workplace means people are losing jobs or being refused work at the time when they need them most, and recent Government welfare reforms could complicate things further for those in mental distress. Gemma Pritchard reports.

“The mentally ill are an easy target. Despite the fact 1 in 4 people have a mental health condition, only sufferers and their families understand what it’s like, because you can’t see their symptoms or their distress.”

“The Great British public get whipped up into a frenzy about the idea of people unfairly claiming money from the state, which means people with mental health problems become a target – we are classed as workshy and useless. Our illnesses may not be visible at all or take socially unpleasant forms, so we end up being doubly ostracised. There is a huge amount of hostility.

“The paradox is that people with mental health conditions do want to work, but often people won’t employ them, which says a great deal about the insecurity of employers,” says Chris Danes, 47, from Essex.

Chris has Bipolar Disorder (Manic Depression). His condition has meant that 11 years ago he was forced to leave a successful career in teaching as a Deputy Head of a public school, after a serious episode of the illness. Chris is one of millions of people in the UK who have found that a mental health condition has become a massive barrier to their employability and career. Chris has been able to continue to earn a living by writing books from home and doing some media work about his experiences. But Government research shows others are less fortunate, and many people in the UK with psychological problems fall into a benefit trap which is then very difficult for them to get out of.

At the end of last year, the Government announced a package of welfare reforms intended to get people on benefits back in to work. This includes the introduction of the Work Capability Assessment which will push people on benefits onto Jobseeker’s Allowance, placing emphasis on the responsibility of the individual to find work. But a growing body of evidence suggests that employers are not willing to take on people who have experience of a mental health condition, and they are failing to provide staff with adequate mental health support.

As the recession deepens, this problem can only get worse, with unemployment currently around the 2 million mark, and increased anxiety amongst employees about their future. The Conservative party predicted in November that we will see a massive 26 per cent increase in the number of people experiencing mental health problems by 2010 as a direct result of the economic crisis in Britain. And for people already struggling with mental distress, debt will only make their problems worse.

A poll by mental health charity Mind found that 58% of people had to leave a job because of lack mental health support, 31% had been sacked or forced out of a job after disclosing a mental health problem and 26% had been demoted after disclosing a mental health problem. Even more worryingly, 1 in 4 had job offers withdrawn after disclosing a mental health problem, which is illegal under the Disability Discrimination Act. Yet they found themselves powerless to do anything about it.

Over 200,000 people with mental illnesses move from work onto benefits each year. Although one review has found 9 out of 10 people with mental distress still want to work, Government research has shown that less than 4 in 10 employers would be willing to take them on.

Chris has experienced first-hand the gung-ho attitude of employers who are unwilling to accept a mental health condition as a legitimate reason for sick leave.

“When I was ill and off work for six months,” he says, “no-one from the school visited or came for a meeting with me. My ex-wife, herself a doctor, was bombarded with phone calls from my fellow deputy saying ‘he’s just got to get back’. As in many boys’ schools of its time, it was ‘sink or swim’ for the boys and the staff. Thus medical evidence and doctors’ opinions were overridden. I was made to feel that it was a moral failure.”

The major mental health charities in the UK, which include MIND, Rethink and the Sainsbury Centre, have battled workplace discrimination for many years. Julia Lamb, spokesperson for MIND says: “There remains a long-term stigma and discrimination around people with mental health issues.

“In the workplace, this can translate as anything from problems applying for jobs in the first place, being turned away from jobs, and even cases where people who have been made a job offer disclose a diagnosis and then have the offer withdrawn. There are off course long-term problems too, such as if they get the right support when they are in a job. It can be a massive barrier.

“Of course, there are people who are lucky enough to have employers who are willing to make adjustments to help them and take their needs in to account, for example if someone is taking medication which makes them slow in the morning, an employer could say they can start work a bit later.

“Generally though, there is a lack of awareness in the workplace about mental distress and people don’t get the support they need. This can put a lot of stress on people, and they may have to take time off sick from work. The problem is the longer they are away from work, the harder it is for them to return and get back into it, because they lose their confidence. There are also incidents where people have been off sick for so long that they get sacked.”

MIND are supportive of the Government’s ‘fit note’ scheme, but remain cautious of how it should be implemented. The idea is that instead of ‘sick notes’ people will be assessed for ‘fit notes’, where their doctor will liase with their employer to tell them what they are capable of doing at work. This should raise retentions rates, with people working at a reduced capacity until they are well enough. The idea has caused a lot of noise and even outrage, but MIND say they are for anything that supports people who want to remain in employment.

“It is more complex than that though,” says Julia. “In some cases, it might have been their job which caused the problem in the first place. There are also concerns over whether GPs will have the ability to say what people are capable of- mental health problems aren’t as tangible as physical health conditions – someone may be physically capable of working a 40 hour week, but psychologically can’t cope with the stress. GPs aren’t psychologists or occupational health experts, and for this to work they will need a lot of training and a great deal of sensitivity when making their assessments.”

Dr Jed Boardman, from the Royal College of Psychiatrists adds: “The Welfare Reform Bill is seemingly designed to combat the workshy, currently in the unreformed benefits system.

But it encompasses a large number of people with a range of mental health problems, many of whom want to work and with the right kind of support could be helped in to work.

“It is crucial that the systems to support people in to work are fair, adequately resourced, and based on evidence of what works for people with mental health problems. As psychiatrists, a key role of ours is to help in the recovery of people with mental health problems and help break down the barriers to social discrimination.”

The Government at present remain optimistic about the benefits of the new welfare reforms and argue that we are in a good position to provide people with the support they need, both in and out of the workplace. Public Health Minister, Phil Hope MP, says: “We are building stronger links between the NHS and employment services, to give people integrated support if their depression is linked to unemployment.

“Our programme for expanding psychological therapies has set up 35 new services in 35 PCTs this year and training more than 1,100 people to deliver cognitive behavioural therapy. More services will come on stream over the next two years.

“We are also piloting Employment Advisors in 12 of the 35 new talking therapy services. This will test whether integrated services like this can help prevent people losing their jobs and help people return to work as soon as possible.”

Despite this, there is no question amongst mental health professionals that these new reforms will provide significant challenges for them and their medical colleagues.

Professor Sally Hardy, Head of Mental Health & Learning Disabilities at City University says: “Mental health care professionals, working from a recovery approach, aim to support and enable survivors to regain their sense of self worth and their place in the world, but at a level that feels right for each individual. Using such a person-centred approach can work well alongside the ‘Fit Note’ scheme, as long as it is focusing on what people can achieve rather than on what they cannot offer.

“However, training GP’s to work with people to identify their strengths is a new technique for the consulting rooms that will take more time than many GP’s are able to offer. Many people experience their GP as hardly someone they can collaborate with and share knowledge, but rather as a one-sided diagnostic procedure. The new fitness scheme will certainly take some getting used to, but if implemented with adequate resources could prove beneficial to mental health care sufferers and survivors seeking employment opportunities, as they offer some valuable insights into what it means to be vulnerable and human in a tough world.”