Whose responsibility is it to support people with mental health problems in/to employment? Later this month, the OECD will publish what looks like an important piece of work examining the myths and realities about mental health and work. The issue is a spectacular tangle of grey areas, discrepancies and imprecision.
There’s the matter of looking after the mental health needs of those currently in employment. There’s the challenge of supporting people with long term mental health conditions in getting off benefits and into work both sustainably and without exacerbating their illness. There’s a complex relationship between recovery (which in the case of mental illness is rarely a linear process), therapeutic occupation and the pressure of responsibility.
There are underlying problems around the hindering of aspiration and ambition as a result of the onset of mental illness. There’s the confusing business of common mental disorders, such as anxiety and depression, and severe mental disorders, all of which can be chronic, transitory and, very likely, fluctuating in degree of severity.
The very idea of mental illness takes us to extremely uncomfortable places
Dealing with these challenges falls neatly between health and social care provision, the welfare system, and the big bad world of the free market. The very idea of mental illness takes us to extremely uncomfortable places, and the fact that employers don’t really want to know and employees don’t really want to talk about their mental health is only one indication of the deep social stigma that still exists.
So even though we know that the costs of mental ill health are enormous (estimated at as much as 4% of GDP in the EU), it does not seem to be an issue that people outside the mental health sector are engaging with very seriously. Employers and corporations are, so far, not a real partner to the mental health care system.
The government is ploughing money into the Work Programme, which pays specialist providers to get people with long term conditions into work, but without any kind of systematic approach towards employers and the workplace. The fact is that employers do not like the idea of mentally ill staff (only four in ten employers say they would hire someone with a mental disorder) and we cannot simply sidestep or overlook this when trying to encourage people off benefits and into work.
The fact is that employers do not like the idea of mentally ill staff and we cannot simply sidestep or overlook this when trying to encourage people off benefits and into work.
And, although there is overwhelming evidence that employment is an important element of continuous, on-going recovery from mental illness, the mental health care system takes minimal responsibility for the employment status of its patients. Part of the problem here is that so much of the mental health care system is geared up towards severe mental disorders, and a long held lack of expectation of recovery. Once a person falls into the system of mental health care, the path towards becoming a career mental health patient is a lot easier to fall onto than any alternative paths.
The OECD’s report will argue that policy can and must respond more effectively to these challenges, but to do so will require a co-ordinated approach and a multi-level shift. This will require a level of integration that is hard to see emerging from what the coalition is up to.
For example, we know that prevention and early intervention are crucial, so we need to find ways to join up vocational support with first line health care response to mental distress. To make working life compatible with long term mental disorder, there is a need to stop trying to shoehorn people with mental health conditions into inflexible and conventional models of working and encourage employers to accept variations in people’s productivity, and a more diverse and creative view of what it means to get the job done.
Within all of this I’m sure there are real opportunities for social enterprises to play a role in bringing about shifts not only in attitudes to mental health at work, but also in terms of matchmaking people with employers and helping employers to respond proactively to the mental health needs of the workforce. The Social Brain and Enterprise teams at the RSA are currently interested in exploring this area, so if you’re working in this space or have ideas you’d care to share, do get in touch.
Related articles
-
The only 'normal' people are the ones you don't know very well
Jonathan Rowson
I haven't taken many sick days in my working life, but whenever I have I return to my desk to find a 'sickness absence form' asking for some basic administrative information including the line:
-
Searching for a way out of hell: mental complexity, wellbeing, and Bob’s Big Idea
Nathalie Spencer
Looking around at the environmental degradation, financial turmoil, and increased social inequality around us, perhaps you’ve had the sinking feeling that we are creating our own demise. Presumably you are hoping there is a way that we can work ourselves out of this mess. You wouldn’t be alone.
-
Stigma of mental illness? Alive and well
The stigma of mental illness is alive and well. Despite the fact that campaigns like Time to Change have been working hard to eliminate stigma and discrimination against people with mental health conditions, it seems that it’s still all too easy to casually slip into a culture of blame.
Join the discussion
Comments
Please login to post a comment or reply
Don't have an account? Click here to register.
Hi,
I am interested in setting up a social enterprise in India which provides sustainable livelihood solutions for mentally challenged and physically handicapped. Right now, I am at the planning stage and considering the different options I could take.
The state of these people is really bad in India specially within the underprivileged sector and they easily become soft targets for trafficking and organ transplantation. I am a 26 year old person, who wants to start this social enterprise in India as I really want to make a change in the society.
Let me know if you'd like to help with this, My email address is chirag11kapoor@gmail.com
Thanks,
Chirag
There
are a number of issues with the whole of the mental health arena.
Quite
often the carer, if needed, is a family member or friend who is unpaid and
no support team is given to the person with these issues.
A
lot of training money is for people on JSA and not DLA - why?
I
have seen employers get rid of people with mental health problems when
these issues are known. Should it be ignored on an application form or
lied about?
More
flexibility in working with people who have mental health issues - I know
someone who wants to try and get into the construction industry but is on DLA
which precludes him/her from training funding. The thought being given
here is that the person could eventually go self-employed and work when able
which could, in some cases, be a number of years before a next epsidoe.
it would also allow flexibility of hours and number of days worked. Which
means they are working the hours they feel able to do so that they don't go
into a new episode
The
benefits system is not geared to help people with DLA get back to work on a
part-time basis. If you are a single person and work 15 to 30 hours you
get no assistance whatsoever. Working tax credits don't kick in until 30
hours or more are worked if you are a single person. Why not encourage
part-time working at least by changing the benefits system so that the person
is not losing out for making an effort. This would also help cut the
benefits bill. Benefits should also be much easier to access in full each
time a new episode precludes working - sometimes this takes weeks or even
months so what are they supposed to live on.
I have serious concerns about how the focus on mental health "at work", for both those affected and the employers of those affected, is dangerously shortsighted. There are between 1.5 and 2 million people in the UK who are self-employed. As I have written http://idea15.wordpress.com/20..., in practice, this results in self-employed individuals who have mental health issues becoming clients or business partners of other self-employed individuals. There is no team to back either of them up, no "coordinated approach", and no "vocational support". If the person shows up at the service provider's home office having some sort of episode, what backup or recourse is there for either of them? Absolutely none. If the person phones round their contacts with ranting paranoid accusations, a whole town's business community is left looking down at their shoes, too embarassed to discuss what just happened.
The dialogue around this issue needs to recognise the fact that there are individuals with mental health issues who, as a result of being unable to gain employment in a traditional work situation, are now going into business for themselves. There is no support, no monitoring or evaluation, and no "advance warning". But there's a lot of cleanup and damage control for the people who tried to work with them in good faith and paid the price.
One in ten people on psychotropics work, so its a bit rich to put pressure on them all to work, when they are debilitated on mind bending psychotropics,and have trouble getting up to face the day, let alone go to work, take away the poisons and try other caring care that lifts their spirits, and nurtures them as opposed to poisoning and dulling them, and you might have a chance, Mental health issues have recently overtaken physical injury as the cause of the longest absences from work. Thats because its being sold to the community every day by mental health and their compliant users, psychiatry,big pharma, media in print, television and internet, billboards, the government, every bloke and his dog, etc, ever heard of that saying , "What you see is what you get"