Mental health and work
Mental Health is the ability to love and work. Love and work are both sources of emotional well being as well as emotional challenges and disturbance.
The role of work in mental health
Mainstream psychiatry sees unemployment of people with severe mental health problems as an inherent effect of psychopathology. DSM-IV requires for a diagnosis of schizophrenia ... the recognition of a constellation of signs and symptoms associated with impaired occupational or social functioning
(American Psychiatric Association, 2000). This view is often held in conjunction with a view that work is potentially detrimental for the mental health of people with mental health problems.
The philosophy of St James's House is that work can maintain or promote mental health of everyone - including people with severe and enduring mental health problems. In contrast, it has been shown that remaining unemployed can have a detrimental impact on mental health and can result in dependence on benefits and treatment, and loss of hope and self-esteem.
(Re-)employment has been shown to promote positive mental health, as it can:
- Provide structure to the day
- Provide opportunities for social contact
- Promote working towards shared objectives
- Help to build a sense of identity
What research suggests
“1 in 4 British adults experience at least one diagnosable mental health problem in any one year, and one in six experiences this at any given time.”
(The Office for National Statistics Psychiatric Morbidity Report, 2001)
People with severe and enduring mental health problems have the the highest rates of unemployment of any group of people with disabilities or long-term illnesses. Only 19 % of working age mental health service users are economically active compared with 35% of all working age people with a disability or long-term health problem (Labour Force Survey, 2000, Office for National Statistics).
Rates of unemployment of people with schizophrenia have been reported as well above 85% (Barnes, Thornton & Campbell, 1998; Hogman & Chapman, 1998) in some accounts as high as 90 - 99% (Perkins & Greville, 1993; Repper & Perkins 1995), and 81.6% of people with psychiatric disabilities are unemployed (Labour Force Survey Trends, 2002).
These statistics suggest that more significant barriers are faced by those with mental health problems compared with other groups of disabled people and that more intensive and innovative support is required to help them gain and retain work.
“There is no case for discouraging mental health service users from pursuing their vocational goals on the basis of their diagnosis, symptoms, level of social functioning or their employment history. In fact, research shows that working is correlated with reduction of symptoms, improved social skills and reduction of hospitalisation.”
(Bob Grove, Effective Mental Health Day Services and Employment
in Adult Day Services and Social Inclusion, 2003)
In recent years the Individual Placement Support (IPS) model has been shown to be highly effective in helping mental health service users achieve paid employment. IPS focuses the service user on rapid job search within the first four weeks of engagement with an employment service. The service is linked in with a Community Mental Health team and provides a coordinated approach with the employment specialist and the clinical team.
“Individual placement and support is an evidence-based practice that has been shown to be more effective than other approaches in helping people with severe mental health problems gain and sustain employment. Research clearly demonstrates that it is the support provided to clients that most affects vocational outcomes.”
(Miles Rinaldi, et al,
Individual placement and support:
from research to practice,
Advances in Psychiatric Treatment, 2008)
How we support people
St James’s House services are linked to evidence from current research and 20 years’ experience of working with mental health service users. Our programmes are modeled on the following approaches:
Person-centred approach
This therapy, developed by psychologist Carl Rogers, is non-directive, meaning that the support worker does not try to steer the client in a particular direction; rather, the client retains control over their own journey of change.
The support worker encourages clients to explore and pursue vocational interests, and provides a supportive environment in which clients can discuss difficulties that they may face returning to work or training.
Therapeutic support
The therapeutic support we provide draws on the principles of psychotherapy and counselling. It aims to help clients increase self-esteem and confidence, reduce anxiety, and improve social networks and relationships.
IPS-based vocational support
Clients are supported through a structured support package providing advice and guidance to access and sustain educational, training and employment opportunities. This includes practical assistance around CVs, application forms, interview practice and rapid job search techniques.
The service is linked in with clinical teams to ensure a coordinated approach to managing the client's mental health condition.
We have found that these approaches have been highly successful in helping our clients to manage their mental health, access employment and feel more integrated within their community. Through service user involvement and community outreach, we continue to develop our programmes and services to respond to the needs of our client group.