Making back-to-work for people with mental health difficulties work

(The below post by Mark Brown is adapted from a 2012 proposal that never got off the ground.  Despite this, the question of how we might redefine back-to-work support to be something that people with mental health difficulties themselves control and shape is ever more relevant)

The issue of benefits change and return to work is the issue that has dominated debate in the mental health sphere, as the broader issue of benefits and welfare state reform has the public sphere.  In a political climate that fetishes choice, those involved in back-to-work activity have been perversely denied it by the structure of back-to-work provision and its mandatory nature under current policy.  Aside from the world of social media there has been little concentrated opportunity for people with mental health difficulties currently involved in attempting to enter or re-enter the labour market to share ideas, frustrations, aspirations and suggestions.

The Department of Work and Pensions’ Work Programme is tasked with the role of returning people to work, including many people with mental health difficulties who are being moved from benefits such as Incapacity Benefit into either the Work Related Activity Group (WRAG) of Employment Support Allowance (ESA) or into mainstream Job Seeker’s Allowance (JSA).

The Work Programme is delivered by prime contractors and their subcontractors.  There has been little research to date into the practical attitudes of people with mental health difficulties to work and, more importantly, what people with mental health difficulties would actually value and engage with from services that exist to support them into work.

There has been little recent research into areas involved in a return to work such as attitudinal factors, user experience of back-to-work services, the role of individual and collective agency and the factors which inhibit or promote back to work activity.

There is a need to answer the overarching question: “Can we do back-to-work services for people with mental health difficulties better and what can we learn from people with mental health difficulties to do so?

Much money, limited success

Present government policy is based upon returning a significant number of those currently claiming benefits to the labour market.  The replacement of Incapacity Benefit with Employment Support Allowance (ESA) represents an undertaking to reduce the number of people with disabilities claiming out-of-work benefits, a move intended to end the number of people with disabilities who remain outside of the labour market for indefinite periods.

In the past the DWP has found it difficult to provide support to people with mental health difficulties and other variable disabilities in relation to the labour market.  There has been a perception that the back-to-work services and benefits provision have not understood the needs and aspirations of people with mental health difficulties and that there is a distance between policy intention and on-the ground practice.

This perception has not been challenged by the introduction of the Work Programme and the acknowledge shortcomings of the Work Capability Assessment delivered by Atos. There is a belief on the part of many people with mental health difficulties that all DWP action to support people to return to the labour market is only based upon reducing overall benefit spending and is not based on supporting people into lasting, meaningful employment.

To date, there has been an overarching argument that work in and of itself is an unequivocal good and that a return to work signifies a recovery from mental ill-health.  Work such as the Sainsbury Centre for Mental Health’s (now Centre for Mental Health) Mental Health and Employment and Dame Carol Black’s review Working for a Healthier Tomorrow have tended to the overall statistical analysis of the outcomes of unemployment mental health and the effects of mental ill-health on employment prospects.  They have tended to conclude that being in work is better then not being in work; and that people who are in work tend to be less disabled by their mental health difficulties than those who are not.  These conclusions, however they have been hedged with caveats, have often translated into blunt mantras.

At present there are large amounts of public money being spent on behalf of people with disabilities – especially people with mental health difficulties –  to help them return to work.  The actions paid for by this money are currently meeting limited success.

No one is asking the right questions

There is currently little research conducted to attempt to capture the personal experiences of people with mental health difficulties who are outside of work.  Mental health difficulty is a diverse range of conditions and those that experience it are also diverse in their life experiences and situations.

For many people with mental health difficulties, the world of work has been a challenging, difficult place.  While in theory the aim is to help people to stay in work, in practice many benefits and forms of support have only begun once an individual leaves the world of work by being deemed incapable of work.  For some, the idea of work becomes conflated with the idea of crisis, ill health and stress, with a literal perception that it was ‘work’ that is to blame for the development or worsening of illness.

Many are wary of the forms of employment or employment readiness training offered to disabled people with non-physical disabilities, or of the types of training and activity into which they may be coerced.

It is time to listen to the experiences and aspirations that people with mental health difficulties have in re-entering the labour market and how services might be better conceived, designed and implemented to make this successful.

It is currently unclear how much the shape of current back to work provision was shaped by actual discussion with people who might use it.  Popular opinion within the world of mental health activism would have it the current regime was designed entirely to act upon people rather than engaging with them.

It is vital that we develop a clearer picture of the ways in which current back to work provision for people with mental health difficulties either supports or creates barriers to returning to work.  To do this we must make the case strongly that DWP and other service designers must understand attitudes and ideas amongst people with mental health difficulties to ways that these services may be improved.

If we take it that people with mental health difficulties should and would wish to contribute to making better back to work services (this is by no means guaranteed, nor should it be expected to be) some of the vital questions, currently under-explored, that could be asked and answered include:

  • How much of successful back-to-work provision is transactional and how much is based on relationships? (Does it matter who does back-to-work support? Can and should people be able to choose?)

  • Can back-to-work provision create perverse incentives that conflict with ‘recovery’ (both social and medical model?) (Does back to work provision as it stands now make some people more ill? How would this be avoided in future?)

  • How does previous unsuccessful back-to-work provision impact on future engagement with back-to-work providers? (Does one bad experience make all future experiences more likely to be felt to be bad, too?)

  • To what extent are there things such as ‘good’ work and ‘bad’ work for people with mental health difficulties? (Does arranging placements at random on the basis that they’ll ‘be good for people’ ever work?  Do some jobs make some people more unwell, especially if they are coerced into them?)

  • Do people with mental health difficulties have strong ideas of what help, assistance and support they need to return to work and if so, how does this match up with existing conditions and provisions? (What happens if you ask people what would help them into work? Can it be provided at present; and, if not, what does that mean for an individual?)

  • To what extent can individual agency and potential be unlocked to help someone move from worklessness into employment? (What if coercion and regimented back-to-work provision wasn’t the model? Does the current model work against itself by removing or minimising the role of self-determination and choice? What if people were supported to develop their own programme of support?)

  • What ideas and experiences of work do people with mental health difficulties have and how representative are they?  Can the experiences of people with mental health difficulties in work be categorised and if so, do these experiences correlate with current or past success in the labour market? (Do people with different mental health difficulties have different experiences in the job market? Are there specific things that help some people more than others?)

If the above questions were to be asked and answered we would be some way towards working out what back-to-work support would look like if it was developed by people with mental health difficulties themselves.

The challenge is: who will ask these questions and who will support the actions suggested by their answers?

Mark Brown (@markoneinfour) is development director of Social Spider CIC.

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4 Responses to Making back-to-work for people with mental health difficulties work

  1. David Higham says:

    Can people with mental health issues necessarily understand: “Can back-to-work provision create perverse incentives that conflict with ‘recovery’ (both social and medical model?) (Does back to work provision as it stands now make some people more ill? How would this be avoided in future?)?”…because as a BSc degree educated person with bipolar I don’t have a fucking clue what this bullshit speak means.

    If you want people to reply to this survey use simple English that means something.

  2. People with mental health problems mostly find it hard to fit into their own lives , they are largely unaware when ill and in health constantly checking self projection. All the above is very draining and causes anxiety which in turn brings us back to a world we don’t want to live in or a lockup ward we cant stay in. You come and work with me take some of my medication youl be surprised at what you cant do.

  3. Silvia Vousden says:

    Does perverse incentive mean you have to take the work placements on offer just because they will cut your money if you don’t? In which case, putting yourself in an unsuitable work situation would make anxiety and depression worse because the people that have assessed your ‘capability for work’ have not considered your medical condition or have no understanding of your needs?

  4. kitty says:

    In my recent experience of the work providers – they do not have any comprehension of a person suffering from a Serious Mental condition – they are just concerned with placing them in work – they go home at five o’clock and at weekends and it is the family that end up picking up the pieces yet again. The work providers do not appear to put the persons Mental Health and Well Being at the heart of the matter. Most people have no understanding how such individuals suffer – only those very close and care for them. It is a disgrace that they have to be placed in the WRAG.

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