Work has many benefits for those recovering from mental illness, but rushing them into it risks driving them to suicide, writes DAVID BELL
IAIN DUNCAN SMITH’S new proposal to restrict access to employment and support allowance (ESA) for people with some mental health conditions, (M Star August 25) will strike real fear into many people living with serious long-term mental illnesses like schizophrenia and bipolar disorder. This is not because they are unwilling to work but because they understand better than Duncan Smith does how difficult it is in British society today for people with mental health conditions to access suitable employment.
But he is correct in one respect: the studies show that most people who have recovered after an episode of serious mental illness will fare better when they are in work. After all, work provides us with a sense of purpose and a social network and improves self-esteem and personal narrative. The value of work as useful occupation should not be underestimated. However in Britain we have an extremely poor track record when it comes to providing meaningful job opportunities for people who have experienced serious mental ill health.
There are currently around 280,000 people being treated for schizophrenia by the NHS. Of those, we know from experience that a substantial proportion — probably around 60 per cent — will in time recover a high level of functioning and be able to work at some level. Yet today only around 13 per cent of people with a diagnosis of schizophrenia in Britain are in any kind of work. The reasons for this are unclear. Some would blame stigma among employers, some would blame lack of support from the government. However the real reasons are probably more complex and stem from stigma not only among employers but also those working with the mentally ill and the general public, who see permanent unemployment as being the natural state for someone with schizophrenia.
Whatever the reasons, it is nothing short of a national disgrace that such a large group of able people who are willing to work and who have so much to contribute to their society have been allowed to fall by the wayside.
But while acknowledging that work is beneficial for people who have recovered from mental illness, it is also important that this quality is not used simply to justify cuts in sickness benefits which are intended to save money, not improve people’s lives.
And certainly there seems to be little comprehension in government at the moment (and indeed little will to comprehend) the real difficulties that people with serious mental illness face when trying to get into the workplace.
For someone with a diagnosis of a serious mental illness like schizophrenia, perhaps experiencing some residual symptoms and who has a long break on their CV to explain to a prospective employer, getting into work is not merely a challenge — it is one of the most difficult tasks that they will ever face in their life. It may take several years of hard jobsearching and exhaustive work developing job searching skills before the offer of a job that truly fits their situation finally comes through.
First there is the problem of the gaping hole in their CV: maybe 10 or more years without having worked, maybe never having worked at all before. Writing a CV that can put a positive spin on that isn’t impossible, but it takes special skills that few people with serious mental illness have at first.
Next there is the lack of experience in the workplace. The way to get over that is by using opportunities in volunteering and work experience placements which give people a valuable insight into the skills needed to hold down a job. But those kinds of techniques need time and allowing people the time they need to build their work skills gradually does not seem to be on the current government’s agenda.
Being in the right job is also key. It is vital that the person and the job are well-suited so that they can do well in the job and are not constantly struggling to keep up — a situation that would quickly erode their self-esteem and stress them to the point where they may risk a relapse of their symptoms. Part-time work or flexible working hours may be all that the person is able to do and we should not try to force them to do more. Forcing people to take the first job that comes along regardless of its suitability to their current level of mental wellbeing will present a strong risk of relapse.
And it is important here that we are clear what we mean when we talk about relapse. One in 10 people with a diagnosis of schizophrenia will die by their own hand within 10 years of their diagnosis. Suicide is a threat to people living with this condition and forcing people into unsuitable work that provokes a relapse of their symptoms will undoubtedly increase their risk of suicide. Duncan Smith may well save money by this measure but he will risk lives. At what cost do we try to reduce the benefits bill?
If ESA is withdrawn there will also be those who will not be able to cope with work, but will nevertheless end up losing their benefits. These people will swell the numbers of those with serious mental illness who are already living rough on the streets or in our homeless hostels.
The government must appreciate that, although work is generally beneficial for people recovering from serious mental ill-health, there is no magic bullet here and that simply forcing people into work in order to get them off ESA without the intensive support needed to make their transition to work a success will be a disaster. It will cause immense hardship to many people with mental illness and will even risk lives.
David Bell is director of Living with Schizophrenia, a British project that provides information and advice on schizophrenia. www.livingwithschizophreniauk.org.