Work in progress
Having ‘meaningful occupation’ is central to everyone’s identity, sense of purpose and satisfaction with life. An income is a definite bonus, especially at a time when welfare benefits are being beaten up, and paid work is certainly the ambition for most people with or without a mental illness. But the enormous pressures the government are placing on people to get a job shouldn’t skew consideration about what is best for each patient. For many, a positive experience of volunteering is the safest, friendliest, most flexible and perhaps the most fun way of getting (back) into the workplace.
There are significant issues around working, not least the impact on people’s benefits and the question of disclosing their illness. We’re only going to dabble our toes in the jobs’ water, though, as there is plenty of excellent information available (see Resources, below).
Links with employment services
- Employment pathways officers come to the hospital.
- We’re negotiating for volunteering by patients (working in the library, for example) to be recognised as part of the supported employment pathway.
- In partnership with the Job Centre but paid for by the Trust, an employment officer liaises with employers (about sick notes, for instance) and also helps with benefits.
- A vocational group develops skills for CVs and job applications, and for adding to individual achievement folders.
- The hospital provides sheltered vocational opportunities assisting the patient in their rehabilitation.
- Clients participate in interviews for new staff. They devise their own questions.
- We have an in-house work programme (for example cleaning and restocking the laundry room, maintenance tasks etc) with pay (up to £10 so it doesn’t interfere with benefits), and including time sheets, records, performance feedback – anything you might expect in a workplace.
- There’s a system of incentives to encourage participation. Rewards might include a cinema trip, retail therapy or even cash. An example could be for 100 per cent attendance at morning planning meetings (excluding agreed appointments).
- Savings accounts with ‘aims and goal’. This encourages budgeting, saving up, and general money management.
- Vocational positions within the hospital aim to provide service users with a valued role and a more balanced routine. They provide work experience and allow service users to develop and learn skills for the future.
Job skills and training
- A patient works as a receptionist alongside administration staff as part of a therapeutic earnings agreement.
- Clients join with permanent staff in mandatory training courses such as first aid, food hygiene, infection control and their certificates are a good addition to achievement folders.
- Catering, art, computers and horticultural courses run in hospital grounds by local college for people to progress onto and to achieve accredited certificate. These courses can still be accessed when people get discharged from the Unit if they wish to.
- Due to the nature of the patient group, the majority of people’s status is ‘retired’, however prior employment is used to inform care plans and support meaningful occupation.
- I am a qualified mental health practitioner working for a Forensic Service in a rehabilitation ward and I am also a professional jewellery maker. The Trust is giving funding for the best ideas in innovation which will help service users in their recovery process. If this is successful many service users will benefit with this project as this will be a professional workshop and service users will learn using Sterling Silver to make ring, earring, engraving, repairs etc. I started a project in jewellery making for the service users to gain interest in this field in order for them to achieve a skill that they will be able to use once they are discharged from hospital. I have been and will continue to teach them how to make and repair jewellery so that they can make an extra income for their living and to minimise risk of relapsing. They will receive a certificate after becoming a confident craftsman with knowledge of all the basic skills. If you have time you can read the story of Laura Rutter from http://www.mentalhealthy.co.uk/news/1801-jewellery-to-support-samaritans.html
- Charity shops
- Café in local Adult Learning Centre.
- Receptionist at the local prison’s Volunteer Centre at the reception desk
- community café
- Local dogs’ home – walking, playing with and grooming the pooches
- Knitting for homeless people
- Volunteering with a wild life conservation charity
Running a social enterprise
- An increasing number of wards are bringing in income from low-key but lovely projects, from weekly patient-run cafés to rehab wards setting up ambitious schemes selling products they’ve grown in the garden or on an allotment.
- Arts and crafts range from ‘treasure island maps’ to jewellery making (with some jewellery sold in a local shop).
- Open University courses
- City & Guilds qualifications including Basic and Key Skills in Adult Literacy and Numeracy
- GCSE level Maths and Science
- An ICS course in Child Care and Development, via a telephone tutor.
- We used to all help tidy up the ward after dinner. It was nice to take some responsibility for our living space.
- Mundane chores keep me grounded. I get a certain sense of satisfaction from completing even something small.
- My husband told my employer that I would not be returning to work. I took control and spoke to my employer saying I would be returning and did so the following week.
- My university have been very understanding of my situation, and I will get extra support when I return to study. It was a big weight off my shoulders as I thought I would have to stop the course.
- It can feel really odd not doing the everyday things like washing up and taking the dog out for a walk. I found I could do things on the ward that were similar to my routine at home. Just opening the door for the catering lady everyday as she brought the trolley into the dining room made me feel like I was doing something beneficial. And I had a walk around the grounds every evening at a similar time to when I normally take the dog out at home.
- I recently applied to university. I had to account for the gap in my studies. I made it clear I was not ashamed of being ill and in fact, the strength and understanding I gained during that time will only ever be an asset.
- I kept thinking ‘who would want to employ me’ and it really held me back. But when I worked on my self-confidence I found that there were many things I was and am capable of doing.
- I started to accept that just because I have times of illness – I still have valuable, worthwhile skills and can be a part of society.
- A major thing for me is not being able to work right now. But I know my job will be there when I get discharged.
- While in hospital I made a big decision to leave my job. I knew it was the right thing to do and it’s a huge relief. Ending employment can be as important and positive as having it.
- I need to work because it keeps me tethered to a well life.
- When I am ill my job is the first thing to suffer. I have found that a good relationship with my employers and good communication has helped me and them understand this.
- I started off small until my confidence in the workplace grew. I made sure I had a lot of support and that the company liaised with my team.
- I took the time in hospital to recharge my batteries ready to go back to work.
- I was extremely anxious about being admitted and losing my job which is a key part of my life. In the first few weeks there were a lot of conversations with my employers on my behalf and it really helped ease the worry.
- I kept in touch with work whilst I was in hospital so when I went back I didn’t feel so uncomfortable and out of the loop.
- I’m doing an Open University law course. It’s a positive focus for me and something to aim for. Both the ward and the university support me doing this.
- I’m studying a masters in psychology. My university’s mental health worker comes in to give me support gives me a connection to my course.
- There’s always a copy of REMIT – a guide to training courses for mental health patients – on the ward. Flicking through it gives you ideas about what courses you could do.
- I go to an evening class each week then return back to the ward.
- I have mental health worker at my university. He comes to the ward to support me in completing my degree.
- Studying helps me feel well. I can’t go to college while I’m on the ward but it’s a good aim for me once I’m discharged.
- I stopped going to my college course a while back and that was a sign that my mental state was deteriorating. I only realised that in the recovery group but now I know to look out for it in the future.
- While on the ward I started going to an art class at a community arts centre in the city. I found out about it by going to the art groups in the unit.
- Being on the ward doesn’t just help you get better; you get a break from it all and you can have a think about your next steps. A member of staff helped me write a list of goals, one of which was to enrol on a upholstery course.
- My time in hospital gave me the time and space to realise that my previous job was playing a big part in my illness.
- The support of my colleagues whilst I have been ill has been absolutely invaluable. I was so worried about drifting away from ‘normality’ and never being able to get back. They keep me grounded in wellness.
- I was so worried my boss would be angry I hadn’t showed up for work when I was first admitted but the staff helped me speak to people who could help and my family took on some of the responsibility for sorting those things out. When I saw them they let me know how it was all going. It helped a lot.
- Part of feeling well for me is staying organised. I’m self employed so I bring in some pieces of work to look at when I feel up to it. My consultants checks that I’m not over doing it.
- My job was so stressful and I was just glad to be away from it. We spent a lot of time before my discharge thinking about when and how I would return to work and it took a lot of the anxiety out of the transition.
Tukes employment and training scheme
Lots of people who have mental health problems continue to work. This is more than just possible – it’s a positive, life-enhancing choice, especially when they have the support they need to keep working successfully. Being in a workplace or connecting with others through work helps avoid isolation, especially as many people with mental health problems are more likely than others to be socially excluded. Going back to work after being ill can actually help a person get better and protect them against a relapse.
Finding the right employment, with appropriate support from employers, health and social care professionals, along with any reasonable adaptations necessary to cope with potential stressors, can enable someone with mental health problems to flourish, improving their health and well-being. And of course the dosh helps!
Ways to work
Full-time working hours are generally around 35 or more a week. However, if someone is receiving certain benefits, they are considered to be full-time if they are working more than 16 hours a week, so this is an important consideration when working out what their income is likely to be. If a patient was in full-time work before coming into hospital, it would be helpful for them to think about how they were coping and whether there would be any changes they and their employer could make to help them manage.
For some people, working part-time is a better option, especially if they may struggle to cope with a long working week. Part-time may also be more suitable if they have other commitments, such as parenting, or they want to be able to do other things as well, such as training.
Learning ‘on the job’
There are different ways to do this and one route a patient might consider is an apprenticeship. The money is low while training but they will get the experience and qualifications they need to follow their chosen career. Internships are a sort of posh work experience, particularly popular in industries which are incredibly hard to break into (eg media) and the traditional ‘old boys’ network’ is gradually being replaced with intern opportunities being openly advertised.
Another option that may be available is an employment project. Employment projects offer a way to work with structured support and one example of this is a successful project in Broadmoor hospital, which was developed to enable patients to work alongside staff as colleagues in running a business. With real work, real deadlines and real pay (within the limits allowed), patients had to be flexible and deal with managing and being managed, as well as having the opportunity to develop existing skills and learn new ones. Set up by The First Step Trust, the project aimed to boost patients’ confidence, self-esteem and motivation, as well as offer them the opportunity to gain experience in a real working environment in preparation for life after their discharge from hospital. You can find out more here.
Mental illness and employment
If someone is returning to a job they were doing before their hospital admission, they may be concerned about having been off sick and how their employer and colleagues will respond to them. You could encourage them to keep in touch to avoid them feeling cut off and this will make the transition back to work less stressful when the time comes.
Because of the stigma attached to mental illness, a patient may be worried about potential employers’ and colleagues’ potential prejudice towards them. This is one of the reasons that trying to access employment can be a real challenge for someone with mental health problems and may mean that they are reluctant to talk about their mental health problems in a way that doesn’t happen with physical illness. Talking with patients about this, discussing what they might say to colleagues and possibly role-playing workplace conversations may all help.
Being realistic about when a patient will be ready to return to work and giving support throughout the process is vital, as the longer someone is off work with illness the less likely they are to return. Because of this, it’s important to start preparing for a return to work as early as possible during their treatment. Identifying a patient’s skills and strengths, along with things that may trigger difficulties for them in the workplace, can help identify ways that their working situation can be adjusted to accommodate their health issues.
As with so many other areas, simply opening a conversation about work can often be supportive and helpful to a patient. If you will be in contact with an employer, or prospective employer, it’s very important to be clear about what information a patient is happy for you to share. For some information, you will need written consent.
Things you might talk to patients about
- How they could talk to colleagues about their illness and being in hospital when they go back to work
- How they feel about their work
- What kinds of skills do they have?
- What sort of work would they most like to do?
- What other sorts of jobs might they consider doing to get (back) into work?
- Are they worried about losing their job because of their illness?
- Are they worried about money as a result of being unable to work? (See idea #64 Help with money)
- Are there ways that working hours or environments could realistically be adapted to support their return to work? Flexi-time, for instance?
- Different kinds of work, such as part-time, full-time, supported or voluntary.
Practical support might include
- Role-playing different situations, such as job interviews or talking to colleagues when returning to work
- Finding out whether there are any supported employment projects locally that could be of interest
- Offering advice, support and information about benefits and tax credits, or helping the patient access this advice
- Developing a return-to-work plan (see below) with the patient, covering how they will cope with going back to work and what will happen if they get into difficulties
- Liaising with the patient and their employer about reasonable adjustments that could be made (see below for examples) and any support that either of them may need.
The Disability Discrimination Act means that employers have to make ‘reasonable adjustments’ to prevent disabled people being unnecessarily and unfairly prevented from working. There are lots of ways that employers can adjust an employee’s working conditions without incurring costs or causing significant upheaval. If someone feels awkward about adjustments having to be made because of their mental health problems, you could point out that there are lots of reasons for needing adjustments at work – parenting, studying or physical health problems, for instance.
Allowing an employee to be flexible about their working hours to avoid particular stressors can make a huge difference in various ways:
- Shifting the working day by an hour to avoid public transport in the rush hour
- Allowing time off for health appointments by enabling the person to work around them
- Enabling them to take a short time out of the office or call a friend/carer for support if they are becoming very stressed or anxious.
This is where creative teamwork between a patient, their employer and health/social professionals is key. Everyone’s needs are different but examples could include:
- Having a mentor while they’re settling into the job
- Offering written instructions and reminders where relevant
- Allowing someone to work from home some of the time where possible if this would help them cope with any ups and downs.
Access to work
‘Access to Work’ is a government scheme that is designed to help employers and employees with costs that may be over and above what are considered reasonable adjustments. This could include things like paying towards a support worker, special equipment or travel costs in certain circumstances. For more information and to check whether someone is eligible for this scheme, visit here.
A little note from Marion (founder of Star Wards)
Before the taxi arrangement with Access to Work, they paid for me to have emotional support with work. This ended when Bright, the charity that runs Star Wards, managed to find (and one of our funders very generously agreed to pay for) a crisis therapist for me. Access to Work don’t pay for therapy, which is fair enough, but switching their funding to cover taxis has worked perfectly for us.
Developing a return-to-work plan
Going back to work can be a daunting experience and you can help support a patient and their employer by planning carefully for their return. If a patient is likely to return to work when they’re still experiencing some problematic symptoms, you could investigate the possibility of returning in stages – one day a week to start with, or a couple of days from home and a day in the office – to make the transition smoother.
It’s important to plan with a patient what they can do to cope with everyday stresses at work: how they can identify things that might be problematic, how they can communicate these to their employer and how they can be addressed.
A return-to-work plan can cover reasonable adjustments that can be made in the workplace and to working arrangements to accommodate any needs an employee might have. If a person’s medication means that they will not be able to perform certain tasks – driving, for instance, if they are taking medicine that causes drowsiness – it’s important that the employer knows this.
A return-to-work plan should include how the person will be supported in their employment and who will support them. This will need to be agreed with the employer. Things to bear in mind include:
- You can’t share personal information about a patient with an employer or prospective employer without their written consent.
- Employers and prospective employers are not allowed to discriminate against people because of a disability.
- A prospective employer can’t ask someone about their health – including their mental health – as part of the application process until they have offered that person a job. This includes asking about time off for illness.
One of the great things about voluntary work is that it enables people to ease into having a job and see how they cope with work. It also helps them discover what they enjoy and what they’re good at. People can volunteer without losing key benefits so they can test the employment waters without losing their income. Volunteering is also an excellent way to gain work experience while training and can be helpful to add to a CV.