Employment within Mental Health Services - Research Paper Example

 The User Employment Programme in South West London and St. George's Mental Health NHS Trust is one such initiative which has been used to transition those with mental health into gainful employment. This programme has the stated purpose of “increasing access to employment within mental health services for people who have themselves experienced mental health problems” (Perkins et al., 2010, p. 14). This programme is comprised of two broad elements. The first element is that there is a supported employment programme, which is modeled after the Individual Placement and Support (IPS) programme. The prongs of this first element are as follows: assistance with recruitment – the mentally ill individual is given information about job requirements, and the support available, as well as given assistance with completing applications and interview preparation; assistance with work transition – the individual is given advice about welfare benefits, workplace mentors, starting work, getting support, and the pros and cons about disclosing his or her mental illness to his or her co-workers; on-going support, which consists of assisting with conflict resolution and how to manage specific symptoms while on the job; and guidance and support to managers, to give them confidence in working with an individual with a mental illness (Perkins et al., 2010). The second element is called the Charter for the Employment of People Who Have Experienced Mental Health Problems. This element is in place specifically to combat discrimination and stigmatization of those with mental health issues. This element consists of a campaign that disseminates the information that mental health problems are not a barrier to job specifications; advertisements which encourage those with mental health problems to apply for jobs; and equal opportunity monitoring (Perkins et al., 2010). Australia has a number of initiatives which help mentally ill individuals transition into work. These include open employment services, which are non-governmental and help people with disabilities obtain employment. Australia also has IPS services, which offers assistance in career planning, job research, job searching and job placement. Group based programmes are also available to individuals in Australia. These include clubhouses, community cooperatives and mobile work crew. Among the group initiatives are social firms, in which a business sets aside a certain percentage of its available jobs to individuals with psychiatric illnesses. A job network is another initiative in Australia which is aimed at increasing employment among the mentally ill. A job network provides a recruitment service for employers, as well as gives mentally ill individuals an avenue to report unfair discrimination. The mentally ill individuals may access (Waghorn & Lloyd, 2005). Clubhouses offers another avenue for the mentally ill go gain employment. According to Roth (2007), mental health clubhouses are a place where mentally ill people can gather with one another for support, friendship and planned events. These centers offer services which may help with gaining employment, including education, outreach and skills training, as well as being an effective resource for finding employment (Roth, 2007). Clubhouses are also designed to address issues regarding adjustment to society, social isolation and community integration (Gumber, 2011). Clubhouses may also help the individuals adjust to working by providing members opportunities to work within the clubhouse itself. For instance, Gumber (2011) states that there is a “work-ordered day,” in which the members of the club, along with the staff of the club, work side by side to accomplish certain tasks within the clubhouse. These tasks might be clerical, food preparation, building maintenance, intake of new members, telephone answering and attendance recording. Tasks might also be higher level, such as training, administrative and accounting tasks. Moreover, transitional employment placements are community jobs which are reserved for clubhouse members through employer agreements. The collective management from the club procures the employment opportunities, train the club members for the opportunities, and cover absences for the employee when the employee is unable to work. Each employment opportunity is limited in time and scope, and transitional employment placements are meant to be a “stepping stone” into actual employment. Independent employment is another resource which the clubhouse provides, as they provide support services for the clubhouse members who obtain independent employment, as well as support for these members (Gumber, 2011). Supported employment is another avenue for individuals with mental illness. Perkins et al. (1997) describe one such scheme. This scheme provides support in recruitment and in employment. In the recruitment process, the support provided includes issuing detailed guidelines for open posts. Project workers and human resource workers work with the mentally ill applicants in “open afternoons.” During these “open afternoons,” the human resource manager and project manager give more information about the posts to applicants and work with them in completing job applications. Guidelines regarding interviews and interview preparation are also issued to the applicants. If an applicant is short-listed, then they receive in-depth counseling regarding interviewing, including training and practicing. If the applicant is unsuccessful, then they are offered detailed feedback on their interviewing and are offered a chance to gain experience through volunteering. Support in employment is another branch of the supported employment initiative detailed by Perkins et al. (1997). This occurs after the prospective employee finds a position with a company. With supported employment, the tasks that the employee is to do are analyzed by examining another employee who do the same tasks as the prospective mentally ill employee for one week. Then, after observing the tasks for one week, the case manager prepares a set of guidelines for the mentally ill employee which details how the tasks are to be performed. Possible difficulties or hurdles which the employee might experience on the job are presented to the employee, with details on how to handle these possible obstacles. Such obstacles include boundaries, coping with staff reactions, and the difficulties which are inherent in moving from a user to a provider role. These guidelines are presented to the prospective employee through a four week training programme – the first week is in a classroom, the remaining three are on the job. Arrangements are made with the employers on meeting the specific needs of each prospective employee. The employee is also provided with a mentor who helps the employee through training and with integrating into the workplace. A project worker is also provided to give support to the employee and to the staff, in an effort to resolve any potential difficulties between the employee and the staff (Perkins et al., 1997). Furthermore, in the supported employment scheme examined by Perkins et al. (1997), individuals with serious mental health issues were recruited to existing posts within the rehabilitation clinical teams, and were provided with support and training necessary to make the employment a success. These were not special posts created just for the mentally ill individuals, but, rather, existing employment posts within the existing existing establishment. Such posts include mental health support worker, care assistant, nursing assistant, physiotherapy assistance and occupational therapy assistant. Furthermore, all the participants in the program are afforded the opportunity gain further qualifications through the National Vocational Qualifications programmes which are a part of the Trust. Posts may be half time or there may be job sharing arrangements. Leaflets advertising these positions are distributed in locations that are used by the mentally ill, such as community health teams, sheltered work and employment agencies, patient's councils and the like. Moreover, in lieu of references from a previous employer, in the case where there is a long period of unemployment, references from general practitioners, mental health workers and other health professionals are acceptable (Perkins et al. 1997). Whether such supportive work schemes help the patients is a matter of research, and is the focus of the research performed by Burns et al. (2009). They performed a randomized trial comparing IPS to high quality vocational rehabilitation in London, Ulm-Guzburg, Rimini, Zurich, Groningen and Sophia, all in Europe. The IPS services which they examined had six key features – each of these centers focused upon competitive employment as a goal; each of these centres required the employees to find jobs directly, as opposed to participating in lengthy training; rehabilitation was not treated as a separate service, but, rather, as “an integral component of mental health treatment” (Burns et al., 2009, p. 950); the services available were based on clients' preferences and choice; assessment was continuous and based upon the experience in the real work world; and there was continuous, indefinite follow-up support. The control group consisted of vocational trained mentally ill individuals who were the recipients of “train and place,” which means that they underwent vocational training and job preparation before they went to seek competitive employment (Burns et al., 2009, p. 950). Burns et al., (2009) followed the patients in both of these groups for 18 months. They looked at the impact of working on overall social functioning, and clinical and social functioning. They found that, even though there were concerns that IPS might lead to anxiety and uncertainty among patients because they had to return to work without long preparation, the patients who underwent IPS did not deteriorate mentally. The IPS group was half as likely as the control group to have been hospitalized. Moreover, the IPS group had better outcomes than individuals who did not work at all. Their outcomes were better in terms of global functioning, social disability, and remission status. Reduced depression was another aspect which was seen in those who returned to work (Burns et al., 2009). Another study conducted by Johnson et al. (2009) found a number of benefits in supported employment. The participants of this study were all participants in supported work schemes, and the researchers found that there were three main positive aspects to supported employment. One aspect was that supported employment provided them with emotional support. They felt that the supported employment team gave them motivation and encouragement, as well as provided them structure and regular contact. Moreover, the supported employment built confidence, comfort and security. The respondents also noted that they had built up positive relationships with their employment social worker (ESW). Practical assistance was another positive related by participants in the Johnson et al. (2009) study. Many of the participants stated that just having to meet with their ESW was helpful to them, because it got them out of the house and gave them structure to their day. It also helped to have human contact, and this helped them prepare for work and improved their mental health. They also stated that having ESWs with them as they researched jobs at the library, went to job fairs, job centres or interviews was helpful, especially if they were experiencing some degree of social anxiety. They also stated that their courses and training that they underwent were helpful because it enabled them to meet people who were going through the same dilemmas that they were at the time, and it enabled them to follow a routine. Moreover, the knowledge regarding the jobs that were available and the advice given to them about job search websites and contacts were invaluable, and enabled the mentally ill persons to feel that they were in a good position to find suitable employment. They generally appreciated getting information from their ESWs regarding employment opportunities. The application and recruitment process was another area where the individuals felt that the supported work scheme helped them, in that the clients got help in constructing and revising their Curriculum Vitaes and completing application forms. They also received help with interviewing by undergoing mock interviews, and this was deemed very helpful by the clients as well. They also appreciated that their ESW mediated by working with potential employers in an effort to help them understand the mental health challenges of the clients. Client centred approach was another aspect which was deemed helpful by those in the Johnson (2009) study. In particular, the participants stated that they appreciated that they were allowed to lead. They also appreciated that the support was tailored to their individual needs, although many of the study participants stated that they felt that there should be more intensive support throughout the process. That said, the participants of the study also stated that a major advantage of supported work schemes is that the ESWs work to find jobs that are tailored for their interests, skills and goals (Johnson, 2009). Chapter 3 – Do These Schemes Lessen Stigmatization, Discrimination and Exclusion? There are a number of barriers to employment for those with mental health issues, and many of these barriers focus upon discrimination, stigmatization and exclusion. Brohan & Thornicroft (2010) state that such discrimination may result when individuals believe that mentally ill people cannot work, that mentally ill people are dangerous and unpredictable, that working is not healthy for those with mental illness and when individuals feel that providing employment for mentally ill individuals is an act of charity. Waghorn & Lloyd (2005) focus on barriers to employment in their study. They state that stigmatization occurs among mental health professionals, the community and employers. The community stigmatizes the mentally ill person because they do not understand individuals with mental illnesses, and are frequently afraid of these individuals. The community withholds opportunities from the mentally ill person, and these persons are not expected to work. When these individuals do not work, this reinforces negative stereotypes about the individuals and also reinforces social exclusion. It also reinforces the belief that mentally ill individuals cannot work because of incapacitation. The mentally ill person also endorses these beliefs, thinking that he or she cannot work. Health professionals and vocational professionals contribute to the stigma, argues Wagnorn & Lloyd (2005). This is when vocational professionals discourage the mentally ill from finding work. They may be reluctant to help an individual with a mental disability. This is particularly true if the individual has a comorbid disorder, such as a physical disorder, a personality disorder, an intellectual disability, a brain injury, or mental illness which is associated with a forensic history (Waghorn & Lloyd, 2005). Further, employers may also have a negative attitude towards the mentally ill. They may be influenced by the community's belief that the mentally ill cannot work, and they may feel that they cannot accommodate a mental illness at their workplace. This may mean that the employer may either not hire an individual with a mental disability, or may not retain or promote such an individual. When a person with a mental illness is hired, they may be treated differently from other employees. This may mean that the other employees will show fear towards this person, may verbally abuse this person, may harass this person or may belittle this person's judgment and abilities (Waghorn & Lloyd, 2005). There is some indication that the problems with discrimination, exclusion and stigmatization persist, even when individuals found their employment through supported employment initiatives of their ilk. For instance, Perkins et al. (1997) states that there were “poor practices” by the employer's staff. These poor practices included being talked down to and being infantalised, which means that these practices were relatively minor. However, these issues were dealt with by informing the supervisors, and training and supervision were the remedies for these practices. This, however, further stigmatized the employee, in that the other staff saw that employee is a “spy.” This was addressed by having collective meetings with the staff group, and the employee was offered support by the supervisor. Other incidents include supervisors not giving work to the mentally ill employee or excluding them. These incidents, however, were addressed in staff groups and through supervision and staff support (Perkins et al., 1997). Other than these few incidents, however, Perkins et al. (1997) stated that there were not significant difficulties. The staff of employer who hired the mentally ill employees were enthusiastic about the project, and the supervisors made efforts to make sure that the mentally ill employee felt at home. Perkins et al. (1997) stated that the decision was made to give the information regarding the employee to the manager and the workplace mentor, and not to the staff, on the theory that singling out the individual to staff as being mentally ill would lead to further stigmatization. That said, Perkins et al. (1997) state that the mentally ill employees are their own best advocates to ward off discrimination. One such example of an employee sticking up for herself was recounted, quoting an employee - “I just asked her to come into the office and said 'What's your problem with me?' She said 'You're one of those users, aren't you?' I just said 'so what? Who can tell what problems any of us have. If you've got a problem with my work then tell me. If not then shut up.' I didn't have any problems with her after that. We get on fine now” (Perkins et al., 1997). Boyce et al. (2008) also conducted a study of individuals who returned to work, supported by different work support programs. Their study consisted of qualitative research regarding 20 participants. Each of these participants received support for work. Some of the participants were apprehensive about returning to work, because they felt that they would be stigmatized because of their illness. Five of the participants, however, chose to disclose their illness to their employees and co-workers. They found that the responses of their employers to be reassuring after disclosure - one stated that she disclosed her illness, and the reaction was one of thanks. Another stated that she felt relaxed and didn't see a problem with disclosure (Boyce et al., 2008). This indicates that, for these employees, stigmatization and discrimination were not problems. That said, five of the participants did not disclose their mental illness, three because they feared losing their job and two because they felt that their personal life should remain private. Regarding job satisfaction, nine of the 20 stated that they were very satisfied with their job. They felt that the employment suited them well and they aspired to develop their career further in the organisation (Boyce et al., 2008). This would seem to be anecdotal evidence that, at least for these participants, discrimination, stigmatization and exclusion were not problems, or else they would not express such satisfaction with their jobs. These individuals felt that they were achieving, expanding their work skills and finding the right balance between work demands and sufficient challenge. Some of the participants also stated that their colleagues, managers and supervisors were supportive. One stated that she could go to her supervisor for anything, another stated that her supervisor was supportive of her mental health issues. Another stated that she goes out with the staff after work for drinks and laughs (Boyce, et al., 2008). What this suggests is that, for these employees, they got along well with co-workers and supervisors, and that, specifically, some of the supervisors were very understanding. This would mean, in turn, that discrimination, exclusion and stigmatization were minimized or non-existent for these employees. That said, the feeling of inclusion and non-discrimination were not universal in this study. Some employees felt like they were belittled, such as the employee who stated that “odd” comments were made to him like “you're not the full shilling” (Boyce et al., 2008). Another individual reported discovering that he was discriminated against on the basis of pay. Specifically, he found that he was making £11,000 for a job that pays £17,000 to another individual who was equally qualified and doing the same job. Another stated that her employer refused to give her any breaks at all, and that she works eight and a half hours a day without a break. However, it was unclear if this was because of discrimination, or because this was how the employer treated everybody. Two other participants stated that they felt isolation, and many of the participants were dissatisfied because their jobs were boring. One employee felt unsupported because of high job demands that often conflicted (Boyce et al., 2008). The data here suggests that discrimination, stigmatization and exclusion were minimized. Even when the participants were dissatisfied with their jobs, they often cited reasons that did not have anything to do with their mental illnesses. For instance, some said that they were bored, one stated that she was unhappy because of the high job demands, and one said that she was unhappy because she did not get a break. These are all aspects which would make anybody unhappy, so they are not indicative of any kind of nefarious discrimination against them because of their illness. That said, the participant who was paid less might have a grievance that he is being discriminated against, and the participant who stated that he was belittled might be another. Still, these are anecdotal. Moreover, there were many positive statements made by the participants in this study. They indicated that they were happy to work because it provided more stability. They also stated that they felt that they were achieving and making contributions. Social contact and financial rewards were other positive aspects. They felt that going to work helped minimize their mental health symptoms, and that being around others helped them feel normal (Boyce et al., 2009). These comments would imply that the positive aspects of employment outweighed any negatives. Perkins et al. (1997) reported similar sentiments among the people that they studied who were employed through supported employment. They stated that the employees were all very positive about the supported work project and all were very thankful for getting the chance to work. One stated that working made him once again feel like a man. Another stated that working makes her happy, and her husband can see that she is happy again. Another stated that she is really doing what she wants to be doing, and was grateful to the service for making it possible. Another stated that he had a reason to get up in the morning. Another stated that her sense of worth had increased phenomenally (Perkins et al., 1997). These responses are all indications that there is not a serious discrimination or exclusion at their work, on the assumption that, if there were, they would not be so happy or effusive with their jobs. Perkins et al. (2010) also state that training and education of the supporting line managers was the key to the mentally ill employees finding gainful employment. They state that, even though the initiatives have a grand goal of finding gainful employment for their clients, these programs can only be strong if the line managers' attitudes and beliefs are accommodating to the employees. They state that they achieved the necessary beliefs and attitudes from the line managers by educating them and building their confidence that they can manage these employees and that they have the capacity for management of these employees (Perkins, et al., 2010). This is strong evidence that these employment initiatives work, because they educate the managers about discriminatory practices and provides them with the confidence necessary to effectively manage the mentally ill employees in their charge. Furthermore, Perkins et al. (2010) state that these initiatives play a large part in combating discrimination, not only because they provide treatment and support, but also because mental health services are major employers of the mentally ill (Perkins et al., 2010). This suggests that the employment initiatives are doing a good job of combating discrimination, stigmatization and exclusion, not only by educating employers and staff about the mentally ill clientele, but also by directly combating discrimination through giving the mentally ill a job. In all, the literature strongly suggests that the employment initiatives which support the mentally ill have been very beneficial to those with mental illness. This is evident through the glowing reports from individuals who got a job through these resources, as well as the fact that, in the Boyce study, there was minimal evidence of actual discrimination based upon the individuals' mental illness. There was, however, good indication that these individuals disclosed their illnesses and found that their supervisors and co-workers were very supportive and did not exclude. There is strong evidence, therefore, that the intensive efforts that those working under these initiatives, on behalf of the mentally ill, is really bearing fruit. Bibliography Boyce, M., Ruskin, A., Seeker, J., Johnson, R., Floyd, M., Grove, B., Schneider, J. (2008) “Mental health service users' expereines of retuning to paid employment.” Available at: http://angliaruskin.openrepository.com/arro/bitstream/10540/113575/1/BOYCE%2520Ret%2520Paid%2520Emp.pdf Brohan, E. & Thornicroft, G. (2010) “Stigma and discrimination of mental health problems: Workplace implications. 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Perkins, R., Rinaldi, M. & Hardisty, J. 2010, “Harnessing the expertise of experience: Increasing access to employment within mental health services for people who have themselves experienced mental health problems,” Diversity in Health and Care, vol. 7, no. 13, pp. 13-21. Roth, G. (2007) The Clubhouse Experience. Ann Arbor, MI: ProQuest Information and Learning Company. Waghorn, G. & Lloyd, C. 2005, “The employment of people with mental illness,” Advances in Mental Health, vol. 4, no. 2, pp. 129-171. Read More