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The discussion about work and mental health is anything but cause for celebration for people with long term mental health needs

Mark Brown

Mark BrownThe theme of World Mental Health Day, October 10th, this year is mental health in the workplace.  This will be a cue for mental health charities to roll out their advice to to employers and for employers to pat themselves on the back for their acceptance of those with mental health difficulties.  However, for those with long term mental health needs the whole question of mental health and work is a seething bed of political and practical discomforts, terrors and worries that often drown our dreams, aspirations and hopes. 

As an issue, mental health and employment has long bubbled underneath other arguments and debates around mental health; with discussion swinging from being one of liberation to one of oppression depending on where you stand and with whom you are conversing. As NSUN’s Sarah Yiannoullou says; the issue of mental health and work has uncomfortable contradictions for those of with more long lasting and life impacting mental health difficulties. Current discussions about work and mental health take place under a cloud of fear and distrust created by an increasingly punitive social security system that has shifted many who had expected to receive disability benefits for life into an increasingly labyrinthine system of back-to-work schemes and obligations.

According to the Trade Union Congress, less than half (45.5 percent) of disabled people with health problems lasting or expected to last more than one year who had depression and anxiety as their main health problem, were in work in 2016.  For disabled people experiencing long term mental illness or phobias as their primary, or most significant, health issue, only just over a quarter (26.2%) were in work in the same year. 

How did we get here?

Current ‘back to work’ policy is all stick and no carrot.  Based on the flawed assumption that all that people need is to change to a more positive attitude to gain employment; successive rounds of social security reform have tried to nudge people closer to work by reducing entitlement to benefits. Making life harder on benefits, the logic goes, will make people find inner reserves of energy and gumption and make them keener to step back into the world of work.  This does not help people with long term mental health needs.

In the past if you were unlucky enough to experience a period of mental health difficulty that was it: you were out. Mental health difficulty and work were considered to be two mutually exclusive worlds. Time off to sort out stuff going on in your head? The gates of the factory shut behind you; the office door hit you on the arse on the way out.  Wandering out into the pale sunlight of the street, numb and blinking you wondered ‘what the hell do I do with the rest of my life?’ 

The wider disability movement has long campaigned for the closing of the disability employment gap; seeing that legal and political pressure to prevent disabled people being closed out of the labour market would lead to liberation from paternalism and would put people with disabilities back in control of their destinies.  From the 1980s onwards successive governments have tried to increase the amounts of people with disabilities at work, providing financial and other support to level the playing field and to reduce the prejudice of employers against disabled workers. 

From the mid 2000s onwards attitudes towards benefits claimants began to harden and ‘scrounger’ rhetoric became more prevalent.  Some within successive Labour governments of the time were uncomfortable with the amount of people claiming out-of-work benefits feeling that this encouraged a lack of personal responsibility. In 2008 Dame Carol Black’s Review Working for a Healthier Tomorrow concluded that there was a positive link between being in work and being healthier, observing that “While around 55% of those coming onto incapacity benefits came either from work or a period of sickness absence from work, a further 28% were claiming Jobseeker’s Allowance or Income Support immediately prior to claiming incapacity benefits.”  From this it was concluded that the aim should be to keep people in work and to, where possible, limit the amount of time people spent on benefits. The review stated that “over 200,000 people with mental health conditions have flowed onto incapacity benefits each year over the last decade,” which the review identified as “an historical failure of healthcare and employment support for the workless in Britain.”  Dame Black recommended that occupational health should be expanded and that more support should be given to people to return to employment.  This for many who have campaigned against the current benefits system was seen as a turning point in attitudes toward those with mental health difficulties claiming benefits.  The roll out of a new benefit Employment Support Allowance, designed to replace Incapacity Benefit, Income Support for illness or disability and Severe Disablement Allowance began the same year. This introduced the dreaded Work Capability Assessment. From a policy perspective the WCA was assessing how able to work a person was.  In practice it is a ruling about how much they are  entitled to in benefits and what they are obligated to do in return for those benefits. 

The arrival of the coalition government accelerated the programme of welfare reform under the zealous championing of Secretary of State for Work and Pensions Iain Duncan Smith. The policy of Austerity, which dictated that the country must ‘live within its means’, led to a focus on reducing public spending. Working age benefits were a prime target for this; despite the fact that Duncan Smith’s various benefits schemes often ran vastly over budget and did not actually deliver many savings.  This made it impossible for many to separate the issue of returning to work from the increasingly difficult experience of making ends meet on an ever-reduced entitlement to benefits.  Getting more people with mental health difficulties into jobs became inseparable from the experience of foodbanks, intrusive assessments and benefit sanctions.

People who don't have jobs don’t control the labour market

People who do not have jobs do not control the labour market.  Mental health difficulty can be a multiplier of exclusion.The colour of your skin can affect your chances of getting the jobSo can whether you can access child careSo can where you live. The TUC lays some of the blame for the lack of people with mental health difficulties in work at the door of workplaces that are not prepared to make reason adjustments so that people with long term mental health needs might work.

According to the government: “Employers must make reasonable adjustments to make sure workers with disabilities or physical or mental health conditions, aren’t substantially disadvantaged when doing their jobs.” This they state is true for all workers, “including trainees, apprentices, contract workers and business partners.”

In theory, employers have a duty to look after the wellbeing of all of their staff.  This includes minimising unnecessary stresses in the workplace.  Individual workers often have very little power to make sure that this legal duty is observed and it can be especially difficult where you might need reasonable adjustments to be made to ensure that you are not put at a disadvantage by your mental health needs.

A bad job is worse than no job

The notion that any job is better than no job has long been challenged by people with mental health needs.  Michael Marmot’s work around health inequalities has consistently found that bad work impacts health negatively. Giving the example of Alan, who worked as a picker in an online warehouse, in a 2016 lecture, Marmot said:  "Added to the heavy physical demands, Alan's work was characterised by high demand with no control over the work task, by high effort and little reward, by social isolation at work, by job insecurity, by organisational injustice, and by shift work  each of which has been shown to damage health. It was as if his employers had taken everything we know about damaging aspects of work, concentrated them in a syringe and injected them into Alan.”

A University of Manchester study published in August found that a bad job was worse for your health than being unemployed.  Of a study of 1000 people aged 35 to 75 who were unemployed during 2009 and 2010, they found those that took “poor quality work” higher chronic stress than those who remained unemployed and elevated risks for a range of health problems, compared to adults who remained unemployed.  Those who took better jobs had better mental health.  Tarani Chandola, lead author of the paper and professor of medical sociology said: “Job quality cannot be disregarded from the employment success of the unemployed.  Just as good work is good for health, we must also remember poor quality work can be detrimental for health.” 

This idea that bad work can do you harm confirms what many people with long term mental health difficulties feel: the right job with the right support at the right time is the important thing.  Being forced into a job too soon, one that is too stressful or not suited to you is likely to be counter productive, even disastrous, especially when just such a change might end entitlement to benefits that take a long time to claim; or might have been changed by your act of ‘signing off’.  For some, the experience of losing their job and the subsequent loss of status is inseparable from their experience of worsening mental health need.

The logic of austerity and the idea that any job, or enforced volunteering, was better than no job was mostly accepted by the major mental health charities.  Grassroots organisations like Disabled People Against Cuts, the independent activists behind various Spartacus Reports, Mental Health Resistance Network and Black Triangle sprang up to hold the government to account.  The major mental health charities were seen to have accepted that there could be no increase in support for people with mental health difficulties looking to get into paid employment without accepting an increasingly draconian benefits system.

Fear and loathing

While the shift in attitudes to people with more severe mental health experiences is often lauded from on high; in practice the changes haven’t been quite as great as some would maintain. 

According to a report published by Business in the Community this month, 15% of employees that disclosed a mental health issue faced disciplinary procedures, demotion or dismissal.  It is possible that for many people with mental health difficulties this total was higher in the past. 

In 2015, Public Health England commissioned a number of mental health questions to be included in NatCen’s British Social Attitudes survey. They create two fictional people, Andy who was paranoid and heard voices and had withdrawn from work and social life, and Stephen who was experiencing lack of joy in his life and was struggling to get through the day. The first was intended to convey a schizophrenia diagnosis and the second a diagnosis of depression.  Andy, described in a way that suggested what might be diagnosed as schizophrenia or psychosis didn’t fare well. 55 per cent wouldn’t want him next door, 45 percent wouldn’t socialise with him, though 39 percent would make friends with him. 44 per cent wouldn’t like Andy as a work mate. Even more calamitously for Andy, who was described as thinking people were talking about him behind his back and criticising him, 73 percent of people would be iffy about him marrying into their family and 90 per cent of people said they wouldn’t be comfortable with him babysitting.  That’s nearly half of the people who were surveyed wouldn’t want someone with a more severe mental health experience in their workplace, confirming the worries of some about the workplace being another place where stigma and bullying may take place.

People with mental health difficulties within the benefits system are increasingly subject to psychologically informed programmes that are not, in themselves treatments but ‘interventions’. Lynne Friedli and Robert Stern flagged up the growth of ‘psychological conditionality’; the “the requirement to demonstrate certain attitudes or attributes in order to receive benefits or other support, notably food.”  The use of ‘nudges’ and other psychological manipulations appear to have become rooted in the free-for- all to replace the Work Programme, which itself proved costly and ineffective - “Of 165,860 people with ‘Mental and Behavioural Disorders’ placed on the Work Programme, 14,720 have been supported into employment (8.9 per cent)”  - failing in its only objective:  getting people into jobs. 

A decade of destroyed trust

Discussions around mental health and work often walk into a political minefield where anything in our own story that is positive may be co-opted and used to justify more punitive actions against other people not so lucky as us.  People are afraid to have work aspirations in case they are used against them as a way to reduce their entitlement to benefits. Coercion has replaced encouragement and sanction has replace support. Most of us long for an end to financial insecurity. Many of us would love to find an occupation that values us and despair that we will ever be free enough to secure it. The last decade has destroyed trust between people with long term mental health needs and people who are available to provide support into work. 

It is in this toxic environment of coercion, austerity and desperation that discussions about work and mental health are trapped.  It is true that far too few of us who have long term mental health needs are currently in good jobs that bring us financial security and a sense of achievement.  It’s true that too many of us are financially desperate; clinging onto what is left of our benefits while prices rise around us. It’s also true many of us live in dread of a brown envelope dropping onto the doormat; calling us to another humiliating interaction with the Department for Work and Pensions. 

On world mental health day, for those of us with ongoing mental health needs, the question of work and mental health is anything but shiny and cause for celebration. It will remain so until we feel safe to voice our hopes for work without the threat of fear and loathing turning our words and dreams against us and the people we care about.


Mark Brown is @markoneinfour on twitter.

10 October 2017




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