Accountant Peter Jones had not worked since he was diagnosed with severe depression four years ago. The former high-flyer felt stigmatised and lost all confidence in his abilities. Whenever he thought about the future, he felt hopeless and was plunged further into despair. But now the 38-year-old has a new job in the City, thanks to a trail-blazing employment scheme set up to support people with severe and enduring mental health problems in finding work.
Under the scheme in south London, mental health service-users have weekly meetings with occupational therapists who work closely with specialist employment coordinators from the local authority. Job opportunities, courses, training and work experience are identified by the vocational staff, who in turn liaise with welfare rights advisers.
The support offers a lifeline to people like Jones (not his real name), who admits he thought he would never work again. "All too often people like him feel they have been written off and are offered a parallel universe, such as a day centre," says Miles Rinaldi, the project's vocational services manager. "The scheme meant there was someone at the end of a phone to help him every step of the way."
Jones is one of the lucky ones: such employment schemes are rare. All too often, people see having a mental health problem as a full-time job in itself. But now the project, at South West London and St George's mental health trust, is being promoted by ministers as a way to improve work prospects for hundreds of thousands of others with mental health difficulties.
While one in four of us is likely to suffer a mental health problem at some point, few realise that a person signed off sick with mental illness has a 50% chance of never working again. Last month, an investigation by the government's Social Exclusion Unit (SEU) spelled out how millions of lives were destroyed by the stigma attached to mental health problems - and revealed that just 21% of people with long-term mental illness were employed, the lowest proportion of any disabled group.
The report of the investigation has given fresh impetus to the government's drive to improve mental health. Ministers have announced that 20 Whitehall departments will work together to ensure that people who suffer mental ill-health enjoy the same chance as anybody else of finding a job, getting education and training and playing a full role in society. A five-year action plan promises that employment advisers will be available to all those with severe mental health problems.
Meeting this target will be a challenge. The report of the SEU's inquiry, Mental Health and Social Exclusion, describes stigma and discrimination as all-pervasive. Researchers found low expectations of what people with mental health problems could achieve and "limited recognition" within the NHS itself that returning to work was associated with better health outcomes.
On top of this, there was a lack of clear responsibility for promoting vocational schemes. Although £140m a year is invested by health and social care in vocational and day services for people with mental health problems, users often fail to receive support to enable them to continue working.
It is support like this that forms an essential part of the employment service run by South West London and St George's, which is likely to become a role model for others. Hundreds of people with mental health problems have been helped back to work, or into training, by two schemes which demonstrate a successful partnership between health and employment workers.
The first of these, the User Employment Programme, was set up in 1995 to find jobs within the trust itself for people with mental health problems. It has helped more than 100 people into work, with roles ranging from administrative work to clinical posts, such as psychologists and nurses.
Four years ago, the trust extended its vocational support to include employment elsewhere, voluntary work, education or training for clients of community mental health teams. Under the Vocational Services Strategy, continuing support is built into care plans, with the focus on individual choice. The results are impressive: in 2002, the trust supported 161 people in open employment, 97 in voluntary work and 182 in mainstream education or training.
"Before we extended the support, 60% of these people were not engaged in any form of work, education or structured activity," says Rinaldi. "After 12 months, this figure decreased to 20%." There are plans to further expand the service, which has links with Job Centre Plus, local colleges, volunteer bureaux, the Connexions service for young people and local employers.
The scheme has made a huge difference to the lives of patients. One person who has benefited is 52-year-old Gerry Stevens. She has schizophrenia. After completing a psychology degree, she saw a job advertisement seeking people with experience of mental illness.
"Until then, I had always lied about my mental illness. I didn't like telling employers there was anything wrong," says Stevens, who lives in Merton, south London. After spending several years working as a domestic at nearby Springfield hospital, she asked staff at the User Employment Project to help her apply for other jobs. She is now training to be a registered mental health nurse.
"I knew I could offer more," says Stevens. "But it took a long time to get where I am today. People from the user employment project were very helpful and supported me during difficult interviews. Now I'm open about my condition and I am very happy. I have got status, identity and money."
Employment is critical to this enhanced sense of self-worth. "The worst thing you can do to someone psychologically is to cut off the opportunity to do something meaningful with their lives," says Geoff Shepherd, director of partnerships at Cambridgeshire and Peterborough mental health trust and professor of health services research at the Institute of Psychiatry.
However, there is much prejudice, particularly among employers, says Shepherd. "They think people with mental health problems are at best unreliable and at worst dangerous." The problem of prejudice was reflected during research for this article: most people who found jobs were prepared to talk about their experience only if their names were withheld or changed.
Shepherd, who has set up a multi-agency group to meet vocational needs, says there is no single solution. "Placement and support in open employment is a good solution for some people," he says. "It helps employers and employees get to know one another -but it's not for everyone. Some might want to work for a social firm or in sheltered workshops, or access training or education."
Whether the government's action plan will achieve this is open to question. Shepherd believes that employment targets need to be set for mental health trusts and that employment or training outcomes need to be built into the service commissioning process.
His views are shared by Bob Grove, director of the employment programme at the Sainsbury Centre for Mental Health, who thinks there will be little progress unless the SEU's report is integrated into the national service framework (NSF) for mental health.
"The message from the NSF is 'safe, sound and supported'. That is not a recipe for living a life," Grove says. "This is an opportunity to have a rethink of mental health services, which are centred on dealing with people's crises. At the same time, there needs to be a shift in emphasis among mental health professionals to make social integration a priority. Until these things happen, no one will do anything."
Support was the measure of success
Four years ago, Simon Regan would wake with a feeling of dread. Paralysed by inertia, he could hardly rouse himself from bed. Whenever he considered his future, he could foresee only long periods of mental illness punctuated by spells in hospital.
Today he is a confident, articulate 28-year-old who works part-time in a busy bar in west London. The change is remarkable and Regan (not his real name) says the turnaround is thanks to support from staff working for South London and St George's mental health trust's employment service.
"They've helped me sort my life experiences and use it to my best advantage," he says. "Without them I could never have written a letter in support of an application. I've never worked. I did my A-levels and was doing an undergraduate course when I had a breakdown and went into a hospital. I had a long period of illness until I got to a point where I thought I had to piece my life together."
Regan hopes eventually to get a job in social services or within the NHS. He believes his current job will show how he can be punctual, reliable and responsible.
"It is fantastic to be given a chance," he says. "I know that I have my family and the employment team behind me. I feel as if I am three-quarters there to an independent existence." Linda Jackson
