Gaining insight from experience: What are service users saying about employment? 


Mark Bertram and Peter Linnett


Context 

The benefits of employment for people using mental health services are now widely documented, but there is little agreement on the terms or concepts, who should be providing it, how, what works best and who for?  The most valuable source of evidence into what is most helpful comes from the experiential insights of service users (Faulkner and Layzell, 2000).  The challenge for providers is how to gather  these insights, and then how to turn them into services. 

Having listened to people using local mental health services talk about their experiences of trying to get into work, we felt the need for an event that would give them a chance to express their views.  It was vital to adopt a user-led approach, so we worked in partnership with two local user groups and a service user-led research project.  Together we organised a ‘Work Opportunities Day’, and invited all local service users and service providers.  The event was held at a day centre and about 70 service users attended.  The day started with a well-attended morning information session with local providers.  After lunch, the providers left and the afternoon was devoted to exploring three questions in user-facilitated focus groups.  To gain an accurate picture we asked questions we feel are relevant to any locality.

Question 1: What do you think of services offering work and training locally? 

People said that there is not enough accessible information and advice:  ‘There is no clear, well-advertised way of informing us of the opportunities available’.   Consequently it is pure chance where people end up.  It is clear that information distribution needs to be co-ordinated by one agency.  People will not even begin to embark on an ‘employment journey’ if they don’t know where to start. 

Claiming benefits was a source of stress and anxiety, often acting as a major obstacle:  ‘There is a fear amongst users that if we demonstrate our abilities to study or work, our benefits will be affected.  Some have come under pressure by having to attend medical tribunals to prove their incapacity – leading to further breakdowns’.   The system is rigid and inflexible, and does not take into account people’s individual circumstances. Based on the experiences of service users, the new system needs a complete overhaul.   

The local adult education service was valued, but people requested ‘access to a greater range of courses’.  Currently there are 22 Return to Learning courses, with plans for bridging classes into mainstream education.  The local college also provides an open access walk-in support and enrolment group. 

Participants identified the role of health care staff and their practice as a vital determinant of whether people get an opportunity:  ‘Work should be an integral part of any care plan – not an afterthought’.  

As well as being a priority, work opportunities need to be individualised:  ‘The abilities of users and survivors can vary from person to person and from time to time.  Many of the employment opportunities available do not take account of this’.  Many opportunities are entry-level, and come under the umbrella of ‘the four Fs’ (Parkes and Downer, 2001) - food, flowers, folding and filth:  ‘The kind of work offered does not take into account our considerable and varying skills’.    

People emphasised the importance of recognising differences in race, age and gender regarding employment:  'I believe a one-size-fits-all policy should be avoided'.  Some older participants highlighted the problems they face:  'Hard to get jobs at older age'.

Question 2: What new services would be most helpful?

To some people, 'Having a job' was what mattered, not servicesAs a path to employment, access to voluntary work was also valued.  However, serious obstacles were identified:  'A lack of understanding of mental distress by many employers, who think such people are also unintelligent and untrustworthy.  They need mental health awareness training, to enable them to employ people – especially large companies'. 

Several positive comments showed that aspects of some current services are valued, but there were calls for better communication between them and changes to the way they work:  'Sort out the old services before we think of anything new'.