People living with a severe mental illness are very likely to be out of work – the employment rate for the group is thought to be as low as 7%. A pioneering approach is meant to change that but the NHS rollout has been slower than planned, at least in part because of Covid.
Colin Stubbings, 53, of Nottingham, says he was unable to leave his house due to a combination of severe mental health issues, including anxiety and post-traumatic stress disorder.
“I couldn’t even walk into a supermarket; it was as if a barrier had come down,” he explained. “I felt as if I had lost a piece of myself, as if I didn’t know who I was or where I fit in society.”
He, like many others, had to give up any paid work. He claims that he was left at home “staring at four walls, seeing blackness in my head the entire time.”
An estimated 280,000 people in the UK suffer from a severe mental illness, which is defined as a psychological problem that is so debilitating that it severely limits their daily activities. This includes severe depression, schizophrenia, and bipolar disorder.
Many people in that category may not feel prepared for paid work. Others, on the other hand, would like to gradually return to work. According to CQC surveys, more than half of those polled would accept a job if one was offered.
‘Part of their recovery’
“It’s not for everyone,” said Andy Bell, deputy chief executive of the Centre for Mental Health, an independent think tank. “But for many, many people, getting into paid work is part of their recovery while living with mental illness.” The evidence suggests that it can result in significant improvements in both mental and physical health.”
Previously, many people with severe mental illnesses were often purposefully kept out of paid jobs and instead offered volunteer or part-time charity work.
In the 1990s, the United States pioneered a new approach. Individual Placement and Support, or IPS, aims to quickly place people with severe mental illnesses in competitive, paid jobs.
Rather than simply placing someone in a job and walking away, the idea is that the assistance will be provided indefinitely.
Trained specialists meet on a regular basis with both employees and employers to work out any issues, such as removing stressors that could trigger a relapse or negotiating a different type of flexible working.
Importantly, those specialists are integrated directly into clinical teams, frequently sitting in the same room as the doctors and nurses who treat people with severe mental illnesses.
That approach has been slowly gaining traction across the UK over the last decade, funded by a combination of NHS and local council funds.
“In the past, most employment services got you to the front door and that was it,” said Clare Kerrigan of the charity Rethink Mental Illness, which is contracted to run the employment support team in Coventry and Warwickshire. “When people come to us, they feel empowered, have a job that works for them, and are supported in their recovery.” It has a significant impact on their mental health.” It also means that more employers will retain employees, resulting in less government spending.”
According to the team in Coventry and Warwickshire, it is now placing 40% of those referred into paid employment. Nationally, however, the picture is much more mixed.
Access to IPS was supposed to increase to 20,000 people per year by 2020-21, according to the NHS’s latest five-year plan for England, published in July 2019. The actual number referred to was 14,600, well below the target, despite the fact that the pandemic had disrupted the rollout.
According to a 2020 CQC survey of community mental health service users, 43 percent of the 17,601 respondents said they would have liked help finding or keeping a job but did not receive it.
Mr. Bell stated: “There is a patchwork of coverage, and getting access to IPS is often a matter of luck, depending on where you live.
“It’s critical that we don’t stop until we’ve covered the entire country.”
According to NHS England, 27 percent of those admitted to the scheme last year, or approximately 4,000 people, ended up in paid employment. It intends to more than triple the number of people referred by 2023-24 to 55,000.
“We’re really confident that we can make up for what we had to pause in the pandemic,” said Claire Murdoch, NHS England’s national mental health director, “and I think we will go further, faster.”
“Our goal of supporting 55,000 people per year by 2024 is extremely ambitious. However, as a long-term mental health nurse, I understand the importance of assisting people in returning to work as part of their therapeutic choice.”
Colin Stubbings was referred to the local IPS programme by his occupational therapist in Nottingham, and he has now begun working in the NHS itself, first as a cleaner on hospital wards, then as a volunteer helping to administer vaccines. He is now applying for a position as a healthcare assistant.
“There are still days when I’m afraid to go to work,” he admitted. “But as soon as I walk through the front door and step inside, I forget about everything.
“I just go around and talk to people and help them in any way I can. It’s a big change, a difficult change, but a good change.”
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