Mental health special 2/2: a personal account of living and working with a mental health condition
Karen Bester, February 15, 2012
A common mantra in mental health circles is that, with occupational support and a successful treatment plan, people with a mental illness can be productive and dynamic members of a diverse workforce.
This is the view of progressive employers, influenced by the campaigns of charities such as Mind (www.mind.org.uk) and Rethink Mental Illness (www.rethink.org). But what is the reality? Are the effects of mental health problems too entrenched and debilitating to allow sufferers to work to any meaningful extent?
It is impossible to generalise, so I will start with my own story. In 2008, while working full-time for the training department of a voluntary organisation, I had a major mental breakdown. It was far from my first - I have suffered from mental health difficulties since my early teens - but it was the most serious and the most enduring. Even now, three and a half years later, I am still unable to work.
Over the years, I have been diagnosed with various psychiatric problems, but most recently have been deemed to have bipolar affective disorder with psychotic features. Contrary to popular belief, and fuelled by the way reporting and celebrity culture have portrayed bipolar disorder, it is not always about swings between depression and euphoria.
In fact, I use outdated terminology - 'manic depression' - to describe my affliction, as that is the most accurate description of what I often go through. Crippling lows I experience are punctuated by agitation, uncomfortable energy and restlessness, as well as racing thoughts. The 'psychotic features' specified relate to hallucinations and delusions, such as commanding, malevolent voices or beliefs that innocuous objects or images are part of a secret code speaking only to me.
With such manifestations of illness, I am unable to work. But initiatives such as the Lottery-funded 'Time to change' campaign - run by Mind and Rethink - would be quick to point out that this can be managed - and if so, then at least some individuals with a mental health problem can work effectively.
Statistically, with 40% of disability benefits directed towards mental health claimants, according to the CIPD, a sizeable number of people with psychiatric histories are not in employment. A significant number of these, myself included, have been claiming benefits for an extended period, at a cost to both UK business and the economy. This cost extends to the personal realm: an oft-quoted truth of long-term unemployment is that the longer 'worklessness' persists, the less likely an individual is to return to the labour market.
Enter Dame Carol Black and David Frost, a duo of business stalwarts, and their proposals to reform sickness benefits and promote a return-to-work agenda, published last November. Without rehearsing the report's entire findings, one recommendation is that the assessment phase of Employment and Support Allowance (ESA) should be scrapped and replaced by a bespoke assessment, tailored for individual employers.
Handled fairly, this could enable the seriously/acutely ill to more quickly access longer-term support, while avoiding stress and uncertainty. At the same time, a person who is unwell but capable of working can be in touch with support services. An important point of the report is that while a person may not be able to return to a job he or she may previously have held, another position may be suitable. Bespoke assessment, combined with appropriate support, could offer a credible avenue for some to return to work.
I have to sound a note of caution. While many organisations have developed a greater understanding of mental health issues, lack of empathy and stigma remain widespread. If the process is inflexible and places too much emphasis on work and not enough on recovery, it could present a serious problem for the individual, and ultimately the employer.
I won't claim to speak for sufferers across the spectrum, but I know from personal experience that being subjected to medical assessments while having a predisposition to mental distress can lead to serious and acute 'episodes', which can threaten both short- and long-term wellbeing. If the process will not work for the mentally ill, it will fail to meet the needs of employers.
Even if the process is capable of delivering, there may be another problem. Bluntly, are employers ready and willing to take on employees with 'a history'?
Let's take a clichéd scenario. Jo and Joe both have excellent qualifications and experience that suit the role of shift supervisor perfectly. The only difference on paper is that Jo gained her skills prior to a five-year absence from employment, while Joe has no gaps in his CV. Even if Jo presents more agreeably at interview, would you really be willing to take a chance on her?
Under the Equality Act, quizzing a person about their health in advance of employment is illegal. But were an employer to offer a job to someone coming off long-term benefits, it is likely that said person would be sent for an occupational health assessment. If that person turns out to have schizophrenia, this could lead to a bias against them.
There probably isn't a one-size-fits-all soluton. And there will be some people with a mental health difficulty that may never be able to work, so our society must be willing to support them. For those capable of it, though, there are a few simple things an employer could do that would ease the transition back to work.
For example, staff awareness training on mental health may be useful to combat stigma and spread understanding of the fact that mental ill-health isn't uncommon, and that it rarely involves violence.
Flexible working in its many forms is an option to be considered; this could be especially helpful to employees taking vital medication with side-effects.
A manager could have a quiet and confidential meeting with the employee to discuss management of the condition - how colleagues can notice the early signs of an 'episode', for instance, thus ensuring that (where possible) the episode is dealt with before it becomes serious.
Even if an employee did become ill, perhaps being allowed to work with a range of adjustments could be key. For example, can the employee work from home for a while to ease an anxiety condition? Can the employee use email instead of the phone or vice versa? Little things can be a big deal to someone with a mental health problem.
Employers could be making a difference at a macro level if they are willing to employ people with psychiatric problems. Even when a person has a diagnosable condition, being in work will often (not always) help their wellbeing and productivity.
If firms were willing to offer jobs to such people, it is reasonable to predict that, socio-economic concerns aside, this could make a positive difference to many. People with mental health issues are not defined by them. Individual traits, skills and qualifications may vary, but what smart business leaves a potential pool of talent untapped?
Psychiatry and psychotherapy are not exact sciences, but this is why someone with a mental disorder may need an extended absence from work; it gives them time to experiment with the medications and/or therapies that work for them individually. Should they eventually find that magic cocktail that relieves their difficulties, they are no different from someone with a physical health issue.
An illness can creep up on anyone, at any point - regardless of its nature - but with time, understanding and a few adjustments, someone in recovery from a mental health condition can be as worthy an addition to an organisation as anyone else.
I am not well enough to return to work yet, because I am still searching for that elusive combination that enables me to manage my symptoms. But I hope to be able to work again in the future, were someone to give me a chance at that juncture.
The secret to employing a person like me is that there is no secret: we may need support to get back to and stay in work, but the fact that we live with a mental illness does not bring with it a demand to employers to practise some sort of managerial alchemy.
We are ordinary people - with the same levels of intelligence, ambition, qualifications and competence as the general population - living with something much more ordinary than many people realise.
Karen Bester is an award-winning freelance writer focusing mainly on mental health issues. Her personal experience of mental health difficulties has led to a significant level of 'service user' expertise. She believes individuals on the patient's 'side of the couch' can have a voice through writing