Mental health special 2/2: a personal account of living and working with a mental health condition

Karen Bester , 15 Feb 2012

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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In fact, I use outdated terminology - 'manic depression' - to describe my affliction, as that is the most accurate description of what I often go through.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


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Managing mental ill-health

Peter Marno 15 Feb 2012

This an excellent 'insider' article - but it will be scary to some employers. The majority of mental ill-health issues at work are no more serious than those with musculoskeletal conditions - short term and relatively easily handled. Karen mentions the issue of needing to react when a condition becomes acute and this is where good employers score well - they have trained staff who know what to do and work both with the employee and their line manager. The key word is 'trained'. Managers, themselves, shouldn't become diagnosticians but they should know who to turn to. Good employers have the correct 'health management tools' to best manage their employees.

Happy and Frustrated

Kevin Friery 15 Feb 2012

Great article, Karen - although I wouldn't expect anything less from you. You write with a clarity that helps people get under the skin of the problems you talk about. As someone who works extensively with employers around mental health I have to agree - there are some that 'get it' and others that don't. There are, on an individual basis, employers striving hard to achieve the level of engagement you talk about but there are others who place it all in the 'too difficult' box and leave it alone. The irony is, for anybody reading your various writings, you clearly demonstrate the value to employers of engaging with people with mental health problems. You should not be unemployed - that is a criticism of our social structures, not of you.

great article

Donna Kelly 15 Feb 2012

Well done Karen on this article, i think employers need to be educated on the small things they can do to help individuals healthy in work and support them and I think your sentence 'The secret to employing a person like me is that there is no secret' is key to this. We do help employers out at hf mind and individuals who are struggling at work and I think it is great to hear your points and the road to recovery in regards to employment. Keep up the valuable writing as you are giving employers and professionals a great insight into personal experience,which is crucial.

Clarity of Thought

Paul Winkler 15 Feb 2012

I congratulate Karen on her retained (or regained) ability to express ideas in such a straightfoward manner. I too am unable to work; for a much longer timeframe, I fear. If I could analyse these issues and express myself as succinctly, I think a return to work might be in the cards for me. Great article; thanks!

Thank You

Karen Bester 15 Feb 2012

Thank you all so much for the positive feedback; I'm glad the article has been of use to people. I completely concur with Peter that training is key to supportive work environments for people living with a mental health condition. At least in some quarters, there is still a dangerous public perception about mental ill health - that sufferers are odd, anti-social, even violent. Decent staff development procedures and courses could mitigate a lot of that, leading not only to less discrimination and a more pleasant work environment, but also to a better understanding of mental illness at a wider, societal level. Donna and Gary - writing has been a blessing for me in terms of recovery. In and of itself, of course, it's not a cure - but a lot of catharsis is derived from getting what swirls around in one's mind out into the written word. It's an adjunctive form of therapy, perhaps, and I also believe strongly that speaking out publicly about this type of thing is key in battling stigma. The problem is that there is such a variance in one's condition when living with a mental health problem - some days writing coherently (or at all!) simply can't be done. Nevertheless, I'm really glad that this article seems to have been of use. Let's just hope that one day, measures such as those discussed can be standard practice in all workplaces. Thank you all again. Best wishes Karen

Excellent article

Rene Delain (cpn and relationship coach) 16 Feb 2012

Unfortunately there is still a lot of ignorance in the corporate world about mental illness. People are still seen as 'the illness' rather than the talented person with great skills to offer. Hopefully, the more the public is educated and publicity enhanced to support, the less stigmatisation there will be. Well done to you.


Debbie Handley 16 Feb 2012

After reading this article, I myself understand how a breakdown can affect all lives, mine included. A good G.P, lots of encougagement and help from others can be benificial, but mosstly you need to understand what has happened to you before you can move forward. No one should give up on themselves, read lots about it to understand your condition. One small step at a time and yes, two years on and i'm finally getting there!

Bespoke assessment

Phil Groom 17 Feb 2012

"Bespoke assessment, combined with appropriate support" — that's the key, I think; but how many employers are willing to turn it? Based on my experience, most employers simply don't want people with 'problems', they want people who can just get on with the job with minimal support...

Better understanding and support structures

Danny Granger 19 Feb 2012

Karen what a fantastic piece of writing and having the ability to bring realism into mental health, you've talked about training for employer's but sadly one of the major area's of concern is our own GP's to who we place our trust they themselves have a very limited knowledge of mental illness and all to often their answer is to prescribe anti-depressants rather than a referal to phycotherapy or psychiatry at an early stage where intervention and mental heath support through various vehicles such as a psychiatric unit/day unit, CMHT,CPN,mind etc could prove crucial to getting an early diagnosis and treatment.

well done

Jennifer 24 Feb 2012

I agree wholeheartedly with Rene Delain..that's an excellent article Karen.!!

In this issue: September 2015
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Out and proud: John Browne on inclusive workplaces

Retirement planning: Shake up your pensions strategy

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