Employment and people with serious mental illness: What can Nigeria government learn
BY OLUSEYI ELIZABETH ODUDIMU
Employment and high income can improve the clinical condition, recovery, quality of life and enhance the social inclusion of people with severe mental illness. However, in the global statistics of the labour force, participation of people with severe mental illness is still very low and this is because many employers have fears and concerns to employ people with serious mental illness base on unpredictable behaviour that usually harms productivity, reduce services speed in workplace and employees relationship performance within the work environment, likewise people with mental illness are really afraid to take more demanding responsibilities at work due to fear of being discriminated or inability to cope with underlying stress and uncertainty about their benefit. (Papakonstantinou, 2018 ;Fleming,2019) . However, in a 2002 report, employees living with depression took 109.7 million days off at work which causes overloaded weight for colleagues, replacements at work and negative economic impact (Papakonstantinou, 2018). Due to stigma and belief that organisations are at significant risk when they employ people with mental illness, 7 in 10 people may likely remain unemployed. However, many studies suggest that the UK government should implement Individual Placement and Support (IPS) which was founded by American researcher Papakonstantinou, (2018) as the most potential employment integration for young adults with psychotic illnesses as a system that supports disabled to maintain a job for a longer period.
2. Analysis of the quantitative and qualitative data……………………………………………5
2.1 Experiences of Black and Minority Ethnic Groups and white British……………………6
2.2 Exploring through the framework to support people with serious mental illness maintain employment……………………………………………………………………………….7
2.3 Mixed data on the recommended Individual Placement and Support (IPS)………..9
2.4 Statistics to show the prevalence of mental illness in the UK……………………………..11
2.5 Data how people many affected are with mental illness and employment in the UK………………………………………………………………………………………………………………………12
2. 6 Gender comparison of unemployment and employment rate……………………………13
3. Policies analysis………………………………………………………………………………………………….14
5. Reference list…………………………………………………………………………………………..17
Issue of employment and people with mental illness is a major concern in the United Kingdom. By and large, in this report, there will be a representation of different data to distinguish the paramount response to the employment needs of people with serious mental illness. It will go further to investigate the experiences of an ethnics minority group, gather statistics to compare men and women and find out how mental health professionals and government has been responding to tackle social inequalities, negative attitudes, and devalued roles in employment and psychotherapeutics treatment challenges preventing people with mental illness from achieving their right. Finally, it will explore the right framework that can be used to tackle unemployment amidst people with severe mental illness.
2. Analysis of the Quantitative and Qualitative data
Islam et al., (2015) found various service users from BMEGhighlighting that majority of the (GPs) do not usually pay attention to the concerns or crisis information the carers give, which usually causes delayed to suitable services and reliance on family or friends who have no idea of the required support to manage mental illness and in most cases, service users exaggerates or involve the police before they can have access to mental health facilities. Culture and beliefs are the major help-seeking barrier, many BMEG service users perceived the onset of mental illness as a positive encounter with God or a negative encounter of being under the influence of supernatural forces or black magic. This cultural belief prompted the proposal of seeking help from faith and spiritual healers rather than seeking professional help (Islam et al., 2015). On the other side clinicians remarkably emphasise on BME inability to seek help directly from mental health professionals, religion or cultural belief that adequate therapy and treatment can only be given by the spiritual leaders, which is the major reason their condition gets critical before they seek help and with involvement of police in most cases, which is as a result of mistrust of services. Howe et al., (2014) semi-structured interview with three male and four female schizophrenic patients, originally British and the result indicates that fear of being diagnosed, stigma and language used by professionals may cause lack of understanding and delayed treatment. Findings suggest that mental health professionals are not giving the service users and carers adequate support and required services to help them stay in a long time job and this is because the resources are not measurable enough, which usually causes delay to their recovery and career progress.
2. 1 Experiences of Black Minority Ethnic Groups and White British
‘if your family and friends around you don’t know what to do and you’re relying on them, to try and support you, it’s really difficult, because, I mean they didn’t know what to do . . . if they . . . haven’t got any professional help for it, you’re stuck ‘. . . . (V15, female)
“. . . I’m a grateful person and a very lucky person because to go through what I went through it goes to show that I’m in God’s memory, God hasn’t forgotten me you know” (SU20, British Pakistani, male).
‘I think they . . . some of the African Caribbean community . . . [take] a very rational view that Mental Health Services are punitive, they’re sectioning a lot of them . . . isn’t that the cycle was, therefore, people don’t come forward until they’re at their most critical stages. Therefore when they do come forward it’s likely to be the Police bringing them in, . . half of the admissions for African Caribbean males is by the Police, . . . it just goes to prove that’s what Mental Health systems do for you. And if you’re an African Caribbean man you don’t go anywhere near them . . . so it’s breaking that. (COM4)’ (Islam et al., 2015)
‘You can tell anybody you’ve got bipolar [disorder], it used to be called manic depression; they just say “oh you’re just depressed”… I think schizophrenia is a unique thing on its own because it’s always associated with violence, which breaks my heart. It’s always associated with violence’ (Carol).
2. 2 Exploring through the framework, to support people with serious mental illness maintain employment
Globally, Employment and Support Allowance (ESA) is a well-known strategy used by the government to improve the employment of the disabled. However, Grover and Piggott, (2010) disagreed with the structural design of Employment and Support Allowance (ESA) as a scheme to develop disabled human capital. Grover and Piggott, (2010) consider (ESA) as indirect discrimination against the disabled or a policy practically paying the incapable people out of work and emphasise secured paid employment and adequate support to sustain it can positively impact the economy. Piggott and Grover, (2013) study draw attention to the promotion of employment programmes for disabled people in the United Kingdom as a scheme that can benefit those that are ready to work and suggest an incentive structure that will primarily favour all groups of people with mental and physical disability and that if UK government did not replace(ESA) with a contractual approach to keep disabled people in full-time employment, there is the possibility that the labour markets will fall, the economy will decline and the country will slump into poverty. It can be argued that Employment and Support Allowance weaken disabled employees to cope with normal employment stress and encourage longer attachment to benefits. On the other side, the UK government can be justified on the account of keeping the economy stable by fighting poverty and inequalities and protecting the disabled against market susceptibility.
Social Cognitive Career Theory (SCCT) is an interconnected theory established to restructure and improve the career procedure of people with disabilities (William, et al 2016). William, et al., (2016) SCCT framework use personality characteristics such as cognitive processes, learning experiences, cultural background, and the impact of a disability to test their success while working with the SE program and staff. William, et al (2016)study did not comply with the suggestion of Social Cognitive Career Theory (SCCT), the study found it unpredictable and may not be constructive in competitive employment in SE for people with disabilities. Lack of experience and incapability to weigh up personal performances and long time work history and the few participants who seem socially strengthen may not get employed due to social inequalities, negative attitudes, and devalued roles. However, the present study recommends existing SEas as the most efficient support that helps people with mental illness get employed.
2. 3 Mixed data on the recommended Individual Placement and Support (IPS)
Fleming, et al.,(2019) studies explore the effects of Mental health professional rehabilitation, actions and strategies in helping people with mental illness get valued roles with Individual Placement and Support (IPS) in Alabama and also investigate if (IPS) can facilitate vocational progress and recovery. Supported employment is a Vocational Rehabilitation arrangement used in guarding people with significant disabilities to get dynamic work. Among professionals providing Individual Placement and Support (IPS), 23% were found in a full-time job, 45% in part-time jobs and many of them stay in employment for 35 years. Only 1 of them reported 400 clients on the current caseload while an average of them reported 31 clients on the current caseload. 54% of the patients discussed 50% of their career with their caseload while 46% discussed 75%–100% of their career with caseload (Fleming, et el.,2019). Investigation of challenges and successes found 48% of employment specialists who described clients as their major concerns and clarified apprehension about their disability benefits, doubt of getting a job, inability to proceed with the treatment plan and lack of enthusiasm to follow up with employment specialist after referral as some of the problems the service users face. In comparison, 22% from the client group underline the employment specialist as the major problem and their difficult encounter with transport, fewer jobs, referral problems, access issues and services delayed as the main hindrances discouraging them from proceeding with the intervention (Fleming, et al.,2019). Fleming, et al., (2019) found IPS as an evidence-based rehabilitation system that can uphold people with serious mental illness gain positive outcomes in employment. IPS model has successively supported many people with mental illness to acquire exclusive requirements and skills to obtain jobs that suit their interests. Nevertheless, lack of sufficient financial support from the government and services users prevented the mental health professionals from meeting the mental illness job seekers effective needs on IPS and lack of acceptance by employers into the labour market. Mental health professionals place a high value on economically integrated employment of people with mental illness and the practice supported many gain employment are found preventing the manifestation of IPS.
2. 4 Statistics to show the prevalence of mental illness in the UK
(Mental Health Foundation, 2016)
Among the adults who thought of being diagnosed with mental illness in their lifetime are 51.2% of women and 35.2% of men. The professionals were able to established diagnoses of 33.7% women and 19.5% of men. Anxiety or depression is the common diagnosis and the data shows that is common in women 22.5% and lesser in men 16.8% (Mental Health Foundation, 2016)
2. 5 Data how many people affected with mental illness and employment in the UK
Tarrier et al, (2007) found of 35 people with the first episode of psychosis, 77%being distressed with the kind of treatment they get and this interfered with their life. 60% encounter instinctive hospitalization which slows down their future ambition, along with 53% that had suffered stigma and 50% are faced with exclusion from society. When compare with NHS, (2017)report of 13% incidents of unpleasant safety of patients with mental disorder and additional CQC, (2017)) report of 40% of inadequacy in services about force or threats in practice. In 2014, people with Common Mental Disorder using treatment increased and research found 45% using both medication and counselling 35% on Counselling or therapy only 29%Medication. it shows that between 2007 to 2017, NHS services are improving in meeting mental health needs. However, to meet the required provision of necessary and specific measures to accelerate intervention, the clinical practice may need to involve in anti-stigma campaigns, as this will enhance help-seeking behaviours.
(Tarrier et al., 2007)
2. 6 Gender comparison of unemployment and employment rate.
A higher rate of unemployment was found among people with ADHD, which shows unemployment 14.6% for men and 14.5% for women. On the other side, 7.3% of men and 6.7% of women remained in employment (McManus et el.,2016)
(McManus et el.,2016)
3. Policies analysis
To maintain protection and maintain benefit equality, UNC, (2006) set forth a law that includes deeds and obligations for the society to make various instruments available for people with disabilities, to improve their sense of belonging and ensure they are save from violations of their human rights. Equality and Human Rights Commission,(2010) put in place legal protection against discrimination and equalize job opportunities between men and women irrespective of their disability, require employers to provide people with serious mental illnesses reasonable personalized job duties, support, training or supervision that can enhance them the ability to carry out their essential productivity at work. Even though it is only 15% of employers reported negative experience, there is a report of 6.3% of employees with a serious mental illness been fired, 3.1% being refused employment which shows less protection in law and career development ( Baldwin &Marcus,2006). In an attempt to tackle disability unemployment, the UK government introduced Employment and Support Allowance in 2008; an aid that supports disabled people to work less and get support from the government (Grover and Piggott 2010). Many studies found it unjustifiable to cut disabled out of paid work and entrap them with ESA as studies suggest that the policy put the disabled in a disadvantaged position, denied them the ability to pursue a higher-level career which can provide them with the opportunity to get high salaries and access to substantial occupational sick pay and pensions. Women have the highest rates of mental illness and are likely found unemployed. Human Rights Act, (1998) upholds good practice and safeguards the patients while accessing adult acute mental health. Equality Act, (2010) incorporates a well-establish and effective legal protection strategy to promote the interest of people with mental illness in employment and treatment intervention. Department of Health and Social Care, (2018) mental health policies focus on a framework to improve women treatment interventions. Despite there is evidence of treatment inequalities, low treatment rates are found in the Black British group, while white British favour the female from the age of 35 to 54 and decrease in unemployment rates of people with mental illness (McManus et el., 2016)
This report specifically examines several academics pieces of writing to identify a wide range of frameworks that can enhance easy access to adequate support to retain people with mental illness in employment. There is a need for mental health services in the United Kingdom to include a holistic approach and person-centred care in their treatment and intervention with fundamental changes in the workplace culture, access and experience of services. This report recommends further research on appropriate Individual Employment Support, how it can be combined with accessible mental health services to promote applicable and excellent fairer treatment for persons with mental illness and people of all races in the workplace. Low mental wellbeing and intellectual impairment are associated with higher rates of chronic physical conditions and dependent on Employment and Support Allowance.
- Berzins et al (2018) ‘A cross-sectional survey of mental health service users’, carers’ and professionals’ priorities for patient safety in the United Kingdom’, Health Expectations, 21 (6), pp. 1085-1094
- Brouwers, E. P. M.. (2020) ‘Social stigma is an underestimated contributing factor to unemployment in people with mental illness or mental health issues: position paper and future directions’, BMC Psychol (8), pp36, DOI:10.1186/s40359-020-00399-0
- Care Quality Commission (2017) The state of care in mental health services 2014 to 2017. Available from: http://www.cqc.org.uk/sites/default/ files/20170720_stateofmh_report.pdf (Accessed on May 23 2020).
- Baldwin, M.L. & Marcus, S.C. (2006) Perceived and measured stigma among workers with serious mental illness. Psychiatric Services (57) 38892.
- Depart Of Health and Social Care (2018), The Women’s Mental Health Taskforce[Online Resource]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/765821/The_Womens_Mental_Health_Taskforce_-_final_report1.pdf [Accessed on o1 May 2020].
- Equality and Human Rights Commission (2010) Services, Public Functions and Associations Statutory Code of Practice. Great Britain. Stationery Office Publisher.
- Equality and Human Rights Commission (2010). Equality Act 2010 Statutory Code of Practice. Available from: https://Employment www.equalityhumanrights.com/ [Accessed on 10 April 2019].
- Howe et al 2014 ‘‘Schizophrenia is a dirty word’: service users’ experiences of receiving a diagnosis of schizophrenia’, The Psychiatric Bulletin, 38(4), pp.154-158. DOI: https://doi.org/10.1192/pb.bp.113.045179
- Legislation.gov.uk ( 2011). Human Rights Act 1998. Available from: https://www.legislation.gov.uk/ukpga/1998/42/section/11 [Accessed on May 2019].
- Legislation.gov.uk( 2011) . Equality Act 2010. [online]. Available from: https://www.legislation.gov.uk/ukpga/2010/15/section/39 [Accessed on 25 May 2019].
- Mental Health Foundation (2016) Fundamental Facts About Mental Health. Available from: https://www.mentalhealth.org.uk/sites/default/files/fundamental-facts-about-mental-health-2016.pdf [Accessed on 29 May 2020].
- McManus S, et el.,(2016) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. . Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/556596/apms-2014-full-rpt.pdf [Accessed on 29 May 2020].
- National Health Service (2017) National quarterly data on patient safety incident reports. Available from: https://improvement.nhs.uk/ resources/national-quarterly-data-patient-safety-incident-reports. (Accessed on May 23 2020).
- Piggott, C. Grover, L. (2013) ‘Employment and Support Allowance: capability, personalization and disabled people in the UK’ Scandinavian Journal of Disability Research,15 (2)pp170-184.
- Papakonstantinou, D. (2018). ‘Why should employers be interested in hiring people with mental illness? A review for occupational therapists’, Journal of Vocational Rehabilitation. 49(2), pp 217-226.
- Tarrier et al, (2007). ‘The subjective consequences of suffering a first-episode psychosis: trauma and suicide behaviour’ Social Psychiatry and Psychiatric Epidemiology, (42) pp.29–35. doi.org/10.1007/s00127-006-0127-2
- United Nations Convention on the Rights of Persons with Disabilities( 2006). Available from: https://www.un.org/disabilities/documents/convention/convention_accessible_pdf.pdf[Accessed on 26 May 2019].
William, R. Et al., (2016) ‘The Role of Work-Related Self-Efficacy in Supported Employment for People Living With Serious Mental Illnesses’ Psychiatric rehabilitation journal, 39(1) pp 62-67.