Mental health and the NHS workforce

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There is much value in bringing people who have used mental health services into the NHS team, says Alastair Henderson

Unemployment affects those with long term mental disorders more than any other group of people with disabilities. Of those who are employed, many continue to suffer regular discrimination in the workplace. Conversely, being employed and having good mental health has a positive effect on the economy, reducing absenteeism and staff turnover and improving productivity.

In 2007 the cost of mental health disorders was a total of 5.3 per cent of GDP. This is projected to rise to 10.1 per cent by 2026, with more than half a million people in Britain currently claiming incapacity benefit for mental health problems.

As part of a cross-government initiative on getting more people with mental health problems into employment in society as a whole, NHS Employers has been commissioned by the Department of Health to lead a campaign to increase the numbers of previous mental health service users and people with severe learning difficulties who are employed within the NHS.

So what do we mean by mental health problems? A broad definition is probably most helpful and should include conditions such as schizophrenia and bipolar disorder (found among fewer than one in 100 people of working age) and less severe but much more common conditions such as depression and anxiety.

At present, only 20 per cent of people with severe mental health problems are in jobs, compared with 65 per cent of people with physical health problems and 75 per cent for the whole adult population. But even for people with more common types of mental illness, such as depression, only about half are employed. Crucially, 90 per cent of people with mental health problems want to work but 38 per cent of employers say they would not employ someone with a mental illness.

Personal achievement

Yet work is not only central to most people's lives, it has also been shown to have a positive effect on mental health. Jobcentre Plus head of employer engagement Sue Veszpremi reports excellent results from its "work trial" scheme, which enables job seekers to demonstrate their capabilities to a prospective employer.

"Work trials are particularly suited to those with health problems," she says. "Previous participants have told us they feel a real sense of personal achievement overcoming the problems they felt might prevent employers considering them. The opportunity to meet and interact with other people in the workplace, coupled with the work experience they gain, means their confidence grows, as does their motivation and self-esteem: it is a realistic goal that the work itself will become permanent."

The 2004 report Mental Health and Social Exclusion published by the government's Social Exclusion Unit identified stigma and discrimination experienced by people with mental health problems as the biggest barrier to social inclusion.

With a workforce of 1.3 million people the NHS can and should make a significant contribution to combating this discrimination. This would benefit not only those people but would also have a positive impact on the diversity of the workforce and the experience the NHS can offer patients.

The Disability Discrimination Act makes it unlawful for employers to discriminate against people who have a mental impairment. Employers may be required to make reasonable adjustments to enable employees to work.

There are a variety of reasons why NHS employers might usefully include in their workforce people who have had, or who continue to experience, mental health problems. In caring roles, those who have had a similar experience are more able to empathise and understand the needs of patients, while increasing the numbers of disabled staff is also an excellent way of demonstrating the organisation's commitment and openness to using the skills of people with mental health problems. People with experience of mental health problems can act as role models for both clients and staff and increase the skill-mix.

And retaining staff avoids up to £80,000 recruitment and training costs for replacing someone.

Valuable expertise

One organisation leading the way is South West London and St George's Mental Health trust, which helps people with mental health problems to get and keep employment within the trust.

Rachel Perkins, director of quality assurance and user/carer experience at the trust, says: "Employing people with mental health problems in mental health services actively improves the service in many ways. People who have lived experience of mental health problems have gained an expertise that is valuable to others who face similar challenges.

"This enables people who use our services to access this expertise and offers hope and images of possibility to both staff and service users: showing what people with mental health problems can achieve to counteract negative stereotypes. It also helps to break down the destructive 'them and us' barriers that continue to permeate our services and society."

NHS Employers' new work programme follows on from the Department of Health's 2002 guidance, Mental Health and Employment in the NHS, which encouraged employers to "tackle discrimination, promote equality and opportunity in their staff and provide the opportunities that people with mental health problems are now entitled to expect".

Our campaign will kick off tomorrow, on World Mental Health Day, when we will reissue an updated version of the 2002 guidance which provides advice both on the employment and support of previous service users and also on supporting staff who develop mental health problems while in work.

It has been extended to include the advice published in February on the management of mental health issues of doctors.

We look forward to working with trusts to ensure the NHS is developing and implementing good practice and that people with mental health problems do not face discrimination in recruitment or employment and also have the right support to perform to the best of their ability in the workplace.

www.nhsemployers.org

www.mhf.org.uk