Work schemes and mental health care: some guidelines for purchasers

No two employment schemes for people with mental health problems are alike, which presents problems of comparison for all concerned. Some forms of work therapy are as old as psychiatry itself; other models have been imported from the USA with little evidence of their effectiveness in a British context. Some emphasise social support; others offer training in a work-like environment. Ideally, through work or work training, some people might come off social security benefits and join the ranks of taxpaying citizens. A more realistic goal in times of high unemployment is for work schemes to reduce dependency on health services. There may also be less tangible benefits, such as greater autonomy and self-esteem for the people whose role changes from ’patient’ to ‘worker’. What are the choices available and what criteria should inform purchasers?