Specialist work schemes and mental health. Funded/commissioned by: Department of Health

<p>Few human activities are regarded with such universal approval as work. Indeed, in most societies, some form of work is itself a pre-requisite for life's essentials (Rowland and Perkins, 1988). Constructive employment is therefore a fundamental adult human experience. It is also a means of participating in families and in other forms of social organisation. Work accords a role, an identity, and channels energy into activities which are generally seen as desirable for the community at large as well as for the individual. </p>

<p>Mental ill health tends to dislocate the individual from society. This may not be the case in every society: in some developing countries mental illness seems to be less disastrous than in western Europe, with better recovery rates and shorter duration. This may be attributed to the socio-cultural environment or to the existence of stronger family ties (Leff et al., 1992). However, in general in Britain today, having a mental health problem isolates, disables and disempowers the person affected, stigmatising them and their family. </p>

<p>Work has been part of mental health care since the first psychiatric hospitals were founded. The labour of patients was essential to the running of many hospitals, and before the establishment of the National Health Service patients would have practised their trades in hospital in order to pay their fees. In the heyday of the psychiatric hospitals, until the 1950s, patients tilled farms, washed laundry, brewed beer and polished brass as an accepted part of the hospital regime. </p>

<p>In the latter half of the twentieth century, deinstitutionalisation and community reprovision have helped to emphasise independence on the part of people with long-tem, or chronic mental illness. Clinical practice is coloured by the emphasis on individual freedoms embodied in the Mental Health Act 1983 and, latterly, by concerns about monitoring and accountability on the part of service providers. </p>

<p>The demand for employment opportunities comes from service users, carers and voluntary organisations (Bumett, 1993; MIND policy on Employment). To meet this demand, providers and purchasers of mental health we require reliable information about what exists, and what is needed. It appears that there is an uneven distribution of work opportunities for people with mental health problems, since there is little choice for consumers, and the nature of different work settings varies greatly. Faced with an array of diverse services, it would be desirable to have information about their characteristics, clientele, activities and costs, in order to be able to compare and contrast the services. </p>

<p>The research into employment and mental health reported here is an attempt to get to grips with this area where empirical data are scarce. We have narrowed our focus to work schemes catering for people with severe mental health problems and which offer long-term support. Whilst models such as supported employment and social firms have promise (Hatch, 1994; Bond, 1996), they are not typical of UK provision for people with severe mental illness, in the sense that they are not commonplace, and (as far as we know) they have not been evaluated fully in Britain. </p>

<p>Many factors affect the availability of work schemes for people with mental health problems. These include the effects of the illness, the psychological impact of unemployment, the stress of returning to work, the context of the wider economy, and the incentives offered by the benefits system. Such factors lie beyond the scope of this study. We chose to focus on quality of life and costs, because of their policy relevance. The workplace environment, psychiatric history, the roles of managers and other dimensions which might affect outcomes for work scheme users were considered only briefly. </p>

<p>This is primarily a cross sectional study, although a small number of newcomers were followed-up. Tberefore the work is largely descriptive, and the portrait painted of the workers, their activities and their quality of life may be of as much interest as the results of our hypothesis-testing. The study is an important preliminary step towards greater understanding of the part which can be played by sheltered employment schemes in mental health care.</p>