Alex Whitelaw wants to work. She feels strongly that she should pay her taxes. She has qualifications, intelligence, enthusiasm and is physically fit. But because the 24-year-old has severe mental health problems, she has spent most of her adult life being told by health professionals that paid employment is beyond her.
“If you’re told that too often, you start believing it,” she said. “But working and paying my taxes makes me feel like I’m contributing to society. I only feel like I’m worth something if I’m doing something for other people.”
Whitelaw has been under the care of mental health professionals since childhood abuse led to an attempt to kill herself at 19. She has repeatedly tried to return to work but without professional support, her CV is a long list of jobs she has walked out of. “The fact that I have a mental illness makes it more important that I work,” she said. “The more time there is for me to think and be on my own, the more ill I will get.”
Thanks to Individual Placement and Support (IPS), an innovative approach dedicated to getting those with long-term and severe mental health problems into work, Whitelaw has been employed by her local BHS department store for the past two and a half months. “After a lifetime of being told I couldn’t work or finding jobs on my own that were badly suited to my mental health needs, the IPS employment specialist found me my perfect job just eight weeks after we met for the first time,” she said. “Equally important is the fact that I know whenever I have a wobble, he’ll be there to help me.”
IPS is championed by the Centre for Mental Health, one of the Guardian and Observer’s nine Christmas appeal charities. The centre’s conviction is that the employment rate of people with mental illness can be raised to a level near that of the general population. It is far from a baseless belief: in a recent US review, the average competitive employment rate for IPS was 61% compared to 23% for traditional vocational approaches. Jobs were found nearly 10 weeks earlier than the control group, with about two-thirds of helped into employment working 20 hours or more per week.
A 2008 study by the Royal College of Psychiatrists, commissioned by the cross-government Health, Work and Well-being programme, found an increase from 11% to 32% in people securing competitive, paid employment 12 months after IPS was implemented. There were also additional increases in people placed in mainstream education or training (6% to 16%) and voluntary work (7 to 15%); more people placed in employment, education or voluntary work in the integrated teams compared to the non-integrated prevocational services; and lower costs of getting someone into open employment in the IPS services - this was 6.7 times higher in the prevocational service.
Whitelaw is one of the lucky ones. She is being helped by a mental health specialist from the Dudley and Walsall mental health trust IPS employment service, one of 14 centres of excellence in Britain for their use of IPS.
“The traditional model of vocational rehabilitation for people with mental health conditions in England is based on certain assumptions,” said Andy Bell, deputy chief executive of the Centre for Mental Health, which is championing IPS in Britain.
“Namely, that mental health conditions are ‘illnesses’ and, as with other illnesses, people should refrain from work and receive treatment until they are better. Then, once better, work rehabilitation should be offered in a ‘train then place’ fashion: starting the journey back to work in a safe, sheltered and segregated setting to develop skills and confidence before moving on to competitive employment.”
In contrast, IPS is a direct, individualised search for competitive employment that avoids lengthy pre-employment preparation or training. It does not screen people for work “readiness” or “employability”, and does not exclude people on the basis of diagnosis, symptoms or substance misuse. Mental health problems have a greater impact on people’s ability to work than any other group of disorders. They cause about 40% of all days lost through sickness absence and cost the UK economy up to £100bn a year.
Since 2009, the number of sick days lost to “serious mental illness” has doubled. In 2013, 40.9% of ESA (Employment and Support Allowance) recipients had “mental and behavioural disorders” as their primary condition. The chief medical officer has said that this may be an underestimate.
In addition, those with a mental illness are more likely to face stigma, prejudice and discrimination in the workplace, with fewer than 40% of employers saying they would consider employing someone with a mental health problem – and this despite the fact that about 85-90% of unemployed people with a mental illness say they would like to work.
Thanks to the Centre’s support, training and advice, IPS is available in about half of the NHS mental health trusts in England. But the Centreworks on a tight budget.
“What readers’ donations would give us is the opportunity to explore ways of adapting IPS for those who haven’t benefited from it, such as those in the criminal justice system, as well as finishing the job of having IPS services across the country,” said Bell. “Crucially, donations would ensure we can carry on without depending on government or commercial or other interests. That is, to continue to be truly independent, impartial and cutting-edge.”
View all comments >