The following is a speech I made to the Mental Health providers Forum AGM in 2008. I’d completely forgotten about it until I was in a meeting recently and some said that they were there when I gave it.
The question of work and recovery is one that has the ability to inspire both visionary zeal and rancorous disapproval. To some it seems to be self evident that people will have better lives if they are working, earning and enjoying a fulfilling professional life. To others it seems as if people who are ill are being forced into jobs to get them off of benefits.
My own story isn’t too different from a lot of people’s. After a number of years of being unwell without really considering myself to be ill, I finally had to drop out of university after a disastrous attempt to get a degree. Very unwell, I found myself excluded, unable to claim benefits and at a loss as to what my future might hold. I was twenty one.
Subsisting on benefits, my life entered a kind of grey period, where things never moved. I was accessing treatments, and trying to achieve a level of being well, but still had no idea of where my life might go. I was worried about the idea of work for a number of reasons:
- I was worried that I would be sent to do work I wouldn’t be able to do.
- I was worried that I wouldn’t fit in at work
- I was worried that people would stigmatise me for my condition
- And I was worried that the work I would end up with wouldn’t suit me as I didn’t have the qualifications to reflect my abilities.
But I was still stuck in this day-to-day existence where I wasn’t really moving on, and every month was taking my further from the world that friends and family existed in where two things; work and the money it brought in, were allowing them to do things that were interesting, to interact with others and to do things that were fun.
What couldn’t see was a way back into work from where I was at that point.
I actually found my way back into work through being involved first on a voluntary basis then a paid basis in a very small social enterprise, which set me off on the path to where I find myself today.
For me, it was getting back into work, slowly and step by faltering step, that helped me to move out of a grey period of uncertainty and stasis and into an active and rewarding period of which I am still reaping the benefits.
As I grew into my role, and them finally moved into my current position, I found myself thinking of myself less as a person with an illness and more as a person with certain legitimate limitations that I and my colleagues needed to be aware of and certain challenges that I had to overcome to get where I wanted to be professionally.
In essence, through seeing the fruits of my own actions realised in my working life, I began to hope for more in the future and moved into thinking of myself as someone who could achieve and prosper.
This is the real role of work in recovery. Work in itself is not a panacea. What really helps is the effect that the rewards of work can have and the feeling of rejoining the stream which everyone else is swimming in, of being part of life rather than at its side lines. Finding the right work for you, your limitations considered, opens up life like a flower. Like blood returning to a numb limb, money, personal relationships and the sensation of doing something and going somewhere do not solve the problems caused by your condition but they do bring feeling back and gradually begin to wake you up.
I think it’s the rewards of work, not something magic and intrinsic about work that makes the difference.
Social enterprise is, in theory at least, the more caring wing of business. Concerned with creating outcomes beyond simple profit, it should be the perfect place for people with mental health difficulties to find work.
Many social enterprises can provide flexibility and support, and often being smaller organisation with less rigidly hierarchical structures and, on the whole tending to be much younger companies, a less ingrained sense of traditional practices.
In practice, social enterprises can also be les structured and be more pinched at the bottom line, requiring more from their staff.
To me, speaking professionally and as a person with mental health difficulties there are three main issues involved in the practicalities of helping people to access work as a way of supporting their recovery.
The first is adjustment. What people with mental health difficulties need most when entering employment is a sense that their new employer is happy to take a creative approach to making sure that they can produce their best work within the limitations imposed by their condition.
In my own working life, my colleagues appreciate that I have a condition and that, to do my best work, there are some things in my professional life that need to be adapted both to make best use of my talents and also to work around the areas where my condition imposes difficulty.
If you think of it in the same way that you would think of the flexibility that working parents sometimes, you’re along the right lines. A store of adjustment to be drawn upon as needs be. A parent doesn’t need to rush off to the school everyday, but they might if their child is taken ill. Similarly, in my own case, I don’t need to get to the office a number of hours later than everyone else every day, but some days I do. It is not a matter of leniency or special treatment, just an acceptance of the fact that factors that are in play for someone with a mental health difficulty can be different to those of someone else. We employ as similar approach with people who write for One in Four, adjusting deadlines or supplying additional research, doing what we can to make sure that the person can get stuff done.
The second important thing is trust. People with mental health difficulties who are in work and those who have been away from work need to trust that their condition will be treated respectfully and even-handedly both by their employers and their colleagues. There is nothing worse than feeling you are being done a favour, or feeling like you must beg for adaptations. The conversation should always be a pragmatic one between equals. When people are going through a crisis, as many people with mental health difficulties do, the effect of being ignored, fobbed off or not treated with due respect can often have a great effect.
The last one is hope and meaning. Many conditions, my own included, can lead to an ebb and flow of energy and motivation. What keeps someone going is the hope that things will improve and a certainty that things are going somewhere. What we try to do with One in Four is to help people see that small positive steps can often lead directly or indirectly to large changes. Feeling that you are having things done to you and that you are a passenger in a process rather than the person driving it makes it difficult for anyone to feel motivated.
For me, the most important thing to remember when discussing work and recovery is that work itself isn’t a magic four letter word; it’s everything that someone gains from being in work that is important.
Mark Brown is the editor of One in Four magazine.
Mark, if I may, I’d like to add an OT perspective to this issue of “work”.
OTs believe that every activity we perform is either self-care (washing, taking medications), leisure, or productivity. We believe good health comes from a balance of these activities. However, we recognise that paid work is but one example of a “productive” activity, which we may not have access to through exclusion, opportunity, or qualification. Other forms of productivity that we could consider could include caring, volunteering, or gardening, for example.
Where access to paid work may be a goal for most of us, getting there might take several stages, in which we consolidate skills such as building a routine that gives a regular timeframe for productive activity, re-learning how to use public transport in order to engage in a chosen productive activity, etc.
We might need to look at how much effort is needed to maintain self-care and leisure needs, and realise that without tackling these there is no available time to accomplish productive activity. In these cases, building up ability to tolerate any activity is key, and OTs often use leisure to do this.
When we are talking about work, it’s always important to remember that coming out of an acute mental health episode we first need to focus on our self-care, then leisure, then move into productive activity. Only by staggering our exposure to the challenges involved in this can we hope to be able to engage in Recovery.
What is missing from the dominant discourse about work and benefit reform, is the acceptance of this simple fact. Most people want to be productive, which may or may not include paid work. In order to be successful at this, focus must first lie in ensuring our ability to engage in Recovery by setting achievable goals, building confidence, and experiencing success.
Thanks for raising this issue, and sharing your own experience. Ultimately, beginning the process of Recovery is the most productive activity anybody with experience of mental distress can do. It’s great to read how you built your Recovery onto your life.
I dont really fit in at work i worked 5 or 6 years and i hated it everyday i had to drag myself there you can never say i was never ceen when i was 21 i had to byke on a pushbike 9 miles to work and 9miles back then as i moved to the city i got more use to city life and start using the bus but with having a mental ilness it makes you stick out like a sore thumb and you get exploited i spent one year trying to learn how to serve a customer i had things thrown at me insults language people calling me backwards i have even been held up at knife point maybee i was just unlucky i will return to work i just need to get my own mental health sorted first been able to deal with people day to day is really hard but i will get there and not stop trying
I recently returned to work after a mental health ‘crisis’. I have not been ‘allowed’ to return o the job I was doing prior to my absence which I loved abd have been assured that I was good at. I have been totally side lined and part of my time is spent lone working without interaction from former colleagues. I am feeling very depressed about this, my confidence which I so badly needed to build up has diminished and I am feeling ‘stupid’ rather than having been unwell. Work I agree has to he suitable for the person and it is not necessarily employers who know what they think is best!