The Job Cure

By Alex Spence

The obstacles to returning to the workforce for someone with a mental illness can be great. What can we do to rectify this?

The past two years haven't been the happiest of Wally Bernard's life. His father was jailed for sexually abusing two of his sisters. His girlfriend had an abortion against his wishes, and they broke up. Then there was a serious car accident. Unable to cope, Wally was diagnosed with clinical depression. "It was extremely traumatic," he says. "The stress just got too much."

A chef whose resumé includes stints at Harbourside and Sky City in Auckland, Wally (not his real name) didn't have much motivation for anything, let alone working. He left his job as head chef at a resort in Tauranga. At 35, he found himself alone, childless and unemployed, living on a sickness benefit of $190 a week, unable to envisage a future. "You get up every morning and wonder why," he says. "You just slowly close up your life." Last Christmas, he thought about hanging himself.

In the past few months, though, Wally has been slowly putting his life back together. He moved to a new town, Thames, where he found a supportive psychologist and an understanding landlord. He has also returned to work. A busy à la carte restaurant offered him a one-month trial: 20 hours a week at $9 an hour. It's not much, but it's something. As a result, Wally has felt his spirits lifting, his enthusiasm returning - for cooking and for life. "Basically, it's like I never stepped out of the kitchen," he says. "I'm doing mains and stuff, doing entrées right through to desserts. It's like I haven't been away from the kitchen at all."

This is no small thing. The obstacles to returning to the workforce for someone with a mental illness can be great: there's the stigma, to begin with, and the fact that mental illness by its very nature robs you of confidence and optimism. In more practical terms, many of the psychiatric medications cause lethargy and inattentiveness, and awkward explanations are required for long gaps in your employment history. For Wally, returning to a job he loves has been the difference between misery and hope, between lassitude and a future beyond depression, but he admits he probably couldn't have done it on his own.

The change came after he was referred to Workwise, a small Hamilton-based employment agency, which helped him put together a CV, and arranged interviews with several restaurants in Thames. A support worker from Workwise even accompanied him to the interviews. (It took only two interviews before he was hired.)

One of only a handful of employment agencies in New Zealand dealing exclusively with clients with a mental illness, Workwise is representative of a changing philosophy among mental health services in New Zealand: upbeat, idealistic, dedicated to the notion that people with mental illness are capable of achieving as much as anyone else in society. Open employment, the thinking goes, is one of the fundamental components of recovery, along with family support, medication and adequate housing. The mentally ill want to work, and they have a right to. "Real jobs for real pay" has become the rallying cry.

Until now, despite international evidence demonstrating that the mentally ill are capable of holding down skilled, high-pressure jobs provided they have access to the right kind of treatment and support, it has simply been assumed they are incapable of functioning in a "normal" workplace. As a result, an appalling number of mental health consumers are unemployed and living in poverty.

In mid-June, an investigation by the British Government found that only 21 percent of long-term mental health consumers in the UK were employed, while a person who had been out of work for more than six months because of a psychiatric disorder had only a 50 percent chance of ever returning to work. No such detailed survey has been conducted in New Zealand, but the situation is believed to be comparable. Currently, 44,688 people receive a sickness or invalid's benefit after receiving a psychiatric diagnosis, and more than 80 percent of those receiving an invalid's benefit have been on it for more than two years.

What little work there is available to someone with a severe mental illness is typically menial, transient and poorly paid. In the past, many people were encouraged to participate in "sheltered workshops", factory-like environments in which they were expected to perform tedious jobs like packaging headsets for airlines or putting stickers on video-cassettes, for which they received as little as $50 on top of their benefit.

The workshops were of limited value either financially or therapeutically. (There are still 3500 people with various kinds of disabilities working in sheltered workshops around the country, though the government is changing the legislation to force the workshops to conform to the requirements of ordinary workplaces, including adhering to minimum wage laws.)

Organisations such as Workwise, however, are now pushing a concept termed "supported employment" - which is to say, assisting people into real jobs in integrated workplaces, rather than ghettoised in sub-standard jobs specifically for people with disabilities. Why patronise and limit someone's future merely because they suffer a mental illness?

"We're clear that it's not just about any job, it's about the right job for the person," says Jacqui Graham, director of Workwise. "That's what we focus on. Finding out what people really want to do and helping them get there."

Since Workwise began in 2000, it has placed 300 people in open employment. "People have obtained a really wide range of positions," Graham says. "Anything from becoming a lab technician to setting up their own business. The job seekers we meet all have really varied experiences, skills and educational backgrounds, so naturally the jobs they go into are just as varied. Having experienced mental illness may be the one and only thing this group has in common."

The Ministry of Social Development was impressed enough to choose Workwise as a partner in its new Sickness and Invalids Strategy pilot scheme in Manukau. Concerned at the growth of those benefits - the number of people receiving an invalid's benefit has risen from 35,000 in 1993 to 71,000 in 2004 - MSD is aiming to ease people with disabilities back into the workforce, and has chosen Manukau as the "social laboratory" for testing various strategies, to use minister Steve Maharey's phrase.

Over 16 months, Workwise will attempt to find jobs for 135 people who have been on a benefit for more than two years due to a mental illness, using much the same approach as it did with Wally.

There are, of course, people worse off than Wally, people who have spent years drifting through the mental health system. In the past five months, I've met several dozen people who suffer from severe, chronic illnesses such as schizophrenia, some of whom have gone more than a decade without fulltime work. They bounce between hospital, boarding houses, group homes and even prison. Heavily medicated, they often experience delusions, hallucinations, paranoia and scrambled thoughts. Helping them rebuild their lives is not as simple as arranging a series of job interviews.

Steve Keir is the manager of employment services for Framework Trust, one of the largest non-government providers of services for people with severe mental illness. Like Workwise, Framework has embraced the concept of supported employment, and has helped more than 200 people find jobs. Recognising, however, that not everybody is immediately ready to venture into the open job market, Framework also runs several "work crews" involved in gardening and commercial cleaning, which provide a first step back into regular employment. In contrast to sheltered workshops, the crews consist of only a handful of people, and the workers are paid the minimum wage.

One afternoon I drive with Keir from his Ponsonby office to Grafton gully, where one of the crews has been clearing weeds and planting shrubs on a steep bank behind a group of office buildings. When we arrived, the workers are leaning against their spades, having just finished for the day. In the past few hours they've planted 80 shrubs and cleared a couple of large sacks of litter.

Earning $9 an hour, they work every Tuesday and Wednesday, taking care of gardens and parks around the city. (The work crews' primary customers are the North Shore City and Auckland City councils.) The money isn't much, but they enjoy the physical labour and the camaraderie, says the team leader, a thirtysomething man dressed in a hooded sweater, mud-caked sweatpants and gumboots. He was formerly a bank teller, but began working for Framework a few years ago after a serious breakdown; he now has no desire to go back to work in an office. "It's a good place to come and chill out," he says.

"Work crews are the way to go," Keir says. "Why have people in sheltered workshops? That sort of thinking is gone."

When I suggest to Keir that clearing scrub and vacuuming offices for a minimum wage has an air of exploitative, menial labour to it, much the same as the sheltered workshops he criticises, he grows irritated. "The distinction has to be made," he says. Work crews are training programmes, he says, not job placements. They're only temporary, a bridge to re-entering the workforce; Framework isn't a profit-making organisation; the work crews allow people who have spent years, even decades on a benefit to gradually build up their self-esteem and stamina starting with only a few hours a week. "We start small, see how they go, and try to build on that," he says.

Once the client is ready to look for a decently paid, permanent job - "It might take months, it might take a couple of years" - Framework helps them put together a CV, coaches them on how to conduct themselves during an interview, shows them how to search the Internet for job vacancies - and so on. "We don't do all the processes for them," Keir says. "Our job is to support them. They have to challenge themselves."

One of the major concerns for someone with a severe mental illness returning to the workforce is the stigma they may encounter from prospective employers. How do you account for the gaps in your CV after spending so many years out of work? Keir says it's up to the individual, but believes it is best to disclose your mental illness. "The most effective way is to be honest," he says. "Employers are normally really good. By and large, we've had very little problem with employers [discriminating]."

Historically, he says, the attitude that people with mental illness are unfit to work has come more from mental health services than from employers. "There's a large part of society who will help you if you only ask them," he says.

There are those among the mental health professionals I've interviewed who believe there is a small group of consumers so damaged by their illness that they will never be capable of holding down a regular job, and they regard Keir and his colleagues' enthusiasm as more than a little naive. But to suggest this to anyone at Framework is almost blasphemous. "There are exceptions," says chief executive Helma van der Lans. "There will always be a group that won't move on and they need to be looked after. But they shouldn't be looked at if they can't do anything."

Framework adopts what van der Lans calls an "assertive" approach in dealing with its clients: even if someone is incapable of returning to fulltime or even part-time employment, they may still be able to participate in training programmes or social activities.

Mental health providers have a "moral responsibility" to treat everyone as if they're capable of making a full and productive contribution to society, she argues. "I do not accept you can say that because a person presents in a certain way that you can't achieve anything with them. That's a cop out. Some may never get to the stage where they're living independently, but they can still gain a number of skills."

These are laudable sentiments, certainly, but there's still an element of wishfulness involved. If mental health consumers are to become totally integrated into the workforce, it will require not only a concerted effort on the part of mental health services and consumers themselves, but also a significant change of attitudes by mainstream employers.

It's one thing for Framework's work crews to rely for most of their business on city councils with actively implemented diversity policies, but it may still be a long time before, for argument's sake, a person with schizophrenia is comfortable disclosing their illness in a competitive corporate office.

In the meantime, thousands of people continue to live in poverty because of their illness. At least Wally Bernard seems to have escaped that fate. Returning to the kitchen has started him thinking about the future again. He is taking his liquor licensing test soon, and has begun dreaming about one day opening his own restaurant.

In the short term, it helps his mood just having somewhere to go. "It takes your mind off things, you know?" he says. "You've got more confidence and stuff like that. It's a good way of bridging the loneliness. I feel more worthy, and I've got a reason to get up in the morning. I seem a lot happier. And I'm earning money."

Not long ago, as his colleagues were sharing a drink after work, he confessed to them that he was suffering clinical depression. He was surprised how well they responded. As he recalls: "One of them said, 'You don't need anti-depressants - we'll make you happy.' And they do make me happy. Which is good, because I haven't laughed much in the last year and a half."

Copyright 2004, Used with permission from The Listener.