Our jobs are central to many of our lives. They provide us with money; but also social interaction, an identity, a sense of worth or value.
It is not surprising that our work and our mental health are often inter-connected. Generally unemployment is bad for your mental health.
The fact that are over 40% less likely to be employed is one of the biggest inequalities that people with mental health problems face. Closing that gap is a priority for many people, including a working group I co-chaired as part of the Mayor of London’s Thrive London programme.
Any job is not enough
One theme that came up repeatedly in the short study we did to inform the Thrive process is that a job, any job, is not enough. It needs to be one that fits with your needs and sense of self. The wrong job can be worse for your wellbeing than no job at all.
So unsurprisingly ‘Good Work’, Matthew Taylor’s recent report into modern working conditions pricked my interest. At its heart is a serious attempt to answer the question about how to maintain the benefits of the growing number of different, more flexible, forms of employment, whilst reducing the scope for the abuses that have hit the headlines.
It chimed with some of the discussions I have had recently about pushing the boundaries of existing forms of employment support for people with mental health problems to respond to the evolving workplace. Individual Placement and Support remains the gold standard for evidence based employment support in mental health.
But it doesn’t work for everyone, and its starting assumption is that service users are ‘placed’ with an employer. What about the people who don’t want to work for somebody else, or who can’t or don’t want to commit to working fixed hours?
The question of the gig economy
Although the majority of the workforce still have a permanent employer, as Taylor makes clear non-traditional models such as self-employment, zero-hours contracts and the ‘gig economy’, such as Uber or Deliveroo that in theory let individuals offer to work as and when they want to, will continue to grow.
Some see these as purely negative phenomenon for people with mental health problems. I have some sympathy for this view.
Many people who have been economically marginalised by their mental health problems, and the prejudice and discrimination they attract, are not well placed to stand up to exploitative employers. As the Taylor review makes clear, too often ‘flexibility’ in the gig-economy or zero-hours contracts is all one way.
Similarly, uncertainty about if and when people will be asked – often told – to work at short notice, and the lack of control this gives them, can be stressful.
A number of our interviewees for the Thrive London project highlighted how it made their mental health problems harder to manage. Many people find routine helpful to managing their condition. Others have treatment or other activities that help keep them well during working hours that can’t be easily rearranged.
But, like Taylor, I think it is important to recognise that these new working practices are not inherently bad, and that some workers value the flexibility they provide.
Flexibility from employers was one of the main positive forms of support that our research participants told us they valued. Be that in terms of hours worked, or the ability to work from home or fit them around medical appointments.
Balancing work and mental health
For some people the right form of self-employment or job in the gig-economy may give them the control to be able to balance their mental health and employment in a way that no regular contract could.
Self-employment may be the best route for some to build a career that fulfils their aspirations and needs. For others a brief period in the gig-economy could be a useful experiment in whether they are ready to work without having to make any commitment to an employer.
So I think the question for the mental health sector is how do we help people who choose to go down a self-employed or gig economy route?
Do we need to adapt or supplement existing models of support such as IPS? Can we understand the risks, and benefits, of working in this way to individual’s mental health? Where are people with mental health problems, or any other marginalised group, open to being exploited?
Can these be tackled through regulatory action (for example enforcement of workers’ rights) and where do people need to be empowered to take action, individually or collectively? How do we reform the benefits system so people dipping a toe into the water of employment in this way don’t risk losing their benefits before they have had an opportunity to understand if they are ready to work?
Collaborating with lived experience
We don’t have the answers to these questions or even know if they are the most important ones. But we want to find ways (and the money!) to collaborate with people with lived experience to understand what the right questions to ask are, and how we answer them.
I know for some this is controversial. However, fundamentally I believe both as a policy maker and someone living with mental health problems that we should support people to make their own choices.
Just as we need to combat the paternalism that suggests that mental health service users cannot work – in the 2016 Community Mental Health survey only a third of service users who wanted help with employment received it – we need to insist that people are free to choose how they want to work too.
We need to find ways to help them make those choices freely, to avoid being exploited, and ultimately to make employment work for them and their mental health.
