1. Service users’ experiences of returning
to paid employment
Jenny Secker
Professor of Mental Health
Anglia Ruskin University/
South Essex Partnership Trust
2. Overview
• Study context
• Aims and methods
• Participants and their jobs
• Results:
• Perceived barriers to work
• Experience of barriers
• Job satisfaction
• Impact of work on participants’ lives
• Conclusions
3. Study context
• SESAMI (Social Inclusion through Supported Employment for people with
Mental Illness; Schneider J., Secker J., Floyd M. & Grove B.)
• 2-year naturalistic study designed to contribute to knowledge of what
works to enable people with severe and enduring mental health problems
find & keep a job
• Carried out in partnership with 6 of the largest employment support
providers in England
• 5 main strands:
• Assessment of fidelity to IPS principles & factors influencing this
• Identification of work outcomes at 12 months
• Predictors for moving into work
• Exploration of clients’ and providers’ views about what works
• In-depth study of the perceptions and experiences of those who had
moved into work.
4. Aims
• To explore:
• Preconceived and experienced barriers to getting back to work
• Job satisfaction
• Impact of working on participants’ lives
Methods
• In-depth interviews (40 - 75 minutes)
• Semi-structured with questions framed broadly to allow flexibility
• Audio-recorded and fully transcribed
• Analysed thematically following Miles & Huberman (1984)
5. Participants & their jobs (1)
• 20 clients of 5 partner agencies (33% of those in work at 12
months after baseline)
• Majority male (13/20) & White British (17/20)
• Average age 41 years (range 27-64)
• Length of tenure:
• 9 = <6 months
• 6 = 1-4 years
• 5 = >6 years
6. Participants & their jobs (2)
• Occupational categories:
• 5 = Professional /Associated professional & technical
• 5 = Administrative & secretarial
• 1 = Skilled trades
• 1 = Personal service
• 3 = Sales & customer service
• 1 = Process, plant and machine operatives
• 4 = Elementary occupations
7. Anticipated barriers
• Fear of disclosure often based on previous experience:
It’s been my experience that people who know about it take advantage of
it.
• Disjointed job history
If you’ve got a big gap on your CV it can be very troublesome can’t it, trying
to explain that gap?
8. Experiences of disclosure
• 14 participants had disclosed their mental health problems:
I think I needed people to know that I am poorly and that’s why I behave in
certain ways in certain times … and I think I needed them to make
allowances for that.
• Despite initial fears responses were reassuring:
I don’t know why it came up but it came up and I mentioned it and she said,
‘Oh, thank you for disclosing that’, you know, ‘I appreciate that’.
• But adjustments only explicitly discussed in 3 cases:
1.Agreed no adjustments needed
2.Time off for meeting with employment support worker
3.Plan of action agreed should participant become unwell
9. Experiences of dealing with gaps in work history
• Most received effective support to find constructive approaches:
Because I’d been through the course and all that I was actually able to
portray it in a positive light, ‘Well yeah, because I’ve had this time off work
I now know I’m ready to go back and I’ve had a chance to really look at
what I want to do’…
• Responses were again reassuring:
…They didn’t even ask me any more about it, what they were interested
was how I was going to be able to deal with the job now.
10. Occupational health: an unanticipated barrier
• Delays in obtaining clearance
The only thing that was holding it up was the occupational health. I mean I
was really worried about that, that I was going to be told I couldn’t start. It
annoyed me because they gave me this appointment which took weeks to
come through.
• Focus on negatives
I had to go for an appointment with the occupational health doctor and he
threw up just absolutely everything that was negative about my past. He
didn’t look at it as, well you know you’ve just dome two months of very
intensive work and you’ve come out of that, you’ve done voluntary work
and you’ve done training before that, it was just, well you haven’t worked
for 5 years, how do you think you can cope with a full time job.
11. Job satisfaction (1)
• 9 participants were very positive about their job:
• Right balance between work demands and sufficient challenge
• Supportive workplace
That’s what I enjoy. If you’re not thinking , you’re not alive are you?
She’s the type of person you could go to and just talk about anything…
it’s very relaxed and so if there’s a problem I can go and talk to her.
They are very supportive and the people are just the best.
12. Job satisfaction (2)
• Others enjoyed aspects but also described some problems:
• Working conditions
• Lack of control and role clarity
He just said when can you start, there are so many hours and I don’t
give breaks. I thought he’s got to be joking, not getting breaks, but he
wasn’t. And that was it, that was the interview.
It can get monotonous. Sometimes the worst thing is I have to request
lots of information from other people and if they don’t return it I get into
trouble… So it is stressful.
On a practical level, it would help if my boss gave me a job description
and we both stuck to it.
• But for most participants advantages outweighed disadvantages
13. Job satisfaction (3)
• 2 participants from one agency described experiences of
discrimination in addition to other problems:
The odd comments that he has made have been snidey, rather than
supportive and helpful, ‘you’re not the full shilling’ and things like that, all
very hurtful.
I’m concerned about the levels of discrimination between what you would
call the employer’s real staff and us, the [employment support agency]
staff. When you’re equally qualified to do the job but someone’s getting
£17,000 and you’re getting £11,000, you’re thinking. Does that qualify as
discrimination?
14. Impact on participants’ lives (1)
• Improving mental health:
• Confidence
• Hope
I’m not as shy as I used to be, I’m more outgoing, I can talk to people,
whereas before I just used to shy away and just sit in the house nearly all
the time... I might not be here now if I hadn’t got a job.
I feel more stable in my head… to have a job now is very good and only
more positive things can come out of it.
15. Impact on participants’ lives (2)
• Social recovery
• Structured day
• Sense of achievement
• A ‘normal’ identity
• Financial independence
It’s something to keep me going, I couldn’t stay at home. I’d get very very
bored, I’d go backwards in my health.
I feel satisfied at the end of the day. It gives you something to live for really,
doesn’t it?
It’s really good to feel normal. It’s such a difference. The world of the ill and
the world of the sane. Two different worlds. Yeah, it feels great.
It’s great having the money coming in, earning you know, earning the
money that I’m living on rather than getting it from the state.
16. Conclusions
• Much of participants’ experience no different from anyone else:
• A normal distribution of occupational categories
• Support, role clarity and appropriate control over workload all
commonly associated with high levels of job satisfaction
• Tolerance of less than ideal aspects in light of advantages
• (The right) job brings mental health and social benefits
• Perceived barriers could be overcome through effective
employment support
• ‘Toxic jobs’ could result from ineffective employment support
• Occupational health procedures an issue for vocational services?
