APPENDIX 16
Memorandum submitted by First Step Trust
(EDP 25)
1. SUMMARY
1.1. We are writing this submission because,
although we are a well established voluntary agency operating
nationally in the field of work and mental health, we have struggled
in the past to make use of government initiatives in this area.
Although ostensibly having the same aims, we find that schemes
such as Welfare to Work and New Deal provide little help in preparing
people to make the major life changes being asked of them. Supporting
people with severe and enduring mental health problems into work
is possible and our own achievements demonstrate this. However,
the focus should be on assisting them to develop life and work
skills that are sustainable in the longer term.
1.2. This paper highlights FST's experience
of assisting people with mental health problems, learning disabilities,
drug and alcohol recovery problems and other disadvantages to
move into open employment and further education during the past
15 years. We have worked closely with a number of other agencies
engaged in the employment field to find ways of assisting service
users to achieve their aims and ambitions.
1.3. In our experience, New Deal for Disabled
People, Workstep, the Welfare Benefits system and the Disability
Discrimination Act (DDA) have been helpful for people who are
more or less "work ready". For people with more complex
support needs the changes have had little impact and in some cases,
have acted to increase the pressures and stigma experienced by
service users.
1.4. Changes introduced under The NHS Plan
and the National Service framework for Mental Health (NSF) although
well intentioned have also acted to shift resources away from
services that focus on providing effective long term rehabilitation
and support.
1.5. To assist people to make real change
in their lives requires a continuum of support including specialist
work projects where they can learn to experience the everyday
pressures and responsibilities of working life. Current initiatives
have focused more on support to access open employment directly.
If the solution to unemployment amongst disabled people was as
simple as proving access to paid work opportunities, then the
government already has effective models in place within the NHS
eg the Pathfinder scheme based in South West London. Despite this
scheme's success at a local level, it has not been widely applied
by other NHS trusts or other statutory agencies, all of whom form
major employers.
1.6. This focus on direct access to open
employment fails to recognise the need for people to prepare for
the rigors of working life. It remains a fact that the majority
of service users will end up working for small employers where
conditions are less favourable than those of statutory agencies
and large employers. Access to the pressures and responsibilities
of work within a supportive but challenging environment although
unfashionable, remains the only way of providing a real chance
for people to sustain open employment.
About First Step Trust (FST)
1.7. FST aims to promote the positive abilities
of people with mental health problems and other disadvantages
combating social exclusion through providing opportunities to
engage in work, both voluntary and paid.
1.8. We achieve these aims by developing
work projects for people with mental health problems, drug and
alcohol misuse problems and other disadvantages. FST provides
places to people with varying degrees of difficulty. This includes
people currently struggling with their mental health difficulties
and those who merely need a few months support to regain the confidence
to enter the job market. Many of these are people with long standing
mental health problems or drug/alcohol dependency problems who
have not worked for many years or who may never have worked at
all.
1.9. We have established a number of projects
throughout the London area with further projects in Sheffield
and the Scottish Borders. In more recent years we have expanded
this range to include people in high and medium secure care environments.
We now have work projects in Broadmoor High Security Hospital
and two Medium Secure Units in the North West (The Scott Clinic
in Merseyside and the Edenfield Centre in Salford). Further specialist
projects are under development in Nottingham, West London and
Bexley. Work available includes gardening, painting and decorating,
office and finance administration, in addition to running a restaurant
and a social club with a snack bar.
1.10. Our projects are based on a unique
model founded on two vital principles:—
1.11. That we provide real work, ie trading
commercially with the general public where the focus is on meeting
the customer's need rather than providing traditional rehabilitation
and training for its own sake;
1.12. People join our workforce not as patients,
clients or service users, but as colleagues and equals, sharing
the responsibility of making the project work.
1.13. People with mental health problems
and other disadvantages form the voluntary workforce, staffing
and managing the projects and head office. FST offers them opportunities
to learn new skills, occupy the day, meet new friends, regain
lost self-respect and develop a future. Our approach is to challenge
people with real responsibility while supporting them with training
and firm structures. There is no fixed timescale because it is
important to recognise that sustainable changes have to come from
within the person. In our experience this can take anything from
a few months to several years. However, this is dependant upon
a number of factors including: the attitude of professionals,
the age of first onset of the illness and prior work experience.
What is important is that there is a pressure to take on increasing
levels of responsibility, dictated by the demands of the business
and this creates the drive to progress in their careers on to
open employment.
1.14. During the past seven years, working
in the way, we have created salaried employment opportunities
for 26 people within our own organisation and assisted a further
150 to move on to open employment or to college.
The success of this approach within secure psychiatric
services has recently been documented in an evaluation by the
Institute for Applied Social Policy. [18]
2. ISSUES AFFECTING
THE DECISION
TO MOVE
INTO OPEN
EMPLOYMENT
2.1. People with severe and enduring mental
health problems face a number of obstacles in finding and holding
down a job. These include the fear of breaking down, loss of current
social networks, loss of financial security and the loss of dignity.
2.2. The fear of breaking down is one of
the most difficult obstacles to overcome for service users. In
our own experience people need opportunities to work with the
pressures and demands of working life without the immediate pressure
of losing their job. Employers are required to make reasonable
adjustments under the DDA. However, few employers are willing
or able to offer this level of support.
2.3. Within the current approach service
users can only hope that they will not break down or that the
severity of an episode will not mean taking time off work.
2.4. In our experience, people can be supported
to develop their own coping skills, moving into a position of
having more control over the difficulties. For example, Arthur
(not his real name) has been employed by FST for the past eight
years in a management position. He still experiences periods of
difficulty and sometimes needs to take time off work to recover
when things overwhelm him. Arthur's knowledge of his own situation
and his willingness to work with his employer (FST) to manage
stressful situations and make contingencies means that both sides
win. Arthur is able to hold down a demanding job and FST retains
the services of a skilled and hard working manager.
2.5. Arthur's success is not a coincidence.
When he was referred to us by his mental health support worker,
he was in his early thirties and had never had a job. He had spent
several years at home looking after elderly relatives acting as
a carer. Other services had assisted him to build some social
networks through his involvement in leisure activities but he
remained relatively isolated and anxious about looking for work.
It took several months of one to one support to get Arthur to
commit to a regular pattern of attendance and a willingness to
work with us to resolve issues that affect his ability to work.
FST would not have been able to sustain his employment without
a willingness on his part to address his difficulties.
2.6. Another young man, Michael (not his
real name) highlights the difficulties faced by younger people
whose experience of mental ill health occurs when they are at
their most vulnerable. Michael is in his early twenties and he
has had a number of problems since he was in his early teens.
He presents well and is a very able young man with a range of
skills and abilities around computers and the internet. He has
been involved with FST for approximately five years but still
finds it difficult to engage. FST has supported him in finding
a number of work placements and feedback from these has been excellent.
He has made a number of attempts to find work himself. A one stage
he attempted to join the Army but was discharged during his initial
training on medical grounds. In our experience, Michael does well
for short periods of time. He can sustain himself for no more
than a few weeks before things get on top of him and he begins
to flag losing interest in himself and his job. He is aware of
these difficulty but finds it difficult motivate himself when
all he sees ahead is a life of recurring illness and difficulty.
Michael has good social networks and is afraid that his mental
health will be seriously affected if he loses these. In many respects
he is a product of the traditional institutional approach to people
with mental health problems where the focus of professionals is
on leisure or social activities. Work and employment is not seen
as an option for service users within this framework and the changes
to the Care Programme Approach[19]
have had little impact here.
2.7. Michael's situation is likely to become
more difficult under the current climate of pushing service users
into employment prematurely. In our experience, NHS Trusts and
local authorities feel pressure from the government to deliver
employment outcomes as part of their performance targets. The
quality and sustainability of these outcomes needs to be properly
researched and evaluated to establish their validity. Michael
could (in theory at least) gain and lose two or three jobs in
any given year if pressured to do so. Whilst this might be good
for the statistics it does little to assist Michael to deal with
the core issues facing him. Michael needs the support of projects
like FST and a new commitment from statutory agencies to provide
clinical support aimed at assisting him to deal with the pressures
and responsibilities of ordinary working life.
2.8. The current Welfare Benefits system
poses a number of problems for service users trying to develop
their ability to cope with the demands of working life. For example,
the 16 hour rule limits a person's ability to develop their ability
to cope with full time employment. There are few part time jobs
around that pay the equivalent of the higher levels of Welfare
and Housing Benefits.
2.9. The results of the "Benefit Trap"
are well documented so we won't go into them here. However, we
do believe that further consideration needs to be given to changes
that will enable people with mental health problems to move away
from the relative security of the Welfare Benefits system towards
working life. For example, Jean (not her real name) is a woman
in her early thirties who has had contact with FST for several
years. In our view Jean is able to work and could hold down a
job given additional support. However, she finds it difficult
to imagine life without the Welfare Benefits system and is prone
to "play the system" becoming unwell when there is any
real threat to her situation. We believe that the situation could
be improved by the introduction of a Welfare Bonus scheme that
aimed to provide financial incentives directly to service users
themselves. For example, financial rewards for getting an interview,
then for getting a job, for holding down a job for three, six,
nine, 12, 18, 24 and 36 months. Payments need to be sufficiently
substantial in order to make it worthwhile and it is important
that the payments remain tax free.
2.10. Supporting and enabling service users
to retain their dignity is vital if we want to encourage service
users to move away from the relative security of the Welfare and
Housing Benefits system. The current system of supporting service
users into work is not conducive with this objective since by
its very nature people need to be identified as unwell before
they are eligible. We believe that the current approach does little
to improve people's self esteem or self worth and that further
consideration needs to be given to the impact of this. For us
the key is to provide the incentives directly to service users
(see above) and for outcomes to be measured in more realistic
terms. Outcomes should be based on a person's ability to adapt
to the pressures and responsibilities of working life after a
period of rehabilitation/preparation.
Ronnie Wilson MBE
Carole Furnivall
Joint Chief Executives
6 January 2003
18 Evaluation, First Step Trust (Berkshire) Project
in Broadmoor Hospital, Final Report, August 2001. Back
19
The NHS Plan required work and occupational activity to form
part of everyone's care programme since April 2002. Back
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