Select Committee on Work and Pensions Written Evidence


Memorandum submitted by First Step Trust

1.  FIRST STEP TRUST

  1.1  First Step Trust (FST) is a voluntary organisation that offers people with enduring mental health problems, learning disabilities and other disadvantages the chance to do real work, in a competitive environment where they have responsibilities and pressures, as well as understanding and appreciation for the difficulties they face. The aim is to help them develop strategies to deal with their problems and thus make the difficult transition into paid employment. Established in 1994, FST achieves this by running 16 social enterprises around the UK, providing around 600 places in a year. These are small, not for profit businesses, trading with the general public in a range of areas. Work available includes gardening, painting and decorating, IT and printing services, office and finance administration, running a restaurant and a café and, in development, an end of life vehicle recycling plant.

  1.2  People with mental health problems and other disadvantages form the voluntary workforce, staffing and managing the business. The majority of these are on IB, and over half on the enhanced level of care programme (CPA) ie with complex support needs and in receipt of a range of specialist mental health services. 20% are service users of the secure psychiatric services, either in Broadmoor Hospital, a number of Medium Secure Units or recently discharged into the community.

  1.3  Our projects are based on a unique model founded on two vital principles:

    (a)    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;

    (b)    People join our workforce not as patients, clients or service users, but as colleagues and equals, sharing the responsibility of making the project work.

  1.4  When ready, people are assisted to move onto paid employment elsewhere through a programme of work placements with other employers and support with the job application process.

  1.5  We wish to comment on two related key areas with respect to their impact on people with mental health problems, drug and alcohol recovery problems and people with mental health problems in the secure psychiatric services:

    (a)    The reforms to IB and the issue of distinguishing between those who are able to return to work and those who cannot.

    (b)    The experience of sick and disabled people and the issues of how the reforms will help those not yet ready for work.

2.  DISTINGUISHING BETWEEN THOSE WHO ARE ABLE TO WORK AND THOSE WHO CANNOT

  2.1  Mental health poses a major difficulty for those trying to establish if someone is able to work or not:

    (a)    because the sporadic nature of the condition itself results in fluctuating capability over days, months or even years;

    (b)    because of the long term dependency on institutions that characterises the experience of so many people with mental health problems, not only those diagnosed with a major psychotic condition but also those experiencing depression and anxiety. This experience can affect people's behaviour and perception of their potential more than the original diagnosis itself;

    (c)    because the ignorance and fear still associated with mental illness in the minds of people unfamiliar with the area can cloud judgements as to a person's ability to work.

  2.2  The real problem in allocating people to one or other of the two proposed benefits is that, in mental health, the level of disability is not related to a person's ability to obtain and hold on to paid employment. For example, people with cyclical illnesses when well can present as fully capable, but the issue for them is about sustaining a level of performance and their ability to present reliably for work may vary widely from month to month. Others with more debilitating, but more consistent long term difficulties, once they find the motivation, can manage their condition in order to carry out a responsible job.

  2.3  Case Study 1

  A had been in prison and had spells in hospital with severe mental health problems, diagnosed as paranoid schizophrenic episodes. At the FST project in Lambeth, A discovered that he had a flair for organising people and managing small teams of workers on site. After two years of working as a volunteer workforce member of the project, he has recently been appointed to a salaried position at FST and manages the gardening section, the project's largest commercial contract, bringing in an annual income of £90,000. "I had to get my life together," says A, "and I did it through work." Today he lives in his own flat in the community and has minimal contact with mental health support services.

  2.4  So the difficulty of the split benefit is that is forces a polarisation into Able to work/Not able to work when the reality is much more a continuum along which people may be assisted to move towards employability given the necessary support. In our experience, also supported by research, the primary factors that enable people with mental health problems to move into paid employment after a period of incapacity are not the severity of their problems. More significant are:

    (a)    motivation to work; and

    (b)    a history of employment prior to their difficulties.

  Thus the issue is not so much "Can someone work?" but "How long will they take to get there?"

  2.5  We appreciate the need to protect benefits for those who clearly are not able to work, but suggest this represents a much smaller proportion than many would assume. We also welcome the approach of starting the intervention when people first come onto IB rather than allowing the apathy and destructive lifestyle of long term unemployment to become entrenched. However, we suggest there is a need to consider a further category for those whose objective is employment, but for whom the timescale is more like three years than six month to a year.

3.  EXPERIENCE OF DISABLED PEOPLE—HOW THE REFORMS WILL HELP THOSE NOT ABLE, OR NOT YET READY, TO WORK

  3.4  Motivation is then one of the key factors. The starting point for FST is that anyone who expresses an interest in work should be facilitated to do so whatever their level of disability or disadvantage. Even those who explicitly state no interest in moving into employment in time, may evidence motivation just through attending an FST project and taking part.

  3.5  If we are to enable people with enduring mental health problems to gain the confidence to decide to work towards paid employment, it is essential to understand the culture of mental health services.

  3.6  Having gone through one episode of mental ill health, people are understandably frightened of breaking down again and develop a lifestyle that is about avoiding stress and pressure in order to maintain their stability. This concern is shared by mental health professionals leading to a degree of over protectiveness of their service users. In addition, there is an apathy and passivity that can result from reliance on the institutions of hospitals, secure psychiatric services, prisons, even community based day centres, and this becomes conflated with the person's actual mental health condition, leading to an underestimation of their abilities. This in turn feeds into general ignorance and fear of mental illness, creating a downward spiral whereby the person and those supporting them lose all belief in their capacity to make any kind of contribution to society, let alone being paid for it.

  3.7  An all too common example of this in FST's experience was the ex-soldier with an apprenticeship in plastering and a diagnosis of schizophrenia who happily told us now that he had DLA (Disabled Living Allowance) he did not need to attend FST anymore because his community nurse had informed him he now never had to work in his life. The man in question was only 26 years old.

  3.8  People come to FST essentially unemployable as their period of unemployment means they struggle with basic work skills such as turning up reliably and on time, having the stamina to work a whole day, dealing with managers and colleagues. They have no work reference, any skills they have are out of date and they have unexplained gaps in their history when they have been in hospital or prison. There is little wonder they feel unable to consider employment. But the experience of working, even in a voluntary capacity, gives them the chance to develop these skills and begins to shift people's thinking as they gain in confidence, and dare to hope they may work one day. But we need to think in timescales of two to three years at least.

  3.9  Case Study 2

  B was being discharged from a day centre in Sheffield, but obviously needing some form of continuing support. Her parents contacted us to inquire if she was able to attend FST. The young woman in question had a severe lack of self confidence resulting from her mental health problem and, following a difficult meeting with B and her parents, we agreed for her to attend initially with her father for a couple of brief sessions of no more than an hour to see if she was able to build up the confidence to stay for longer without parental support. To cut a long story short, with support provided initially on an individual basis and then by key workforce members, she now conducts herself with a confidence that has amazed her parents and key worker, all of whom say they would not have believed it possible in such a short time.

  3.10  Case Study 3

  C has had mental health issues for 25 years, exacerbated by alcohol and drug abuse. He has been in prison and more recently in a secure unit after his mental health deteriorated. He was initially required to attend FST under escort, but after transferring to an open ward his attendance gradually became more reliable and his relationships with managers and workforce changed out of all recognition.

  He now does four full days a week and his commitment is greater than anyone else on the team, with faultless attendance and punctuality, and internal certificates attesting to 250 hours in gardening and 200 hours in painting and decorating. His next target will be a job, and even though that may yet be some time away his determination to put his old life behind him and the support he attributes to FST make this a realistic target.

  3.10  FST's concern about the reforms is that people who are not obviously ready for work, those in the examples given above of which we have many more, will be put onto the disability benefit as unable to work since they will not be able to take advantage of the more intensive Pathways to work schemes.

  3.11  We recognise it is intended that those on the disability benefit will still be encouraged to work towards employment at a slower pace. However, the impact of having been categorised as unable to work cannot be overestimated in a culture where so much conspires to weaken people's confidence in themselves as employable.

  3.12  Finally, our experience on the ground indicates that there is s real risk that people whose problems and difficulties present the most challenge will be written off as incurable. The thinking seems to be that people in these circumstances should be treated in the same way as people who have a terminal illness. The aim will be to make life as comfortable as possible from a clinical perspective. Our concern is that in the current climate of blame and litigation it will be easier to write someone off than it will be to invest the levels of time and risk required to rehabilitate them.

  3.13  We fully anticipate a drop in referrals to the work projects as a result of the reforms as they currently stand as both mental health professionals and this particular group of people themselves make a decision that they are not able to work within the framework set by the Pathways to Work schemes.

4.  RECOMMENDATIONS FOR ACTION

  We would value the category of "Able to Work" being divided into a fast track—as already described in the reforms and a slower paced one, still within the rehabilitation benefit, where there is a timescale of up to three years to prepare to return to work. This would enable the major barriers of confidence and loss of self-belief to be addressed through practical work projects such as FST and ensure a real and sustainable change in people lives.

Carole Furnivall and

Ronnie Wilson MBE

28 September 2005



 
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