On 18th October 2024 NSUN published an online article: ‘Response to plans to introduce job coaches into mental health hospitals’. Two days earlier, the BBC website had reported Liz Kendall (Work and Pensions Secretary) as saying she was planning a wider roll-out of certain existing projects involving employment advisers working from within the wards of mental health hospitals. She apparently cited a project at the Maudsley Hospital. Then on 24th October, Disability News Service pitched into the fray with some fact-checking: ‘It is believed that Kendall was referring in her BBC interview to South London and Maudsley (SLAM) NHS Foundation Trust’s Work Well scheme. The Trust has confirmed that its Work Well employment specialists never initiate contact with inpatients …..that most of those who receive support through the scheme are outpatients…. and that Work Well employment specialists rarely if ever visit a ward, and would only ever do so if they had specifically been asked to make such a visit by an inpatient.’
The whole matter might easily appear to have been the merest storm in a teacup. But it raises some issues that deserve serious thought.
For those of us whom society has labelled ‘mentally ill’, and whose so-called illness has led them into hospital, this problem of finding (and maintaining) gainful employment is very often a crucial strand in the complex weave of difficulties comprising the thing itself, the ‘illness’. In other words, for many it is an internal problem and not just something located ‘out there’ in society at large; we suffer not just because of the culture fostered by politicians and employers (which is brutally competitive and feels inhumane to anyone struggling), but because we ourselves are torn and tortured by our own sense of duty and obligation to earn a livelihood. Those stigmatised as ‘economically unproductive’ are all too liable to internalise the stigma. And in that sense, it is admittedly tempting to blame the politicians for creating and encouraging our low sense of self-worth.
But I see the matter in different terms. We have evolved as human beings, from our origins as pack animals, with an inbuilt instinct of belonging. Therefore the sense of society’s having a claim over us can be seen to derive not so much from individual leaders and their policies, as from our own evolutionary memories of a time when humans were somewhat more like apes. Moreover, this ‘herd instinct’ is surely capable of producing good as well as harm. The hospital patient scared witless of competing for a job, is scared precisely because the whole idea of work possesses such an emotive charge of energy. But what if that same energy, currently driving their fear, should turn out to contain the future seeds of a different kind of drive, more akin to ambition? My own journey through the mental health system, twenty years ago, ran something like that.
This being the case — no matter how passionately we lobby to protect hospital patients from being required to seek work — such safeguards are useless (arguably worse than useless if they compound our isolation) when it comes to facing the psychological pressures and demands we may be inflicting upon ourselves, driven by internal factors for which no politician can be blamed. So we should be hesitant to dismiss any reaching out of the state towards the individual which, potentially, might help us negotiate that point of overlap where society’s anxieties about us, its most vulnerable members, meet ours about society.
I felt strongly, reading NSUN’s official response to Liz Kendall, that it was making a tragic mistake — in effect simply buying into that same unnuanced, ‘us and them’ mentality which characterises so much of our media coverage and political discourse around these matters. More specifically, NSUN seems to assume the employment advisers to be capable of nothing more constructive than a ratcheting up of pressure upon their clients. It’s certainly a danger to be guarded against. And yet on the other hand, in my own personal journey from dependence on the state towards paid employment, I was lucky enough to receive support from one dedicated charity (Jobs in Mind, now sadly defunct) and one not-for-profit (Ingeus, still operational) both of whose staff were brilliantly sympathetic, while also maintaining focus on the purpose of our meetings.
In all conscience I do need to acknowledge that I know, from experience, just how intimidating and hopeless things can appear, on the job front, to anyone stuck in the mental health system. Supposing ‘job coaches’ were working directly for the government, they might easily experience considerable pressure themselves; they might, figuratively, be working with a voice at their shoulder spouting tabloid garbage. And if such pressure were passed on to their clients, then undeniably, they’d be doing more harm than good. But this is merely one possible outcome, one aspect of a much more complex picture than NSUN has portrayed.