Back to work on the recovery model

‘The recovery model’ has been much touted over recent years, and is equally loved and loathed by the service user community. It is seen by some as an escape route from responsibility by wider society for the necessary ups and downs in life that happen in the course of a mental health journey. The recovery model has to an extent been heralded by government and services as an easy road back to employment and away from dependency on the state. It is not of course that easy. And recovery models that suggest that once someone has ‘recovered’ from mental ill health, they can put it behind them and move on with their lives unchanged, are by their nature flawed and unrealistic. Mental health conditions affect us all to one extent or another throughout our lives. For those of us who receive a diagnosis, for at least some or maybe all of our lives, it will be a time consuming and resource intensive task to manage them. It will require much of us personally, and much of professional services too.

The issue of time is I think a pertinent one. Time is after all a limited resource for all of us. I was looking at the social model of disability and wondering if we could apply this to time to learn something about how to facilitate recovery journeys, which may or may not involve a route to employment, volunteer work or study. Certainly it has been documented that a sense of contributing something to society is beneficial for the service user and their road of recovery. But for those trying to hold down a job, course of study, or voluntary work, it often seems that being able to do that and to manage their mental health within the NHS system are mutually exclusive things.

There is an assumption by the NHS, social workers and support services that mental health service users are necessarily free in office hours. This is not always the case for those in employment. Equally, if they are to be honest with their employers, the stigma associated with mental health, drug or alcohol dependency or the impact that it might have on family and relationships will have to lessen. There must be vast swathes of service users in employment in professions or in the city, working too hard and playing harder, suffering from a dual diagnosis of mental ill health and alcohol or drug addiction. There must also be numerous examples of people holding down high stress low pay work, for whom sympathetic bosses and pastoral care at work is a dream rather than a reality. For them the NHS model of only being open in office hours falls down completely. Where can they get help and continue to manage their lives and their mental health without losing their employment? For sure, employers have to change. But so too does the system if it is going to encourage service users to aspire to the kind of recovery that includes paid employment.

This is where we get to the social model of disability, the notion that it is not the disabled who must change, but society that must change to adapt to them. The classic example of this model that is frequently cited is the city planner’s tendency to put stairs everywhere. As I went into Vauxhall tube station the other day I went down the stairs and thought of the expense that wheelchair users must be forced to go to to travel around town in taxis. As an employed professional with say a dual diagnosis of mental health and alcohol addiction not in need of rehab, and hoping to continue to manage as independently as possible, the NHS might offer for example attending a 3 month course every day from 10am to noon. Impossible to do in employment. It’s like sitting in a wheelchair looking down the steep set of stairs into Vauxhall tube station. Even if you wanted it to happen, it’s just not going to. Something has to give.

Surely office hours only are the NHS equivalent of stairs. They say they want recovery, and the state certainly wants to reduce the welfare burden, but it is a fact of life for mental health service users all around the country that being a mental health service user and attending the necessary appointments is a full time job in itself. When I had a CPN and employment advisor, I saw my CPN once every 2 weeks, my employment advisor and psychiatrist once a month each. I also had fitness appointments and parenting appointments. My career has been largely dictated by my mental health and my willingness to be open with an employer. Imagine explaining away that level of appointments and work absences. In my 30’s, I even put off coming off my pills in order to have a baby because I was in a work environment where I couldn’t countenance explaining to my employer that I was going to be absent for appointments related to my mental health. After leaving that contract, I became self employed again. I have been working for myself, apart from a total period of around a year, all my working life. The year that I was employed I spent with niggling doubts at the back of my mind as to the openness of my employer to my undisclosed mental health diagnosis. For me, the security of being employed wasn’t worth the stress caused by the possibility that I might be forced to disclose. I left, and was much happier on a lower wage as a freelancer. However, if we are going to integrate service users into all areas of society, we mustn’t confine them to portfolio and largely low paid jobs.

If we are to understand the social model of disability, and how it relates to mental health, we have to offer services that work outside office hours. And if we are to expect people to recover, we have to facilitate their journeys, whether or not that involves a route to employment. Even if it is a cynical hijacking of the recovery agenda to encourage people to focus on employment, it is a half cocked cynical hijacking if it doesn’t involve making it possible for them to attend their appointments and hold down a job. It doesn’t matter where you stand on recovery, whether you are a cynical hijacker, a government crony or a service user activist, if you were asked to design a tube station from scratch, you’d make damn sure there was a lift as well as the inevitable stairs.

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