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Supported employment


Mental illness: Why getting back on the job is hard work


By Susan Misicka



Going back to work gives the day more structure  (Keystone)

Going back to work gives the day more structure 

(Keystone)

Having fought depression and addiction, Peter* has a steady job. Finding work for people like Peter or keeping them in jobs can be a win-win situation for both employee and employer. While Switzerland compares well with other countries in this regard, the OECD says there’s room for improvement.

“Three or four years ago, I didn’t have any prospects. It’s way better now,” says Peter, who once struggled with addiction and depression. Now he works at the reception and back office of a retirement home four days a week.

The slim and soft-spoken 27-year-old found the job via Job Coach Placement (JCP), a supported employment programme run through the University of Bern’s psychiatric services.

“The goal is to reintegrate people into the competitive workforce, step-by-step,” JCP job coach Caroline Wyss told swissinfo.ch. Some are recovering from a burnout or depression; others have illnesses like schizophrenia or bipolar disorder.

“When they come to us, first we analyse the situation – their job background and where their strengths lie,” explained Wyss. Peter, for example, had trained as a mediamatician, someone with a broad range of skills – administration, ICT, multimedia, and marketing.

But his problems kept him from getting a foothold on the career ladder. He held a couple of casual jobs, but nothing steady, and he eventually began collecting unemployment and disability benefits.

Swiss situation

Worldwide, one in five people has a mental problem at some point in life – which can have a devastating effect on career prospects.

“About one in three people on [Swiss] unemployment, disability or social assistance benefits has a mental disorder,” according to an OECD report published earlier this year. “The unemployment rate of people with mental illness is more than double the overall rate.”

Their risk of poverty is less dramatic compared with other OECD countries, Switzerland being generous with sickness, disability and unemployment benefits. And with more psychiatrists per capita than any other country surveyed, Switzerland offers a wide range of clinics and treatment options – including sheltered workshops.

“That’s an incredible thing here in Switzerland. We have so many sheltered institutions with very low-skilled work. But a lot of people with mental health problems are very intelligent and have good qualifications,” psychiatrist Niklas Baer, co-author of the OECD study, told swissinfo.ch. Baer is the head the rehabilitation department of canton Basel Country’s public psychiatric services.

According to Baer, supported employment – which gets people back into “normal” jobs in the free labour market – makes more sense, since people are able to seek work more suited to their qualifications. This is where programmes like JCP come in, but the offer varies depending on the canton.

Turning point

For Peter, quitting his drug habit and giving up alcohol was a turning point. He did some written, verbal and practical work-aptitude tests administered by the disability insurance authorities. Afterwards, a social worker referred him to JCP.

The JCP programme has three phases, with the first part focussed on finding a job and getting used to the rhythm of a daily work structure again. This phase – which lasts for six months – is financed by the disability insurance.

“My coach at JCP helped me find an internship really quickly. He also helped me build up my résumé again, because that was where I really had problems. I couldn’t bring myself to write letters of motivation,” Peter said. After his internship at a cultural institution, he was offered a temporary job at the retirement home.

If all goes well, the employer pays an incentive wage, which might be enhanced by welfare-related funding. The ultimate goal is for the person to be offered a permanent position with a monthly salary – like in Peter’s case.

Still a stigma

In some countries, supported employment programmes have existed for decades. When they first began to appear in Switzerland in the 1990s, they caused a sensation.

“It was really a revolution. People had the idea that if you had a mental disorder, you couldn’t work – that you weren’t stable or reliable. The stigma is still prevailing, but I think that’s changing now,” psychiatrist Baer said.

For Wyss, convincing employers to hire someone with a mental health issue can be a hard sell – despite the fact that the initial investment is so minimal.

“The most frustrating thing is when they say things like, ‘We don’t need one of them’ or ‘They’d just be in the way’”, Wyss said, “I wish people would have a certain level of understanding. It could happen to me or you.”

“The employer has to have some patience,” she admits. “Maybe the person can’t work full-time, or the output might not be 100%.”

Peter says it feels really good to be weaned off of the social and disability benefits. In addition to being grateful to JCP and Senevita, Peter appreciates the variety of tasks his work involves – from bookkeeping to updating the website to interacting with residents and their visitors.

Working well

According to Baer, work is the “most important thing” for mental health. “It’s not just the money – but the sense of social identity, structure, and feeling useful.”

Baer said that while reintegration is an important issue, it’s not the only thing for society to consider.

“So many beneficiaries would really like to work, but you shouldn’t put all of the energy into that. Job retention and early intervention also very important. We should do a lot more. The majority of people with mental health problems are still working, and you should intervene much earlier,” he told swissinfo.ch.

As the OECD report recommended, “Employers should be given more responsibility to deal with mental health problems in the workplace and work together with sickness insurers,” noting that better follow-up could reduce absenteeism.

“Employers should also be required to contact the disability insurance quickly when health issues arise for one of their employees,” continued the report.

And what about strain felt on the job?

“Psychiatrists don’t focus enough on their patients’ work-related problems. They should focus more on work and not just see it as stressful, but as something good for mental health,” Baer said. “I think psychiatrists could do a lot more and make a difference here.”

Thanks to his supportive employer, Peter can cope with his workload without getting stressed out.

“My to-do list has lots of stuff on it, but I have a really nice boss who isn’t on my back too much if things don’t go right on the first try.”

And Peter’s advice for people struggling to cope with psychiatric issues, whatever their work situation?

“Set small goals – you can’t just change from one day to another. You have to be patient and just give it time.”

*Not his real name

Missing the target

Some 230,000 people in Switzerland were receiving disability pensions – either full or partial – in 2013. Of these, 102,000 were suffering from mental illness.

Between 2012 and 2018, the Swiss government wants to reduce the number of full disability pensions by 12,500 (based on a total of full and partial). But as the Federal Social Insurance Office announced on August 18, 2014, it is not on track to achieve this.

Within the first two years of the reform period, the goal was to cut 4,364 pensions, but the insurance administrators only managed to trim 2,776. Ultimately, the goal is to get 17,000 people with disabilities back to work by the start of 2018.

By Susan Misicka, swissinfo.ch