Introduction

Historically, if people with enduring mental health problems have been seen as capable of work at all, this has been framed as ‘therapy’ to be undertaken in sheltered, socially excluded settings. Real work in real workplaces has been seen as something to be put off until recovery, in the clinical sense of the disappearance or control of ‘symptoms’, is complete, in effect indefinitely for many people. This chapter starts by examining that historical context, contrasting it with the research evidence regarding the work aspirations of people with enduring mental health problems and their potential to become valued employees. The authors argue that what is required to enable people to fulfill their potential is a shift from a clinical model of recovery from mental ill-health towards a model more akin to a social model of disability.

To support that argument, the results of a study exploring approaches to employment support for this group are presented. In conclusion, the chapter looks at the progress being made in developing appropriate supported employment in the UK and at the challenges ahead.

The historical legacy – a waste of potential

The use of ‘constructive occupation’ has been part of mental healthcare since the development of the mental hospitals. For the most part, however, it has been assumed that the best people can hope for is low-grade, low-paid work within institutional or protected settings. Yet where more ambitious schemes have been tried, ‘patients’ have often risen to the challenge, causing some psychiatrists to question their assumptions. This thread of questioning and experimentation re-emerged several times during the 20th century, but in the end has always been overwhelmed by clinical pessimism and a presumption that people must be ‘cured’ before they can work.

In the 1950s and 1960s, British psychiatry led the way in vocational rehabilitation through pioneers such as Rudolf Freudenberg, Douglas Bennett and Donald Early, and they in turn derived many of their ideas from earlier work in Germany. Freudenberg was himself German by birth and was influenced by the work of Dr Herman Simon, Director of the psychiatric hospital at Gütersloh in in Western Germany.