Schizophrenia and Work: Why work?
Work is a difficult issue for many people living with schizophrenia in the UK. Of course for people whose symptoms are too severe, work may not be an option but others will over time find that they have made a substantial recovery from their symptoms and are now able to function very well. At this point they may well begin to think about getting into work. If they are on a high level of state benefits the advantages of getting into work may not be immediately apparent.
But the benefits of work as part of a pro-active recovery plan should not be underestimated. There is now increasing evidence that people who have made a substantial recovery from their acute symptoms will fare better if they are in work than if they are living “on the sick”.3 They will suffer fewer relapse events and go into hospital less.
Can people with schizophrenia work?
About 25% of people who experience an episode of schizophrenia will recover completely and have no further problems ever again. In addition a large proportion of the remainder will do very well with the aid of the correct treatment. Despite this in the UK today only about 13% of people with a diagnosis are in any kind of work2. There may be a number of reasons for this disparity such as the stigma that people with schizophrenia face when looking for work or the residual symptoms that some people experience even after they have made a substantial recovery.Various figures have been postulated for the proportion of people with schizophrenia who could do a full time job but Fuller Torrey, a psychiatrist in the USA estimates that 15-20% of his patients with a diagnosis of schizophrenia could work full time whilst a further 20% could do a part time job.1 However we can see examples in some industrialised countries where much higher rates of employment for people with schizophrenia have been achieved: for instance in Northern Italy. Richard Warner, in his book, describes a study carried out in Bologna which found the rate of people being treated for schizophrenia and in continuous work in that city as high as 50% with about 20% being in full time work.2
It is thought that one of the reasons why people with schizophrenia in developing countries have better outcomes is because they have more ready access to employment through subsistence agriculture.But for some people their illness follows a more or less chronic course with repeated relapses and admissions to hospital and for these full time employment may be beyond their grasp.
What are the benefits of work for people with schizophrenia?
For those who are able to work there are a number of benefits. Here are a few4:
1. Work provides financial independence and frees you from the constraints of the benefits system. Of course in today’s fluid jobs market there are very few “jobs for life” but without a doubt earning a living rather than relying on state benefits improves your feeling of self-worth and your standing with your friends and neighbours.2. Work is one of the main ways in which people interact with the society they live in. We all need to feel that we are doing something useful to contribute to the society we live in and for most people work is an important means of making their own personal contribution.
3. Work improves your self-esteem. All of us need to feel good about ourselves and having a high self-esteem has been shown to reduce the frequency of relapses in schizophrenia.
4. Work provides social contact and enables you to make new friends. Many workplaces have active social scenes and workers will continue to meet each other outside of work socially. Even when the job doesn’t have such an active social life it is still an important place for people to meet new friends and acquaintances.5. Work enables you to learn new skills. Human beings by nature enjoy learning new skills especially when we turn out to be good at them. Learning a new skill will give you a real sense of achievement and another entry on your CV.
6. By being given responsibility in a job you will feel more valued. We all need to feel a valued part of our community. We need to feel needed. Working, even in a manual job, involves being given responsibility which makes us feel valued.
7. Work gives you an identity. Do you ever get fed up always having to answer “unemployed” when you are asked what you do? Working gives you a role in society that others can identify you with.
8. Work gives you a reason to get up in the morning. For most people early morning is not their best time. We all need a reason to get up and something worthwhile to do with the day. Work provides you with the motivation to get up early and have a full and productive day.
9. Work gives you a purpose in life. People suffering with psychosis score very poorly in tests designed to assess their purpose-in-life. Feeling that their lives are so empty often leads to a dependence on alcohol or street drugs and feelings of intense despair that can often lead to suicide.7
What are the prospects of getting into work?
Under the old system of care in large institutional asylums people with mental health problems had access to well-equipped sheltered workshops or community farms and had more opportunity to work than today where they have to negotiate the increasingly competitive commercial job market. In those settings it was often observed that residual symptoms were more apparent in patients when they were not occupied than when they were working in the workshop or farm.
Over the last 50 years in the UK the number of people living with schizophrenia who are in work has declined. We don’t yet know why this is. It may be that the workplace has become more competitive or that employers, being influenced by adverse media reporting, are more resistant to employing people with schizophrenia.
However there are factors that will help people get back into work. For instance people who have worked before becoming ill will generally find it easier to get back into work after an episode of schizophrenia. Similarly people who experience schizophrenia later in life or who experience only one episode will be better placed to find work. But be under no illusions finding work in today’s competitive workplace is a real challenge for people who have been diagnosed with schizophrenia and job-searching will require much hard work and commitment.
What are the obstacles to finding work?
Why do people with schizophrenia find it so hard to get into work? It would be wrong to blame it all on stigma. In fact there are a number of obstacles to employment faced by people with a diagnosis.
1. Stigma: Unfortunately many in our society have a very negative view of people with schizophrenia. This unhelpful view of what is a major public health issue is often fed by adverse reporting in the media. Fuller Torrey, an American psychiatrist, talking about the experience in the USA, says that stigma is the biggest impediment to vocational opportunities for people with schizophrenia.5 Without a doubt schizophrenia is one of the world’s most misunderstood illnesses and stigma remains a serious problem for people trying to get into work.
A form of stigma also exists within the caring professions: in many developed countries such as the UK, unemployment is such a routine state for people living with schizophrenia that many psychiatrists and other professionals see it as the natural and indeed the inevitable way of life for people with a diagnosis.32. Long absence from work: Employers, particularly in the private sector, tend to view any period of unemployment longer than a couple of months with great suspicion. For this reason it is a very good idea to try to occupy your time with voluntary work or study while you are not well enough to work full time so that the gaps in your CV can be minimised4.
3. Criminal record: Sadly some people who have experienced an episode of schizophrenia come into contact with the criminal justice system and are sentenced before their illness can be diagnosed and tragically sometimes despite their diagnosis. They will not be able to get a clean Criminal Records Bureau check. An increasing number of vacancies advertised require a CRB check and this factor may prevent employment in certain fields such as teaching or the caring professions.6
4. Lack of confidence: Schizophrenia is a ruthless destroyer of self- esteem and many people who have experienced an episode end up having little faith in their own capabilities. The journey back to a sense of personal self–worth can be a long and hard one and involves a good deal of hard work on the part of the sufferer. This is where counselling, support groups and the support of friends and family can make a real difference4.
5. Fear of the unknown: Schizophrenia often strikes in late teens or early twenties and many people who have suffered from it do not have any previous experience of work. For them getting a job is a massive leap into the unknown.
6. Lack of qualifications: Because schizophrenia so often strikes at a time when people are trying to gain their qualifications the illness can leave people un- prepared for success in a job market where they are competing against much more highly qualified candidates.
7. Poor social skills: Many people who have recovered well from an episode of schizophrenia are left with residual symptoms such as hearing voices which make it difficult for them to relate to other people and this impacts on their ability to do full time work.8. Poor job-searching skills: As with any other activity good job-searching technique is vital if you are to be successful in getting into work. It is very easy to send out lots of poorly written CVs indiscriminately to employers who are not recruiting and feel that you are making an effort but a more targeted approach may involve less effort and have more success. Job-searching skills can be learnt and there are organisations who specialise in helping people with this4.
9. Lack of role models: Most support groups and activities that are run for people with mental health problems tend to be run during working hours and thus exclude people who are working. Consequently most people living with schizophrenia do not get the chance to meet with other people with schizophrenia who have managed to make the move into paid employment and do not get to share their experiences and values.Although this list of obstacles may seem insurmountable, in fact experience has shown that it is possible for people living with schizophrenia to find long lasting and fulfilling jobs – it is just a bit harder than for people who don’t have the experience of this particularly cruel condition.
Of course because schizophrenia affects different people in different ways it may be that a nine to five, five day a week job may not suit everyone. Part time work for instance can vary from just one day a week to most of the week. Similarly studying can be full time or part time and for those who can’t yet manage formal attendance at college there is also distance learning at home.
The prospect of getting into work after a long period “on the sick” can be very scary for people living with schizophrenia. Make no mistake finding a job in today’s increasingly competitive workplace is a considerable challenge for people living with schizophrenia. But if you are able to work the benefits of having a job are too great to ignore.
1. Torrey E Fuller, 2001, Surviving Schizophrenia, Quill, P264.
2. Warner R, 2000, The Environment of Schizophrenia, Brunner Routledge, P73.
3. Bevan S, Gulliford J, Steadman K, Taskila T, Thomas R and Moise A, Feb 2013, Working in Schizophrenia: Pathways to Employment, Recovery and Inclusion, The Work Foundation
4. Author’s personal experiences.
5. Torrey E Fuller, 2001, Surviving Schizophrenia, Quill, P265.
6. Conversations with people living with schizophrenia.
7. Warner R, 2000, The Environment of Schizophrenia, Brunner Routledge, P71.