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Although work has a fundamental role in the individual’s psychological well-being, the vast majority of mental health service users are not in employment. This is the result of various barriers that impede their work re-integration process despite their desire to work. Apart from the illness’ symptoms, these barriers are strongly associated with the negative effects of long-term unemployment, the negative stereotypes and attitudes towards mental health service users and the fear of losing disability benefits. There are several occupational intervention models aiming at vocational rehabilitation of mental health service users. Arguably, the Individual Placement and Support (IPS) model of supported employment has proved to be more effective compared to other models. This chapter presents an innovative career counselling approach that combines elements from the IPS model and from the newly emerged career theories that have been developed to address today’s world of work challenges. This model was developed by the Pan-Hellenic Association for Psychosocial Rehabilitation and Work Integration (PEPSAEE) in Greece during the recent major economic crisis. Further implications of the model’s implementation regarding vocational rehabilitation of mental health users as means for social inclusion are discussed.

Evidence accumulated over many years illustrates the benefits of work for mental health, including that of mental health service users. Despite strong evidence of the effectiveness of the individual placement and support (IPS) approach in enabling this group to find and keep paid employment, employment rates among mental health service users remain low, and IPS is not widely implemented in the UK. This paper reviews recent evidence for IPS, describes the key features of the approach and compares these with service users' accounts of the kind of support that they find helpful. The current situation regarding implementation of IPS is then considered, together with the barriers hindering implementation. It is clear that the barriers are multifaceted, and action will be required at a number of levels if mental health service users are to be enabled to achieve their employment goals.

This paper brings together findings from current research into mental health and employment from an economic perspective. The economic impact of reduced employment and productivity for people with mental health problems is described from both individual and societal viewpoints. Interventions reported to have an impact on employment are considered, looking at both clinical interventions that have reported employment outcomes and interventions that have as their primary target the improvement of employment outcomes. The paper also describes the impact of common mental health problems on employment and productivity and reports the findings of some studies in this area. However, the quantity and quality of economic information in this area are limited.

Recovery principles have been central to debates in both the government and the mental health field, when thinking about the best way to support people who have experienced mental health distress into employment and education. The purpose of this paper is to review how this principle has been employed within the most effective approaches. This information will contribute to the development of the South London and Maudsley (SLaM) NHS Foundation Trust apprenticeship/return-to-work scheme for people who have experienced mental health distress.

NHS evidence was used to undertake searches journals on CINAHL, EMBASE, PsycINFO, MEDLINE, HMIC, AMED, BNI, HEALTH BUSINESS ELITE and the Cochrane Library. Common search terms used were as follows: apprentice*; mental illness*; mental disorder*; psychiatric; psychosis; chronic mental disorder*; patient*; service user*; client*; return to work schemes; work; employment; unemployment; peer worker*; supported employment; vocational rehabilitation; peer training*; outcome measure*; recovery.

Although the available literature writing about these employment schemes were not explicit in using Recovery as its guiding principle (i.e. Hope, Control and Opportunity), many of the participants in studies about a particular type of supported employment called Individual Placement Support (IPS) referred to recovery concepts in their narrative accounts, i.e. doing work that is meaningful, building self-esteem. This particular type of employment scheme was shown to have better outcomes for people who have experienced mental health difficulties then others schemes. The importance of employers having systems in place to support people’s control/self-management of their mental health condition was a key factor in helping them retain jobs once they have got them.

The SLaM education and training service plans to develop a return to work programme for people who have had lived experience of mental health distress, through a workforce skills apprenticeships scheme. This is first apprenticeship scheme of this type in London. Therefore, this paper will review the literature on previous and current employment programmes for people who have experienced mental health distress, specifically highlighting what has worked well and what could be improved. This paper will also draw on the literature presented in this review and conclude on key points, which will contribute to the development of SLaM’s apprenticeships scheme. This literature review will form the basis of further research about the outcome/evaluation of the actual apprenticeship scheme after the first year.

This Research Watch aims to summarise two recent research papers relating to employment and mental health, one relating to all sectors of the working‐age population and the other to women who had recently had a child.

A search was undertaken to identify research papers with a mental health and social inclusion focus published within the past 12 months.

Both studies involved large samples of people in Australia. The first paper used information from over 7,000 people of working age, and investigated whether the quality of employment was related to mental health. Poor quality employment turned out to be worse for mental health than no job at all. The second paper focused on over 1,000 women who had given birth in the previous 12 months, and found that quality of employment predicted whether they experienced mental distress.

These two papers add to our understanding of the relationship between mental health and employment, the first focusing specifically on the quality of employment rather than simply employed versus unemployed status, the second by highlighting how poor quality employment may contribute to psychological distress after having a baby. Real social inclusion through employment may depend not only on being in work but the quality of that work.

Past research on self-employment and health yielded conflicting findings. Integrating predictions from the Stressor-Strain Outcome model, research on challenge stressors and allostatic load, we predict that physical and mental health are affected by self-employment in distinct ways which play out over different time horizons. We also test whether the health impacts of self-employment are due to enhanced stress (work-related strain) and differ for man and women.

We apply non-parametric propensity score matching in combination with a difference-in-difference approach and longitudinal cohort data to examine self-selection and the causal relationship between self-employment and health. We focus on those that transit into self-employment from paid employment (opportunity self-employment) and analyze strain and health over four years relative to individuals in paid employment.

Those with poorer mental health are more likely to self-select into self-employment. After entering self-employment, individuals experience a short-term uplift in mental health due to lower work-related strain, especially for self-employed men. In the longer-term (four years) the mental health of the self-employed drops back to pre-self-employment levels. We find no effect of self-employment on physical health.

Our research helps to understand the nonpecuniary benefits of self-employment and suggests that we should not advocate self-employment as a “healthy” career.

This article advances research on self-employment and health. Grounded in stress theories it offers new insights relating to self-selection, the temporality of effects, the mediating role of work-related strain, and gender that collectively help to explain why past research yielded conflicting findings.

People who have used mental health services in Scotland have the lowest employment rates of all working ages, despite a national programme for mental health and well‐being that provides significant investment in anti‐stigma initiatives and employment support services. This paper qualitatively identifies barriers to employment from the perspectives of people who have experienced mental health issues by conducting in‐depth focus groups with 20 people who have experienced mental health issues undertaken through collaborative research involving people who have experienced mental health issues alongside practitioners and academics. Researchers who have experienced mental health issues instigated and determined the direction, execution and dissemination of the study. The findings add to the growing evidence base outlining the complex and interlinked barriers to employment which include previous experience of workplace discrimination, financial uncertainty, disclosure concerns, quality of jobs available and the potential of work at times to worsen mental health conditions. Despite this, most participants expressed hopefulness and resilience. Many wanted paid work and outlined practical steps that employers can take in terms of recruitment and retention. However, participants also stressed the equal importance of voluntary work and not just as a step to paid employment. A multiple‐perspectives approach provides important insights into the complex and sensitive policy area of mental health and employment. Meaningful involvement of people who have used mental health services should be a central aspect of further research that aims to understand and address these barriers. This study has shaped the development of a national service user research consortium in Scotland.

There is an established international evidence base on supported employment for people with severe and enduring mental health problems, and now a growing evidence base on how to successfully implement this into practice. The process involves substantial organisational development and change, and therefore effective leadership is critical. This article outlines some of the challenges to implementing supported employment services and explores what recent leadership theory could contribute to this process, as the Sainsbury Centre embarks on its Centres of Excellence Programme in England and seeks to build a wider learning community from our partnerships formed through the International Initiative for Mental Health Leadership (IIMHL).