Another environmental factor that can affect relapse is employment. Employment is a complex issue for people with mental illness: it can be a stressor that precipitates relapse or a source of meaningful activity and an essential source of economic wellbeing. Employment is fundamental to how most people define themselves in western societies, and appropriate and supportive employment has many protective elements: it "increases people's satisfaction and self-esteem and breaks the cycle of poverty and dependence. Work also provides an opportunity to socialise and communicate." (NSW Health 2002a p13).

People with mental illness report that work gives them a sense of pride, self-esteem, financial freedom to do things that others can do, the capacity to financially support others, the opportunity to build things, the chance to be more independent from others, a sense of being a part of the whole, and a sense of integration rather than isolation (Clarke 2004).

Work is how we measure ourself in society. The first thing we do when we meet each other at parties or out or socially - it's a matter of 'Well what do you do?" If I don't do anything then I am more likely to be viewed as a 'mental illness' – as a schizophrenic or bipolar – and I'm more like to measure myself that way, if I don't have some form of meaningful activity. —Psychosocial rehabilitation provider
Work can also be a major source of stress, and flexible and appropriate employment options are essential to preventing relapse. There is considerable untapped capacity for employers and organisations to contribute to preventing relapse for people with mental illness by providing more flexible work arrangements and more supportive and less stressful workplaces (Berry & Butterworth 2004).

It's important to have people helping you understand what going back to work means - you've changed - it's ok to not work - I don't work fulltime anymore. —Consumer

This job helps me. It allows me to get involved. If I went back to my other job I wouldn't last any time. —Consumer

The 9-5 grind is a meat grinder. We learn that we can't do that. —Consumer

I have changed my career - I had the most spectacular blow up at work. I find getting back on the horse is the worst thing. —Consumer

Rehabilitation services for people with mental illness often focus on vocational rehabilitation and there is a growing body of knowledge in this area (see Rogers 2003, Waghorn & Lloyd 2005). A recent review of 18 randomised controlled trials concluded that supportive employment was the most effective approach (Crowther, Bond, Huxley & Marshal 2001). Notably, pre-vocational training that aims to assist people to acquire the skills and work habits that will make them able to be employed was found to be no more effective in helping people obtain competitive employment than standard community and hospital care. In contrast, supported employment models, where the vocational services are highly integrated with psychiatric support through multidisciplinary teams, have highly successful employment outcomes (Cook et al 2005).

Vocational and pre-vocational programs need to be flexible and non-threatening – by that I mean they don't threaten somebody's disability support pension, because that's one of the biggest barriers to vocational activity. These are the events that have a huge impact – safe, affordable secure accommodation, meaningful activity – these are the core elements of wellness – for everybody. We just focus on symptom amelioration. The too hard basket is the whole of life picture. —Psychosocial rehabilitation service providerTop of page