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Social enterprises: good for mental health?

My latest blog for the Social Care Elf today reviewed a Canadian study of social enterprises. The firms in the research employed people with mental health problems. Although the paper’s conclusions were broadly positive, I wasn’t overwhelmed by the study. Methodologically it was not strong and the social enterprises appeared to be modified sheltered workshops, which run the risk of perpetuating the segregation of people with mental health problems from ‘mainstream’ employment.

In subsequent discussion of the blog, Sonia Johnson pointed me towards some of her work on social firms in the UK. For example, a survey she collaborated in found  that social firms can be a viable employment option for people with experience of mental health problems. However, they are an under-utilised resource. I hope that some discussion of this research may help practitioners to see their potential value and support people to access employment opportunities with local social firms.

The Social Care Elf

Background

People who experience mental health problems such as psychosis or bipolar disorder sometimes find it difficult to find or sustain employment. In fact, rates of employment amongst people with these diagnoses are very low. For example, the Schizophrenia Commission (2012) reported that about only 8% of people with a diagnosis of schizophrenia in the UK were in paid employment, which is much lower than international averages of 16-23% (Haro et al., 2011).

Some community mental health teams have employment specialists who advise people how to find employment. Other teams use specialist approaches such as Individual Placement and Support, which appear effective at supporting people to find and keep a job (Heffernan and Pilkington, 2011). Although these may help some individuals, they appear to have limited impact on employment rates. Similarly, Government welfare reforms, which have included the introduction of Work Capability Assessments, also appear to have made a negligible impact on employment rates.

These initiatives implicitly suggest that the problem lies with individuals themselves rather than workplaces. Although the Disability Discrimination Act 1995 requires employers to make reasonable adjustments to support all employees, it is possible that many workplaces are simply not accommodating or enabling environments for people with mental health problems to work within.

In their research, Buhariwala and colleagues (2015) suggest that social enterprises could be better able to “’unlock’ the capabilities of people bypassed by markets” and provide employment opportunities for people with mental health problems. Their research had three aims:

  • To understand the range of social enterprises which created employment opportunities for people with mental health problems
  • To examine how these social enterprises created accommodating employment opportunities and work environments
  • To understand the challenges these organisations faced in sustaining work opportunities

Method

The authors contacted 21 organisations which were involved in running 38 different social enterprises. They conducted key informant interviews with executive directors or managers. These semi-structured interviews were conducted by telephone or face to face and aimed to find out more about how the social enterprises were run. The interviews were transcribed and coded.

Findings

The Canadian social enterprises studied in this research appear to have been established specifically for people with mental health problems, many from former sheltered workshops.

A prominent feature was their flexibility to accommodate an individual’s physical or mental health. They also had considerable latitude with work tasks which were allocated or the agreed pace of work. There was job security for employees who may not be able to come to work because of deterioration in their mental health. These social enterprises appeared better equipped to provide support to employees than in ‘mainstream’ employment, both in the workplace and at home.

These social enterprises carefully balanced the pressures of being part of a market economy whilst providing an alternative economic space for those unable to work full-time hours. This was most prominent in decisions about who to hire and how many hours employees should work.

Conclusions

The social enterprises studied provided a social and economic service to employees. They were able to provide meaningful roles to people with mental health problems, which many ‘mainstream’ employers were unable to. However, poverty remained a reality for many employees, many of whom earned little more than the minimum wage or less than the threshold above which welfare benefits would have to be reduced.

Strengths and limitations

This paper provided a valuable insight into social enterprises as alternative workplaces for people with mental health problems. It highlighted their social and economic functions, and how they can accommodate to individuals’ needs. However, the respondents were executive directors or managers rather than employees, possibly painting a rosier picture than one which employees may prefer. It was also a descriptive rather than an evaluative study, so it leaves many unanswered questions, such as: how does working in a social enterprise compare with ‘mainstream’ employment? Are jobs more stable? Is job satisfaction higher? Do employees feel socially included?

To be honest, I was quite disappointed with this study. The social enterprises studied appeared little more than sheltered workshops which have transformed into businesses. It was unclear if they employed people who did not have mental health problems, suggesting that they could be mini-ghettoes. They certainly did not appear to promote inclusion in the ‘mainstream’ economy and had a limited impact on inclusion in wider society.

I have come across many excellent social enterprises and businesses which are good employers to people with mental health problems. I do not believe that separate social enterprises have to be created to provide employment opportunities, though they do seem to benefit many people. It will be useful to find out more about the experiences of their employees and compare them with those working in more ‘mainstream’ settings.

Summing up

With the Disability Discrimination Act 1995 in place it should not be necessary to create special employment opportunities for people with mental health problems. It is perhaps preferable for people to be supported in ‘mainstream’ employment to maximise both their income and contribution to society. However, it is a disappointing reality of life in contemporary Western societies that special employment opportunities continue to be created for some groups of people.

References

Buhariwala, P., Wilton, R. & Evans, J. (2015) Social enterprises as enabling workplaces for people with psychiatric disabilities. Disability & Society, 30, 865-879.

Haro, J. M., Novick, D., Bertsch, J., Karagianis, J., Dossenbach, M. & Jones, P. B. (2011) Cross-national clinical and functional remission rates: Worldwide Schizophrenia Outpatient Health Outcomes (W-SOHO) study. The British Journal of Psychiatry, 199, 194-201.

Heffernan, J. & Pilkington, P. (2011) Supported employment for persons with mental illness: Systematic review of the effectiveness of individual placement and support in the UK. Journal of Mental Health, 20, 368-380.

Schizophrenia Commission (2012) The Abandoned Illness. A Report by the Schizophrenia Commission. London: Rethink Mental Illness.

One thought on “Social enterprises: good for mental health?

  1. Bill d Dare says:

    HI Martin, I posted a reply in the mental elf posting of your article, though the link to James Mandiberg discussion article was removed. (it was an informal discussion paper for a conference).

    anyways, while I liked many of your points, I think the role of social enterprize in Mental Health, is too easily dismissed, in the name of full social inclusion. There is more to it, so below is my reply, but I also wanted to pass on this link to Journal issue focused on social enterprize,… just out that could be useful for discussion, but sadly quite a paywall, but you may be able to dig out.
    http://www.tandfonline.com/doi/full/10.1080/15588742.2016.1109959

    Journal of Policy Practice

    Volume 15, Issue 1-2, 2016
    Special Issue: On mental health consumer-survivor participation in social enterprise

    comment from Bill Dare to your review of
    Martin, in your review of the study, I like your willingness to address the tensions between actual social inclusion by asking if people are mixed together with not everyone living with a mental illness. I think this question needs to be asked about other areas like recreation and housing.
    Depending on the person and our rather massive unhelpful depictions of mental illness, supporting the job “fit” for people entering the economy needs to look at the breadth of both an formal and informal economy. After all most job seekers are encouraged to develop a skill and network via volunteering, get some education, etc.
    The theory I sometimes hear about community enterprise is that people will be able to move out into the mainstream. I read how an integrated supported employment approach as an evidence based practice by mental health professionals, yet it is clear this is not going so well for many of us in the field, with some exceptions.
    Jim Mandiberg of the Silberman school of social work, Hunter College CUNY does some interesting conceptualizing and supports us to reflect on the system of care. He suggests
    “Recognizing the potential for interdependence among people with psychiatric disabilities has been discouraged in the mental health field (6). Independence, integration, and reliance on normal community supports constitute an article of faith among mental health service planners. Many providers may be concerned that encouraging development of an identity community will increase stigma, discrimination, and social exclusion. Experience and research indicate otherwise.”
    Please see his “Commentary: The Failure of Social Inclusion: An Alternative Approach Through Community Development” http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201100367
    He address’s some themes I am interested listed below, in his paper he presented recently: A community development approach to social enterprise for economically and socially stigmatized and excluded populations http://programme.exordo.com/5emesconf/delegates/presentation/96/ (http://emes.net/events/conferences/5th-emes-international-research-conference-social-enterprise/ “Building a scientific field to foster social enterprise eco-system”)
    – How do excluded people gain power, influence, and choices about who they want to be, and where they want to be?
    – The importance of market forces in bringing about change rather than exclusively relying on laws, policies, and services.
    -Enticing but unhelpful offers by traditional mental health services that keep people dependent.
    Taking an approach of looking at client access to both the formal and informal economy where interests and skills are developed in an entrepreneurial fashion could be well linked to many clients’ personal recovery goals and social enterprise can be a key resource. It would be useful to have more dialogue on employment and as you note impacts of poverty. Employment, this critical indicator of recovery.
    – See more at: http://www.nationalelfservice.net/populations-and-settings/employment/employment-opportunities-social-enterprises-mental-health/#sthash.iuZOPwFz.dpuf

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