Report 48: Mental health, employment and the social care workforce
The social care workplace and mental health
‘Employers in all sectors, including the public sector, can play an important role in supporting the health and wellbeing of their staff by providing healthy workplaces which support their employees’ mental health and wellbeing’ (51).
Social care is a major source of employment in England. The adult and children’s social care workforce consists of almost two million, mainly female, employees (3), (4) (63). Data suggests that 17 per cent of the independent sector social care workforce in England is black and minority ethnic and around 13 per cent of social care workers have a non-European Economic Area nationality.
Several studies have looked at issues of workplace stress in the social care workforce, finding high risk of mental health problems due to factors including abuse and violence at work, staff experiences of racism, discrimination and gender issues, and demanding roles. However, evidence shows the majority enjoy working on social care, and find their jobs fulfilling.
There have been efforts to bring more people into specific peer support roles and there are good reasons for actively trying to include more people with lived experience of mental distress as well as improving mental health support for the existing workforce.
Which aspects of social care work are valued? Open
Research in social care found that the vast majority of staff enjoyed spending time with clients and developing relationships with them; and the sense of camaraderie of working in a team with friendly colleagues (65), (64).
‘I love my job as a carer. I find it very fulfilling’
‘Camaraderie between colleagues...supportive colleagues’Other findings describe how working with people in a caring situation, together with the satisfaction of making a difference and helping their clients were sources of job satisfaction among care workers in the northwest of England (66), and in a national survey (64).
Which aspects of social care work can be difficult? Open
Studies have shown that employees in social care may be at high risk of poor mental health because of their challenging and demanding roles (67), (68).
Residential care workers in a study in the North-West said that they routinely did unpaid overtime to get the job done satisfactorily (66). Workers may have a heavy workload and feel a lack of control or absence of boundaries in their work (67).
Work patterns of constant change, and management responses that could sometimes come across as intolerant or bullying were also contributory factors to mental health problems (67).
Work insecurity was demoralising issue for residential care workers who believed that to save money, local authorities were freezing posts, shifting to part-time contracts with inferior conditions of service, re-organising shift systems and relying more on casual staff (66).
A study that explored working conditions and quality of life in two social services departments in the UK came to similar conclusions. Determinants of distress included organisational culture and function; lack of time and rigid timescales; lack of resources; responsibility for people; the rate and pace of change, and poor communication:
‘Our initial assessments are supposed to be brief, but you’re frightened in case you miss any information. You miss any information and then something happens and it’s ‘why didn’t you put that in your initial assessment?’ (65).
Staff sometimes feel undervalued by their own hierarchy, poorly paid, and misunderstood by the public (64), (65)
Social care workers who experience mental health problemsOpen
Interviews with social workers found that more than a quarter of the fifty participants had had between one and three months sickness absence associated with depression; and just under a quarter had been off for between four and six months (67).
Regulation of social care is critical for the protection of the public. However there are over seventy separate pieces of legislation and statutory guidance, much of it at odds with equality legislation. These set out unclear requirements for ‘good health’ or ‘physical and mental fitness’ in social care as well as nursing and teaching (70). These standards hinder disabled people’s access to social care professions and can lead to discrimination and exclusion of people with mental health problems (see Law, policy and guidance).
For some people with mental health problems, discrimination in the workplace is greater than in any other part of their lives. A qualitative study that explored first hand experiences of discrimination associated with mental health problems confirmed this to be so (43).
Why Social Care would benefit from employing more people with personal experienceOpen
Many people who use social care services themselves have mental health problems. Employees perceived that their own experiences were of value to their employer and to performing their role with insight and skill:
‘I work in the mental health sector where my experience is valued’ (19).
Qualitative research with people with mental health problems makes plain that they have something positive to contribute to the workforce, not least because of their keenness to prove themselves in the workplace:
‘I would like to inform them [employers] that they are missing out on a great opportunity. There are a large group of people who are willing and able’ (22).
The importance of including the expertise of lived experience in the workforce, alongside professional competencies is now widely acknowledged. A nurse consultant working with a peer support programme said:
‘Peer support offers something that can go beyond the professional support and therapy offered to people during crisis’ (71).
An evaluation of peer support in mental health found that the best approach was to base new peer support workers in teams that were beginning to implement a recovery approach. However:
‘Peer support workers thrived and had positive impacts on service users and culture in a range of settings’ (72).
Support, Time and Recovery (STR) worker roles were created with the intention that people with direct experience as service users could bring something valuable to the role of supporting others to recover. An evaluation of three pilot STR programmes found this had worked best where there had been a good consultation process with everyone involved from the outset:
‘we didn’t really know the best way to [recruit service users] so we set up a working group with service users, HR, unions, vocational health, STR workers, managers and some providers, and really kind of a blank form really - how can we address that?
‘ On our job description we said that it was desirable to have experience of mental health distress, either as a worker, carer or a service user, and that covers the three criteria. On our covering letters we had signposted people to support through the application process, so like Rethink, job net, the Job Centre’.
‘My main qualification for the job was having been a service user . Got good support. 2hr supervision once every month and manager knows my background, am well supported.’
‘have been a service user, then became a service user co-ordinator then into STR. User perspective brings another aspect to the job’ (73).