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Realising people's potential
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Enabling people with experience of mental distress:
a guide for business advisers
Foreword
Introduction
Frequently asked questions
Success stories
For more information …
Foreword
"We all know that for many people, starting one’s own business can be a viable route towards social and economic inclusion. It can be hugely satisfying to support oneself, one’s family and one's community through the skills of enterprise. Business advisers are well aware of the research which proves that people who take advice from an enterprise agency before starting in business have a 20 per cent better chance of survival and 20 per cent faster growth.
But if we are to bring the enterprise message to all parts of the community, we need to be sensitive to the individuals we work with and their individual needs.
Which is why the National Federation of Enterprise Agencies (NFEA) has been delighted to work with Mind in producing this simple guide for business advisers. We hope it removes some of the myths surrounding people with mental health issues and gives advisers the confidence and knowledge to help even more people into self-employment."
George Derbyshire, CEO of the NFEA
"This guide has been produced for advisers who are likely at some point in their work to be contacted by someone who has experienced mental distress. It is hoped that the information given will make the support and guidance provided that much more relevant to their needs. Part of the problem with society’s treatment of people who experience mental distress has been the assumption that a diagnosis of mental illness signals the end of one’s career. I hope this guide will encourage a shift in this attitude, and demonstrate that with the right support, individuals who experience mental distress, like anyone else, are capable of the highest achievement."
Lee Smith, Director of Mind Network Support
We would like to thank Phoenix Development Fund for their generous support of this project.
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Introduction
This booklet is the product of a joint project between the mental health charity Mind, the National Federation of Enterprise Agencies (NFEA) and the Teleworkers Association. The purpose of this project was to train people with experience of mental distress to start up their own trainer consultancy businesses. A significant part of this project was for course participants to design and deliver training to local NFEA members. This training was on mental health awareness and supporting people with mental distress to access business startup services.
The partnership worked well and this booklet has been designed to answer frequently asked questions and explore issues that have been raised by business advisers.
Why produce a booklet on enabling people with mental distress to access business support?
One definition of mental distress is: “A change or disruption to how someone usually thinks, feels, and perceives the world around them. This in turn can have an adverse effect on how they are able to relate to others and look after themselves. It can affect their understanding, judgement and decisionmaking.”
One in four people will experience a mental health problem during their lifetime. This could be your next client (it could also be a colleague).
Accessing employment can be difficult for people with a history of mental distress. They may face discrimination. They may be anxious about taking on a job, especially if they have experienced work-related stress in the past.
For some people an alternative to trying to compete directly in the workplace, feel in control or working around a fluctuating condition is to look for self-employment opportunities.
This alternative has been furthered by the Government’s social inclusion drives and proposed reforms to claiming Incapacity Benefit.
So it is likely that more people with experiences of mental distress will be looking at business start-up options. People with a history of mental distress may be worried about how others will react to them and whether they will be dismissed or thought of as incapable or problematic. It can take a lot of courage to approach a business adviser. The response of the business adviser can make a big difference to whether someone takes their business idea any further. Many people can have experiences of mental distress and still be able to set up and run a successful business.
Mental distress did not stop the following from achieving: Winston Churchill, Margery Hurst (founder of Brook St Bureau), Kelly Holmes, Buzz Aldrin, Charles Dickens …
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Frequently asked questions
What causes mental distress?
No one factor has been identified. Many different reasons have been cited. It may be that some people have a genetic predisposition to developing a mental health problem or are more vulnerable as a result of childhood experiences or other trauma.
Mental health problems may be triggered in response to stress, difficult life events, or adverse living conditions. They may also arise out of biochemical or hormonal changes, or an inability to express feelings and needs.
Mental distress may not occur unless a combination of factors are present, for example, someone might have a genetic tendency to developing a specific mental health problem but that problem may not be realised unless someone becomes extremely stressed or traumatised.
Many people with a history of mental distress have an understanding of what can trigger mental distress for them. Individuals often organise their lives to avoid these triggers or to minimise any adverse affects they might have on their mental health.
What is the difference between the terms ‘mentally ill’ and ‘mental distress’?
Many people find the term ‘mentally ill’ limiting or inappropriate. It refers to illness of the mind in the same way that physical illness refers to the body. It is a more medical way of understanding mental health problems. Yet mental health problems can occur in response to life events such as bereavement or social issues such as moving away from support networks owing to divorce, and may need nonmedical solutions to be helped.
Many people prefer the term ‘mental distress’, as mental health problems often result in people feeling distress. This distress can be felt in many different ways including, anxiety, fear, anger, confusion, hopelessness and feeling out of control.
How does mental distress show itself?
Mental distress can affect how people think, feel and act. Individuals experiencing an episode of mental distress may behave, communicate or respond in ways that seem very different or incongruent with what is happening around them. Psychiatrists classify mental distress into different categories according to how the distress presents itself. Each category gives its name to a diagnosis.
The diagnosis allows the doctor to advise the patient and decide on a course of treatment. The diagnosis can be difficult to make. Some people will behave in ways that seem different or bizarre, but are actually in keeping with their cultural or religious experiences. Unless the psychiatrist assessing the person is aware and understands their cultural or religious background, the person could be given an inappropriate diagnosis. Also different doctors might give the same person different diagnoses.
Although a diagnosis can be helpful it should not be seen as a label or as a way of defining that person. Everyone experiences mental distress differently even if they share the same diagnosis. For more information on individual mental health problems see Mind's booklets and factsheets or contact Mindinfo Line (0845 766 0163).
What are the treatments?
Treatments commonly prescribed by GPs or psychiatrists include medication, talking therapies and ECT (electro-convulsive therapy). Many people find complementary therapies, exercise, support groups and following a good diet helpful. For more information on different treatments please see Mind’s booklets and factsheets or contact Mindinfo Line.
Does taking medication affect someone’s ability to run a business?
Medication can produce side effects. These side effects may be more severe when someone starts on a course of drugs or after an injection. In addition individuals can experience withdrawal problems when they come off specific medications. If someone knows they are likely to be changing medication or coming off, it might be worth building this into a business plan. Side effects can include problems with insomnia, sweating, muscle trembles or spasms. Some drugs may cause agitation, restlessness and affect how people walk or make eye contact. Having a dry mouth can be one side effect of many drugs. For many people being on medication will not have any adverse affects on their ability to set up or sustain their business.
What do the terms mental health service user and survivor mean?
Some people who have experienced mental distress will refer to themselves as a ‘mental health service user’ (or just ‘service user’). Although not everyone will use or like this term. A ‘mental health service user’ is someone who is or has used mental health services including hospital or outpatient services.
Some people with a history of mental distress prefer to identify themselves with the expression mental health survivor. This means someone who has come through (survived) the experience of mental distress or the experience of using mental health services. Again the use of this term is very subjective.
What if I say the wrong thing and cause offence?
You don’t necessarily have to be familiar with mental health jargon (for more information see Mind’s website). Although it is useful to be aware that descriptive words such as ‘nutter’, ‘loony’, ‘schizo’, and ‘psycho’ are perceived as derogatory. Individuals may refer to themselves using seemingly unflattering terms, but they probably will not like you to do the same. It is just a case of applying the same respect you would to any client.
What does it mean if someone tells me they have a specific diagnosis, for example, bipolar?
Bipolar (or manic depression) [1] is just a name given to a set of symptoms. Remember two people could have the same diagnosis, but experience the condition differently. The fact that someone has disclosed their diagnosis is likely to mean that they feel comfortable talking with you. It is OK to ask them how their mental health problem affects them. It may be that that their mental health would have no bearing on being able to start up and sustain a business. If likely problems are identified then these could be incorporated into a SWOT (strengths, weaknesses, opportunities and threats) analysis and business planning.
I am ok, but my medication makes it difficult for me to function first thing in the morning. My adviser was great. We looked at my personal maintenance budget and worked out how many hours I would need to work in order to survive. I could work in the afternoons and evenings, as long as I could book appointments with clients after midday to discuss web designs. Good planning and advice now mean I am off benefits and into my second year of trading. Plain sailing it ain’t been, but I feel so proud. I used to hate it when people asked me what I did for a job, now I can’t wait to describe myself as business person. Jo
Starting up in business can be stressful; is it a real option for someone who has experienced mental distress?
Yes. Although obviously starting up in business is fraught with uncertainty, anxiety and the likelihood of long hours, which can put a strain on both the business person and their close relationships; it can also allow for greater flexibility, autonomy and control. Stress can be very subjective; one person’s positive pressure is another’s breaking point. For some people having control over their environment, decision-making and the hours they work is less stressful than being out of work or holding down a job they hate. This is especially so if they feel overwhelmed by work over which they have little say or authority. Again, incorporating this issue into planning and carrying out a support needs analysis could decrease the potential for stress.
I used to feel very ashamed about money. I had problems managing in the past and used to go into ostrich mode whenever it was mentioned. Being able to go into business was very important to me, but I was having sleepless nights over how I was going to manage the financial side. Going over the financial planning was very hard for me, but my adviser was very supportive. He showed me how to plan and how to keep track of what was going in and coming out. For the first time ever in my life I am in control of my money, because I have to be. This has made a huge difference to my life, not only to be able to run a business, but it has increased my confidence and helped me take control of other areas in my life. Jas
I felt very unsure about negotiating; I found it very difficult to turn a client down even if I knew I would be stressed trying to fit that work in. I was working well into the night to have cakes finished on time. I became very anxious and felt it was all getting too much for me. My business mentor suggested I tried assertiveness training, I was sceptical at first, and felt very uncomfortable, but after a while it did make a difference to me. My mentor helped me practise. She also helped me formulate policies stating that orders required at least 72 hours’ notice. It made everything much clearer and I didn’t have to worry about offending people or losing clients. Mel
What if a client with experience of mental distress becomes difficult or violent?
Anyone can be difficult whether they have a mental health problem or not. People with experiences of mental distress may be very anxious or worried that you are going to dismiss them and their ideas out of hand. So some people may seem abrupt or defensive at first, but then so can anyone feeling anxious about exploring the idea of setting up in business. Many people with a history of mental distress will come across as professional, and easy to relate to.
It is extremely unlikely that any client with a history of mental distress will become violent.
Myth buster:
over 95 per cent of people who kill a stranger do not have mental health problems
People with experiences of mental distress are statistically at greater risk of being the victims of violence or harming themselves.
It is easy to understand why myths around mental distress and violence persist when you look at how this issue is frequently reported. For many people their only source of information on mental health comes from the media, especially newspapers, magazines, and popular films. How often do you see newspaper headlines such as ‘Man with a diagnosis of schizophrenia sets up successful community project’ or ‘Diabetic charged with drive-by shooting’? Obviously tragic events involving people with mental health problems do occur, but thankfully they are rare. Messages that feed into popular myths as well as people’s morbid fascination increase sales but not understanding. There is a danger that myths can affect how specific groups of people are perceived, related and responded to.
I have set targets to meet; can I afford the time offering support to a client with mental health problems?
It is true that people with mental health problems are more likely to succeed if they are given support. You do not have to be nor should you be their one source of support. Once support needs (other than business advice) have been identified (for example, talking about emotional needs), then it can be helpful to ask the client where they can get this support. It is worthwhile maintaining an up-to-date list of local organisations that might be able to offer further advice, information or support such as a local Mind association, registered childcare provider or book-keeping services.
Some people may find they need a couple of short visits before they feel confident about discussing their ideas. They may also attend your sessions or undergo training and then leave a long gap before acting further. Although this can feel timeconsuming, many enterprise agencies that allow for this in policy and practice, as well as in funding bids, find that people have higher chances of setting up and running successful businesses.
Can you ever really recover from experiencing an episode of mental distress?
Yes, but it is different for everyone. Some people only have one episode of mental distress during their lifetime. Others may have several episodes or find their mental health can fluctuate. Others still may learn to adapt to living with an ongoing mental health problem.
How can you sustain a business if you are at risk of experiencing further episodes of mental distress?
Anyone can experience a mental health problem. However, many people with a history of mental distress have some understanding of what might trigger a mental health problem for them. This knowledge can then be contained within a SWOT analysis and business plan.
Support is very important. Carrying out a ‘support needs’ analysis can obviously help a potential business owner identify their support needs and where they can obtain this support. It can include anything from childcare, financial advice and bookkeeping to emotional and talking through decisions. It is also worth considering what support is needed if someone feels their mental health is deteriorating to both help them (and hopefully prevent a crisis arising), and allow them to sustain their business. This can be built into business plans.
I lost three people who I was extremely close to within the same month. I now find it very difficult around this time of year. I don’t want to do anything; I just want to hide myself away. I find it so hard just to function. I was worried about jeopardising my business. Once I accepted this issue I was able to plan around it. I don’t take on any consultancy work leading up to this time, even if it means I have to adjust my cash flow or take on additional work and prepare papers during my allotted free time. I try now just to get away for a few days during this time, anywhere, although the coast is best. I still feel bad, but at least I don’t get over-anxious about money or letting clients down and building a bad name for myself. Eleanor
The ability to self-manage is essential. Many people can help to regulate their mental health by eating well, exercising, getting enough sleep, learning to be assertive, and maintaining a good life/work balance. Self-management issues may need to be considered when planning business operations in order to maximise the chances of the business being successful.
Cath and I run a market stall and specialist Internet delivery business. I know if I don’t get enough sleep I can start to go manic. I feel restless and as ideas come to me, I feel a real need to try them out. Cath can get annoyed as I Iose interest in fulfilling the orders we do have. We nearly broke up over it, but managed to work things out. Cath now opens up the stall in the morning, so I don’t have to get up early. I deal with suppliers and sort out the post, and then I go and take over from Cath after lunch. She dispatches orders, does admin and then picks her children up from school. I close up the stall, and then work for a couple of hours dealing with orders. When Cath goes on holiday, her sister or mum stands in for her, and we pay her cousin to cover Saturdays. It seems to be working for us. Tish
Do mental health and services come under the Disability Discrimination Act (DDA) 1995?
Yes, this Act makes it unlawful for service providers to refuse to serve a disabled person, offer a lower standard of service or provide a service on worse terms to a disabled person for a reason related to his/her disability.
Service providers have had to make reasonable adjustments for disabled people in the way they provide their services (1999 code of practice).
The DDA defines disability broadly as “a physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities”. This definition includes any “impairment resulting from or consisting of a mental illness”. It may be less easy to perceive how to make your service more accessible to people with mental distress. It might be beneficial to undergo mental health awareness training.
You could ask a local mental health group to carry out an assessment for you. You may want to think about the office environment, does the layout make it more difficult for people to talk, is it intimidating? It might be worthwhile evaluating working practices such as how people are greeted when they first contact or enter the office. It is good, of course, to have a welcoming office environment for the benefit of all clients. It may be useful to consider looking at outreach surgeries. These could be run on a regular basis from local job centres, libraries, community centres, shopping malls or anywhere where people might visit generally or feel more relaxed in. In can feel intimidating walking into a business office, especially if you are lacking confidence and have low self-esteem.
What are the positives?
For some people experience of mental distress can help them adjust their lives for the better. It can allow them to evaluate their lives, understand themselves better and allow them to make positive decisions for the future. Obviously not everyone is suited to running a business, but experience of mental distress should not automatically rule someone out from setting up in commerce. For many people with mental distress self-employment is a viable option. In fact running a business can actually help some individuals to keep mentally healthy.
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Success stories
Bernie
Bernie experienced mental health problems as a result of discrimination and stress at work. She had to leave her job as a result. Bernie needed to find paid employment, but she was also conscious of what had gone on in her previous role. She was determined not to put herself in that position again. It was very important for Bernie to be in control of her mental health and not subject herself to the possibility of experiencing harassment, bullying or discrimination again. She knew that in order to attain this, she needed to be her own boss and work for herself. Bernie now runs a successful jewellery business employing five staff. She is very aware of creating a mentally healthy workplace and being supportive of staff. As a result she has a very loyal workforce who enjoy working for her and who have contributed to developing the business into a flourishing enterprise.
Michael
Michael is a talented graphic artist. He had experienced mental health problems at work. He often felt very isolated. His employers made it very difficult for him and he had to leave his job on medical grounds. He started up a business illustrating CD covers, books and journals, and put on exhibitions. This period was difficult for Michael as he had to battle discrimination and stigma as well as a fluctuating mental health condition. But the ability to produce high quality work gave him a sense of achievement.
"As I shuffled down the road after being given my medication, passers-by would either stare or turn away embarrassed; as if I didn't exist. Kids would taunt and laugh. By the time I reached the corner of my street my eyes would be brimming with tears and I felt subhuman, as if I shouldn’t be seen in public; just exist in the shadows. Starting up in business gave me dignity. It allowed me to go through a transitional stage in my life. I make a contribution to society rather than just surviving on the edge of it."
In order to help him deal with his mental distress Michael learnt how to use meditation. Over time he started to teach techniques to other people. He has now left his graphic design business to teach meditation. Michael wants to share with others the ability to find strength and resources within themselves to deal with what ever is going on for them.
"People sometimes say it is easy for me. I don’t have to cope with their problems. Telling them about my experiences can help people gain hope and confidence. I used to feel a victim. Starting up a graphic business and teaching meditation have been empowering and I want to share that with others. I no longer recognise that person on the corner of the street."
J
J has set up a research and consultancy business running workshops, providing training and advising different sectors on engaging and working with people who have experienced mental distress.
"In order to maintain my mental health I have to build in rest periods between blocks of training and plan when I sort out admin tasks. Having to be organised has given me back a lot of control. Although I still have times when I struggle with my mental health and every so often I worry about work commitments and tax bills, etc. I am far happier now then when I worked in a secure job."
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For more information…
Mind legal line
operates Monday, Wednesday and Friday from 2pm to 4.30pm
T: 020 8519 2122
e: legal@mind.org.uk
NFEA (National Federation of Enterprise Agencies)
NFEA is the national network of local enterprise agencies, which are locally based, independent organisations providing advice, guidance and support to new and early-stage businesses and to the people setting them up. To locate your nearest office visit www.nfea.com, ring 01234 831 623 or email enquiries@nfea.com
Disability Rights Commission (DRC)
w: www.drc-gb.org
Helpline: Monday to Friday 8am to 8pm
T: 08457 622 633
e: enquiry@drc-gb.org
Mindful Employer
provides businesses and employers with information around mental health issues www.mindfulemployer.net
This booklet was written by Kaaren Cruse.
© Mind 2006
1. Manic depression (bipolar disorder) is a mood disorder. During manic episodes, people tend to be hyperactive, uninhibited, reckless, full of grandiose schemes and scattered ideas. They may feel high. At other times, they may go through long periods of being very depressed. Not everyone experiences both these extremes.
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