Skip to main content
    • Aa
    • Aa

The nature and correlates of paid and unpaid work among service users of London Community Mental Health Teams

  • B. Lloyd-Evans (a1), S. Marwaha (a2), T. Burns (a3), J. Secker (a4), E. Latimer (a5), R. Blizard (a1), H. Killaspy (a1), J. Totman (a6), S. Tanskanen (a6) and S. Johnson (a1) (a6)...

Little is known about how the rates and characteristics of mental health service users in unpaid work, training and study compare with those in paid employment.


From staff report and patient records, 1353 mental health service users of seven Community Mental Health Teams in two London boroughs were categorized as in paid work, unpaid vocational activity or no vocational activity. Types of work were described using Standard Occupational Classifications. The characteristics of each group were reported and associations with vocational status were explored.


Of the sample, 5.5% were in paid work and 12.7% were in unpaid vocational activity, (including 5.3% in voluntary work and 8.1% in study or training). People in paid work were engaged in a broader range of occupations than those in voluntary work and most in paid work (58.5%) worked part-time. Younger age and high educational attainment characterized both groups. Having sustained previous employment was most strongly associated with being in paid work.


Rates of vocational activity were very low. Results did not suggest a clear clinical distinction between those in paid and unpaid activity. The motivations for and functions of unpaid work need further research.

Corresponding author
*Address for correspondence: Dr Brynmor Lloyd-Evans, Mental Health Sciences Unit UCL, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ, UK. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

G Bond , RE Drake , D Becker (2008). An update on randomised controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal 31, 280289.

T Burns , J Catty , T Becker , RE Drake , A Fioritti , M Knapp , C Lauber , W Rössler , T Tomov , J van Busschbach , S White , D Wiersma , EQOLISE Group (2007). The effectiveness of suported employment for people with severe mental illness: a randomised controlled trial. Lancet 370, 11461152.

K Campbell ., G Bond ., R Drake ., G McHugo ., H Xie . (2010). Client predictors of employment outcomes in high-fidelity supported employment: a regression analysis. Journal of Nervous and Mental Disease 198, 556–63.

J Catty , P Lissouba , S White , T Becker , R Drake , A Fioritti , M Knapp , C Lauber , W Rossler , T Tomov , J van Busschbach , D Wiersma , T Burns (2008). Predictors of employment for people with severe mental illness: results of an international six-centre randomised controlled trial. British Journal of Psychiatry 192, 224231.

R Crowther , M Marshall , G Bond , P Huxley (2001). Helping people with severe mental illness to obtain work: systematic review. British Medical Journal 322, 204208.

S Dittmann , NC Biedermann , H Grunze , B Hummel , LO Schärer , N Kleindienst , A Forsthoff , N Matzner , S Walser , J Walden (2002). The Stanley Foundation Bipolar Network: results of the naturalistic follow-up study after 2.5 years of follow-up in the German centres. Neuropsychobiology 46 (Suppl. 1), 29.

TA Furukawa , W Konno , S Morinobu , H Harai , T Kitamura , K Takahashi (2000). Course and outcome of depressive episodes: comparison between bipolar, unipolar and subthreshold depression. Psychiatry Research 96, 211220.

RW Goldberg , A Lucksted , S McNary , JM Gold , L Dixon , A Lehman (2001). Correlates of unemployment among inner-city adults with serious and persistant mental illness. Psychiatric Services 52, 101103.

A Honey (2004). Benefits and drawbacks of employment: perspectives of people with mental illness. Qualitative Health Research 14, 381395.

LM Howard , M Heslin , M Leese , P McCrone , C Rice , M Jarrett , T Spokes , P Huxley , G Thornicroft (2010). Supported employment: randomised controlled trial. British Journal of Psychiatry 196, 404411.

J Leff , R Warner (2006). Social Inclusion of People with Mental Illness. Cambridge University Press: Cambridge.

S Marwaha , S Johnson (2004). Schizophrenia and employment: a review. Social Psychiatry and Psychiatric Epidemiology 39, 337349.

S Marwaha , S Johnson (2005). Views and experiences of work among the seriously mentally ill: a qualitative descriptive study. International Journal of Social Psychiatry 51, 302315.

S Marwaha , S Johnson , P Bebbington , M Stafford , MC Angermeyer , T Brugha , JM Azorin , R Kilian , K Hansen , M Toumi (2007). Rates and correlates of employment in people with schizophrenia in the UK, France and Germany. British Journal of Psychiatry 191, 3037.

S Marwaha , S Balachandra , S Johnson (2009). Clinicians’ attitudes to the employment of people with psychosis. Social Psychiatry and Psychiatric Epidemiology 44, 349360.

R Perkins , M Rinaldi (2002). Unemployment rates among patients with long-term mental health problems: a decade of rising unemployment. Psychiatric Bulletin 26, 295298.

J Sanchez-Moreno , A Martinez-Aran , R Tabarés-Seisdedos , C Torrent , E Vieta , JL Ayuso-Mateos (2009). Functioning and disability in bipolar disorder: an extensive review. Psychotherapy and Psychosomatics 78, 285297.

J Schafer (1997). Analysis of Incomplete Multivariate Data. Chapman and Hall: London.

J Secker , B Grove , P Seebohm (2001). Challenging barriers to employment, education and training for mental health service users: the service user's perspective. Journal of Mental Health 10, 95404.

DC Strickler , R Whitley , D Becker , RE Drake (2009). First person accounts of long-term employment activity among people with dual diagnosis. Psychiatric Rehabilitation Journal 32, 261268.

N Turner , S Browne , M Clarke , M Gervin , C Larkin , J Waddington , E O'Callaghan (2009). Employment status amongst those with psychosis at first presentation. Social Psychiatry and Psychiatric Epidemiology 44, 863869.

G Waghorn , D Chant , J Jaeger (2007). Employment functioning and disability among community residents with bipolar affective disorder: results from an Australian community survey. Bipolar Disorders 9, 166182.

N Wewiorski , E Fabian (2004). Association between demographic and diagnostic factors and employment outcomes for people with psychiatric disabilities: a synthesis of recent research. Mental Health Services Research 6, 921.

J Wing , A Beevor , R Curtis , S Park , S Hadden , A Burns (1998). Health of the Nation Outcome scales (HoNOS): research and development. British Journal of Psychiatry 172, 1118.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology and Psychiatric Sciences
  • ISSN: 2045-7960
  • EISSN: 2045-7979
  • URL: /core/journals/epidemiology-and-psychiatric-sciences
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 22 *
Loading metrics...

Abstract views

Total abstract views: 86 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th June 2017. This data will be updated every 24 hours.