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JUMPING THROUGH
HOOPS: not my choice
OCTOBER 2007
T h i s r e p o r t w a s c o m m i s s i o n e d b y t h e N e w S o u t h W a l e s N u r s e s ’ A s s o c i a t i o n
authors Christie Breakspear is a former academic who currently runs her own business in workplace relations and mediation. In recent years, Christie has also been part of a number of research projects, including From Juggling to Managing: the Evolution of Work and Family Policies in Three Australian Organisations (UNSW); Getting a Life :Understanding the Downshifting Phenomenon in Australia (with Dr Clive Hamilton) and Baby Boomers and Retirement (the Australia Institute).Christie has degrees in Arts, Education, Industrial Relations and M Commerce (Hons). Kerry O’Neill is a Professional Officer at the NSW Nurses’ Association. Kerry has completed a number of degrees including BA (Hons) Industrial Relations and Human Resource Management and Masters in Health Sciences. Prior to taking up her current role at the Association, Kerry spent 20 years working in mental health services.
acknowledgements We would like to thank very sincerely the twenty two mental health professionals who so generously gave their time to be interviewed for this research. We would also like to thank the Advisory Group for their assistance and expert advice on this research. They provided us with the guidance to ensure that the research was accurate, rigorous and current. The members were:
• Ms Kate Adams, Manager Professional Services, NSWNA • Dr Mairwen Jones, Senior Lecturer In Psychology, Co-Chair Mental Health
Research Group, Faculty of Health Sciences, University of Sydney • Mr Bill Koffman, Clinical Nurse Consultant, ACT & NSW Consultation Liaison
Mental Health Nurses Association • Ms Leonie Manns, Quality Assurance Coordinator, The Richmond Fellowship • Mr Michael Raper, President National Welfare Rights Network of Australia • Mr Gerard Thomas, Policy & Media Officer, Welfare Rights Centre
copyright © 2007 NSW Nurses Association PO Box 40, Camperdown, 1450 43 Australia Street, Camperdown, 2050 http://www.nswnurses.asn.au gensec@nswnurses.asn.au ISBN: 0-978-1-921326-01-1 ISNB: 0-978-1-921326-02-8 1. mental health 2. welfare 3. NSW Nurses Association 3. Christie Breakspear Layout: Angela Garvey This publication may be downloaded for use in private study, research, criticism and review. Permission is granted for librarians to download a single copy to be made available to library users. The publication may not be reproduced in any other form without permission of the copyright owner.
TABLE OF CONTENTS
E X E C U T I V E S U M M A R Y ............................................................................ 3
RESEARCH METHOD...................................................................................... 4
FINDINGS ........................................................................................................ 4
CONCLUSION ................................................................................................ 8
I N T R O D U C T I O N .......................................................................................... 9
RESEARCH METHOD.................................................................................... 10
L E G I S L A T I V E C O N T E X T ......................................................................... 14
WORKCHOICES ........................................................................................... 14
WELFARE TO WORK..................................................................................... 19
LEGISLATIVE INTERSECT ............................................................................... 21
F I N D I N G S ..................................................................................................... 26
HEIGHTENED ANXIETY OF CLIENTS............................................................. 26
LACK OF EMPLOYMENT SUPPORT ............................................................. 56
IMPACT ON MENTAL HEALTH PROFESSIONALS........................................ 67
B I B L I O G R A P H Y ......................................................................................... 82
A P P E N D I X 1 ................................................................................................ 90
A P P E N D I X 2 ................................................................................................ 92
A P P E N D I X 3 ................................................................................................ 95
jumping through hoops 2
I have a client who’s a torture victim from
overseas. He’s young, traumatised, without
any family support.…….
He’s totally confused, caught up in the
system without understanding it….
He has so many needs, but Centrelink wants
him to go through their process, jump
through all these hoops…
jumping through hoops 3
EXECUTIVE SUMMARY
It’s a wonderful thing to get people back to work,
but the Government has to consider social justice
principles in this process. To blame the individual
is not just unreasonable, it’s cruel. I think we’ve
developed a cruel system with this current Job
Capacity Assessments (JCA)
Director, SESIAHS, 7 years
ince the enactment of WorkChoices and Welfare to Work
legislation, the New South Wales Nurses’ Association (NSWNA)
has received an increasing number of reports from their
members about the adverse effects of these laws, specifically in regard
to how they affect people with mental illnesses who are receiving
income support.
In addition, many mental health professionals are reporting negative
impacts on their workload, the way they do their job and their sense of
personal well-being. Because of this anecdotal evidence, the NSWNA
commissioned research to investigate these claims.
S
jumping through hoops 4
The report presents the experiences and opinions of twenty-two mental
health professionals whose clients have been affected by the recent
industrial relations and social security legislation.
Research Method The researchers employed qualitative methodology. Because the
researchers sought to investigate, explain and analyse the impact of
new legislation on mental health professionals and their clients, semi-
structured in-depth interviews were selected as the most appropriate
data collection method.
These qualitative methods allowed the mental health professionals’
stories to be told as well as the stories of their clients and the
researchers to understand and explain their different experiences.
Unlike quantitative methodologies which are concerned with the
frequency of various occurrences, qualitative methods ‘seek to
describe, decode, translate and otherwise come to terms with the
meaning of certain more or less naturally occurring phenomena in the
social world’ (Van Maanen, 1983:9).
The interviewees were employed in hospitals, community health
centres and in non-government organisations (NGOs). Their job titles
included clinical psychologists, occupational therapists, psychiatrists,
clinical nurse consultants, social workers, policy officers, consumer
advocates and case mangers. The interviewees came from three
geographic regions in Sydney.
Findings Overall, we found that although the mental health professionals
interviewed reported a diverse range of experience a certain
jumping through hoops 5
commonality of experience was evident. When asked about the
recent industrial relations and welfare to work legislation, its impact on
them, their work and their clients, three main themes emerged during
every interview. These were:
• the heightened anxiety of their clients who were living with
mental illness
• the lack of employment support for their clients
• the negative impact on mental health professionals, notably
their increased workload and decreased well-being.
The heightened anxiety of clients with mental illness The twenty-two mental health professionals interviewed worked mainly
with clients who had mental illnesses and were receiving income
support. Across the sample, the proportion of clients with mental
illnesses ranged from 40 percent to 100 percent. The interviewees
related stories of their clients who in recent months were presenting in
highly emotional states. This included clients who were fearful and
anxious about changes, both actual and anticipated, to welfare to
work arrangements. When asked how they would describe their clients’
concerns, the interviewees nominated three specific factors that were
causing distress and anxiety in their clients. These were: changing
income support arrangements, the new job capacity assessment
procedures and the prospect of seeking and maintaining employment.
In the first few months after the welfare to work laws took effect on 1
July 2006, the interviewees reported they had noticed their clients with
a mental illness who were receiving income support had become very
anxious. Those receiving the Disability Support Pension (DSP) were
anxious that they would lose this pension and instead be placed on the
lower Newstart Allowance.
jumping through hoops 6
Another source of anxiety for clients was the requirement that they
participate in the new Job Capacity Assessment (JCA), a
comprehensive assessment of a person’s ability to work. The interviews
demonstrated that many mental health professionals were concerned
about the actual process of job capacity assessment and the way it
was applied to their clients. Typically, interviewees referred to the new
procedures as ‘punitive’, ‘all about compliance’, ‘penalty based’,
‘big-stick approach’. Further, they saw the JCA as involving ‘no support
or understanding of these clients’ who were required to ‘jump through
hoops’.
Of great concern for clients, too, was the prospect of seeking and
maintaining employment. Research has shown that mental illness such
as depression can have a significant impact on a jobseeker’s capacity
to find and maintain employment. Interviewees reported that their
clients faced significant barriers to finding and maintaining sustainable
work. Some of the barriers nominated were financial costs, the stigma
and burden of mental illness, the episodic nature of their mental
health, homelessness and lack of flexible employment. Such factors
meant that the prospect of seeking and maintaining employment
induced extreme concern and anxiety among these particular clients.
Lack of employment support The second theme that emerged in the interviews was the perceived
lack of adequate employment support for people with mental illnesses
who were receiving social security benefits. While most interviewees
acknowledged the existence of a variety of government support
services, programs and allowances, it was generally reported that
support was inadequate for their vulnerable clients, that is, those with
mental illnesses. Apart from poor mental health, this particular group of
people was also often homeless and demoralised. Many of the
jumping through hoops 7
interviewees believed that special intervention, preferably one-on-one,
was critical to match the requisite level of assistance with the individual
needs of the jobseeker. Too often, this level of support was not
available.
Impact on mental health professionals When the mental health professionals were asked whether they had
experienced any change to their jobs in recent months, there was
widespread agreement that they found their work had become more
demanding and challenging. While the interviewees nominated a
range of factors that had impacted on their jobs and the way they
worked, there were three main effects that were repeatedly
mentioned. These were: a heavier, more complex workload; having to
liaise with Centrelink for clients, and having to spend more time
analysing legislative changes, explaining and re-assuring clients about
these changes.
In addition, a proportion of the mental health professionals reported
that their own sense of personal well-being had been adversely
affected as they grappled with the Government’s new policies. They
most commonly reported feeling greater levels of stress and frustration
arising from new job demands, anxious clients and a lack of resources.
Not all the mental health professionals interviewed considered that
there had been a notable effect on their health and well-being since
the implementation of new policies and procedures. Some indicated
that their jobs had always been stressful, that change was inevitable
and demands incessant. Further, they considered the new
requirements were ‘just all part of the job’ and therefore it was not
unreasonable or unrealistic that they should deal with them. This, after
all, was what mental health professionals did.
jumping through hoops 8
Conclusion The report concludes with some observations on the effects of the
recent legislative changes in industrial relations and welfare to work.
jumping through hoops 9
INTRODUCTION
ince the enactment of the new industrial relations and welfare to
work legislation, the New South Wales Nurses’ Association
(NSWNA) has been receiving an increasing number of reports
from their members of the adverse effects of these laws, specifically on
people with mental illnesses who are receiving income support.
Anecdotal evidence from mental health professionals suggests that this
particular group of individuals is experiencing increasing levels of stress
and anxiety. NSWNA members are further reporting that new Federal
Government policies and procedures in this area are causing
widespread confusion and apprehension among many income
support recipients, particularly those who have mental health
problems. As a consequence, many mental health professionals are
reporting a negative impact on their workload, the way they do their
job and their sense of personal well-being. Because of this anecdotal
evidence, the NSWNA commissioned research to investigate these
claims. The claims are examined in the context of recent industrial
relations and welfare legislation - the Workplace Relations Amendment
Act (WorkChoices) Act, 2005 and the Employment and Workplace
Relations Amendment (Welfare to Work) and Other Measures Act, 2005
(Chapter 1).
S
jumping through hoops 10
The report is structured as follows. Firstly, the research methodology is
explained. Then, in order to establish a broad context, the next section
discusses the relevant legislation, WorkChoices and Welfare to Work,
and how they interact. The following three sections document the key
findings of the research. The report concludes with some observations
and suggests that further research is necessary to understand the full
and ongoing implications of such radical reforms.
RESEARCH METHOD The information used in this study was generated by in-depth interviews
with twenty-two mental health professionals (15 female, 7 male). The
interviewees were variously employed in hospitals, community health
centres and in non-government organisations (NGOs). Their job titles
included clinical psychologists, occupational therapists, psychiatrists,
clinical nurse consultants, social workers, policy officers, consumer
advocates and case mangers. The accumulative total number of
clients that the participants were working with was over 800.
As such, this research encompasses the experiences of not only
mental health professionals, but also that of their clients.
The twenty-two interviewees came from three geographic regions in
Sydney, including the Northern Sydney and Central Coast Area Health
Service (NSCCAHS) extending from North Sydney to Central Coast, the
South Eastern Sydney and Illawara Area Health Service (SESIAHS)
suburbs extending from Sydney to Shoalhaven, the Sydney South West
Area Health Service (SSWAHS) extending from Balmain to Bowral. There
were also three interviewees from rural and regional NSW.
The interviews were conducted individually and lasted between 60
and 90 minutes. The researchers developed a set of 20 interview
jumping through hoops 11
questions (see Appendix 1) which guided the discussion between the
researcher and interviewee. The questions related to six broad areas
including: background information of interviewee, their knowledge of
the legislation, the perceived effect of the legislation, description of
their clients, job capacity assessment of their clients and employment
support for their clients.
While guided by the questions, interviews were open ended and
interviewees were encouraged to elaborate on their experiences. The
researchers often asked additional questions and sought clarification
of information. However, to ensure consistency of interview material, all
interviewees were asked all 20 questions.
Most of the interviews were conducted in person, except for three
people living in rural/regional areas who were interviewed over the
telephone. All interviewees gave permission for the interviews to be
taped. To ensure accuracy, the researchers took notes during the
interviews and transcribed them after completion. The interviews were
then closely analysed and themes arising from them were recorded. As
much as possible, the researchers tried to use the exact words of the
interviewees in the report. This enabled them to tell their own stories in
their own way and in their own words. The opportunity to relate their
experiences was the main reason the mental health professionals
agreed to be interviewed. All interviewees were assured of
confidentiality and were given different names to preserve their
anonymity.
The mental health professionals interviewed were selected by the
Snowball Sampling method. This method, frequently used in research
requiring small numbers of participants for intensive interviewing, is
described as follows.
jumping through hoops 12
A method whereby interview subjects for a study are obtained
from subjects already interviewed from that study. Those subjects
first contacted are asked to name acquaintances, who are then
approached, interviewed, and asked for additional names. In this
way a sufficient number of subjects can be accumulated to give
a study adequate power (Medical Dictionary Search Engine,
2004).
Initially, the interviewees were identified by the NSWNA, but then by
referral from those already interviewed. The disadvantage of this
method is that a biased sample may be chosen. Efforts were therefore
made to ensure that participants were diverse in location, gender, job
and type of ‘story’. Some basic data are shown in Appendix 2.
Qualitative methods only, specifically interviews, were used to collect
and analyse data for this study. These qualitative methods allowed the
mental health professionals’ stories to be told and the researchers to
understand and explain their different experiences. Unlike quantitative
methodologies, which are concerned with the frequency of various
occurrences, qualitative methods ‘seek to describe, decode, translate
and otherwise come to terms with the meaning of certain more or less
naturally occurring phenomena in the social world (Van Maanen,
1983:9).
Because the researchers sought to investigate, explain and analyse the
impact of the new legislation on mental health professionals and their
clients, in-depth interviews were selected as the most appropriate data
collection method. Although interviewing is often claimed to be ‘the
best method’ of gathering information, its complexity can sometimes
be under-estimated. It is a time consuming method where the
researcher is invariably saturated with information whose accuracy
jumping through hoops 13
can be questioned because of its often subjective nature. Certainly, all
interviewers are vulnerable to the subconscious bias of information
provided by those interviewed. The researchers acknowledge that in
this study, all sources are biased and that there is no such thing as
flawless, objective research. In an attempt to overcome the problem of
bias, the researchers sought to check interview material with co-
researchers, Advisory Group members and the interviewees
themselves.
Another criticism sometimes levelled at qualitative research of this
nature is that it is not possible to generalise from a relatively small
number of cases. This criticism is understood and acknowledged. As
already explained, the researchers would like to emphasise that the
study is not concerned with gathering facts and figures or with
analysing the ‘where’ and ‘when’ of events. Rather it attempts to
understand and explain the twenty-two mental health professionals’
different experiences of the recent legislative changes on their
particular clients.
jumping through hoops 14
LEGISLATIVE CONTEXT
It is not a bad thing for people to work, but the
problem is that the work is not meaningful. What’s
being offered to my clients is temporary, casual or
part-time work. It is not always about capacity, as
people with a mental illness will fluctuate (in their
capacity to work). People need to be encouraged
to work, not forced. The Government needs to
consider a recovery based approach – you get
better long- term outcomes
Psychiatrist, non-NSW based, 16 years
WORKCHOICES he new WorkChoices laws, the Workplace Relations (Work
Choices) Amendent Act 2005, became fully operational on 27
March 2006. These laws fundamentally change how industrial
relations have been regulated in Australia for the last century. Up until
now, the AustraIian Industrial Relations Commission (AIRC) played a
significant role in the regulation of the employment relationship, as well
as recognising the role of trade unions and collective bargaining
T
jumping through hoops 15
(Creighton & Stewart, 2000). However, with the passing of the
WorkChoices legislation, the role of the AIRC is diminished to the point
where it ‘no longer possesses the power to hold test cases to declare or
modify industry standard conditions of employment like maternity
leave, redundancy pay or superannuation’ (McCallum, 2006; 2). In
other words, the WorkChoices laws abolish compulsory conciliation
and arbitration, which has been the basis of federal labour law for over
100 years.
Essentially, the WorkChoices laws include:
- the placing of individual workplace agreements (AWAs) above
collective agreements
- a reduction of issues which awards and agreements can cover
- increased capacity to dismiss employees
- a reduction of union access to workplaces
- strengthening of potential for insecure employment through
extended probationary periods
- improved capacity of employers to use contractors.
Historically, the Commission had been responsible for the protection of
lower paid workers under the award system (Watson, 2003). The advent
of WorkChoices means that those protections are now removed and
workers are left to negotiate their working conditions with their
employer at the enterprise level. Further, the legislation restricts the
capacity of trade unions to bargain with employers on behalf of their
members (Ellem, Baird, Cooper & Lansbury, 2005). There is only a role
for trade unions to bargain if ‘the employer agrees to bargain for, and
to enter into a collective agreement with a trade union’ (McCallum,
2006).
jumping through hoops 16
Traditionally, the role of labour law has been to regulate the
employment relationship and to ‘counteract the inequality of
bargaining power which is inherent in the employment relationship’
(Kahn-Freund, 1972; 8). It was also the purpose of labour law to
manage the power of organised labour such as trade unions. The
Coalition Government claimed trade unions possessed too much
power and the WorkChoices legislation would remedy the imbalance.
Consequently, the Federal Government included prohibited content in
the WorkChoices laws in order to limit the power of trade unions.
Examples of prohibited content include trade union training leave,
staffing levels, minimum and maximum hours for part-time employees
and trade union representation (McCallum, 2006; Sarina & Riley, 2006).
Further, the WorkChoices legislation reduces the number of allowable
matters in awards. Formerly, the award system protected workers
across an industry and set standards that ensured employees under the
award enjoyed the same minimum standards. Critics of the legislation
are concerned that the erosion of the award system will have a
detrimental effect on the working conditions of employees and on the
broader society. A recent report tabled by seventeen of Australia’s
leading academic researchers, states that:
the proposed changes will do nothing to address labour and skill
shortages or the productivity slowdown. They will, however,
damage the fabric of Australian society by encouraging poorly-
paid jobs with irregular hours and little security, worsening work-
family balance (University of Sydney, 2005; 4).
One of the most controversial aspects of the WorkChoices legislation is
the change to unfair dismissal laws. In organisations with fewer than 100
employees, employees are no longer able to seek redress from an
jumping through hoops 17
independent tribunal where they have been unfairly dismissed.
According to McCallum (2006:3):
a majority of employees have lost their right to be protected from
harsh, unjust or unreasonable employer behaviour that leads to
termination.
Further, the idea that employees can be dismissed for operational
reasons is contentious and potentially exploitative. Operational reasons
are broadly defined as ‘reasons of an economic, technological,
structural or similar nature relating to the employer’s undertaking,
establishment, service or business’ (Howe & Murray, 2006: 2).
There continues to be much debate about how this legislation is
interpreted and what it means for employers, trade unions and
employees. According to employers, arrangements under
WorkChoices provide flexibility and choice. The Federal Government
concurs, maintaining that it is a ‘simpler, fairer, national workplace
relations system for Australia’ (Australian Government, 2005). According
to trade unions, however, WorkChoices will be used to drive down
wages and conditions. Other critics of the legislation contend that
WorkChoices has both diminished the rights of employees and
elevated managerial prerogative to new heights over and above fair
outcomes (McCallum, 2006).
While the full impact of WorkChoices is still unfolding, it is evident that
the laws are very detailed, complex and ‘unintelligible to all but
experts’ (Creighton, 2005 as cited in Riley & Sarina, 2005; 343). In an
effort to clarify and simplify, and perhaps popularise, the Federal
Government recently launched (May, 2007) a series of industrial
relations advertisements which did not even include the term
jumping through hoops 18
WorkChoices. According to market research, this is a term that has
negative connotations and one that the Government now prefers not
to use. Instead the Federal Government has set up a ‘Workplace Info
Line’.
Another recent alteration was the Government’s introduction of the
‘fairness test’, legislated at the end of May, 2007. This amendment is
designed to ensure that workers earning less than $75,000 are
compensated if their workplace abolishes penalty rates or other award
conditions. It has been argued, however, that under the new ‘fairness
test’, it is unclear how ‘fair compensation’ for the loss of penalty rates
will be measured, Furthermore, once the decisions are made by
bureaucrats, they are unreviewable and secret (MCCallum R, cited in
Horin A, 2007:33). Another challenge is that employees wanting to
challenge a compensation ruling would have to apply to the High
Court, a very daunting and costly exercise indeed.
Critics of the WorkChoices legislation argue that the impetus for the
changes to Australia’s industrial relations system is an ideological one
(McCallum, 2006). The Howard Government resurrected ideology
when it legislated to give the power in industrial relations to employers.
This destroyed the delicate historical balance of protecting workers’
rights and employers’ rights. Under WorkChoices, new rules give
employers the power to introduce individual contracts under which
employees potentially lose penalty rates, overtime and public holidays
without compensation. Under WorkChoices, employees are no longer
protected from unfair dismissal or allowed to bargain collectively.
Further, the laws ensure the diminishing role and importance of the
union movement in public life. And finally, as Professor McCallum
states, ‘the levers of choice are exclusively in the hands of the
employers’ (McCallum, 2006).
jumping through hoops 19
WELFARE TO WORK
I think (paid) work is very very beneficial to clients.
It’s very highly valued, if you don’t work, you don’t
exist……..I’ve never come across any bludgers. If
you ask clients what they want in life they say I’d
like to get married, have kids and have a job.
Case Manager/RN, NSCCAHS, 10 years
The Federal Government’s Welfare to Work: Employment and
Workplace Relations Amendment (Welfare to Work) and Other
Measures Act 2005, came into effect on 1 July 2006. Arguably, it is the
most radical reform of Australia’s income support system since the
Social Security Act 1947. Ideologically, it marks a departure from the
longstanding acceptance of the government’s role in mediating
imbalances in the market and protecting the disadvantaged. Instead,
the emphasis is on individual agency and individual responsibility for
developing individual talents and social capital by way of participation
in the paid workforce (Jayasuriya, 2001).
In theory, the welfare to work laws stress the role and actions of the
individual over the protective role of the state. In practice, the aim of
the legislation is to encourage single parents, disabled and older
workers off pensions and into self-reliance through employment (Gray
and Collins, 2006:83). To achieve this aim the Howard Government’s
approach is to rely heavily on the ‘big-stick’ aspect of encouragement
(Carney, 2006:31).
The legislation has made significant changes in income support
arrangements. The four main groups targeted in the welfare to work
policy are people with disabilities, single parents, the long-term
jumping through hoops 20
unemployed, and mature-aged jobless people. However, because the
Government decided to exempt most existing welfare recipients from
its 1 July 2006 welfare to work reforms, their effects will mainly be felt by
new claimants for sole parent and disability payments, along with
those people covered by phased impact arrangements (Carney,
2007).
The Federal Government believes that encouraging parents into work is
the best way to help children and families. While welfare agencies and
other groups support this aim, there is concern that the reforms will
result in many single parents (and people with disabilities) being placed
on lower payments until they secure employment.
As mentioned, the main aim of Welfare to Work is to move more
people into work and reduce their reliance on pensions and
unemployment payments. While projections vary, the Australian
Council of Social Services (ACOSS) estimates that 30,000 sole parents
and 20,000 disability claimants will be affected by the changes each
year (Davidson, 2006:12).
Other critics have contended that under the welfare to work changes,
income support recipients with mental illnesses are disproportionately
affected and are at particular risk. Risks include reduced income,
penalties for breaches or non-compliance with all of these having a
detrimental impact on the persons’ well-being (Cowling, 2005; King,
Waghorn, Lloyd et al, 2006). In broad terms, the changes have been
condemned as a narrow ‘work-forcing’ and disciplinary approach to
welfare reform, in order to drive more people off welfare into whatever
jobs, of whatever quality, which the labour market can create for them
(Carney, 2007:10).
jumping through hoops 21
LEGISLATIVE INTERSECT
With WorkChoices there’s an increased focus on
the individual. With Welfare to Work the main
feature is the movement away from a supportive
regime to one of compliance
Senior Policy Officer, SSWAHS, 4 years
This was the way one interviewee summed up what the new legislation,
WorkChoices and Welfare to Work, meant to them. The comment
echoed the opinions of many of the interviewees who considered the
notions of individual responsibility and mutual obligation were now
paramount. One critic warned that the new laws were ‘creating a
system that is coercive and which could contribute to the emergence
of a working poor’ (Boucher, 2007:5). This section examines the way the
two pieces of legislation interact.
In 2005, the then Federal Minister for Employment and Workplace
Relations, Kevin Andrews, stated his support for the proposed changes
to welfare:
This bill will respond to our twin challenges: the imperatives to
increase participation for these groups and reduce their level and
incidence of welfare dependence (Andrews, 2005).
For the Government, the notion of lessening the incidence of welfare
dependence was an appealing one, both financially and
ideologically. As one critic pointed out:
one of the important implications of adopting the jobs-first policy
setting is that it lessens the load borne by social security as an
instrument of social protection, and shifts that burden to the lower
reaches of the job market by bringing downward pressure on
jumping through hoops 22
minimum wages through shoring up jobs of marginal viability
(Karger, 2006).
By encouraging the deregulation of workplaces and allowing market
forces a greater role in setting the price of labour, the WorkChoices
legislation has facilitated the coercion of the weakest workers into
marginalised jobs.
The Government, in its support of WorkChoices, argued that lower
wages would create jobs for unemployed and other disadvantaged
people whom businesses might not otherwise be prepared to employ.
Indeed, Minister Andrews’ rationale for the changes emphasised the
importance of ensuring that disabled people have access to the
benefits associated with paid employment. However, as O’Brien et al
(2005:306) point out, there has been no evidence presented to support
the assumption that employers are eager to employ individuals with
disabilities.
Clearly, WorkChoices and Welfare to Work legislation intersect. As one
commentator observed:
The changes to the industrial relations framework under
WorkChoices will specifically affect those moving from welfare to
work. Changes to the compliance system will essentially compel
people moving from welfare to work to accept jobs that might be
below award conditions. Under the Welfare to Work legislation,
and consistent with a ‘work first’ approach, income support
recipients who do not accept a ‘suitable’ job will have their
payment suspended for 8 weeks. However, a ‘suitable’ job no
longer has to meet the relevant award and only has to meet the
[fair pay standard (Smith, 2006:7).
In other words, the welfare to work reforms create the environment in
jumping through hoops 23
which market forces are able to set the terms and conditions of work.
At the same time, the rights of income support recipients are
weakened as they are coerced into compliance. For example, if
employees leave jobs because they are unhappy with pay and
conditions, their access to unemployment benefits is reduced because
they have ‘voluntarily separated’. At the same time, the government
has admitted that job seekers must accept the first available job in
order to stay on benefits, even if the job has sub-award wages and
conditions (Seccombe, 2005).
Further, the WorkChoices legislation makes it difficult for people with
limited or no bargaining power, people with mental illness for example,
to negotiate fair and reasonable working conditions. In essence, these
two pieces of legislation enable the government to create an
environment in which many already vulnerable individuals are
condemned to an even more difficult and impoverished existence. As
another academic surmised:
WorkChoices really brings to an end what was left of functional
welfare through industrial policy, rendering the welfare to work
reforms much more draconian than otherwise would have been
the case (Carney, 2007:6)
Essentially, WorkChoices has made it easier for employers to offer
reduced employment conditions and to negotiate these conditions
with employees on an individual basis through AWAs. In tandem with
this, welfare to work legislation has made it more difficult for a person
currently on Newstart Allowance or Parenting Payment to refuse to sign
an AWA. Since 1 July 2006, this decision has been regarded as a
‘serious participation failure’ incurring an 8 week no-payment penalty.
Under the new system, moving from welfare to work leaves no room to
negotiate with employers over wages or conditions (Archer, 2006:9).
jumping through hoops 24
The Government has used the term ‘compliance’ to refer to the system
of penalties designed to punish welfare recipients for infringements.
Those who are voluntarily unemployed, have been dismissed for
misconduct, have three participation failures in 12 months or refuse
what the legislation calls ‘suitable work’ will have a payment
suspension for eight weeks.
According to the Welfare Rights Centre, the Federal Government ‘has
withheld $27.2 million from the pockets of the most vulnerable
Australians’ (Rights Review, September 2007; 3) with the new penalty
system since July 2006. Recent research figures indicate that 15,509
people had their welfare payments suspended for eight weeks
between July 2006 and July 2007 (Peatling, 2007:4). To put this in
context, in the year before the new legislation kicked in, there were
6432 people penalised for not meeting requirements without a
‘reasonable excuse’. Welfare groups have concerns about the
negative impact of the narrow definition of ‘reasonable excuse’. For
example, reasonable grounds do not include refusing a job because it
pays below the award wage. Nor do they include refusing
employment because the work requires self-employment status
whereby a person must make their own superannuation contributions,
cover their own public liability and manage their own tax (WRC,
2006:8).
For the Government, the intention underpinning no payment periods is
to facilitate entry into the workforce. Boucher, a critic of this rationale,
argues that there are problems with this compliance approach. Firstly,
no payment periods impact disproportionately on disadvantaged
groups; secondly, the no payment periods are punitive provisions which
will have the opposite effect – they will further entrench unemployment
and will ultimately reduce the capacity of recipients to comply with
jumping through hoops 25
their activity requirements and third, the grounds for ‘serious
participation failures’ can operate in a coercive manner inconsistent
with the language of ‘choice’ which underpins the WorkChoices and
Welfare to Work legislation (Boucher, 2007:50-1).
With the interface between industrial relations and social security
compliance, the Government is well on the way to achieving a
reduction in the welfare budget and complete flexibility for employers.
jumping through hoops 26
FINDINGS
very mental health professional’s narrative is unique, but a
certain commonality of experience was evident in the accounts
of the interviewees. When asked about the recent industrial
relations and welfare to work legislation, its impact on them, their work
and their clients, interviewees reported a diverse range of experiences.
However, three main themes emerged during every interview. These
were:
• the heightened anxiety of their clients with mental illness
• the lack of employment support for their clients
• the impact on mental health professionals, notably their
increased workload and decreased well-being.
HEIGHTENED ANXIETY OF CLIENTS Under the new Welfare to Work reforms people with mental illness who
are on income support are a particularly vulnerable group. The mental
health professionals interviewed indicated that anywhere from 40 -100
percent of their clients had mental health problems. They further
reported that many of their clients had a mental illness, which was
undiagnosed, sometimes unrecognised. Other clients denied that
anything was wrong with them and had never sought treatment.
E
jumping through hoops 27
Not only is this particular group of
clients very vulnerable under the new
welfare to work changes, but they are
particularly challenging for mental
health professionals and job capacity
assessors to deal with because they so
vehemently deny their condition. Their
denial of illness means they have no
record of treatment or medical
evidence.
Another vulnerable group includes
those particular individuals who have
severe episodic psychiatric illnesses,
such as schizophrenia. Previously, these
people would have qualified for the
DSP, but from 1 July 2006 many have
been placed on the Newstart
Allowance. Under the former system, this
group would most likely have been on
the DSP with the provision they could
choose to work when they were not
symptomatic. However, on Newstart
Allowance there is no such provision,
instead, people are required to seek
and undertake work.
According to welfare groups, these
requirements create significant
difficulties for people with mental
ANTONELLA
Antonella is very intelligent, articulate and informed. She studies social security legislation every day, is obsessive with detail and makes sure the welfare agency staff have got the story clear, and in exact order. Antonella drops into the agency regularly to provide updates and is determined that Centrelink is just trying to out manoeuvre her, but that she’s one step ahead. She has to be, because, at the heart of the matter is a complex set of arguments that go deep into the past where obscure Centrelink offences provide all the causal links. Antonella refuses to go to a job capacity assessment as she sees things differently. She believes there is nothing wrong with her; she is just unemployed and everything would be all right if Centrelink would just leave her alone. She repeatedly complains that Centrelink should ‘stop harassing me, it’s no one else’s business’.
jumping through hoops 28
illnesses including, worsening their
medical condition because of
pressure to look for and accept work;
the need to disclose their medical
condition to their Job Network
agency to avoid the imposition of
onerous job seeking requirements;
and erosion of the person’s capacity
to self-manage their illness by
identifying when they can and
cannot work (Coad et al, 2006:7). In
addition to these problems, there is
the reality of the paucity of employers
who provide flexible work
arrangements to people with episodic
illnesses.
Mental illnesses such as depression
and anxiety cost Australian
workplaces approximately 3.5 billion
dollars per year (Butterworth, Crosier &
Rodgers, 2004). The costs have been
attributed to absenteeism and
reduced productivity (Butterworth et
al, 2004). The relationship between
mental health, work and welfare is
complex and under researched. It has
been demonstrated that ‘45% of sole
parents had a diagnosed mental
health condition over a 12 month
period’ (Coad et al, 2006; 6). Further,
ADEN
Aden claimed Newstart Allowance after release from involuntary in-patient treatment in a psychiatric hospital for schizophrenia. He provided a medical certificate attesting to the diagnosis, and a treating doctor’s report, which explained his history, the diagnosis and ongoing treatment – all of which made his vulnerable mental state very clear. When Aden was sent a JCA appointment notice, he got a friend to ring Centrelink to advise that he was too ill to attend and that he urgently needed income support. His friend was told that until our client attended the JCA, no payments could be made. Aden was fortunate in having a supporting, articulate friend who was able to advocate for him, but often this is not the case for people with schizophrenia. However, forced referral to a JCA may have served only to alienate a young man whose most immediate need was stable income support.
jumping through hoops 29
85% of people with a psychotic illness such as schizophrenia are on DSP
and they receive these payments because their mental illness hinders
their ability to participate in the paid workforce (Butterworth, 2003). As
already discussed, under the new welfare to work regime both of these
groups of people are expected to demonstrate to Centrelink why they
are unable to participate in the paid workforce. For some clients,
having to demonstrate this is neither practicable nor possible. Another
case study showed the frustration of a client with a mental illness trying
to deal with Centrelink:
I have a young client who’d been working part-time for a few months,
but Centrelink kept pressuring her to find full-time work. I don’t know
whether this would even be possible for her because she was severely
depressed, taking anti-depressants, was self-harming and had been
sexually assaulted. So she wasn’t in great shape to find and keep a full-
time job. But it was the pressure from Centrelink that got to her, so that
in the end she threw up her hands, refused to go near Centrelink and
decided it was easier to earn money as a sex worker. She reckons it’s
too stressful trying to deal with Centrelink and easier to support herself
this way despite a recent diagnosis of HIV positive. She’s 22
.
Social Worker/Counsellor, SSWAHS, 7 years
The association between poor mental health and income support
recipients has been attributed to a number of factors. Some of these
include financial hardship, social isolation, trauma both physical and
psychological, and relationship difficulties such as divorce (Butterworth,
Crosier & Rodgers, 2003; Butterworth, Fairweather, Anstey & Windsor,
2006). It has been suggested that the consequences of being on
income support, including poverty, lack of self esteem and uncertainty
jumping through hoops 30
can either cause mental health problems or exacerbate them -
particularly depression and anxiety. Interviewees reported this was the
case with a number of their clients. For example:
Some of my clients have experienced acute distress after their
interaction about employment with Centrelink, a real increase in
anxiety levels. Some clients find the correspondence difficult to
understand and feel pressured to work when they ‘get the letter’ - this
causes them to feel more worried and anxious. My clients are reluctant
to challenge Centrelink, they feel they have to comply, even though
they find it very difficult to go to work. They also feel confused about all
the changes and do not know where to start. This means that their
mental health deteriorates, but they are too afraid to challenge their
job agency or Centrelink.
(Psychiatrist, non NSW based 16 years)
and
There’s a sense not of government caring for but of government
watching clients …very threatening for those with a paranoid illness or
anxiety problem. It makes them worse. So I suspect that some people
might even avoid going on any sort of government support because of
the intrusion.
(Case Manager/RN, NSCCAHS, 10 years)
The concept of self-determination is very important to people with a
mental illness in facilitating their recovery (Tse & Yeats, 2006). Having
control over their life and work is an inherent aspect of this. Neither
WorkChoices nor the welfare reforms adequately considers this
concept, and are actually more likely to result in the person feeling
jumping through hoops 31
demoralised (Butterworth et al, 2006). There was considerable
evidence of clients with mental illness feeling generally powerless,
demoralised and victimised. For example:
There’s a feeling of failure and uncertainty among many of my clients,
a sense that the Government is checking on them. People aren’t
confident about their income support anymore. There’s a deliberate
government policy change, it’s all about work, not welfare
(Case Worker, Sydney SESIAHS, 9 years)
and
Recently I’ve seen an increased anxiety among clients about having
their pension taken away from them….. Even though people are
motivated to work there’s a lot of disincentives eg Centrelink ringing
them up, having to notify them all the time. A lot of them just feel like
giving up, that there’s no point; they think no-one will ever employ
them…that sort of thing
(Case Manager/RN, NSCCAHS, 10 years)
With the new welfare to work requirements, I was getting clients starting
to really act out, saying things like:
‘am I going to be able to stay here’ (rehabilitation centre)
‘I don’t have the ability to work’
‘what am I going to do, how am I going to live’
(RN, Sydney SESIAHS, 5 years)
The interviews for this research were conducted barely 12 months after
the Welfare to Work legislation took effect on 1 July 2006. Although it
jumping through hoops 32
was early days, many of the interviewees considered the new
legislation was beginning to have an impact on both their clients and
on the way they, themselves, approached their work. Overwhelmingly,
they reported negative effects, particularly in relation to heightened
levels of anxiety, distress and uncertainty among their client base.
As stated previously the mental health professionals interviewed dealt
primarily with clients with mental illnesses who were receiving income
support. The proportion of their clients who had a mental illness ranged
from 40 percent to 100 percent across the sample. The majority of
interviewees related stories of their clients presenting in highly
emotional states, including being fearful and anxious about changes,
both actual and anticipated, to welfare to work arrangements. When
asked how they would describe their clients’ concerns, the
interviewees nominated three specific factors that were causing
distress and anxiety in their clients. These were:
• changing income support arrangements,
• the new job capacity assessment procedures and
• the prospect of seeking and maintaining employment.
Changes to income support
In the first few months after the Welfare to Work laws took effect, the
interviewees reported that their clients with mental illness and on
income support had become very anxious. Those on DSP were anxious
that they would lose this pension and instead be placed on the lower
Newstart Allowance.
The Newstart Allowance is an income support payment for adults who
are unemployed. A person may qualify for Newstart Allowance if they
are at least 21 years old, have lived in Australia for more than 2 years,
jumping through hoops 33
are unemployed, are capable of undertaking work, are available for
and actively seeking work or undertaking an activity to improve their
employment prospects and either satisfy activity test requirements or
are exempted from these (Job Capacity Assessment Service Provider
Guidelines, 2006:18).
The Disability Support Pension (DSP) is an income support payment for
people with long-term disabilities or medical conditions that keep them
from working (Job Capacity Assessment Service Provider Guidelines,
2006:19). Since 1 July 2006, the criteria for the DSP have become more
stringent. People with disabilities who apply for income support after
June 2006 and who are assessed as having a ‘partial capacity to work’
– defined as a capacity to work between 15 to 29 hours per week
without on-going support in the open labour market - will no longer be
able to claim the DSP (Cowling, 2005:3). Estimates indicate that 81,000
people with disability will be put on lower payments, mainly Newstart
Allowance (ACOSS, 2006). Those without work will receive $46 per week
less than the pension and those who study full time will receive up to
$166 per week less. If they get a job for 15 hours a week at the
minimum wage, their weekly disposable income will be $99 less than if
they were on DSP (ACOSS, 2006).
The number of people with disabilities who will be affected under the
new welfare to work arrangements is significant. It is estimated that
those individuals who currently qualify for DSP but who will shift to full or
part-rate Newstart Allowance over the next three years (2006-9) is
approximately 75, 700 (Department of Employment and Workplace
Relations, 2005).
jumping through hoops 34
As the following quotes show, clients expressed great concern about
both real and anticipated changes in their pensions. Interviewees
reported:
Clients are calling us more frequently, anxious about being moved off
their pension (to Newstart Allowance). If so, it could mean a drop of
$46 a week for them. There’s never been such a dramatic change to
the system.
(Policy Officer, SESIAHS, 4 years)
When the (Welfare to Work) legislation first came in, I had a lot of my
clients ringing me up really concerned that if they didn’t get work
they’d have their pension taken away. So I had to do a lot of re-
assuring, explaining that it didn’t apply to them.
(Case Manager/RN, NSCCAHS, 10 years)
I’m definitely seeing a lot more anxiety among clients; lots of them are
ringing up very anxious about losing payments. Many of them don’t
understand why they have to go through JCA and are anxious about it
having an effect on their payment
(Education/Liaison Officer, SESIAHS, 8 years)
My clients became more stressed, anxious and some got very angry.
They got angry because they couldn’t understand why the
Government would not let them do the program (rehabilitation
program) then think about getting a job. The pressure was on to get a
job, regardless.
(Registered Nurse, SESIAHS, 5 years)
jumping through hoops 35
Clients are having to meet a lot more requirements. I feel I have to
know a lot more about Centrelink – the rules and regulations. It has
made me more aware and conscious that there may be issues with
Centrelink. Clients seem unclear about the changes and are stressed.
Some of our clients are homeless, so they never get their mail and are
breached and not even aware until they try to get money. Then they
become angry and frustrated.
One of my clients was on DSP because she has schizophrenia and she
got a job – the environment she was working in was not very stable- the
boss would sack people if they did not turn up, She did not tell
Centrelink about her job it was only casual. Centrelink found out and
she was worried, I am not sure if her DSP was cut off – there is not much
concern for their safety net if getting a job can mean people on DSP
payments can be cut.
(Social Worker/Case Manager, SESIAHS, 18 months)
Even though DSP is not subject to activity test requirements or the
penalties that apply for failure to seek and maintain employment,
interviewees reported that their DSP clients were still very anxious about
potential changes to their income support. Interviewees indicated their
clients were confused too, about the nature of these changes, as were
they themselves sometimes.
As with any reform, there was a proportion of clients who were fearful
of change in general. Others were specifically concerned about the
prospect of having to deal with Centrelink and having to undertake
courses or rehabilitation programs as part of being re-assessed for
jumping through hoops 36
employment. Interviewees reported that these new requirements not
only increased their clients’ stress and anxiety levels, but in many cases,
exacerbated their mental illnesses.
Many of my clients are panicky about the possibility of being taken off
DSP. They’ve never worked, usually because of mental illness. The
changes are really affecting them, making them worse, it’s just makes
no sense.
(Community Mental Health Nurse, SSWAHS, 16 years)
My understanding of Welfare to Work is the reciprocity requirements.
My clients are happy with that, but they do get very anxious about
their pensions being threatened. Quite bizarre really because many of
them have a major mental illness and no-one in the world would take
away their pensions, but they still get very anxious about it.
(Case Manager/RN, NSCCAHS, 10 years)
I feel people are being enforced by Centrelink to get off pensions
without any consideration of what their actual needs are. My clients
think this and are so anxious about all the hoops they will have to jump
through just to keep their pensions (DSP)
(Occupational Therapist (OT), SESIAHS, 10 years)
Interviewees also reported clients’ apprehension about what they
perceived as the Government intruding into their lives. Clients
expressed great suspicion and anxiety at having to go through new
bureaucratic processes, for example being asked questions by
Centrelink about their financial affairs, their health and capacity to
jumping through hoops 37
work. While many of these clients would remain unaffected by the
Government’s reforms, it was their anticipation of these possibilities that
caused anxiety.
Interviewees reported that their clients’ perception of greater
Government intrusion into their lives was a real source of frustration and
worry for them. Most commonly clients perceived Centrelink as a kind
of ‘big brother’ who asked questions, sent letters, tested, assessed and
‘made them jump through hoops’.
I have a client who’s a torture victim from overseas. He’s young,
traumatised, without any family support. They’ve put him in some place
way out of the city and expect him to find his way to Centrelink, pay his
train fares, understand the expectations. He’s totally confused, caught
up in the system without understanding it….he has so many needs, but
Centrelink wants him to go through their process, jump through all
these hoops…
(Social Worker/Counsellor, SSWAHS, 7 years)
Other interviewees recounted the fear and confusion many of their
clients felt about being interviewed by Centrelink staff. In particular,
clients with mental health problems were totally overwhelmed by
Centrelink’s questions, requirements and demands. This was particularly
so for those clients trying to qualify for DSP under the new rules.
Over the last 12 months, I’ve noticed my clients are more worried and
anxious. They are more afraid of seeking assistance from the
Government – one woman I am seeing at the moment would rather be
jumping through hoops 38
a sex worker than see Centrelink. She
works on the streets and I am worried
about her
(Community Nurse, SSWAHS, 2 years)
The new system seems to be stricter and
the Government thinks that everybody
can work, but this is not true. The
Government seems to make decisions
without any consultation. It’s not as easy
as they think.
(RN, SESIAHS, 5 years)
Centrelink does not recognise that
some of our clients do not have insight
or acknowledge their mental illness or
mental health issues – and they do not
have the capacity to work. So they are
breached.
(Social Worker/Case Manager, SESIAHS,
18 months)
New Job Capacity Assessment
Some of my clients report that job
capacity assessors do not tell them who
they are or what their qualifications are.
Some of my clients are sometimes not even aware they are having a
job capacity assessment – they think they are just attending a meeting.
The problem with the current system is that a person receives only one
THERESE
We recently had a client who was on Newstart and had been in hospital with a mental illness for five months. Since she came out of hospital six months ago she hasn’t received any payment. We’re advocating for her to get back payment, but so far they’ve only given her payment for six weeks. It’s difficult for her to contest this, really overwhelming for her. So we’re trying to do it for her. We actually have to go down to Centrelink with her because she gets so confused. She’ll say yes to anything. We’re contesting that she is capable of work. She has medical evidence to support this. She’s been put back on the Newstart incapacitated allowance which means she doesn’t have to look for work for 3 months. I hope that she will go back to work at some stage. Manager, Crisis Accommodation, 4 years
jumping through hoops 39
assessment and a decision is made. This is a major problem as quite
often it takes more than one interview to assess a person’s capacity to
work. The new system is complex, people do not know where to start or
who to talk to.
Centrelink staff and job agencies need more training in mental health
and how to assist people to get back into work. Health care
professionals should also be given training on how Centrelink works and
the changes, like JCAs. It is not easy for health professionals to speak to
Centrelink
(Psychiatrist, non NSW based, 16 years)
The new Job Capacity Assessment (JCA) is a comprehensive
assessment of a person’s ability to work. The assessment involves
identification of barriers to a person’s employment and any
interventions that may be required to help them overcome these
barriers (Job Capacity Assessment Service Provider Guidelines,
2006:15). The barriers include both physical and psychological
disability, homelessness and addiction. The Government is focusing on
employment as the remedy to solving issues such as homelessness,
affordable housing (public & private) and substance abuse.
The issue of capacity is not as straightforward as the Federal
Government claims. Peter Dutton the Minister for Revenue and
Assistant Treasurer argued that ‘the community feels it is a fair principle
that people are asked to work in keeping with their abilities and
capacity’ (Dutton, 2005:5). This is a simplistic approach to a complex
situation, as capacity is not just about an individual’s disability but also
the local labour market (Cowling, 2005). As Cowling (2005:12) further
jumping through hoops 40
points out, there are numerous factors that impact on a person’s
capacity to work such as hours of work, flexible working conditions,
proximity to public transport and access to affordable childcare.
One mental health professional interviewed explained that most of his
clients had been failures in the school system and had come from
homes where their parents either abused or neglected them. Because
of these factors, he considered it unlikely that these clients would ever
be work ready. He contended the whole notion of being assessed for a
job was inappropriate and irrelevant for most of his young clients. He
stated:
My clients need parents, the kind of parents that most kids have.
They’ve never had this, they’ve never been able to negotiate all the
milestones. They’ve been disengaged from school, neglected or
abused by their parents. These are not kids who are going to find a job.
(Social Worker/Counsellor, SSWAHS, 7 years)
The situation is even more problematic for those people with mental
health problems who may regularly require a reduction in hours due to
the episodic nature of their condition. Furthermore, it is not always
possible to predict when this work flexibility will be required. Even more
challenging for people with disabilities, is that under the new welfare
arrangements the definition of ‘work’ has been changed so that in
order to receive the DSP an individual’s disability needs to be such that
it prevents them from working 15 hours per week, as opposed to the
earlier test of 30 hours per week. The new test only applies to new
applicants for the DSP, hence the long transition associated with the
process of implementation (O’Brien et al, 2005:315).
jumping through hoops 41
There was very little indication that the Government was recognising
the needs of these particular clients, let alone trying to accommodate
them with flexible arrangements. According to interviewees:
There seem to be more barriers for my clients to get through before
they can get work. Some of them have the kind of illness where they
can’t work consistently, often this precludes them from even turning up
to job interviews. Increasingly, too, the problem of disclosure and
employment information is really worrying people more and more.
I think the current JCA should have a separate category for those with
a psychiatric disability so that they can be assessed by people trained
in mental health and sensitive to their particular needs. ..It’s really a
specialist field, but this is not happening.
(Consumer Advocate, SSWAHS, 7 years)
There’s also a problem with the Newstart requirements where they
have to apply for 10 jobs. If my clients with mental illness are going
through a manic phase they scrub up quite well at an interview, get
the job, but then can’t or don’t turn up. Even if they do (turn up) they
often present a danger to other employees. The government has a
duty of care to potential employers.
(Case Worker, SESIAHS, 9 years)
Clients are experiencing more stress and are disorganised – they don’t
know about the changes in rules. What they need is guidance and
support. The breaching is disastrous – you can be cut off for eight
weeks for not attending a JCA – their payments can be reinstated and
their money controlled by a charity. I don’t know what charities have
jumping through hoops 42
been set up for this, but all I know is that clients are more stressed and
they are presenting with a lot more issues with Centrelink.
(Social Worker/Case Manager, SESIAHS, 18 months)
The new system (JCA) is not transparent, it doubles the service provision
and it’s inefficient. Clients often have to do another JCA for no
understandable reason.
(Clinical Nurse Specialist, SSWAHS, 6 years)
Under the new system, JCAs are conducted by assessors employed by
Centreliink, Health Services Australia, Commonwealth Rehabilitation
Services (CRS) and by 15 non-government organisations contracted by
the Department of Human Services. JCAs may be doctors or other
allied health professionals. Currently, over fifty percent of job capacity
assessors are psychologists (575); others include registered
occupational therapists (269), accredited rehabilitation counsellors
(191), social workers (162), registered nurses (77), registered
physiotherapists (65), accredited exercise physiologists (61) and
registered medical practitioners (43) (Department of Human Services –
Job Capacity Assessments, Hansard Written Question on Notice HS33,
31 October 2006). Assessors are not required to have a mental health
background or to have work experience in that setting.
Recently, some welfare groups dealing with clients who have mental
health problems have reported a high degree of client dissatisfaction
with JCA findings and recommendations. Reasons for poor quality
assessments related to a lack of medical evidence; lack of expertise
and experience of some assessors (NSW Welfare Rights Centre, 2007).
jumping through hoops 43
Clearly, if people with mental illnesses are to maintain stable income
support and be fairly and accurately assessed for work, it is essential
that Centrelink staff and other assessors understand both the
prevalence and nature of mental illness and the effect it has on a
person’s capacity to work. However, evidence is emerging that too
many job capacity assessors lack the appropriate qualifications, skills
and experience to accurately assess the group of clients with mental
health problems. Welfare groups argue that the assessors do not
always have a mental health background relevant to clients’ illness,
condition or disability and therefore lack the specialist skills required to
make informed and accurate assessments (Cowling, 2005; WRC, 2006,
ACOSS, 2006).
The Welfare Rights Centre summed up their experience of dealing with
clients with mental illness who were facing job capacity assessment:
Too many people are having their mental illness exacerbated by
inappropriate and undesirable activity demands and the imposition of
harsh ‘participation failure’ penalties when they should not be on
activity tested payments in the first place (Rights Review, 2007:12)
The Welfare Rights Centre is further concerned about the way new
‘activity testing’ is applied to people with a mental illness:
Many of our clients who have a mental illness or who have a long-term
and debilitating psychiatric disability, may acknowledge nothing more
to our caseworkers than temporary anxiety caused by Centrelink’s
treatment, or they may fail to recognise that they are ill at all. Such
clients may present to Centrelink (and our service) as eccentric,
aggressive, neurotic or paranoid but without psychiatric evidence
many clients with severe psychiatric disabilities face a future of
unstable income support due to problems satisfying Social Security
jumping through hoops 44
activity tests and obligations regarding when and how to notify
Centrelink of changed circumstances (WRCb, 2006:8).
Finally, the WRC is particularly concerned about the potential impact
of JCAs on people with serious psychiatric disabilities:
…the guidelines are prompting an excessive number of referrals, and
these referrals are creating hardship for clients and producing ill-
advised decisions as to entitlements (Rights Review, 2006:6)
As the pool of people subject to job-seeking requirements increases,
the Welfare Rights Centre has recommended that the Federal
Government develop training programs to raise the awareness of
mental health issues among Centrelink and Job Network staff involved
in the activity testing of social security recipients.
Many of the interviewees echoed the welfare groups’ concerns. They
too expressed a desire to see better training for job capacity assessors
enabling them to more sensitively and knowledgeably deal with clients
with mental illness.
The new system is more stressful – clients have to have an assessment
before they can get payments and there are delays in being put on
payments. It depends on who you speak to at Centrelink to what
information you are given. I had a client with a serious undiagnosed
mental illness who was paranoid and delusional. She got breached
because she did not attend a JCA. She needed extra support, so I had
to go to the assessment. If I hadn’t been with her she would not have
got her payment.
(Social Worker/Case Manager, SESIAHS, 18 months)
jumping through hoops 45
Centrelink asks the wrong questions of my clients, they don’t have the
expertise. Lots of enquires about a person’s mobility, can they move
from their bedroom to kitchen. Completely irrelevant. My clients’
problems are they think the food in the kitchen is poisoned, and that
someone is out to get them – that sort of thing. There are no boxes to
tick on their forms about this.
(Clinical Psychologist, SESIAHS, 7 years)
Lots of clients can’t talk to Centrelink about anything. Centrelink staff
has adopted a ‘work first’ approach. Clients feel this inflexibility
(Policy Officer, SESIAHS, 4 years)
My understanding of the new system is that everyone who applies for
income support must now have a job capacity assessment
administered by people outsourced by Centrelink. Some of the people
administering aren’t necessarily qualified in mental health area. This
means there’s no standard, the quality of the service is very variable.
It’s very much up to the individual assessor, so there are no checks and
balances.
(Senior Policy Officer, SSWAHS, 4 years)
There was considerable evidence from the interviews that the mental
health professionals were concerned about both the actual process of
job capacity assessment and the way it was applied to their clients.
Typically, interviewees referred to the new regime as ‘punitive’, ‘all
about compliance’, ‘penalty based’, ‘big-stick approach’, ‘no support
or understanding of these clients’ needs’.
jumping through hoops 46
In essence, much of the interviewees’ negativity was associated with
the compliance model underpinning the new assessment procedures.
Interviewees were not critical of the Government’s aim to place more
people into work, but were apprehensive about the process being
used to achieve this objective. They were also concerned about the
appropriateness of the job for the client, some commenting that the
Government seemed to have a ‘work first’ approach and that any job
would do.
There’s no doubt that these new rules are causing so much stress.
Clients are ringing up more frequently, anxious and crying about what
will happen to them under the new rules. They spend so much time
ruminating over the new assessment procedures.
I don’t think there is anything wrong with getting people into work who
have been on welfare, but the type of work has to be meaningful and
match their skills…The Government is not looking at the best interests of
people on welfare, but just providing the state with a cheap labour
force.
(Policy Officer, SESIAHS, 4 years)
From what I know of the new system (JCA) is that it’s making clients feel
more stressed and concerned when they have to go to Centrelink for a
JCA. The new system seems harsher; it is not focused on helping a
person, it seems punitive.
(Community Nurse, SSWAHS, 2 years)
jumping through hoops 47
The current system is not improving people’s economic or social
participation – people are feeling an increase in stress, due to reporting
conditions.
(Psychiatrist, non NSW based, 16 years)
Many of the interviewees commented that the new system was flawed
in that it further marginalised and inappropriately penalised their most
vulnerable clients. They considered the majority of their clients did not
need to be coerced into finding work, most of them would have liked
to work and be part of society, but because of their mental health
problems this was not always possible. Some of their comments were:
I think people should be encouraged, not coerced into work. I don’t
think people should be forced to work, but there are people who lose
hope without work. That’s my concern. If some government decided
on a strategy to encourage people to sensitively get off the DSP and
into employment, I’d encourage this. But not the way they’re doing it
now.
My clients aren’t coping too well with the new system; it hasn’t been
sold very well. Clients are worried they are going to be worse off. They
feel things they were used to eg living skills centres, health services,
work programs are going to be cut too. Also worried their income will
be reduced.
(Consumer Advocate, SSWAHS, 7 years)
My problem with the new system (JCA) is that it seems to be based on
the premise that the average person with a disability is trying to rip off
the system. I just don’t think that’s true. I think the average person in the
jumping through hoops 48
system is very honest and their work ethic is just as high as everyone
else in the population. But this new system seems to be punitive, about
catching people out….It’s a very small percentage of people who are
doing the wrong thing, but they get all the publicity.
(Case Worker/RN, NSCCAHS, 10 years)
Some of the requirements that Centrelink puts on my (young) clients
exacerbate their mental health issues….Many of their lives are chaotic
…they’ve been thrown out of home, are disengaged with school, have
no adult support, usually no job and lack the skills and experience to
get one. They need proper parenting!
(Social Worker/Counsellor, SSWAHS, 7 years)
Another concern with the JCAs is the emerging trend for Centrelink not
to accept clients’ medical evidence requesting exemption from
activity testing. According to recent research, Centrelink will no longer
accept more than two 13 week exemptions without an automatic
referral to a JCA. For this particular group of clients having to go
through the activity test process, frequently results in the cancellation
of income support for 8 weeks (Rights Review, 2007:13).
As the quotes below show, the issue of Centrelink not accepting
medical certificates was becoming increasingly common in the
experience of the mental health professionals interviewed:
Previously clients would have a treating practitioner report but now
(under new system) these reports are not seen as sufficient. There is no
integration of treating health professionals into these assessments. And
it seems that the job capacity assessors do not have experience with
mental health. I now have to contact a senior person at Centrelink and
jumping through hoops 49
speak to them directly with my patient’s consent and sort out the
process. My clients find the system complex. They feel they have fewer
choices, that they are jeopardising their payments if they question the
assessment process.
(Psychiatrist, non NSW based, 16 years)
One change I’ve observed is we’re getting clients returning over and
over, trying to put in a medical certificate for JCA. I don’t understand
why the medical evidence is not being accepted, though. I’ve seen
some clients with mental illness put in a medical certificate to
Centrelink and be refused. This didn’t happen before this new system.
(Case Worker, SESIAHS, 9 years)
It’s dangerous when the treating psychiatrist’s advice is ignored by
Centrelink.
(Education/Liaison Officer, SESIAHS, 8 years)
This current job assessment system is incompetent because it does not
guarantee the integrity of the process………..expert medical opinion is
ignored by Centrelink.
(Director, SESIAHS, 7 years)
Under the Government’s previous system of assessing people’s
capacity to work, experienced Centrelink staff were often able to
repeatedly grant activity test exemption to clients where deemed
appropriate. For the group with episodic mental illness, when it was
clear there was little or no capacity to seek or maintain work,
Centrelink was able to exercise its discretion. With the new ‘work first’
jumping through hoops 50
agenda, this practice is no longer feasible. Interviewees recounted
incidents of clients with mental illness being subjected inappropriately
to activity testing. Invariably, these were their most vulnerable clients
who often had little insight into the nature of their illness and often
denied they were even ill.
Time and again, interviewees expressed deep concern for their most
vulnerable clients in the new ‘work-first’ regime:
It’s so concerning because some of these people who are going to be
assessed to work 30 hours per week, have never worked that in their
lives. In the past Centrelink used to give an exemption to particular
clients, but now they have to go for a job capacity assessment.
(Policy Officer, SESIAHS, 4 years)
The Welfare to Work changes mean more people are being
challenged by Centrelink…… In the past Centrelink generally
accepted medical opinions, but JCA has changed all this.
(Case Worker, SESIAHS, 9 years)
I think it’s changed now and Centrelink doesn’t put much value on a
doctor’s or psychologist’s report saying their client can’t work at all.
There’s no trust, it’s almost as if Centrelink thinks we are doing
something to trick them about the (mental) health of our clients
because we say they can’t work, Many of my clients are not working,
so they need help from Centrelink. But Centrelink puts conditions on
them that they can’t meet….
(OT, SESIAHS, 10 years)
jumping through hoops 51
LINDA
Linda has had psoriasis and severe depression for over 12 months. She claimed Disability Support Pension as she has a serious disability and was unable to work and earn an income. However, she was given a zero impairment points rating on the grounds that her condition was not ‘treated and stabilised’. As she did not qualify for DSP, Linda was required to claim and was placed on Newstart Allowance. As a result of a mandatory Job Capacity Assessment she was required, as a term of her Activity Agreement, to attend the Commonwealth Rehabilitation Service for an occupational rehabilitation program. On appeal to an Authorised Review Officer in relation to the original DSP decision, the ARO upheld the Centrelink decision and added that, with treatment (whether or not it was actually available to her) Linda would be fine within two years. At the time of this decision, Linda had a detailed, lengthy medical report from her treating psychiatrist who had been treating her for over 12 months. The report indicated that Linda had severe psoriasis that extended all over her face and that she was being treated for severe depression. It further indicated that she was suicidal and had been admitted to a psychiatric hospital, that she had left after six months, but that she had only lasted a few weeks before being readmitted. The comprehensive report also explained that her depression was treatment resistant and that she had deteriorated recently due to both the effect of the psoriasis and to the anxiety arising from having to attend occupational rehabilitation. The report explained that Linda was on medication and was undergoing electro convulsive therapy along with diversional and psychological therapies. Despite this, she remains depressed, suffers excessive ruminations, struggles with suicidal thoughts on a daily basis and had recently overdosed on her anti-depressant drugs. The psychiatrist was very categorical in stating that Linda was not able to work or to engage in non-mental health based rehabilitation, was not capable of engaging in vocational rehabilitation and that the rehabilitation she was being required to undertake was inappropriate. He stated that with her treatment she was likely to remain significantly unstable for two years and clearly would be unable to work. He stated that he completely disagreed with Centrelink's assessments and that this was a mental illness with a high incidence of completed suicide.
jumping through hoops 52
Seeking and Maintaining Employment
As mentioned, research shows that mental illness such as depression
can have a significant impact on a jobseeker’s capacity to find and
maintain employment. It affects qualifications and skill levels; reduces
work experience and increases the likelihood of discrimination by
prospective employers. Its episodic characteristics, together with the
effects of medication, limit job prospects and impact on productivity
(Derr, Hill and Pavetti 2000).
Despite this evidence, the recent welfare to work arrangements fail to
take account of the needs of clients with mental illness as they attempt
to find and maintain jobs. This group of jobseekers faces significant
barriers to finding and maintaining sustainable work, for example
financial costs, the stigma and burden of mental illness, the episodic
nature of their mental health, and lack of flexible employment.
According to the interviewees, such factors meant that the prospect of
seeking and maintaining employment induced extreme concern and
anxiety in these particularly susceptible clients. Many of the
interviewees commented:
Recently I’ve had a few more clients dismissed from work because they
have a mental illness………There’s so much pressure on these people
now to keep a job when they are obviously unwell.
(OT, SESIAHS, 10 years)
Recently, I’ve noticed a deterioration in the mental health of clients,
increased anxiety about work. They’ll say things to me like, they’re
going to make me look for work, I can’t leave the house, what am I
jumping through hoops 53
going to do? The biggest concerns for clients with mental illness are loss
of money and having to look for work.
(Education/Liaison Officer, SESIAHS, 8 years)
Because many of my clients haven’t been in the workplace for a long
time, they get very anxious about it. Sometimes they’re suicidal about
the thought of having to prepare for work.
(Registered Nurse, Crisis Team, SSWAHS, 7 years)
July 1 2007, there’s a whole lot of single parents (45% have a diagnosed
mental illness) who have just been coping. Now there will be
interference from Centrelink and/or JCA (assessors). This will create a
whole lot of turmoil when these people have to come in and sign an
activity agreement (to do 15 hours a week work). They will be the first
group to have to do this. We’re getting calls from single parents very
anxious and confused about the changes.
(Policy Officer, SESIAHS, 4 years)
Research has also shown that jobseekers with mental illnesses are less
likely to be able to meet activity requirements and therefore are
penalised and further marginalised by current policy settings (Parkinson
and Horn, 2006). Under welfare to work reforms, the Government has
introduced a system of penalties designed to punish welfare recipients
for infringements. Those who are voluntarily unemployed, have been
dismissed for misconduct, have three participation failures in 12 months
or refuse what the legislation calls ‘suitable work’ will have a payment
suspension for eight weeks.
jumping through hoops 54
Welfare agencies have expressed serious concerns about aspects of
the new system. Of particular concern is the immediate eight-week no
payment periods and the emergence of a larger pool of activity tested
recipients (WRC, 2006:9). The mental health professionals interviewed
echoed these concerns. One interviewee summed up the problem as:
There is a real collision between WorkChoices and Welfare to Work as
far as our clients are concerned. The Government is saying that if a
client doesn’t accept a suitable job offer (and they have a definition of
suitable job offer) then the client will lose payment for 8 weeks. A lot of
our clients are unskilled, so not in high demand for skilled jobs. But if
they don’t accept what’s thrown at them then they will be penalised.
(Policy Officer, SESIAHS, 4 years)
Between 1 July 2006 and 30 June 2007, the first full year of operation of
Welfare to Work, there were 15,509 eight week no payment penalties
imposed whereas during the last full year of the previous system there
were 6,432 eight week no payment penalties. This increase of 9,077
represents a significant rise of 140%.
The Welfare Rights Centre has estimated the combined monetary
value of these penalties at $27m and has claimed that ‘this has come
out of the pockets of the most vulnerable Australians’ (‘Rights Review’
September 2007: 3).
Those interviewees who had experience of their clients being placed
on no payment periods were strongly critical of the new compliance
regime and its adverse effect on their clients:
jumping through hoops 55
If a person doesn’t actively engage in some sort of return to work
process then they get breached. I have serious concerns about people
with mental illness in this new system. These people are living with and
trying to work through complex issues. Perhaps the priority isn’t meeting
with a return to work officer…….but rather to ensure they have some
stable housing.
(Manager, Crisis Accommodation, SESIAHS, 4 years)
It’s really important to get people into work, but it’s not going to be
done with a bludgeon approach. We need people involved who are
mental health professionals to encourage people and certainly not
threaten to cut off their payments.
(Consumer Advocate, SSWAHS, 7 years)
The Government’s belief that welfare to work transitions will increase
through this harsh compliance framework does not appear to be
supported by any substantive evidence. There is no question that the
Government is entitled to take reasonable measures to ensure that
income recipients are not rorting the welfare system. However, this new
compliance framework, like the previous system, is predicated on the
false assumption that the majority of income recipients are ‘bludgers’.
jumping through hoops 56
LACK OF EMPLOYMENT SUPPORT
My experience is none of these support services are particularly
effective. I’ve had one client doing the rounds with them for over 5
years…….they have no faith they’ll ever get a decent job.
Community Mental Health Nurse, SSWAHS, 16 years
The second theme that emerged from the interviews was participant’s
perception of a lack of employment support for people receiving
income support who had mental illnesses. While most interviewees
acknowledged the existence of a variety of government support
services, programs and allowances, it was generally perceived that
support was inadequate for those vulnerable Centrelink clients, that is,
those clients living with mental health problems. Apart from poor
mental health, this particular group of people was also often homeless
and demoralised. Many of the interviewees believed that special
intervention, ideally one-on-one, was critical to match the requisite
level of assistance with the individual needs of the jobseeker. Too often,
this level of support was not available. One interviewee described his
experience as follows:
There’s a group of people who are especially vulnerable under this
new system. These are the ones who have to get medical evidence
that they are not capable of 30 hours work a week. But often they
have mental illnesses that are undiagnosed and untreated, so this is the
real challenge. How do you deal with these clients who don’t have a
history of medical assessment. Part of the nature of their problem is that
they have no insight into the nature of their mental illness, even that
they are ill. These clients are extremely difficult to deal with; they’re
aggressive, seen as trouble-makers, often transient, easily stigmatised
which means they are locked out of support. This is an increasing
jumping through hoops 57
problem and it’s gotten worse under Welfare to Work. It’s brought them
more out into the open because the current system doesn’t deal
effectively with this group, they don’t fit into either category – being
exempted or deemed fit for work.
(Policy Officer, SESIAHS, 4 years)
RUTH
Ruth had lived in Department of Housing accommodation with her daughter for many years. She was known to local mental health services, but did not have a diagnosed mental illness. She did not believe she had a mental illness and declined any assistance offered by the local mental health service. Ruth saw her GP regularly and they made sure she was safe and treated her with antipsychotics as she had a long history of paranoia and delusional ideas. She trusted her GP. Ruth was on Newstart and was breached because she did not comply with the new compliance regime. She tried to resolve the matter but became confused with the new system and this further exacerbated her paranoia. Ruth reported that Centrelink was not helpful because they kept telling her different things and she became confused and disorganised. Ruth was breached and did not receive payments for eight weeks. She did not pay her rent or bills and was evicted from her housing. Ruth came to our service because she was homeless and had no money to buy food. While she was here she was suspicious of us and refused to see the local mental health service and was reluctant to let us help her with Centrelink. She had no insight into her situation especially her need to see a mental health team. We did not make her as we wanted her to stay with us and trust us as we did not want her to remain homeless. While she was here we tried to help but she left before we could, she went out one day and never came back. No one knows what happened to her or if she was ever able to sort things out. It is likely that she is now homeless, whereas before these changes she had an income and housing.
jumping through hoops 58
The research on suicidality and demoralisation in regard to welfare
reform in Australia, found that poor mental health and suicidal
behaviour were common amongst income support recipients
(Butterworth et al, 2006). Butterworth et al’s study investigated
concepts such as hopelessness, worthlessness, suicidal ideation,
dissatisfaction with life and reported suicide attempts. It found that
‘welfare recipients are among the most psychologically vulnerable and
this needs to be considered when evaluating current welfare and
social policy’ (Butterworth et al, 2006; 654).
The evidence clearly points to the benefits of work for people with
mental illnesses (Honey, 2004; Marrone and Golowka,1999). However,
all too often, the interviewees reported that their clients were not
receiving the assistance they needed. As a result, many interviewees
feared their clients would be further marginalised and their sense of
helplessness reinforced. When questioned about their assessment of
employment support services for their clients, interviewees summed up
their experiences as:
I’m not impressed with Government support services for my clients.
These days I seem to waste my counselling sessions with clients
preparing them for Centrelink job assessments. They’re so stressed
about all the new requirements; they often don’t understand what they
have to do, so I have to go through it all with them before I can even
begin any therapy. It’s ridiculous.
(Clinical Psychologist, SESIAHS, 7 years)
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They (support services) work for some. But not for those clients who’ve
been mentally ill for a long time.
(Registered Nurse, Crisis Team, SSWAHS, 7 years)
With Job Network providers, I get mixed reports, it’s quite confusing. The
information I get from Centrelink is not clear and I think Centrelink is the
only one that can make a referral. The clients report that they have
difficulty with the job Networks. We use counsellors and support groups.
I refer to Psychiatric Rehabilitation Association (PRA) they are really
helpful. CRS are good but they are very busy.
The Personal Support Program is good but the problem is that if a
person misses an appointment with PSP they can be breached, this is
not helpful. Overall, these services are not very effective in increasing
people’s economic and social participation.
(Social Worker/Case Manager, SESIAHS, 18 months)
The purported aim of the Welfare to Work legislation is to promote
employment, including for those with disabilities and mental health
problems. In so doing, it is very important that both assessment
procedures and service delivery fully take into account the high
prevalence of mental illness among long term job seekers. Yet,
according to some critics, the current welfare to work model of
intervention and compliance pays insufficient attention to the
importance of responding to mental illness in parallel with assistance to
resolve other health and personal barriers and employment targeted
assistance (Horn and Jordan, 2006).
jumping through hoops 60
Many interviewees echoed these concerns, pointing to the
inadequacy and inappropriateness of current programs and services.
Others mentioned the long waiting times and shortages of both
government and non-government assistance programs. Typical
responses were:
There’s a shortage of support programs.
(Case Manager/R N, NSCCAHS, 10 years)
Centrelink and Job Network give useless help to the kind of clients we
get.
(Policy Officer, SESIAHS, 4 years)
Programs need to be improved and expanded. Clients find it daunting
to work with all this bureaucracy.
(Case Worker, SESIAHS, 9 years)
CRS is under-funded. There’s a specialist unit in Parramatta but that’s
not much use to my clients.
(Case Manager/RN, NSCCAHS, 10 years)
More than two years ago, the Human Rights and Equal Opportunity
Commission (HREOC) recommended in their report Workability II:
Solutions (2005:66) that:
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‘………..there be further investigation and implementation of measures
that address the recruitment and support needs of people with mental
illness………..’
This and other recommendations were based on the high number of
submissions to the Commission emphasising the prevalence of mental
illness in Australian society and the special needs of people with mental
illness. For example, it was recommended that flexibility at all stages of
the employment process is crucial in accommodating people with
episodic mental illnesses. Other research has identified the importance
of support in the workplace in helping people with mental illnesses
undertake paid employment (Tse & Yeats, 2002).
Welfare groups, too, attest to the inadequate level of support and
training for people with disabilities when trying to enter the workforce.
According to the Brotherhood of St Laurence (2006:4), training is often
interpreted by many employment services to mean short or refresher
courses in computer use or interview skills. This type of training is neither
relevant nor adequate for people who have not been in paid
employment for some years and who suffer from mental health
problems.
Interviewees were aware of various support services available to their
clients with mental illness, including the Commonwealth Rehabilitation
Service (CRS), TAFE, STEPS, Centrelink, Job Network, Sheltered
Workshops, Psychological Rehabilitation Association, NGOs and
charities. The interviewees repeatedly emphasised how important it
was to encourage their clients to work to their full capacity. While not
all their clients were capable of participating in paid employment,
those who were, needed significant and appropriate support.
jumping through hoops 62
However, when asked about employment support programs and
government assistance schemes, many of the interviewees expressed
similar concerns to those expressed by the Brotherhood of St Laurence
and other welfare groups:
There are not enough programs to support these people into
employment. There are new barriers for people trying to get into
work…...they can only do limited courses of six months because of the
new work first rules. That sort of stuff is not going to help the kind of
clients we get here.
(Education/Liaison Officer, SESIAHS, 8 years)
There are specialist mental health NGOs in the community that provide
housing support, employment support, help with income. The Welfare
Rights Centre provides help for people who have difficulties dealing
with Centrelink. CRS tries to get people with disabilities into
employment. But when people leave hospital, they often fall into a
vacuum, so not in touch with what’s available.
(Consumer Advocate, SSWAHS, 7 years)
It’s disappointing for my clients when nothing comes of the job
assessment process and all those programs they have to go through.
There are letters from Centrelink saying clients are capable of 15 hours
work per week, when I don’t think they are. But my views aren’t
considered. Under the new system they have to go through another
three - four months of assessment, at taxpayers expense. In my
experience, they don’t ever end up getting jobs.
(Community Mental Health Nurse, SSWAHS, 16 years).
jumping through hoops 63
My clients want to get back to work, but they need support. They don’t
need Centrelink sending them letters every couple of weeks about
activity tests.
(OT, SESIAHS, 10 years)
The interviewees explained that if their clients’ Centrelink assessment
indicated that they were not ready to participate in employment
assistance, they were usually referred to the Personal Support Program
(PSP). Alternatively, an additional assessment would be done to assess
any mental illness, permanent disability or incapacity which often led
to placement on the DSP and the option of participating in disability
open employment services. Interviewees nominated the Federal
Government’s PSP as the most effective program because of its range
of services including assessment, counselling, personal support, referral
and advocacy, practical support and transition. Another advantage
mentioned was the on-going nature of the service, which gave clients
up to two years assistance. Furthermore, the Federal Government
allocated an additional 29,000 places in the Personal Support Program
as part of the new Welfare to Work changes. Those interviewees who
had direct experience of the Personal Support Program, commented:
There are some good Government support services eg Personal
Support Program. Clients can go on it for up to two years, which is
good for them. The only problem is that there are long waiting lists.
(Policy Officer, SESIAHS, 4 years)
There are some good support programs eg Personal Support Program
has some really useful programs. But it’s getting more difficult to get
people into work when they don’t put in the effort….this is because the
jumping through hoops 64
system is very onerous now. There’s a lot of pre-work and appointments
required of people. They feel like they’re being made to jump through
more hoops for no purpose. It’s a frustrating process.
(Education/Liaison Officer, SESIAHS, 8 years)
However, there were some dissenting voices:
There are some job agencies, which are more helpful than others.
Some of my clients have been able to access computers and have
minimal training, but that is only a few. The Personal Support Scheme is
not necessarily helpful to some of my clients, but they have this
imposed upon them. They must see their Personal Support worker every
two weeks. Clients find this yet another appointment they need to
attend.
(Psychiatrist, non NSW based, 16 years)
I think we’ve got a long way to go with providing assistance to people
with mental illness and on income support. It’s not producing the results
we hoped for. Economically, I think the clients are becoming worse off.
With social participation, we try to provide a consumer network, have
a meeting every month, encourage people to join clubs, get involved
in the community. But there’s still incredible stigmatisation because of
their mental illness.
(Consumer Advocate, SSWAHS, 7 years)
PSP is a waste of money. There needs to be services provided to my
clients post-employment, this is when problems can arise for them. In
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my experience the CRS comes closest to providing this necessary on-
going support.
(Clinical Nurse Specialist, SSWAHS, 6 years)
A number of the interviewees were critical of their recent and
increasingly frequent, dealings with Centrelink. Some indicated they
often had to accompany particular clients who were not capable of
dealing with Centrelink by themselves. One rural mental health worker
stated:
In the last few months I’ve had to go down to Centrelink more and
more often with my clients. Partly it’s because they are so strung out,
convinced they won’t be able to get any money and therefore won’t
have anything to live on. But it seems to me the bureaucracy is getting
more complicated, I often can’t make any sense of what Centrelink
staff are saying to us. This situation is really adversely affecting clients
and their families.
(Clinical Nurse Consultant, Rural, 4 years)
Other interviewees indicated it was rare to find specialist Job Network
services for people with mental health issues. More than half the
interviewees commented that the Government’s generic job support
services (Job Network) were not effective in helping clients who had
mental health problems. These clients required specialist employment
assistance and assessment by specialist staff to help them prepare for,
find and retain jobs in the open labour market. A range of their
comments were:
jumping through hoops 66
I have a client who will be capable of doing a job eventually, but the
system says he has to lose his disability pension first. That’s ridiculous; he
needs it while he gets better and prepares himself for work. All very
gradual…there’s no-one in the system who seems qualified to
understand this.
(OT, SESIAHS, 10 years)
Some people need non-conditional income security and the biggest
group needing this is clients with mental illness. They also need to deal
with bureaucrats who understand about mental illness, particularly the
episodic kind.
(Case Worker , SESIAHS, 9 years)
The most effective way of getting people with mental illness to
participate is to make it voluntary. Our current approach of coercion
won’t do it.
(Policy Officer, SESIAHS, 4 years)
Centrelink’s job is to ensure that vulnerable people have income
support. But income is now less secure than it was because of
conditionality.
(Education/Liaison Officer, SESIAHS, 8 years)
While acknowledging that a small proportion of their clients were
unlikely ever to be capable of paid work, all the mental health
professionals agreed that appropriate employment provided
enormous benefits for clients. Some of the benefits interviewees
jumping through hoops 67
reported were improved self-esteem, increased well-being, a sense of
purpose, independence and participation in society. Clearly, greater
levels of employment assistance, integrated and ongoing support are
required to ensure more clients with mental health problems can
overcome barriers and participate in the paid workforce. Most of the
interviewees considered that the current level of employment support
was inadequate to achieve this goal.
Their view was reinforced by one welfare commentator who stated:
The effectiveness of the current suite of employment programs at
working with these client groups (parents and people with
disabilities) is constrained by a lack of resources across the major
employment programs. Eligibility for Intensive Support
Customised Assistance (ISCA) in Job Network has been
tightened. No additional resources have been……provided to
the Work for the Dole program to work with these client groups
(Smith, 2006:9).
IMPACT ON MENTAL HEALTH PROFESSIONALS
The phenomenon of mental health professionals’ roles and
responsibilities being impacted by the Work Choices and Welfare to
Work reforms emerged as the third major theme identified in our
research.
When the twenty-two mental health professionals were asked whether
they had experienced any change to their jobs in the last 12-18
months, most acknowledged they found their work more demanding
and challenging. While the interviewees nominated a range of factors
jumping through hoops 68
that had impacted their jobs and the way they worked, there were
three main reasons that were repeatedly mentioned. These were;
• a heavier, more complex workload
• having to liaise with Centrelink for clients
• spending more time analysing legislative changes and re-
assuring clients.
In addition, a proportion of the mental health professionals reported
that their sense of personal well-being had been adversely affected as
they grappled with the Government’s new policies. They most
commonly reported feeling greater levels of stress and frustration
arising from new job demands, anxious clients and a lack of resources.
Not all the mental health professionals interviewed considered that
there had been an effect on their health and well-being since the
implementation of new policies and procedures. Some indicated their
jobs had always been stressful because of the nature of the work and
the clients they dealt with. Some interviewees commented they were
accustomed to adjusting to new legislative requirements and the
demands of the bureaucracy. Change was inevitable and on-going
indeed it was ‘all part of the job’ of mental health professionals.
Heavier, more complex casework load
The new laws have meant that I have had to be more flexible with my
appointments; I’ve had to change my hours of work and I’m doing a
lot more advocacy for my clients. I’ve also had to contact Centrelink a
lot more, and on one occasion, I had to visit their office. I do not speak
to junior staff at Centrelink – I only get results when I talk to a senior
person. I’ve had to be more vigilant in making sure my clients are able
jumping through hoops 69
to work, and are not being forced. Overall, I have to do more work,
chasing up more people.
(Psychiatrist, non NSW based,16 years)
Interviewees reported the new Government policies meant more
complex systems and more regulation for clients. For example, there
were now several types of Newstart Allowance, with different
conditions according to the age, health and parenting status of the
recipient. Mental health professionals reported they often had to help
their clients negotiate their way through these new procedures and
requirements.
I now feel I have to advocate a lot more. Before this new system, I
would not feel I had to attend Centrelink and could do all my
advocacy on the phone. This is not the case anymore. It’s more
important that someone goes with them (the client) – the system is
much more complex and confusing.
I feel more worried about clients and what will happen to them. I think
they are being punished for having a mental illness or being homeless. I
also feel like I, personally, have to know a lot more about Centrelink.
(Community Nurse, SSWAHS, 2 years)
I’ve found that I have to spend more time trying to prove things and
get more support for clients; more time trying to advocate for them. A
lot more of my clients have become unwell because of the pressure
that’s put on them………..there’s constant pressure on them, letters
that are confusing for them.
jumping through hoops 70
(OT, SESIAHS, 10 years)
Under the new system everything at work is more time-consuming,
intense and mandatory.
(Community Mental Health Nurse, SSWAHS, 16 years)
Welfare to work changes is a massive overhaul. Essentially biggest
change since the system started……..so more of my work is now
devoted to client advocacy rather than case work. Consequently, it’s
now a more stressful job.
(Policy Officer, SESIAHS, 4 years)
It’s (the new legislation) made me prioritise employment and welfare
issues for clients.
(Consumer Advocate, SSWAHS, 7 years)
What’s really sad is that Centrelink has lost specialist staff, disability
officers, who had expertise in dealing with clients with mental illness.
They did a tremendous job, but their positions have gone. It’s a shame
and makes it more frustrating for our clients (with mental illnesses) and
this in turn impacts on us.
(Director, SESIAHS, 7 years)
I have noticed that my workload has increased because clients are
coming in asking for certificates more often and Centrelink want more
paper work. I find I am doing more welfare work, because we don’t
jumping through hoops 71
have any welfare workers I seem to be picking up more and more
work.
(Clinical Nurse Consultant, Rural, 1 year)
Having to report to Centrelink every 2 weeks and feeling fearful about
possible breaches, eg withholding income, severely impacts on the
mental health of clients. People are worrying unnecessarily sometimes
about these changes. They have made a big difference to our clients
and as a result we now have to manage them.
(Consumer Advocate, SSWAHS, 7 years)
I think when clients are expected to negotiate with Centrelink, I get a
sense that they are overwhelmed which increases their anxiety – and
all adds to our workload.
(Manager, Crisis Accommodation, SESIAHS, 4 years)
It’s more and more difficult dealing with clients with behaviour
problems and mental illness. The front-line level is particularly difficult.
You have to recognise when clients should be referred.
(Case work Co-ordinator, SESIAHS, 9 years)
Liaising with Centrelink for clients
As discussed previously in this report the mental health professionals
interviewed reported a huge rise in their clients’ stress and anxiety levels
because they did not fully understand the new welfare system.
Frequently, as a direct consequence of this they found themselves
having to liaise with Centrelink on their clients’ behalf about
jumping through hoops 72
administrative procedures such as social
security debt, correct rate of payment,
no payment penalties and job capacity
assessments.
In the last few months there have been
big content changes. Welfare to Work is
lots of new content, plus dealing with
Centrelink has become more
complicated. It’s very rarely
straightforward now because of the
structural and cultural change. Clients’
matters appear more complicated.
Recently I’ve noticed a change in the
clients I see. There’s more fear and
anxiety, sometimes they’re open about
this, sometimes not. They particularly fear
having to deal with Centrelink. A lot of
clients with mental illness don’t disclose
(their condition) which can make it tough
to deal with Centrelink; difficult for us too,
so we tend to target people in Centrelink
who are more senior, more aware. All this
takes a lot of time ….and it’s getting
worse.
(Education/Liaison Officer, SESIAHS, 8
years)
VERA
Vera is in her late 50s and has schizoaffective disorder. She lives with her family and up until two years ago worked but relapsed at work and was terminated. Vera is now on the DSP. Prior to 1 July 2006 she was able to work casually when she was well and understood the system. Her husband is near retirement and was working. She did not tell Centrelink and was confused about all of the changes to Welfare to Work. Because of the changes she did not tell Centrelink how much money her husband earned and as a result was fined. She has become very anxious and needy, she rings me constantly and frequently attends the centre without an appointment. Before this she was independent and worked casually. She is now scared of Centrelink and I think they are making her ‘jump through hoops’. She cannot understand why she was fined. She did not mean to break the rules and this has impacted negatively on her mental health.
jumping through hoops 73
We have to be a lot more proactive in advocating for our clients with
Centrelink. Our clients don’t have a voice, they just cop it, so we have
to do it for them. All these new requirements are adding to our
workload.
(Manager, Crisis Accommodation, SESIAHS, 4 years)
Clients’ anxiety levels have increased around their Centrelink
payments. They get really worried about having to go in for interviews,
be assessed, so we spend a lot more time coaching them.
(Registered Nurse, Crisis Team, SSWAHS, 7 years)
Recently there’s been a huge increase in raising issues with Centrelink
or DEWR. I spend much more of my time dealing with issues around
how people are coping with Welfare to Work and trying to find
solutions for people who don’t fit into the parameters which the policy
department has set for Centrelink to implement.
(Policy Officer, SESIAHS, 4 years)
I am now having to spend an enormous amount of time liaising with
Centrelink on behalf of my clients – who have to be there with me. I
feel a lack of control in my job. Once I used to be able to refer these
clients on to other, specialist service. Now everything has to go through
Centrelink. It’s very frustrating and stressful.
(Clinical Nurse Specialist, SSWAHS, 6 years)
Increased time spent analysing impact of legislative changes and reassuring clients
Many interviewees reported they were still grappling with the welfare to
work reforms and their significance for clients. As with any change, this
was proving to be a very time consuming exercise, not helped by
jumping through hoops 74
having to simultaneously reassure clients. Some typical comments
were:
The main challenge is that we seem to be spending most of our
working time understanding and analysing the changes under welfare
to work, then we have to assess the impact of these changes.
(Policy Officer, SESIAHS, 4 years)
The demands of families, restrictive nature of the Mental Health Act
and keeping up with the changes are big challenges in recent times.
(OT, SESIAHS, 10 years)
It’s getting harder trying to support clients in relation to security of
income support. There’s less we can do, fewer people we can call on.
We used to have access to disability officers in Centrelink, but their
roles have been abolished .It’s all become much more complex for
our clients, which makes them much more anxious – and we have to
deal with that now.
(Director, SSWAHS, 7 years)
Welfare to Work is all about getting people off the DSP. It seems quite
punitive…putting responsibility back on to the individual (and the
family) to be a good citizen. That’s not easy to accept when you’re
dealing with such vulnerable clients.
(Manager, Crisis Accommodation, SESIAHS, 4 years)
jumping through hoops 75
There’s more bureaucracy, more questions from the top, more
expectations from the community. Clients don’t always get the service
they’re entitled to……all this has to be worked through with our clients.
(Registered Nurse, Crisis Team, SSWAHS, 7 years)
I think the new legislation has made our organisation look really closely
at what it’s doing around welfare and work. …put it higher up our
agenda. We’re starting to hear a lot of anecdotal stuff from our
members. Things like: ‘it’s just not fair’, ‘ it’s a disincentive to work’,
‘people are afraid of losing their pension’
(Senior Policy Officer, SESIAHS, 12 months
Not having enough time in the day to get the job done and feeling
under-resourced; wanting to do the best for your clients but feeling
that is very challenging with limited time.
(Case Manager/RN, NSCCAHS, 10 years)
Detrimental effect on mental health professionals’ personal wellbeing
Some interviewees stated that the new industrial relations and welfare
to work climate had definitely negatively impacted on them. Typically,
they reported feeling pressure to do more to support and advocate for
their clients while, simultaneously, having to grapple with the changes
to the welfare system. Inevitably, these factors combined to have an
adverse effect on some interviewees’ personal sense of wellbeing.
Some examples included:
jumping through hoops 76
Now it’s more work, more pressure, so more stress. Things aren’t
happening to assist our clients, so this makes you feel very frustrated.
(OT, SESIAHS, 10 years)
I feel I’m under pressure all the time. I’m met with suspicion. I feel angry,
frustrated, but mostly tired all the time.
(Clinical Psychologist, SESIAHS, 7 years)
I find that I am more irritable and extremely tired. I find the changes
very stressful. I have noticed an increase in my workload.
(Clinical Nurse Consultant, Rural, 1 year)
Perhaps because the new legislation is so recent, it was difficult for
some interviewees to directly attribute any deterioration in their health
and wellbeing to the changes. As mentioned, other interviewees
indicated their jobs had always been stressful and that this had not
changed over time.
Well, it’s all part of your job isn’t it? We’re working with vulnerable
people. Although, the one thing I have noticed with the recent
changes is that I don’t have as much time to spend with my clients
picking up clues, seeing how they’re doing with Centrelink. That makes
it all harder because I don’t have the chance to train my clients in how
to deal with Centrelink – it’s all more complex now too. That adds to it.
(Director, SESIAHS, 7 years)
jumping through hoops 77
I’m OK, I’ve had years of experience. But I see the impact on my less
experienced colleagues. They’re really struggling with work overload.
(Registered Nurse, Crisis Team, SSWAHS, 7 years)
jumping through hoops 78
OBSERVATIONS & CONCLUSIONS It’s a wonderful thing to get people back to work, but the Government has
to consider social justice principles in this process. To blame the individual
is not just unreasonable, it’s cruel. I think we’ve developed a cruel system
with this current JCA.
Director, SESIAHS, 7 years
his report presented the experiences of twenty-two mental health
professionals in regard to the way they and the clients they
manage have fared under the recently implemented industrial
relations and welfare to work legislation. Although participants
experience varied, three common themes emerged, namely, the
heightened anxiety of clients who had mental illnesses, as a result of
the changing income support arrangements, the new job capacity
assessment procedures and the prospect of seeking and maintaining
employment; the lack of employment support for clients; and the
impact on mental health professionals, notably their increased
workload and decreased wellbeing.
T
jumping through hoops 79
Nineteen of the interviewees came from the Sydney metropolitan area
and three from rural and regional areas of NSW. The predominance of
city participants reflects the difficulty the researchers experienced in
accessing people from non-metropolitan areas. It was not a matter of
physical distance being a barrier for research participation, but rather
that people from more remote areas were reluctant to participate in
the research. When questioned about the reasons for this they
indicated they were fearful of speaking out in case they jeopardised
their jobs or displeased their employers. Other organisations and
individuals approached stated they were supportive of recent
government initiatives and did not wish to participate in research
potentially critical of these policies. Many of the twenty-two individuals
who did agree to be interviewed stressed their need for anonymity.
One of the participants’ in the research stated ‘It is not a bad thing for
people to work…. People need to be encouraged to work, not forced.
…..’. This sentiment was expressed by all of our participants, and none
of them disputed the benefits of encouraging and supporting their
clients to participate in the work force. However, as this quote illustrates
it is the level of coercion that the Federal Government has placed
upon those already vulnerable, to meet the compliance regime that
has had a negative impact on some of the mental health professionals
and their clients. The consequence of not complying is having your
payment cancelled for eight weeks. The Federal Government has
already withheld $27.2 million from the pockets of the most vulnerable
Australians since July 2006 (Rights Review, September 2007; 3).
This report has identified and described some of the concerns mental
health professionals have about the reforms on the mental health of
their clients. Currently, Job Capacity Assessors do not consider the
jumping through hoops 80
reports and recommendations from treating teams such as case
managers and psychiatrists. As one of the participants stated; ‘the
current job assessment system is incompetent because it does not
guarantee the integrity of the process………..expert medical opinion is
ignored by Centrelink’. Ignoring medical evidence and making
inappropriate referrals to job agencies will not increase the social and
economic participation of people with a mental illness who are
receiving income support.
The issues for people with a mental illness are complex. These reforms
do not factor in the complexity of their needs and thereby enable
them to participate in the work force. This notion that, ‘any job will do’,
is not reasonable or practical. The participants identified that their
clients are experiencing an increase in their anxiety levels as a result of
these reforms.
The findings in this report reveal the human cost of these reforms. While
the Federal Government focuses on the quantitative data and
economic implications of these polices, we have chosen to investigate
the everyday experiences of mental health professionals and their
clients. After all, we are not just a configuration of facts and figures,
and the negative effect of these reforms on the lives of those already
marginalised and vulnerable cannot be ignored.
We recommend that the Federal Government review the current
reforms and:
1. Undertake qualitative research investigating the issues for people with a mental illness who are receiving income support
2. Collect data on the new compliance system to review its
effectiveness
jumping through hoops 81
3. Ensure the transparency of the reform process and the data are on the public record
4. Consult consumer groups and other stakeholders to identify the
issues for people with a mental illness who are receiving income support
5. Provide training in mental health for Job Capacity Assessors
6. Review the current system so that the reports of treating
clinicians are included
7. Review the Welfare to Work legislation, notably eight week no payment period
jumping through hoops 82
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APPENDIX 1
RESEARCH QUESTIONS Background information 1.What is your job title?
2. Where do you work? (organisation and location)
3. How long have you been in your current position?
4. What are your main job responsibilities/duties?
5. Broadly, what have been the main challenges of your job in the last 12-18 months?
Knowledge of legislation 6. What do you know about the recent new Australian laws in the areas of industrial relations and welfare? (Prompt: Workplace Relations (WorkChoices) Amendment Act 2005 and Welfare to Work and Other Measures Act 2005)
Effect of legislation 7. Although this legislation is very recent, do you think it has had any impact on (indicate which law is impacting):
(a) the way you do your job. Can you give me some examples? Extra responsibilities?
(b) the clients you see
8. In what ways, if any, have the legislative changes affected your personal wellbeing at work?
Details of clients 9. Approximately what proportion of your clients receiving income support would have a mental illness?
10. What kinds of mental illnesses do they commonly have?
11. In the last 12-18 months (ie since legislation enacted) have you noticed any change in the mental health of these particular clients?
12. If so, could you describe these changes?
jumping through hoops 91
Job Capacity Assessment of clients 13. How are the new job capacity assessment requirements different from the previous system?
14. What is your experience of the effect of these new assessment requirements on your clients?
15. Do you have any comment on the current system of job capacity assessment compared with the previous one?
16. The Federal government claims ‘Welfare to Work is getting record numbers of Australian men and women who have the capacity to work into jobs’. Isn’t that a good thing?
Assistance for clients 17. What assistance is available for your clients eg govt and other training programs, mental health services?
18. In your opinion, how effective is this assistance in increasing the economic and social participation of clients with mental illnesses?
19. Do your clients need more support from government and other groups? Examples?
Case study 20. Is there one of your clients on income support and with mental illness who stands out for you as being particularly vulnerable during the last 12-18 months? Without disclosing personal details and information, how would you describe their situation?
jumping through hoops 92
APPENDIX 2
LIST OF INTERVIEWEES Laura (F)
Case Worker, South Eastern Sydney Illawara Area Health Service (SESIAHS), 9 years
Marian (F)
Education/Liaison Officer, South Eastern Sydney Illawara Area Health Service (SESIAHS), 8 years
Robyn (F)
Community Mental Health Nurse, Sydney South West Area Health Service (SSWAHS), 16 years
Tom (M)
Policy Officer, South Eastern Sydney Illawara Area Health Service (SESIAHS), 4 years
Steven (M)
Case Manger/RN, Northern Sydney Central Coast Area Health Service (NSCCAHS), 10 years
Jane (F)
Director, South Eastern Sydney Illawara Area Health Service (SESIAHS), 7 years
Scott (M) Consumer Advocate, Sydney South West Area Health Service (SSWAHS), 7 years
jumping through hoops 93
Rebecca (F)
Senior Policy Officer, Mental Health, Sydney South West Area Health Service (SSWAHS), 4 years
Sara (F)
Occupational Therapist, South Eastern Sydney Illawara Area Health Service (SESIAHS), 10 years
Sigrid (F)
Clinical Psychologist, South Eastern Sydney Illawara Area Health Service (SESIAHS), 7 years
Christine (F)
Registered Nurse Crisis Team, Sydney South West Area Health Service (SSWAHS), 7 years
Senya (F)
Manager, Crisis Accommodation, South Eastern Sydney Illawara Area Health Service (SESIAHS), 4 years
Pauline (F)
Community Nurse, Mental Health, Sydney South West Area Health Service (SSWAHS), 6 years
Phillip (M)
Clinical Nurse Consultant, South Eastern Sydney Illawara Area Health Service (SESIAHS), 2 years
Angela (F)
Registered Nurse, South Eastern Sydney Illawara Area Health Service (SESIAHS), 5 years
Melanie (F)
Psychiatrist, non NSW based, 16 years
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Alice (F)
Clinical Nurse Consultant, Sydney South West Area Health Service (SSWAHS), 9 years
Brad (M)
Social Worker/Counsellor, Sydney South West Area Health Service (SSWAHS), 7 years
Melissa (F)
Social Worker/Case Manager, South Eastern Sydney Illawara Area Health Service (SESIAHS), 18 months
Joe (M)
Clinical Nurse Consultant, Rural, 4 years
Alana (F)
Clinical Nurse Consultant, Rural, 1 year
James (M)
Clinical Nurse Specialist, Sydney South West Area Health Service (SSWAHS), 6 years
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APPENDIX 3
INFORMATION SHEET The New South Wales Nurses’ Association is investigating the impact of the Welfare to Work and Work Choices legislation on mental health consumers and others. We would like to interview service providers such as case managers (both government & non-government), general practitioners (GPs) and mental health professionals.
The overall aims of the project are to:
Investigate whether the current reforms have had an adverse effect on the mental health of people receiving income support;
Identify the changes to the type of work and workload of services providers as a result the legislation.
As a participant you will only be required to meet with the researcher on one occasion. Depending on your preference, the interview will be conducted at the NSW Nurses’ Association or your workplace. No other person will be present during the interview. The interview will be taped and it is anticipated it will take approximately 60 to 90 minutes. You are free to withdraw from the project at any time.
Your confidentiality is assured. Under no circumstances will your name, address, workplace or phone number be published or shown to anyone apart from me or Kerry O’Neill. When documenting the findings your name or any other details will not be used. All information will be held in a locked filing cabinet.
If you would like more information or are interested in participating, please contact me, Christie Breakspear on Christie.breakspear@bigpond.com or 0417 069 026. You can also contact Kerry O’Neill Professional officer at the NSW Nurses Association on koneill@nswnurses.asn.au or 8595 1234.
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