'employment is nature's best physician and is essential for human happiness.' Galen AD 172

It has long been recognised that employment has importance, not just for the collective economic benefit, but also for the individual psyche. In the rehabilitation of people with mental health difficulties, it has especial significance; with a psychiatric disability there is often opportunity and a great scope therein for rehabilitation.

Employment is thus one of the key elements of our organisation, along with Support, Training, Education and Research (STEER). In developing our own tailor-made training and support program for people with mental health difficulties, we wanted to include all the elements, but we focussed on Support and Employment as key attributes.

We see employment in the widest sense; it is not merely about the 9 to 5 grind that many people have to endure, but a range of activities which provide purpose and meaning and also have a key element of status. A person with a mental health difficulty may have orientate their employment around their condition. Thus it could be voluntary work, which has great flexibility and one could maintain the security of receiving state benefits; it could be part-time work which allows space for rest and recuperation; it could be employment in a social firm, whereby the needs of the business are balanced with the needs of individual employees. It could also be self-employment, whereby one is one's own boss, working when it suits. This employment has to be supported.

At the present time, there are increasing demands from the younger generation of mental health service users for 'real' work and not the often rudimentary and basic nature of the old industrial therapy units. This is not to say that these units do not have a role, they clearly do, but there needs to be the choice for work that is more stimulating and rewarding and does not carry the stigma of industrial therapy.

The difficulty for the service providers is that people with mental health difficulties need support over a number of years, and this often clashes with the constrained resources of community services. They prefer to see a rapid turnover of people; input the people into the service and output a rehabilitated person at the end. The reality is that the needs of the person with mental health difficulty are often more complex; and are often long-term, a simple time-limited course of rehabilitation is not enough. The person with mental health difficulties needs support over a number years, the level of support can vary according to phases in their mental health and situations that arise at work Ð promotion, job relocation, new management practices or redundancy,

Funding for these services is difficult to attract, because the outcomes are difficult to measure and are seen as 'soft' results, which cannot be reproduced in hard laboratory-type conditions. It is not sufficient to measure the outcomes in terms of how many people attain full employment, the qualitative aspect needs to be taken into account as well. It is this aspect which tends to occupy a periphery role, we at STEER believe that it should be central; we will measure our successful outcomes in terms of how far an individual trainee has progressed. How far have they have come in increasing their levels of self esteem and confidence, how much better they feel their social functioning have increased. How they are increasing aware of their mental health needs and consequently how they now feel they management the wrinkles and creases that come up in their lives.

We need to educate policy makers and service providers, that this is they way forward; there is plenty of necessary research and academic pursuit in the biological nature of psychological dysfunction. We see that the real challenge is in finding practical solutions in community settings, not just in the established psychiatric institutions.