During the past five years or so, centers have been set up in Northern Ireland to help persons recovering from mental illness regain their self-confidence and acquire skills that will help them get jobs. This is no small task since one in 10 persons in Northern Ireland is estimated to suffer from mental health difficulties, undoubtedly exacerbated by the stressful political situation there. Moreover, persons in Northern Ireland with mental health problems are four times more likely to be unemployed than are individuals without such problems.

The centers are part of a network called ACCEPT. The idea came from a team of people at Action Mental Health, a charity in Belfast with almost 40 years of experience in helping persons disabled by mental illness.

ACCEPT stands for "Assessment, Counseling, and Coaching in Employment, Placement, and Training" for individuals with mental illness. The title was also adopted to convey a deeper meaning—that society should stop being prejudiced against persons with mental health troubles and accept them.

The steering group for the ACCEPT centers includes both government and nongovernment organizations in Northern Ireland and is chaired by Cecil Graham, chief executive of Action Mental Health and a man with a diverse background, including training in economics and 20 years with the civil service. Funding to get the centers under way was provided by local Northern Ireland government bodies and by the European Union.

There are four ACCEPT centers, located in Belfast, Bangor, Lisburn, and Portadown. Civil unrest has had some impact on their operations. For instance, Suzanne Loudon, a social worker and a development officer for the ACCEPT center in Belfast, said that the unstable political situation does not have any effect on the operation there, at least "not in any major way, not more than usual." It is "because we are in the city center, neutral territory if you like, that it hasn’t been a problem," she explained.

In contrast, she pointed out, political turbulence has been a problem for the Portadown ACCEPT center from time to time, and when the situation gets unstable and people have trouble visiting their facilities, they simply close down until the situation eases up again. This was the case last July during the Protestant "marching season."

All four ACCEPT branches in Northern Ireland are similar in that they provide social and occupational help to persons recovering from mental illness. All four are also similar in that they operate mental health information centers in downtown areas, where anybody can walk in and obtain information. However, each center has its own flavor, so to speak, in how it does things.

For example, in Belfast, Loudon explained, persons with mental health problems receive their medical care from psychiatrists, psychiatric nurses, and social workers employed by the national health care system. However, the psychiatrists, psychiatric nurses, and social workers often then refer such individuals to the ACCEPT center for focused help in the social and occupational arenas. Persons with mental health difficulties can also visit the center on their own initiative. The center offers courses in both confidence-building and in the development of preparation-for-work skills.

The ACCEPT operation in Lisburn is headed by Ingrid Braithwaite. "I come from the vocational side of things," she said. "I have tried to work closely with the trust [national health care system] in the sense that they provide the clinical and I do the vocational and general health promotion. This is why we have strong links. The trust has worked hard to foster that partnership. So we have the best of both worlds. We have a psychiatrist when we need a psychiatrist."

One of the biggest parts of the Lisburn ACCEPT operation, Braithwaite said, is people coming in for mental health information. "I think it is because there is a lack of mental health resources, if you like, in the area, so a lot of people are directed to ourselves," she explained.

Raymond McKimm, a psychologist, is the development officer for the ACCEPT operation in Portadown. He said that they too work closely with psychiatrists, psychiatric nurses, and social workers employed by the national health care system and take patients referred by them. This means working with people recovering from reactive depression to schizophrenia, and the Portadown ACCEPT staff offers multiple strands of help: ongoing support and counseling; courses in esteem building, stress management, and communications; courses to develop work skills, from very elementary to quite advanced; and an employment service.

And as for the ACCEPT operation in Bangor, Lesley Stewart, the development officer there, said, "We support people through a range of programs. I deliver some of them, and we also bring in specialists to deliver other programs." Stewart has a master’s degree in education.

The centers are having a favorable impact on the lives of a number of people. The Portadown project, for instance, has worked with some 400 to 500 persons since it was founded four years ago, McKimm reported, and of the 200 people assisted last year, 61 percent went on to find work full time.

The Belfast project staff have worked with at least 500 individuals since it was set up four and a half years ago, Loudon said, and of these 500, about half have gained some employment skills, and about 20 percent have gone on to find employment, either paid or voluntary.

Some statistics also underscore the effectiveness of the projects. For example, one of the activities to see whether the center’s efforts are making a difference in Portadown, McKimm explained, is to ask one of every three persons who come to them for help to fill out a questionnaire both before and after receiving assistance.

"We do find there is a statistically significant difference in self-perception," he said, "which we think is one of the most critical issues in moving forward."

The best evidence that the ACCEPT projects are making a difference in people’s lives, however, are individual case histories. An example of someone whom the Belfast project has especially benefited, Loudon said, is a 24-year-old woman suffering from severe depression and agrophobia, "Jan."

"She really had difficulty going out," Loudon recalled. "When she came to us [for the first time], her father brought her." She was also very anxious and had little self-confidence.

Jan then took a confidence-building course offered by ACCEPT, which lasted about two months. She then took another course called "Preparation for Work," where she practiced interviewing, filling out application forms, and other related activities. After that, Loudon and coworkers talked about her working. She was still very nervous and afraid she couldn’t handle it, so they decided to let her get work experience at their center, to help with answering the phones and other administrative duties.

She is now doing voluntary work at a hospital, and Loudon and her coworkers are trying to find paid work for her. "She is a very bright, very enthusiastic person," Loudon said, and "she has come along fantastically."

However, there are still hurdles to be overcome for those seeking help, since in Northern Ireland, as in the United States, prejudice against persons with mental illness exists and since severe mental illness often imposes limitations on people’s ability to function in society and at work. For instance, some 30 percent of the people who seek social and occupational help at the ACCEPT project in Belfast are not able to find work or become ill again.

It is precisely because of this hurdle, in fact, that the Lisburn ACCEPT center has set up some alternative activities to vocational training for those with severe mental health problems. For instance, whereas in the past they might have offered a word-processing class, they now offer clubs where people can come together and perhaps put their ideas into a poetry book on the computer.

"So that is something just a little bit different," Braithwaite said. "But at the same time it is very tangible for the service users and of benefit to them at that point in time in their life."

What are Northern Ireland ACCEPT’s biggest successes? "Many lessons have been learned through this project," Graham told Psychiatric News. "But to me the big success . . .well, I suppose it depends on which level you look at things, but to me the big success has been in effective partnership—working in a region of the United Kingdom with a reputation for division. The other big success has been getting mental health issues onto the main street with these one-stop information and referral shops that we have in downtown Belfast, Bangor, Lisburn, and Portadown. To get our presence on the main street, some of our professional colleagues, such as the consulting psychiatrists we were talking to at an early stage, thought it was totally inappropriate to do something like this on the main street, that there was still too much stigma attached to mental illness. They really felt that we should keep a low profile. I don’t think we’ve overstated it, but we have located our information shops near city centers and have tried to make them, like travel agencies, bright places where anybody can walk in to get information."