Many people who develop or have MS will be finishing education or training, or will be in employment. In some people the MS will have little impact, but for most people MS will have some impact. It is important to minimise the impact if possible because being in employment has many health benefits and among other things enables an individual to retain self-esteem, social contacts, financial independence and a valued place in society. The importance of vocational rehabilitation services for people with MS at all stages but especially in the early stages was emphasised many years ago,17 and has been reiterated recently.259
The Department of Employment has some schemes available for people with disability, but generally specialised vocational rehabilitation services are not available. MS is relatively rare and usually poses very specific problems. For example cognitive losses and fatigue are probably the major impairments affecting employment, yet both are outside the normal scope of employment services. Therefore health service personnel have a vital role to play in providing people with MS and their employers with accurate, impartial information and advice, recognising both the abilities and limitations of the person with MS. Sometimes they may need to offer advice about alternative appropriate work.
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