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Mental health and employment: much work still to be done

  • Samuel B. Harvey (a1), Max Henderson (a1), Paul Lelliott (a2) and Matthew Hotopf (a3)
Summary

Mental illness is now the leading cause of both sickness absence and incapacity benefits in most high-income countries. The rising economic and social costs make health and work an increasing priority for policy makers. We discuss the findings from Dame Carol Black's recent review of the health of Britain's working-age population and examine how her recommendations may impact and challenge mental health services.

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Copyright
Corresponding author
Correspondence: Dr Samuel B. Harvey, Institute of Psychiatry, King's College London, Department of Psychological Medicine, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK. Email: s.harvey@iop.kcl.ac.uk
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Declaration of interest

P.L. is Chairman of First Step Trust, a national charity that provides work opportunities for people with mental health problems, and Director of the Royal College of Psychiatrists' Research and Training Unit, which was commissioned to write a report on mental health and work for the National Director for Health and Work. S.H., M. Henderson and P.L. were co-authors of this report. Funding detailed in Acknowledgements.

Footnotes
References
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1 Black, C. Working for a Healthier Tomorrow. TSO (The Stationery Office), 2008.
2 Department for Work and Pensions & Department of Health. Improving Health and Work: Changing Lives. The Government's Response to Dame Carol Black's Review of the Health of Britain's Working-Age Population. TSO (The Stationery Office), 2008.
3 Organisation for Economic Cooperation and Development. Transforming Disability into Ability: Policies to Promote Work and Income Security for Disabled People. OECD, 2003.
4 Confederation of British Industry. Attending to Absence. CBI/AXA Absence and Labour Turnover Survey 2006. CBI, 2007.
5 Reinhardt Pedersen, C, Madsen, M. Parents' labour market participation as a predictor of children's health and wellbeing: a comparative study in five Nordic countries. J Epidemiol Community Health 2002; 56: 861–7.
6 Waddel, G, Burton, A. Is Work Good for your Health and Well-Being? TSO (The Stationary Office), 2006.
7 Shiels, C, Gabbay, MB, Ford, FM. Patient factors associated with duration of certified sickness absence and transition to long-term incapacity. Br J Gen Pract 2004; 54: 8691.
8 Lelliott, P, Tulloch, S, Boardman, J, Harvey, S, Henderson, M, Knapp, M. Mental Health and Work (http://www.workingforhealth.gov.uk/documents/mental-health-and-work.pdf). Health, Work, Wellbeing, 2008.
9 Kooyman, I, Dean, K, Harvey, S, Walsh, E. Outcomes of public concern in schizophrenia. Br J Psychiatry 2007; 191 (suppl 50): s2936.
10 Burns, T, Catty, J, Becker, T, Drake, RE, Fioritti, A, Knapp, M, et al. The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet 2007; 370: 1146–52.
11 Crowther, RE, Marshall, M, Bond, GR, Huxley, P. Helping people with severe mental illness to obtain work: systematic review. BMJ 2001; 322: 204–8.
12 Bond, GR. Supported employment: evidence for an evidence-based practice. Psychiatr Rehabil J 2004; 27: 345–59.
13 Rinaldi, M, McNeil, K, Firn, M, Koletsi, M, Perkins, R, Singh, SP. What are the benefits of evidence-based supported employment for patients with first-episode psychosis? Psychiatr Bull 2004; 28: 281–4.
14 National Social Inclusion Programme, National Institute for Mental Health in England & Care Services Improvement Partnership. Vocational Services for People with Severe Mental Health Problems: Commissioning Guidance. Department of Health & Department of Work and Pensions, 2006.
15 Kessler, D, Lloyd, K, Lewis, G, Gray, DP. Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. BMJ 1999; 318: 436–9.
16 Department of Health. Improving Access to Psychological Therapies. Implementation Plans: National Guidelines for Regional Delivery. Department of Health, 2008.
17 Blyth, B. Incapacity Benefit Reforms – Pathways to Work Pilots Performance and Analysis. Department of Work and Pensions, 2006.
18 Bond, GR, Becker, DR, Drake, RE, Rapp, CA, Meisler, N, Lehman, AF, et al. Implementing supported employment as an evidence-based practice. Psychiatr Serv 2001; 52: 313–22.
19 Sylvester, R, Thomson, A. Welfare is a mess, says adviser David Freud. Daily Telegraph 2008; 2 February.
20 Simon, GE, Barber, C, Birnbaum, HG, Frank, RG, Greenberg, PE, Rose, RM, et al. Depression and work productivity: the comparative costs of treatment versus nontreatment. J Occup Environ Med 2001; 43: 29.
21 Filson, P, Kendrick, T. Survey of roles of community psychiatric nurses and occupational therapists. Psychiatr Bull 1997; 21: 70–3.
22 Healthcare Commission & Commission for Social Care Inspection. No Voice, No Choice. A Joint Review of Adult Community Mental Health Services in England. Commission for Healthcare Audit and Inspection, 2007.
23 Working for Health. Health, work, wellbeing. Healthcare professionals' consensus statement. Working for Health, 2008 (http://www.workingforhealth.gov.uk/documents/healthcare-professionals-consensus-statement-4-march-2008.pdf).
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Mental health and employment: much work still to be done

  • Samuel B. Harvey (a1), Max Henderson (a1), Paul Lelliott (a2) and Matthew Hotopf (a3)
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eLetters

Rise in Unemployment and mental health: Crisis or opportunity?

Rebecca. A.K Lasseko, CT2 in psychiatry
15 July 2009

It was interesting to read the editorial by Harvey et al1. The mentalillnesses are the leading cause of sickness absence and incapacity benefits in Britain and elsewhere as noted in your editorial. Also the Dame Carol Black’s report recommended the need to adjust the criteria of being fit to return to work in order to encourage more people to return towork earlier 2. The editorial has also pointed out there are challenges which make the processes to returning to work more complicated such as stigma and discrimination. Furthermore you noted the mental health services may have to extend their remit and more resources are needed for this.

The area, in which this editorial has not discussed and yet is of importance, is that of the rising levels of unemployment in Britain and its implication in the mental health. 1 in 4 unemployed people in Britain will have mental problems as indicated in the National statistic report 20013. The research on life event by Brown and Harris4 indicated that lifeevents such as unemployment, increases the risks of mental health problems. Hence there will be an increase of mental health problems due to unemployment which will add to the burden of an already struggling economy. Moreover more resources will be needed in Primary and secondary care to look after an increasing number of people with mental health due to unemployment. This is a chicken and egg scenario, thus effort to offer more support in terms of coping strategies to those losing employment is paramount. Therefore they do not develop mental illnesses which will make it possible for them to return to work as well as encouraging those off sick to return to work as early as possible.

Another issue when encouraging people suffering from depression andanxiety in returning to work is the jobs competition with people currentlyout of work who have no mental illness. People with mental illness more than often lack confidence after being off sick. This is an added disadvantage to these people in terms of job competitions. Most organizations are currently making more of their staff redundant. The question remains, are all people involved doing enough to support people out of employment to cope hence not develop mental health problems. Meanwhile are there more opportunities created to help return those peoplerecovering back to work? Working people have healthier mental and psychological health. The rehabilitation and prevention work need to go hand in hand. This will reduce the chances of people entering the circle of poor mental health and its detrimental effect on the unemployed, or vice versa.

References1. Harvey S. B, Henderson. M, Lelliott. P, Hotopf. M Mental health and employment: much work still to be done. The British Journal of Psychiatry 2009; 194:201-203. 2. Black C. Working for a Healthier Tomorrow. The stationery office, 2008.3. A longitudinal study of the Mental Health of Adults in Great Britain, Better or Worse. National statistics 2003 UK. 2003.4. Brown GW, Harris T. Life events and illness. New York, Guildford Press. 1989.
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