Two cheers for the PM's focus on mental health at work
9 Jan 2017
The Prime Minister’s announcement today of a review into workplace mental health support is, of course, very welcome. Mental illness in the UK’s working-age population is a very real challenge which can perpetuate worklessness and social exclusion, reduce the quality of working life and undermine our already flagging labour productivity, so action to improve the mental health of the workforce should be a national priority. In Lord Dennis Stevenson and Paul Farmer, CEO of Mind, the PM has placed the stewardship of the Review in safe hands and there is no shortage of evidence for them to draw upon.
Here at IES we have conducted a large number of studies and reviews of good practice in managing mental health at work and we have developed a robust view of what more needs to be done. So while the review will be a very timely opportunity to focus attention on a serious problem, here are some of things which I feel need to feature in its terms of reference if it is to have a sustained impact.
Making the economic and social case for early intervention
To grow and to thrive, the economy needs a workforce which is skilled, engaged and healthy – especially as the workforce ages and has to retire later. With healthcare spending under greater scrutiny, investments in early interventions which help working-age citizens with poor physical or psychological wellbeing to remain active in the labour market are going to be essential if we are to raise labour productivity and avoid social exclusion. More specifically this means that, if employers are playing their part in identifying employees who need support, the clinical services they need are in place or existing vocational rehabilitation services (such as Fit for Work or Access to Work) are prominently signposted and promoted. Among people with severe mental illnesses such as schizophrenia (where employment rates are as low as 8%) or bipolar disorder, the evidence of the economic effectiveness of early intervention is strong.
Parity of Esteem
Mental illness is rarely given the priority that physical ill-health receives. Somebody with a cancer diagnosis is rightly guaranteed to see a specialist within two weeks of diagnosis. For somebody with, for example, schizophrenia no such guarantees exist even though the case for early intervention here is arguably just as solid as it is for cancer. Mental illness needs to achieve parity of esteem with physical illness - with something approaching parity of funding to match. In workplaces, it is still common to find that some managers and even HR professionals seek to downplay mental illness at work or even suggest that it is not a sufficiently serious reason (in comparison to physical illness) to have time off from work.
Quality of Work
During the financial crisis, with unemployment rising, a big challenge was to find a job for everyone who wanted one. Now, as more jobs begin to be created, we also need to think about the quality of these jobs. We know that jobs with low control and discretion can be bad for psychosocial health and health inequalities. Professor Sir Michael Marmot and his colleagues at the Institute of Health Equity have prioritised ‘good work for all’ in their top six policy areas central to reducing health inequality. We need to make sure that as many of the new jobs we create as possible are of good quality, rather than precarious and insecure. Given that the PM has previously asked Matthew Taylor of the RSA to conduct a review looking at employment practices, it is imperative that the link between poor quality work and mental illness is looked at with some urgency. If both reviews proceed without joining up on at least the topic of mental health at work, then both will be flawed.
Very often physical and mental illnesses go hand-in-hand. Among people with chronic musculoskeletal disorders (MSDs), for example, up to 30 per cent also have comorbid depression or anxiety. We know that comorbidity can increase healthcare costs by up to 45 per cent and that living with both a mental and physical illness can make staying in – or returning to – work, much more difficult to manage. As the workforce ages, healthcare systems, active labour market policy and employment practice will need to adapt to improve the management of employees with multiple health conditions including mental illness.
Placing Service-Users at the Centre
We have seen some good progress towards genuine service-user involvement in the planning and delivery of healthcare in mental health. However, in the UK stigma still stalks many workplaces: over 30 per cent of employees say they would never work with someone who has a mental illness. The more we can make sure that those living with a mental illness are given the opportunity to have a strong voice in the way their working lives are managed, the less likely we are to see mental illness causing premature job loss or total withdrawal from the labour market. Much more progress in attitudes and action is needed here, especially as we known that both self-management and peer support initiatives can be very effective.
Over the next decade the challenges posed across the UK by declining health in an ageing population will occupy more resources and effort. Unless we recognise, through this new review, that the mental health of our working-age population can be an enormous asset in our drive to build a competitive, productive and inclusive, knowledge-based economy, we will be guilty of presiding over a catastrophic and avoidable waste of our human resources.
Any views expressed are those of the author and not necessarily those of the Institute as a whole.