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Whose responsibility is it to support people with mental health problems in/to employment? Later this month, the OECD will publish what looks like an important piece of work examining the myths and realities about mental health and work. The issue is a spectacular tangle of grey areas, discrepancies and imprecision.

There’s the matter of looking after the mental health needs of those currently in employment. There’s the challenge of supporting people with long term mental health conditions in getting off benefits and into work both sustainably and without exacerbating their illness. There’s a complex relationship between recovery (which in the case of mental illness is rarely a linear process), therapeutic occupation and the pressure of responsibility.

There are underlying problems around the hindering of aspiration and ambition as a result of the onset of mental illness. There’s the confusing business of common mental disorders, such as anxiety and depression, and severe mental disorders, all of which can be chronic, transitory and, very likely, fluctuating in degree of severity.

The very idea of mental illness takes us to extremely uncomfortable places

Dealing with these challenges falls neatly between health and social care provision, the welfare system, and the big bad world of the free market. The very idea of mental illness takes us to extremely uncomfortable places, and the fact that employers don’t really want to know and employees don’t really want to talk about their mental health is only one indication of the deep social stigma that still exists.

So even though we know that the costs of mental ill health are enormous (estimated at as much as 4% of GDP in the EU), it does not seem to be an issue that people outside the mental health sector are engaging with very seriously. Employers and corporations are, so far, not a real partner to the mental health care system.

The government is ploughing money into the Work Programme, which pays specialist providers to get people with long term conditions into work, but without any kind of systematic approach towards employers and the workplace. The fact is that employers do not like the idea of mentally ill staff (only four in ten employers say they would hire someone with a mental disorder) and we cannot simply sidestep or overlook this when trying to encourage people off benefits and into work.

The fact is that employers do not like the idea of mentally ill staff and we cannot simply sidestep or overlook this when trying to encourage people off benefits and into work.

And, although there is overwhelming evidence that employment is an important element of continuous, on-going recovery from mental illness, the mental health care system takes minimal responsibility for the employment status of its patients. Part of the problem here is that so much of the mental health care system is geared up towards severe mental disorders, and a long held lack of expectation of recovery. Once a person falls into the system of mental health care, the path towards becoming a career mental health patient is a lot easier to fall onto than any alternative paths.

The OECD’s report will argue that policy can and must respond more effectively to these challenges, but to do so will require a co-ordinated approach and a multi-level shift. This will require a level of integration that is hard to see emerging from what the coalition is up to.

For example, we know that prevention and early intervention are crucial, so we need to find ways to join up vocational support with first line health care response to mental distress. To make working life compatible with long term mental disorder, there is a need to stop trying to shoehorn people with mental health conditions into inflexible and conventional models of working and encourage employers to accept variations in people’s productivity, and a more diverse and creative view of what it means to get the job done.

Within all of this I’m sure there are real opportunities for social enterprises to play a role in bringing about shifts not only in attitudes to mental health at work, but also in terms of matchmaking people with employers and helping employers to respond proactively to the mental health needs of the workforce. The Social Brain and Enterprise teams at the RSA are currently interested in exploring this area, so if you’re working in this space or have ideas you’d care to share, do get in touch.

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