Mental health & work

Recovering Ordinary Lives identifies that more occupational therapists need to support adults to attain, maintain or retain a work role

The following College publications can assist with this aim:

• Work Matters - Vocational navigation for occupational therapy staff (COT 2007)
• Vocational Rehabilitation Strategy (COT 2008)
• Working for Health - occupational therapy and how it can benefit your organisation (COT 2010)

 
Dame Carol Black, National Director for Health and Work commissioned the Royal College of Psychiatrists to conduct a review of the available evidence relating to mental health and work as a supplementary report to Working for a Healthier Tomorrow (Black 2008). There is general recognition that work is important for mental health and this is supported by the United Nations Declaration of Human rights which states “everyone has a right to work, to free choice of employment, to just and favourable conditions of work and to protect against unemployment” (RCP 2008).
 

There are three broad categories of mental health problems that are likely to impact on work

1. general symptoms of mental ill health e.g. irritability and sleep problems
2. common mental disorders like anxiety and depression
3. severe mental illness such as schizophrenia, bipolar disorder or severe depression

 
The impact of the stigma of mental health problems results in people having more difficulty gaining work as employers are not keen to employ a person with a mental health problem
People are scared to disclose their histories of mental illness and then run the risk of dismissal if the information comes to light at a later date. Mental health stigma effects people's confidence to apply for work and if they gain employment it is often poorly remunerated, part time and temporary (RCP 2008).
Mental health problems result in both absenteeism and presenteeism where a person remains in employment but their productivity is affected. Many people who are experiencing difficulties continue to work because of fears about the employer’s reactions. They do not discuss their difficulties and then declining performance is interpreted as lack of effort, motivation or competence.
Those in higher status jobs tend to take less sick  leave and this may be due to perceived levels of control, rewards and sense of achievement. Workers in public sector jobs such as occupational therapists, social workers and probation officers are more likely to develop common mental health problems and go off sick (RCP 2008).
 

Mental health problems now account for 40% of Incapacity Benefit Claimants

The longer a person is off sick the harder it is to return to work and many believe that work will acerbate their symptoms. People face difficulties with the 'benefits trap' which leaves people financially penalised if they return to work. Occupational  health schemes for employees varies greatly and many occupational health departments have limited knowledge of mental health. In addition, it is estimated that approximately half of people with common mental health difficulties are misdiagnosed by their GPs often attributing difficulties to physical rather than mental origins. Even with a diagnosis, a gap exists between primary and secondary care services as most specialist services only deal with those with severe and enduring mental health problems. There is little incentive for healthcare workers to encourage return to work and specialist services often focus on symptom reduction and risk management rather than functional outcomes. There is also a separation between healthcare workers and Job Centre Plus (RCP 2008).
 

To tackle these difficulties five elements will be required and occupational therapists will be key to ensure these are in place:

1. each team should have a mental health professional that takes a lead on vocational rehabilitation, offering advice, guidance and brief interventions
2. each team should also have an employment specialist who may not have a health and social care background that provides support to gain and retain employment and provide continuing support
3. public services should be exemplar employers in this area
4. supported work opportunities should be available
5. local commissioning arrangements should be in place between specialist and mainstream providers (RCP 2008)

 
There are currently four types of work scheme in the UK and occupational therapists may be involved in each:

1. sheltered employment - typically very simple activities which do not pay the minimum wage and are not considered open employment
2. clubhouse model - a form of psychosocial rehabilitation which offers transitional employment schemes
3. social firms - businesses which emphasise participation by employees in all aspects of the enterprise
4. supported employment schemes - these place people in open employment and then provide job support e.g. Individual Placement and Support (IPS)

Recent reviews of research identify interventions to reduce sickness absence which can be offered by occupational therapists (RCP 2008)

• stress management techniques may improve people’s ability to cope with stress
• short courses of up to eight weeks of Cognitive Behavioural Therapy may be beneficial for those with common mental health problems although booster sessions may be needed
• early return to work is aided by managers keeping in touch with the employee at least once every two weeks
• telephone care management by mental health professionals may lead to better mental health outcomes and financial benefits to employers
• interventions in this area should address both individual and organisational factors

Although better interventions for mental health problems are necessary, a complex inter-relationship of contextual and environmental factors exist and therefore healthcare interventions alone will not reduce levels of sickness absence.
 

Reference

• Lelliott P, Tulloch S, Boardman J, Harvey S, Henderson M, Knapp M (2008) Mental health and work - Commissioned by the cross government Health Work and Well-being Programme. London, The Royal College of Psychiatrists.