We need to make it easier for people with mental illnesses to enter and stay in work
I once had a patient who was able to start a part time job after being unable to work for 40 years due to a psychotic illness. She finally accepted help to manage this condition and with support became able to hold down a job.
It was a complete revelation to see my patient’s self-esteem improve drastically after returning to work and how the position gave new meaning to her life. This has made me very conscious that many others with mental illnesses are not as lucky.
This was highlighted in the recent Stevenson and Farmer review of mental health and employment, which found that hundreds of thousands of people are pushed out of the workplace every year due to mental illness.
Employment alone does not answer all woes, particularly for people with mental health problems, but it certainly can go a long way. Without “good work” it’s not just finances that suffer. No job almost always means social networks dwindle and motivation shrinks. Long term health prospects diminish and the chances of being admitted to hospital are increased.
The UN Declaration of Human Rights states that “everyone has a right to work, to free choice of employment, to just and favourable conditions of work, and to protection against unemployment.” That you are twice as likely to lose your job if you have a long term mental health condition (a far higher likelihood than if you have a physical health condition) surely can’t be seen as anything other than an abnegation of this right.
Our training enables psychiatrists to improve patients’ lives through the biopsychosocial approach. This means that we can provide our patients with the best blend of medication, talking therapies, and social interventions to help recovery.
Many with mental ill health continue to work successfully, although often employers aren’t fully aware of their employees’ mental illnesses. Work can be part of the recovery process and help prevent a mental health condition from worsening.
But most need some type of support to continue to work well. This is why Farmer and Stevenson’s “core mental health standards” for employers have the potential to make a truly significant difference. The standards, which include implementing mental health at work plans and developing employee mental health awareness, could help provide a healthy environment and appropriate support for those with mental health problems and reduce absenteeism.
But is there a risk that the extent of acceptable watercooler chat—or, more importantly, conversations with managers of HR—are stretching only to better known and understood conditions, such as anxiety and depression?
As few as one in four people with a mental illness lasting more than a year are in employment. This figure drops to as low as one in 10 for people with psychotic conditions such as schizophrenia or bipolar.
It isn’t at all easy for people with severe mental illnesses to enter and stay in work. It requires more than raising general awareness in the workplace. The Royal College of Psychiatrists believes that good quality employment support should be available for those in this group of people who are well enough to work—such as individual placement support, where employment specialists work with clinical teams to provide individualised support for the person and their employer.
It is also critical that mental health professionals see helping people into—or to stay in—employment as a priority. Mental health clinicians don’t need to be employment support experts, but awareness of the importance of employment in recovery and their role in supporting patients into—or to stay in—work is critical. As is understanding that people don’t need to be symptom-free before clinicians consider supporting them back into work.
The NHS has a big part to play as an employer, as Stevenson and Farmer rightly stress. I can talk honestly and passionately about the many rewards of working in the NHS, but this does not detract from the fact that it is a demanding place to work. Nearly one in 10 nurses has taken time off work for anxiety, stress, or depression.
When I started work doctors with mental illness were often managed out of the NHS. Things are improving, but we still have a way to go.
Resources are thin, but support can and must be given to those NHS staff who need it. As bluntly set out in the report, failing to do so only stores up further problems, with human and financial costs attached. Prioritising the mental health of our staff must be beyond question.
We cannot allow another generation of people with mental illness to languish and miss out on the benefits that a good job can bring.
Wendy Burn is the president of the Royal College of Psychiatrists.
Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: None.