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Mental Health at Work
Still the Elephant in the Room?
Stephen Bevan
Director, Centre for Workforce Effectiveness,
The Work Foundation
Honorary Professor, Lancaster University
©The Work Foundation
The Work Foundation
• Established 1918 – acquired by Lancaster Uni in 2010
• Programme of applied research & policy influence
focused on workforce health & productivity
• Main Projects:
Each involves translating
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research findings into
Fit for Work – MSDs & Work (2007):
policy recommendations
& guidance for
Employment impact of Crohn’s & Colitis (2011)
practitioners
Working with Schizophrenia (2013)
Ready to Work – Multiple Sclerosis (2011)
Medical Devices & Employment effect (2011)
Body & Soul – co-morbidity and employment (2010)
Presenteeism & productivity (2011)
Health Workforce Wellbeing & Patient Outcomes (2009)
Health & Wellbeing of Knowledge Workers (2009)
Well-being at Work: The Problem
©The Work Foundation
Mental Health of the UK Workforce
• Serious mental illness ‘flat’ but devastating
• Trebling of depression & anxiety since early 1990’s
• In UK Mental Health accounts for 2% of GDP – at
least as important economically as Poverty
• 16% of adults of working age have a mental illness,
of whom up to a half are seriously ill
• Accounts for over 40% of the flow onto ESA
• Comorbidity, self-stigma & disclosure issues
©The Work Foundation
MSDs in the EU Workforce
Major cause of
incapacity in the
workforce
MSDs cost €240 bn
each year – 2% of
GDP
Over 40m EU
workers have
MSDs
MSDs – cause 49%
of absence from
work
Some workplace
risks for MSDs
growing
Major & growing impact on
productivity, labour market
participation & social inclusion as
the workforce ages & health
spending is scrutinised
Pre-existing MSDs
& psycho-social
factors understated
Ageing
Workforce
Early labour
market
withdrawal
Increased
healthcare
costs
Later
Retirement
Reduced
productivity
Poor
Workforce
Health
Reduced
tax revenue
©The Work Foundation
Increased
welfare
spending
More Chronic
Illness
More social
exclusion &
poverty
Increased
burden on
families &
carers
LTCs in the UK Working Age Population - 2030
Cancer
800k
Diabetes
1.3m
Mental
Health 7m
Mental Health
CHD
MSDs
7m
Stroke
COPD
Asthma
MSDs
Cancer
Diabetes
Comorbidity
©The Work Foundation
N=21.6m
Asthma
2.6m
COPD
1.6m
Source: Vaughan-Jones & Barham, 2009
CHD
1m
Stroke
367k
Co-morbidity and Work
©The Work Foundation
King’s Fund/CMH/LSE Review
• By interacting with and exacerbating physical illness,
co-morbid mental health problems raise total health
care costs by at least 45 per cent for each person
with a long-term condition and co-morbid mental
health problem
• Between 12 per cent and 18 per cent of all NHS
expenditure on long-term conditions is linked to poor
mental health and wellbeing – between £8 billion and
£13 billion in England each year
©The Work Foundation
Musculoskeletal Disorders (MSDs)
200 conditions affecting bones, joints & connective tissue
Affect over 40m workers across the EU (240 bn Euros)
Cause 49% of all lost working days
About 25% of people
with arthritis report a
co-morbid mental
health condition
©The Work Foundation
Co-morbidity can
increase psychological
barriers to functioning
and increase absence
from work
Around 19% of absentees
from work due to chronic
pain have depression,
whereas only 8% who are
not absent are depressed
Cardiovascular Disease (CVD)
Conditions that impact the heart and blood vessels Includes
heart attacks and strokes
Major cause of disability and premature death
One in five individuals
with coronary heart
disease reports
major depression.
©The Work Foundation
Poor mental health is
a risk factor for
cardiovascular
disease
Women with coronary heart
disease who lack social
integration & have depressive
symptoms are 4 times more
likely to have a
cardiac relapse within five
years.
Chronic obstructive pulmonary disease (COPD)
A group of respiratory conditions that includes chronic bronchitis
and emphysema
Responsible for 9% of certified sickness absence in the UK
People with COPD are
more
likely to have mental
health conditions such as
depression and anxiety.
©The Work Foundation
The combination of
COPD and anxiety can
impact quality of life
and lead to greater
disability
Anxiety also increases
the frequency of
hospital admissions for
COPD
patients.
Diabetes
The umbrella term for the two types of diabetes: type 1 and type 2
Estimates suggest that diabetes deaths will double between 2005 &
2030
People with diabetes
are 50% more likely to
suffer from common
mental health
conditions
©The Work Foundation
Individuals may
experience
psychological distress
related to maintaining
tight
glycemic control.
Co-morbidity can result in
less adequate glycemic
control, more
complications, increased
service use and lower
medication adherence
The Role of Good Work
©The Work Foundation
A working definition of “Good Work”
• Employment security
• Control over the content & pace of work
• “Task discretion” and interesting/challenging work
• A proper balance between effort and reward
• Opportunities for learning & growth
• Procedural justice
• High trust relationships (“social capital”); collective
and individual voice
©The Work Foundation
Is Any Job a ‘Good’ Job?
• Being out of work is bad for income, selfesteem, dignity, social inclusion, relationships
and health
• Being in even poor quality work which is
boring, routine or represents underemployment is widely regarded as a good
way for the workless to remain connected to
the labour market and to keep the work ‘habit’
• BUT…
©The Work Foundation
A Message from HILDA
• Household, Income and Labour Dynamics in Australia
(HILDA) Survey
• Analysis (Butterworth et al, 2011) of seven waves of
data from 7,155 respondents of working age (44,019
observations) from a national household panel survey.
• Longitudinal regression models evaluated the concurrent
and prospective association between employment
circumstances (unemployment and employment in jobs
varying in psychosocial job quality) and mental health,
assessed by the MHI-5
Butterworth, P., Leach, L. S., Strazdins, L., Olesen, S. C., Rodgers, B. et al. (2011). The psychosocial quality of work determines whether
employment has benefits for mental health: results from a longitudinal national household panel survey. Occupational & Environmental
Medicine, first published online on March 14, 2011, doi:10.1136/ oem.2010.059030
Psychosocial Job Quality (1)
Job
demands &
complexity
1. My job is more stressful than I ever imagined
7. My job is complex and difficult
8. My job requires learning new skills
9. I use my skills in current job
Job control
10. I have freedom to decide how I do work
11. I have a lot of say about what happens
12. I have freedom to decide when I do work
Job security
4. I have a secure future in my job
5. Company I work for will be in business in 5yrs
6. I worry about the future of my job
Effortreward
fairness
3. I get paid fairly for the things I do in my job
Source: Butterworth et al, 2011
Psychosocial Job Quality (2)
“As hypothesised, we found that those
respondents who were unemployed had
significantly poorer mental health than those
who were employed. However, the mental
health of those who were unemployed was
comparable or more often superior to those in
jobs of the poorest psychosocial quality.”
Source: Butterworth et al, 2011
Challenges
• The sustained impact of ‘good work’ & job design on
health outcomes will always be better than lettuce!
So what 21st Century interventions will work?
• How to support personal ‘empowerment’ & healthy
lifestyle choices?
• Work & non-work factors – we need realism about
the ‘reach’ & impact of workplace interventions
• Interaction effects between physical and mental
health must inform both interventions and evaluation
• How can clinicians, organisations & policy-makers
embed the principles of ‘Good Work’ into
interventions?
©The Work Foundation
www.theworkfoundation.com
sbevan@theworkfoundation
@StephenBevan
©The Work Foundation