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Stephen BevanDirector, Centre for Workforce Effectiveness, The Work FoundationHonorary Professor, Lancaster University

Mental Health at WorkStill the Elephant in the Room?

The Work Foundation

• Established 1918 – acquired by Lancaster Uni in 2010• Programme of applied research & policy influence

focused on workforce health & productivity• Main Projects:

• Fit for Work – MSDs & Work (2007):• Employment impact of Crohn’s & Colitis (2011)• 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)

Each involves translating research findings into

policy recommendations & guidance for practitioners

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Well-being at Work: The Problem

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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

MSDs in the EU Workforce

Major cause of incapacity in the

workforce

Over 40m EU workers have

MSDs

MSDs – cause 49% of absence from

work

MSDs cost €240 bn each year – 2% of

GDP

Some workplace risks for MSDs

growing

Pre-existing MSDs & psycho-social

factors understated

Major & growing impact on productivity, labour market

participation & social inclusion as the workforce ages & health

spending is scrutinised

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Poor Workforce

Health

Reduced productivity

More social exclusion &

poverty

Early labour market

withdrawal

Increased healthcare

costs

Reduced tax revenue

Increased welfare

spending

Increased burden on families &

carers

Ageing Workforce

Later Retirement

More Chronic Illness

LTCs in the UK Working Age Population - 2030

©The Work Foundation N=21.6m Source: Vaughan-Jones & Barham, 2009

Mental Health

CHD

Stroke

COPD

Asthma

MSDs

Cancer

Diabetes

Asthma2.6m

Diabetes 1.3m

Stroke367k

Mental Health 7m

MSDs7m

COPD1.6m

Cancer800k

CHD1m

Comorbidity

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Co-morbidity and Work

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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

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Musculoskeletal Disorders (MSDs)

200 conditions affecting bones, joints & connective tissueAffect 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

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

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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 reportsmajor depression.

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 acardiac relapse within five

years.

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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 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.

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Diabetes

The umbrella term for the two types of diabetes: type 1 and type 2Estimates suggest that diabetes deaths will double between 2005 &

2030

People with diabetes are 50% more likely to suffer from common

mental healthconditions

Individuals may experience

psychological distress related to maintaining

tightglycemic control.

Co-morbidity can result in less adequate glycemic

control, morecomplications, increased

service use and lower medication adherence

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The Role of Good Work

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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

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Is Any Job a ‘Good’ Job?

• Being out of work is bad for income, self-esteem, dignity, social inclusion, relationships and health

• Being in even poor quality work which is boring, routine or represents under-employment is widely regarded as a good way for the workless to remain connected to the labour market and to keep the work ‘habit’

• BUT…

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)

1. My job is more stressful than I ever imagined7. My job is complex and difficult8. My job requires learning new skills9. I use my skills in current job  10. I have freedom to decide how I do work11. I have a lot of say about what happens12. I have freedom to decide when I do work  4. I have a secure future in my job5. Company I work for will be in business in 5yrs6. I worry about the future of my job 

3. I get paid fairly for the things I do in my job

Job demands & complexity

Job control

Job security

Effort-reward fairness

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

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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?

www.theworkfoundation.com

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sbevan@theworkfoundation

@StephenBevan