Working for a healthier tomorrow

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Working for a healthier tomorrow

• Mental Health and Employment
• 21st April 2009

Carol Black DBE National Director for Health and
Work
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The value of work

• Employment is natures physician and is
  essential to human happiness
• Galen (129-200)
• Work is generally good for physical and mental
  health and well-being
• Waddell Burton (2006)
• Work needs to be good work. Poor
  relationships and poor work environments can lead
  to poorer health.

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Social Determinants of Physical and Mental Health
Social Determinants of Physical and Mental Health

• The social gradient
• Stress
• Early life
• Social exclusion
• Work/Unemployment
• Social support
• Addiction
• Food
• Transport

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Mental health and well-being

• Mental health and mental wellbeing are
  fundamental to the quality of life and
  productivity of individuals, families,
  communities and nations
• enabling people to experience life as
  meaningful, and to be creative and active
  citizens.
• WHO Mental Health
  Declaration for Europe
  (quoted by L.Friedli, WHO, 2009)

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Mental health

• Mental health influences a very wide range of
  outcomes for individuals and communities.
• These include
• healthier lifestyles
• better physical health
• improved recovery from illness
• fewer limitations in daily living
• higher educational attainment
• greater productivity, employment and earnings
• better relationships with adults and with
  children
• more social cohesion and engagement and
• improved quality of life
• L.Friedli, Mental health,
  resilience and inequalities, WHO Europe 2009
  

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Positive mental health

• The focus on mental health activities capable
  of improving the wellbeing of the whole
  population marks an important shift towards
  recognising the benefits of promotion and
  prevention, in addition to improving the
  treatment of existing disorders.
• It is also an acknowledgement that positive
  mental health and wellbeing can contribute to
  achieving a wide range of health and social goals
  of crucial importance to the long-term prosperity
  of Europe.
• 
  L.Friedli, WHO, 2009

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Mental health the facts

• 1 in 4 people will suffer some form of mental
  health problem during their lives
• At any given time 1 in 6 working age adults have
  symptoms associated with mental ill-health (e.g.
  sleep problems, fatigue, etc) which do not meet
  the criteria for diagnosis
• A further 1 in 6 working age adults experience
  diagnosable mental health problems (e.g.
  depression, anxiety, etc) at any given time
• An estimated 1-2 of the population have severe
  mental health problems (e.g. schizophrenia,
  bipolar disorder, etc)
• The Royal College of Psychiatrists Mental Health
  and Work (2008)

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Mental health and work

• Being in work generally leads to good mental
  health, self-esteem and well-being
• Being out of work is associated with poor mental
  health, increased likelihood of anxiety and
  depression, and increased use of medication
• When people return to work their mental health
  and well-being generally improve
• Although work can pose a risk to mental health,
  the positive effects far outweigh the risks
• People with mental health problems attach a high
  priority to work, and work has the potential to
  be part of the recovery process

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Health of unemployed and re-employed men
Unemployed 18 24 months -v-
Unemployed gt6 months before re-employment
Mean scores
Nottingham health profile
Unemployed Re-employed Weighted random population
sample
Emotional reaction Social isolation
Physical mobility
A.NewmanTaylor, after McKenna and Payne, 1989
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Worklessness and the next generation

• Children in workless households suffer higher
  rates of psychiatric disorders
• Evidence that behavioural/conduct disorders are
  more likely where no parent in the household is
  working
• 30 of children who have a parent with a
  disability or health condition live in poverty
• Evidence of correlation between lower parental
  income and poor health in children.

• Children living in workless households are
  more likely to experience worklessness
  themselves during adult life

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Most people off work have conditions that people
in work may have

• Mild and treatable conditions
• Depression, anxiety, stress-related mental health
  problems
• Musculoskeletal conditions
• Cardio-respiratory conditions
• Responsible for over two-thirds of sickness
  absence and long-term incapacity
• Inappropriate medicalisation - contact with
  the workplace is often lost.

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Cost of working age ill-health

• Overall costs of working age ill-health are in
  excess of 100billion per year
• Around 172 million working days were lost to
  sickness absence in 2007, at a cost to the
  economy of over 13 billion (CBI)
• Total costs to the taxpayer, in terms of benefits
  and forgone tax revenue, are over 60 billion per
  year.
• Loss of productivity for those who are ill but
  still in work likely to be even greater
  estimated cost due to mental ill-health alone is
  15 billion a year (Sainsbury Centre for Mental
  Health)

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My Review of the health of the working-age
population A new vision for health and work
Review commissioned by Secretaries of State for
Health and for Work and Pensions in 2007 to lay
the foundations for reform

• At the heart of my vision
• Prevention of illness and promotion of health and
  well-being in the workplace
• Early intervention for those who are employed but
  absent with a sick note
• Improvement of the health and well-being of those
  within the benefits system

Working for a Healthier Tomorrow
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The workplace
There is poor understanding of health and
well-being initiatives that employers can
implement

• Many employers do not have sickness-absence
  policies to enable early and sustained return to
  work
• Many employers have no policy on handling mental
  ill-health
• Many employers are unaware of the business case
  for investing in health and well-being
• SMEs struggle to find accessible and affordable
  sources of support and advice
• No national standards are available to employers
  when they purchase occupational health or
  well-being services

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Promotion of health in the workplace

• The promotion of physical health and fitness,
  and the prevention of physical disease, are
  highly-desirable goals, often pursued in large
  companies.
• But the promotion of positive mental health
  and fitness is done by very few companies. Do we
  think it important, and how would it be done?

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The role of the workplace

• 60 of line managers underestimate the percentage
  of the UK population that experiences mental
  ill-health
• 76 of line managers are aware they have managed
  at least one person with mental ill-health
• Only 13 of managers have received training on
  mental health awareness
• Many employers have no policy on handling mental
  ill-health
• Few line managers have confidence in GP
  assessments particularly with regard to stress
• Employers Forum on Disability survey (2008)

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A world-wide programme for team resilience and
positive mental health

• GlaxoSmithKline publicly report on the financial
  impact of their health and well-being programmes
• GSK report shows that staff who are physically
  energised, mentally focussed, and have a clear
  sense of purpose, show sustained improvements in
  performance
• Since 2002
• 60 reduction in work-related mental illness
• 20 reduction in absences due to mental
  ill-health, equivalent to savings of 2.4 million
• 10-15 reduction in fatigue and 15 increase in
  self-esteem and job satisfaction

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BT implementing a mental health strategy

• Impact of a long-term structured approach
• More than 5 years since BT rejected a candidate
  on the grounds of mental illness
• Sickness absence rate due to mental health
  problems has fallen by 30 in 4 years despite
  pressured market conditions
• Now get almost 80 of people who are off for more
  than 6 months with mental illness back into their
  own jobs (vs. 30 5 years ago, and 20
  nationally)
• Medical retirement rate for mental illness has
  dropped by 80 in 5 years
• Stress claims dramatically reduced
• Enhanced reputation with key customers

Courtesy of Dave Wallington, BT
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An international comparison Australias
beyondblue programme

• beyondblue seeks to address depression in
  Australia through a comprehensive programme of
  activities, including
• Reducing stigma in both the community and
  business by raising awareness of the symptoms,
  causes and treatments for depression a
  programme for line managers
• Acting as an advocate for issues raised by people
  with depression and their carers
• Supporting programmes which either prevent or
  provide early intervention for depression
• Assisting primary care practitioners
• Promoting research into the causes and effective
  treatments for depression

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Early intervention the role of healthcare
professionals

• All healthcare professionals need to understand
• Good work is good for health and well-being
• A return to functional capacity, and a sustained
  return to work where appropriate, should be key
  indicators of clinical success in the treatment
  of working-age people
• Work-related issues within the healthcare setting
  (e.g. Vocational Rehabilitation, communication
  with employers, etc)

GPs are usually the first port of call they
issue most sick notes. A sick note is a powerful
therapeutic tool.
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Consensus statement March 2008

• Consensus Statement, signed on 5 March 2008 by
  the leaders of the healthcare profession.
• It is a pledge to promote the link between good
  work and good health.

• In future, all healthcare professionals should
  see retention in or a return to work as a key
  indicator of clinical success in the treatment of
  working age people

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Early intervention
Paper Sick note
Electronic fit note
40 of all incapacity benefit claims are due to
mental ill-health
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The Fit for Work Service

• Early intervention
• holistic
• non-medicalised
• case managed
• good positive contact with employers
• addressing the real problems which keep people
  out of work
• effective vocational rehabilitation

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Worklessness
In the UK the scale of the numbers on Incapacity
Benefits represents an historic failure of
healthcare and employment support to address the
needs of the working-age population. Working
for a healthier tomorrow (2008)
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Health conditions and incapacity benefits
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Improving the health of those who are out of work

• 40 of all incapacity benefits claims are due to
  mental ill-health as the primary condition an
  increase of 1/3 since 1997
• Total of 600,000 new incapacity benefits claims
  each year
• 200,000 new incapacity benefits claims each year
  are due to mental ill-health as the primary
  condition, plus many others with mental
  ill-health as a secondary condition likely that
  over 1/2 of all new claimants suffer mental
  health problems
• Only 15 of people with mental health problems
  come off incapacity benefits within 3 months
  compared with 20 of other claimants

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An improvement in the health of those out of work

• My Recommendations to Government
• When models for the Fit For Work Service are
  established it should be made available to all
  those on out-of-work benefits
• Health support should be fully integrated with
  employment and skills support
• Consider incentives for employers to support the
  employment of those with disabilities or
  long-term health conditions
• Develop a mental health and employment strategy.
• Review the support available for people with
  mental health conditions and determine the most
  effective method of assisting this group of
  people back to work

Working for a
healthier tomorrow 2008
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The Governments ResponseImproving health and
work changing lives

• The response was published in November 2008.
• It sets out how, in partnership, Government can
  work towards
• Creating new perspectives on health and work
• Improving work and workplaces
• Supporting people to work
• Measuring progress

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Improving health and work changing
lives.Creating new perspectives on health and
work

• A new electronic Fit Note
• Support through new education and training
  initiatives
• For GPs and nurses
• For other professionals
• Changing aspirations of children and young people

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Improving health and work changing
livesCreating new perspectives on health and work

• Developing standards and guidelines and a
  national accreditation system
• Changing perspectives through social marketing
  and public health initiatives
• A National Centre for Working-Age Health and
  Well-being

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Improving health and work changing
lives.Improving work and workplaces

• Helping businesses identify and quantify the
  costs of ill-health, and benefits of health and
  well-being initiatives
• The Business HealthCheck Tool
• Investors in People Framework

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Improving health and work changing
lives.Improving work and workplaces

• Support for SMEs
• Extension to NHS Plus Programme of occupational
  health services for SMEs
• National Occupational Health Helpline Pilot
  providing advice to SME line managers on managing
  individual cases
• Championing Action at a Local Level health,
  work and well-being coordinators
• Challenge Fund to encourage initiatives that
  improve health and well-being in the workplace
  and worker engagement

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Improving health and work changing
lives.Supporting people to work

• Piloting early intervention services from
  2009-2011
• Fit for work services pilot
• Employment Advisers in Improving Access to
  Psychological Therapies pilot
• Employment Advisers in GP surgeries (pilot
  extension)
• Access to Work pilot for people with fluctuating
  health conditions

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Mental health and employment next steps

• Mental Health and Employment Steering Group
  overseeing the creation of a national strategy
• Steering Group membership has been drawn from a
  range of experts from business, academia, the
  medical profession, trades unions and the third
  sector
• Intention is to complete and publish the new
  mental health and employment strategy by early
  summer 2009

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A national strategy for mental health and
employment mapping the continuum

• What intervention is most appropriate at each
  stage of the journey?

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Improving health and work changing
livesAchieving the Government Vision

• Success depends on working in partnership with
  employers, healthcare professionals, service
  providers across the public, private, voluntary
  and charitable sectors, individuals and their
  representatives