Report 48: Mental health, employment and the social care workforce
What keeps people with mental health problems from working in social care?
Too many people have been given the message, both by health professionals and society more generally, that work is not a realistic possibility for them (18)
There are some obstacles to working that are more general across all types of employment, but some are specifically an issue in social care and health, including legislation and guidance that is meant to protect the public from risk but which acts in a discriminatory way preventing people with mental health problems from getting work.
Evidence shows that stigma and discrimination towards people with mental health problems both in wider society and within the workplace still exists, despite efforts to eradicate this. Given this, it is difficult for people to disclose current or past problems with their mental health. Despite much evidence that work is beneficial for mental health, workplaces can be a cause of stress and mental health problems, or make problems worse, and there is often a lack of awareness among managers and staff about what support is needed. However, people do not have to be fully recovered from mental health problems to go back to work.
Stigma and discriminationOpen
The term stigma refers to problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination) (23). Stigma (in relation to mental health problems) can be defined narrowly as a prejudiced attitude towards people with mental illness labels, or more broadly as a social process including attitudes, behaviours and structures that create and perpetuate inequalities (24).
Stigmatising attitudes in society can stop people from asking for and getting help when they need it. Public attitudes about mental health show some positive changes in recent years, but continue to be mixed (25). Anti-stigma campaigns such as Time to Change are raising awareness and increasing openness about mental health problems (26).
Many people with severe mental illness want to work and 30-50 per cent are capable of work, though only 10-20 per cent are working (20). Negative assumptions by doctors and medical staff play a significant role:
‘My doctor told me I would never work again...’ (18)
There is evidence of stigma and discriminatory behaviour faced by people with mental health problems when trying to find work or retain their jobs, and their low workforce participation offers demonstrable proof of the impact of stigma (18), (27), (28) (29).
Employers’ attitudes also show signs of stigma. Research shows that even though employment agencies would consider putting forward individuals with previous mental health needs to employers, the latter had high levels of concern in employing them (30).
A Mind survey found that almost one fifth of the 30m adult working age population admitted to having called in sick because of stress, but had lied about the reason. Instead they cited stomach upsets, housing problems and the illness of a loved one (31).
Although the Equality Act 2010 makes illegal the use of routine pre-employment screening questionnaires, and the spirit of the Act is to prevent discrimination, the knowledge that an employer might ask health questions before any final job offer could discourage people from applying.
For example a social worker described how openness was treated:
‘I decided to be open … about my mental health problems...they have made me feel as though I have something to be ashamed of and punished for, rather than recognising the additional expertise my experience gives me as a practitioner’ (32).
Even if a decision to disclose is made, employees with mental health problems will often wait until they have made a good impression in the hope that their performance will offset any negative views (33) (22).
The Clothier Inquiry recommended that no applicant for a post in the NHS with a previous mental health issue should be employed unless they had been free of drugs and other support for at least two years. Guidance now recommends that the “two-year rule” should no longer to be used in the NHS. The rule is not part of regulators’professional standards. However the rule may still have an enduring effect on attitudes. (seeLaw, policy and guidance).A national survey (35) found more than seven in ten workplaces lacked a formal policy on mental health. Smaller businesses and employers with no human resources responsibilities were more likely to answer ‘don’t know’ when asked their views on mental health problems in the workplace. Given this situation it is no surprise that less than two in five people said they would disclose any mental health problems to an employer.
Mentally or physically unsafe working environmentsOpen
Safety at work means freedom from dangers or risks. However, health and wellbeing are much broader and more positive concepts. Stressful working environments with lack of control over one’s work can lead to mental health problems. While stress is not an illness, it is recognised that prolonged stress is linked to psychological issues such as anxiety and depression (20), (32), (36).
Racial discrimination in the workplace is common and is a known risk factor for mental health problems. Research also shows a higher risk of mental health problems such as anxiety and depression among individuals reporting unfair treatment at work (37).
While employment is generally viewed as good for people’s mental health (1) it remains the case that some jobs may be damaging for some people. (38); (39); (40); (36) for example; the reasons for high incidence of sickness absence associated with depression in social worker according to one study were heavy workload, lack of control, absence of boundaries and the demanding nature of the work. (67) A range of research has shown that while encouragement and support to enter employment can be helpful, attempts at coercion generally fail:
‘The net result is that interventions which encourage and support claimants to come off benefits and successfully get them (back) into work are likely to improve their health and well-being; interventions which simply force claimants off benefits are more likely to harm their health and wellbeing’ (20) (p.30).
‘Reintegrating claimants furthest from the labour market requires longer-term and personal engagement with individuals. This seems to be particularly critical in relation to people with mental health conditions and the intensive support needed to help them into work’ (41) p. 9.
Lack of needed supportsOpen
‘In 14 years as a service user, mental health professionals have never offered me help with working towards getting back to work.’ (18)
Some of the clients using an employment adviser scheme described the lack of support they received from their employer, despite confiding in them about their mental health difficulties before taking sick leave: ‘I did tell my manager probably two months before I was off that if it carried on I would have to leave because I couldn’t put up with it, nobody listened.’ (42).
Returning to work following a period of mental health related sickness absence also posed problems. Participants described a variety of negative responses such as pressure to take early retirement; the necessity to appeal against threatened termination; and being moved and downgraded within the organisation (43).
One study found that almost half of people with physical health problems experienced mild to moderate depression but were more worried about telling their employer about their mental health problems:
‘...after the cancer, it wasn’t so bad...but I think I was much more frightened going back after last year’s bout of depression ... maybe my overall boss
wouldn’t be very sympathetic if I took time off.’ (44)
People who return to work after absence with depression do not always receive the levels of support required to ensure a smooth re-entry to employment. Retention is jeopardised by scant regard for relevant policies, poor communication and line managers’ lack of competence in managing return to work (44).
Employees with mental health problems can feel isolated and ostracised by colleagues who do not know how to support them and might be unsure how to react or whether to acknowledge a mental health issue:
‘I came back to work after a bout of depression; people didn’t even ask how I was. No one visited or sent a get well card – things that always happen if people have a physical illness’ (19).
A persistent fallacy, that people with mental health problems are incapable of work, is still widespread and impedes employment opportunities. As a rule, health and social services have not considered employment, and its role in maintaining mental wellbeing, as part of their remit. As a consequence they have often failed to address the employment needs of the people with whom they work, implicitly or explicitly counselling against it (18).