Report 48: Mental health, employment and the social care workforce
Law, policy and guidance
Mental health problems are now the most common reason for long-term sickness absence... As a result work and psychiatric disorders is a high priority for policymakers (45).
A series of government reforms since the mid 1990s have aimed to reduce the numbers of people on incapacity-related benefits. Programmes including the ONE Advisory Service, New Deal for Disabled People, and Pathways to Work have focused on encouraging people to seek work by providing incentives to work and disincentives to remain on benefits. However, these reforms have been shown to have limited success in increasing the employment of people with long term and complex problems, especially those with mental health problems. Alongside these measures is a need to address the barriers to employment of people with mental health issues (41).
Since the turn of the century governments have aimed to reduce health inequalities and social exclusion by demonstrating the contribution of employment to personal health and wellbeing. This has been reinforced by legislation which outlaws employment discrimination (28, 46). A major report by Dame Carol Black provided an evidence base for this (47). Action to improve health and work and reduce sickness absence and avoidable job loss is being taken forward by the Health, Work and Wellbeing initiative (HWWB), run by a cross departmental group (Department for Work and Pensions, the Department of Health, the Health and Safety Executive, the Scottish Executive and the Welsh Assembly Government).
HWWB has established a national agenda to improve awareness of health and wellbeing at work, and developed evidence-based methods to enable people to remain in work or get back to work more quickly after a health problem (48), (47), (1), (49), (21). Since mental health problems, such as anxiety or depression are one of the leading health problems among people of working age (45), strategies for enabling people with mental health problems to retain or regain work are an essential part of this plan (49), (50).
Current Government mental health policy (51) highlights the importance of improved employment rates for people with mental health problems as one of their key objectives in promoting mental health and wellbeing.
The Public Sector Duty (52), makes it illegal for employers to require candidates to disclose a disability at the recruitment stage of securing work. However once a job offer has been made, employers can lawfully make such a request. The legislation emphasises that employers must be able to demonstrate, having asked for this information, that they have made every attempt to put reasonable adjustments in place that will allow the candidate to take up the job and perform to the best of their ability.
People with mental health problems are covered under the Act’s ‘protected characteristic’ of disability, which is defined as:
“... a disability if s/he has a physical or mental impairment which has a substantial and long-term adverse effect on that person's ability to carry out normal day-to-day activities.”
The Equality Act 2010 sets out nine protected characteristics that employers need to take into account. Disability is one of these and incorporates mental health problems. Some people may experience mental issues and one of the other protected characteristics. This may impact on their mental health and/or be another source of discrimination within employment. (See example below)
The interface between mental health problems and some of the other protected characteristics under equalities law
By 2020, one in five people in the UK will be aged 65 and over and nearly two in five will be aged 50 and over (53) At the same time, the numbers of young people in the population are decreasing. As a result there will be pressure to retain older people in the workforce. Mental health problems linked more commonly to later life include depression, associated with chronic physical ill health or social isolation. About 20 per cent of older people have reported being depressed (54).
There are particular hazards for the mental health of employees from ethnic minority groups, especially among individuals reporting unfair treatment at work (37). The daily discrimination experiences of people from these communities have been seen as the source of ill health (55). For example, the insults and accompanying humiliation to which these groups are exposed are known to be risk factors for depression (56).
A recent review of the mental health of girls and women in England and Wales has concluded that almost two-thirds have been affected by mental health problems triggered by bullying, physical or emotional abuse, bereavement or unemployment (57). The review described how more than one in ten women experiencing mental health problems had quit a job; more than two in five had taken related time off work; and more than a quarter had been off work for at least a week.
The mental health of lesbian/gay/bisexual and transgender people (LGBT) is affected by the stressors associated with their sexuality, discrimination, negative messages about identity and difficult familial interactions (58). A qualitative study of LGB experiences in the workplace suggested issues similar to those for mental health, on stigma, risk and disclosure (59).