Mental health and work
In comparison to the general UK population where the employment rate was around 74%, for those affected by a mental health condition this rate is substantially lower at around 21%.
Even when compared to the employment rate of 47% for all people declaring a disability, the rate for those with a mental health condition is low. There are many reasons for this including the fluctuating nature of mental health conditions, prejudice and discrimination, low expectations by health professionals and society4 and the side effects of medication5. Despite these figures, the evidence shows that those with a mental health condition "have the highest 'want to work' rate of all disabled groups"6.
Impact of Work on Mental Health
The role of work in promotion of mental health and well-being is important, as it is a key determinant of self-esteem, identity, sense of fulfilment and opportunities for social interaction7. The evidence shows that those in work experience better mental health8. However, again there is a major proviso in that poor working conditions can cause mental illness.
It is difficult to categorise the types of employment which commonly cause mental illness. This is because according to NICE, 'employees in public administration, defence, education and health and social work had some of the highest rates of self-reported stress, anxiety and depression', whilst 'people in low paid jobs are more likely to experience poor working conditions, such as a lack of control over their workload, lack of job security, limited support and exposure to physical hazards'9 which one could argue is likely to be a precipitator for mental illness. In addition, the individual's personal circumstances may contribute to the stress experienced at work. It is therefore imperative that the nature of the individual's job and personal circumstances are analysed holistically in order to fully understand the impact of their employment on mental health.
Impact of Worklessness on Mental Health
Perkins et al10 noted that 'worklessness robs people of their identity, status, social network and a sense of purpose'; and that those already experiencing exclusion because of their mental health condition, are even further marginalised when denied the opportunity to achieve their potential and contribute to society. The evidence also shows that the unemployed have higher rates of anxiety, depression and suicide, and that this is exacerbated if it continues into the longer term1.
The Recovery Model Consultation
The Recovery Model looks beyond the limitations imposed on those with mental health conditions in order to help them have full control of their lives despite the symptoms experienced. In applying this model, the clinician can empower the patient to achieve their goals and aspirations. For most people, the GP is usually their 'first port of call when they fall ill and need advice about fitness for work' and has a huge impact on whether a person is absent from work and for the length of such an absence2. GPs therefore have a key role in raising the expectations of employment for mental health patients and 'good clinical practice should include employment as an outcome'.