Mental ill health and fitness for work

Mental ill health at work seems to be rising inexorably both in terms of self report (as shown by comparing surveys of work related illnesses throughout the 1990s), and as a cause of absenteeism, long term sickness, and early retirement.

Abstract

ental ill health at work seems to be rising inexorably both in terms of self report (as shown by comparing surveys of work related illnesses throughout the 1990s), and as a cause of absenteeism, long term sickness, and early retirement.It is a burgeoning field for many professionals; human resource, medical, psychology, and, with the advent of anti-disability discrimination legislation, lawyers."Fitness for work" is considered in two main areas: recruitment of new staff, and return to work of those who have been off sick.In many cases the issues are the same for employers, human resource, and occupational health staff: Is the person able to perform the job adequately?Do they pose health and safety risks?How likely are they to require future sick leave?The introduction of anti-discrimination legislation in several countries has also introduced the requirement to consider workplace adjustments that "enable" the disabled.Mental ill health poses particular problems when addressing these issues, as the impairments associated with such illness are difficult to distinguish from the cognitive and behavioural performance intrinsic to many jobs.Summarising the effects of mental ill health on work (and vice versa) is complicated by the wide spectrum of "mental ill health" which tends to be covered by three different streams of research.Firstly, there is a literature, drawing predominantly from the fields of occupational psychology and health, examining the differing and interacting effects of workplace stressors and "stress" (or what will be termed here "common mental disorder"), performance, health, and absenteeism.Secondly, there are epidemiological studies demonstrating associations between functioning, often as "disability", and psychiatric disorders.Finally, stemming from psychiatric and rehabilitation research is a body of work investigating the area of supported employment, training, and education for those people with serious mental illnesses, generally psychoses.There are enormous differences in the prevalence in the working age population of these different levels of "mental ill health" as shown in fig 1 .Overall, mental ill health is the second largest cause of work related problems after musculoskeletal disorders.In the UK it accounts for one third of all work related illness, 1 is the second major cause of long term absences in the Whitehall studies, 2 and is responsible for 20% of all early retirements from the National Health Service. 3 Given the stigma attached to mental ill health this is probably under reported.Despite this, there seems a lack of ideas over what to do to ameliorate these problems. c TYPES OF MENTAL ILL HEALTHCommon mental disorder This encompasses those who are considered as cases by such measures as the General Health Questionnaire, 4 the most commonly used measure of "stress" or "mental ill health" in occupational studies, and those with the minor, and usually mixed, anxiety and depression often seen in primary care.At any one time some 20-35% of the working population fall into the former category 5 and approximately 10% the latter.Even this level of mental ill health has adverse effects upon externally rated work performance, 6 disability days, 7 and absenteeism. 2Sickness absence has a multifactorial nature.Within the workplace those with common mental disorders are approximately 1.5 times more likely to later suffer from musculoskeletal problems, such as low back pain, 8 radiating neck pain (with dose response at increasing levels of stress), 9 and work related upper limb disorders, 10 and associated absences. Depression and anxiety disordersThese are the common, but more discrete, conditions that are associated with more obvious individual impairment and symptoms.The UK survey of psychiatric morbidity estimated that at any one time some 5% of the population would have an anxiety disorder, and 2% be suffering a depressive episode. 11Lifetime prevalence is far higher, with US estimates of 17% for a major depressive episode and around 20% for an anxiety disorder not including phobias. 12These people are far less likely to be employed than the general population, and even those that are report twice the amount