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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

Work is a key clinical outcome


A return to work is, for most patients, a positive clinical outcome, and sometimes, an intervention in its own right.


'Employment is Nature's physician, and is essential to human happiness'

Galen of Pergamon, Greek physician, surgeon and philosopher, 172 AD

As the quote from Galen, the Greek physician shows, it has long been recognised that work, be it paid or unpaid, plays a central role in the health and well-being of most people.  We know that work gives us material rewards, but it also gives people a sense of identity and connection with others in our society; it gives us a sense of personal achievement; it is a means of structuring and occupying our time and helps us to develop mental and physical skills.  Work also provides us with the financial and material resources necessary for our daily lives. 

 

Of course work sometimes has negative connotations.  Some workplaces are associated with stress where choice in activity is limited and the work culture is one of bullying and harassment, particularly for people with a mental health condition.  Despite this, research studies have found that unemployed people do not exploit the extra time on their hands to follow leisure and social pursuits.  Instead unemployment is associated with increased apathy, a shrinking social circle and decreased motivation. The consensus is that being out of work causes ill-health and that poor health tends to deteriorate when a person is not working.  This sets up a vicious circle which reduces the chances of a person returning to work. 

 

Work and employment are important for health and well-being

We know that many people with a mental health condition do not participate in key activities of society, they are socially excluded, and that being in work can reduce the likelihood of this.  The right work, with the right support from employers, colleagues, carers and health and care professionals can actually aid recovery for people with mental health problems.  No one is intrinsically unemployable,  studies show that, given the right conditions and support, the vast majority of people who are out of work and use mental health services want to return to or to start work.   However, people with mental health problems do face significant challenges when trying to access employment.  Some of these challenges are shared with other people such as the need to adjust the physical environment, or to mitigate language difficulties or the need for extra support or training.  However, often these obstacles are less tangible owing to some differences between mental health problems and other impairments:

*  They are not immediately obvious and can develop at any time in a person’s life

*  They attract fear and prejudice e.g. myths of incompetence or dangerousness

*  They typically fluctuate and it can be difficult to predict when these fluctuations will occur

*  They affect a person’s ability to negotiate the social, rather than the physical world of work.

Importantly, the right employment actively can improve mental health and protect against relapse

Remember also that many people who are working also experience mental health problems and may have periods of ill-health whilst at work thus contributing to presenteeism and absenteeism.

The comprehensive systematic review of the research evidence carried out by Waddell and Burton, 2006, concluded that in general:

*  Work is beneficial to health and well-being

*  Lack of work is detrimental to health and well-being leading to higher consultation rates with GPs than in the general population, increased prevalence of depression and anxiety and higher suicide rates.

*   For people without work, re-employment leads to improvement in health and well-being, whereas continued unemployment leads to deterioration

*   For people who are sick or disabled, placement in work improves health and psychosocial status

*   The health status of people of all ages who move off welfare benefits improves

*   These benefits apply equally to people who have mental health problems including those with severe mental health problems. 

There is no evidence that work is harmful to the mental health of people with severe mental illness.

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Work and employment are important for health and well-being

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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