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


Taking Work and Employment seriously


Clinicians can help or hinder the process of getting people with mental health problems into work, or keeping them there.  Clinicians are often a barrier for people with mental health problems getting into work.  Unfortunately, by omission or commission, physicians and other health or social care workers have contributed to the belief that employment is not a realistic possibility for many people with mental health conditions.

People with mental health problems often speak about the negative attitudes of people they encounter in health and social services. Realising Ambitions, the Perkins review of employment support, highlights the experience of some users of mental health services when faced with the attitude of health and social care professionals to the issue of employment for people with mental ill-health.  It concludes that many health and social care workers have not seen employment as part of their remit and do not ask patients about their work or employment status. 

The Centre for Mental Health briefing ‘Removing barriers: the facts about mental health and employment’, draws on a variety of research studies and surveys of users of mental health services.  It shows that the low expectations and lack of knowledge of healthcare professionals constitutes a major barrier to the employment of people with mental ill-health.

You should consider an occupational history as part of your comprehensive assessment.  There is now compelling evidence that appropriate work is good for patients; it helps their recovery and protects against relapse.  In addition, there is an increasing body of evidence that shows certain approaches can help people with mental health problems to remain in or gain open employment.  This means that health and social care workers need to play a key role in facilitating employment, or employment related activity such as training or education.  Your  occupational history should include information about the patient’s employment status, the type of work environment and support mechanisms that are in place. 

Remember, that for those in work, the stressors that may cause problems at work may often not be related directly to the workplace, such as marital or family problems.  However for others the stressors may be part of their working environment and may cause or exacerbate their condition.  Steps can be taken in the workplace to mitigate these factors.  If the issues in the workplace are not resolved then it is unlikely that a period of sickness absence on the part of your patient will make any positive difference to his/her long-term health and well-being.

  • What might these work related stressors be? 
  • What are the possible sources of work related stress?

An occupational history may also help you to identify the factors in the workplace which may cause or exacerbate neuropsychiatric symptoms.  Some of these factors may include exposure to substances such as lead and manganese which are known to cause both temporary and long-term psychiatric symptoms and illnesses.

An incomplete occupational history may lead to a missed occupational diagnosis and inappropriate management.  If the link between work and health is not recognised and the causal factors are not managed effectively, including ongoing review, then the patient’s condition is unlikely to improve. 

 

Links to resources:


Creating a healthy work environment

Employer module

Removing the barriers: The facts about mental health and employment

Briefing 40, Centre for Mental Health, August 2009

This briefing looks at the barriers to employment for people with both common and severe mental health problems and at the initiatives that are being undertaken by the public, voluntary and commercial sectors to support their efforts to find and sustain work.

 

Realising ambitions: Better employment support for people with a mental health condition

Rachel Perkins, Paul Farmer and Paul Litchfield

Department for Work and Pensions, December 2009

This review was commissioned by the Secretary of State for Work and Pensions to look at mental health and employment and to identify how Government could help people with mental health conditions fulfil their employment ambitions.  Chapter 4 includes a summary of the 4Rs (raise, respond, recommend, refer) for primary care and mental health professionals when addressing the employment needs of people with a mental health condition. 

 

ACAS (Advisory, Conciliation and Arbitration Service)

Health, work and wellbeing, 2010

This booklet includes checklists to help you to evaluate how healthy the workplace is and to identify situations where action is needed.

 

Health and Safety Executive (HSE)

The mission of the HSE is to prevent death, injury and ill health in Great Britain’s workplaces.  HSE resources on mental health conditions are focussed on work related ‘stress’. 

This is the link to a step by step approach to implementing the HSE management standards which represent a set of conditions that, if present, reflect a high level of health well-being and organisational performance.  This approach is supported with specific guidance and tools to see whether the organisation is ready to change and how to secure the commitment across the organisation needed to effect change.  This may help in any discussion or evaluation of the conditions in your patient’s workplace.


The HSE has produced a simple questionnaire which links questions about the nature of a person’s work and workplace environment to the six categories or causes of stress. 

 

MIND

Is a mental health charity in England and Wales.  It has resources for employers accessed via the website link to Employers take care of your business

The ‘Taking Care of Business’ booklet includes practical tips on how to assess mental wellbeing in the workplace, how to plan improvements, how to tackle the causes of mental ill-health and support staff.  These may be useful in discussing the culture and support available in your patient’s workplace.  

 

SHiFT

SHiFT is a Department of Health-funded initiative to tackle stigma and discrimination surrounding mental health issues in England.  This checklist is designed for managers to help them to assess the capability of the organisation with respect to managing mental health issues in the workplace.  The checklists may be helpful in discussing the support available in your patient’s workplace.

Body and Soul: Exploring the connection between physical and mental health conditions
Katherine Ashby and Robin McGee, September 2010
The Work Foundation
This report includes a section on interventions in the workplace to improve work outcomes.

Promoting mental wellbeing through productive and healthy working conditions: guidance for employers, November 2009
National Institute for Health and Clinical Excellence (NICE)
This public health guidance was developed by NICE using rigorous methodology including reviewing the available academic evidence, economic analysis and engagement with various stakeholders.  The guidance includes recommendations for action in the form of ‘who should take action’ and ‘what should they do’.

 

Mental health and environmental exposures

Institute for Children’s Environmental Health, Learning and Developmental Disabilities Initiative, November 2008

This fact sheet discusses the connections between environmental exposures to physical and chemical agents with mental health symptoms and conditions.  While it is recognised that environmental exposures to toxic substances can lead to disease, disability and other medical conditions, the connections to psychiatric conditions are not as well known.  However, there is a substantial amount of scientific evidence that certain exposures can lead to both temporary and long-term psychiatric symptoms and illness.

 

eLearning for health

This is an eLearning resource for primary care professionals. It aims to improve their knowledge, skills and confidence when dealing with issues relating to work and health. 

Health e-Working offers six interactive sessions of e-learning with practical examples and guidance on how to improve patient care. One of the six sessions is called “Making the occupational link”.  This resource has been developed by a steering group led the Faculty of Occupational Medicine in partnership with the Royal College of General Practitioners, the Society of Occupational Medicine and e-Learning for Healthcare.

 

Healthy working UK

This website has been developed in collaboration with the Royal College of General Practitioners, the Faculty of Occupational Medicine and Society of Occupational Medicine and is based on the Healthy Working Wales pilot developed by Cardiff University and the Welsh Assembly Government. It provides GPs and other primary healthcare professionals with timely access to information, training and decision aids to support the management of health and work. 

 

Practical tips for a busy GP

Royal College of General Practitioners, A healthier tomorrow

This links to the health tomorrow- practical tips part of the website.  It includes simple questions that GPs can ask patients about their work and any potential issues linking health issues to the workplace.   Please note that these pages are only accessible to members of the RCGP and subscribers to the college. 

 

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Regaining occupational function: a vital measure of clinical success

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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