2 Apr, 2015

Air disaster by German suicide-pilot elevates importance of treating mental ill-health in workplace

Imtiaz Muqbil

The Germanwings air-disaster triggered by an alleged suicide-pilot came just weeks after the Paris-based Organisation of Economic Cooperation and Development (OECD) released a report highlighting the impact of mental ill-health on communities, companies and countries. Whereas the report’s primary focus was on economic impact and productivity, the human-life cost of the aviation disaster has elevated the importance of the report to a significantly higher level.

Entitled “Mental Health and Work – Fit Mind, Fit Job”, the report is based on the definition of mental ill-health within the mild-to-moderate spectrum, where most disorders are mood or anxiety-related. It says, “Mental ill-health exacts a high price – on individuals, employers, and the economy. Apart from the distress they suffer individually, people with mental health problems also suffer economically through lower employment, higher unemployment and a high risk of poverty. Employers struggle with significant losses in productivity at work and high rates of sickness absence. And the economy at large bears the costs in the form of elevated social and health care expenditures.”

It notes that in OECD countries, mental ill-health is responsible for between one-third and one-half of all long-term sickness and disability among the working-age population. “It causes and exacerbates chronic physical illness, pushing up health care costs. And it lowers education outcomes – partly because those who are ill leave school early – so shutting off employment opportunities. Relatively to the mentally healthy, the employment rate of people who suffer from poor mental health is 15-30 percentage points lower and their unemployment rate is twice as high. They are also twice as likely to live in poor households.”

It adds, “At any given moment, some 20% of the working-age population suffers from a mental illness, and one person in two will suffer a period of poor mental health during their lifetime. Most people with mental ill-health are affected by mild-to-moderate illness – predominantly mood and anxiety disorders, commonly referred to as ‘common mental illness’.”

This is the second OECD report of its kind. An earlier report, “Sick on the Job? Myths and Realities about Mental Health and Work,” was published in early 2012. That was followed by nine country reviews (Australia, Austria, Belgium, Denmark, the Netherlands, Norway, Sweden, Switzerland and the United Kingdom)published between early 2013 and mid-2015. They looked in depth into how selected OECD countries were tackling those policy challenges and drew detailed country-specific policy conclusions.

This new OECD report provides a synthesis of the findings of the OECD’s four-year review. It concludes that a transformation is required in policy thinking about mental health and work and sets out the key elements for an integrated policy approach to promoting better mental health and employment outcomes. Launched and discussed at the High-Level Policy Forum hosted by the Dutch Government in March 2015, the report provides useful insights for interventions across the policy areas of education, employment, health and welfare. The report says all these sectors “need to work towards the same goal in a co-ordinated and integrated approach to generate the desired impact: better labour market inclusion of people with mental illness. Governments can also use the framework as a yardstick when evaluating the performance of the measures and policies they have taken.”

To address the high costs of mental ill-health it needs to become a priority for stakeholders in the workplace, in the health system, and in every branch of social policy, including unemployment and disability. The report says that the big issues are clear:

• The early onset of mental ill-health that affects negatively education outcomes and the transition into employment;
• High levels of under-treatment and unmet health care needs;
• Significant stigma associated with mental ill-health which harms employment prospects of people affected;
• The high prevalence of mental ill-health among all working-age benefit claimants, including recipients of unemployment benefit.

Says the report, “It is important that policy makers address the interplay between mental health and work. They are slowly coming to recognise that they have long neglected an issue that is critical to people’s well-being and for contributing to sustainable economic growth. The report concludes that a policy transformation is needed in regard to when and what type of intervention is needed and who should carry it out, as follows:

• When to intervene. Mental ill-health is often identified too late. Support and intervention at a time when people have been out of work for several years is often ineffective. Policy should focus on prevention, early identification, and early action.
• How to intervene or what to do. Different institutions, especially in the health and employment areas, often operate in isolation in pursuit of their own objectives.
• Who needs to intervene. The role of mainstream actors such as teachers, managers, general practitioners and employment counsellors is often poorly harnessed. They are best placed to help people early.

Some important quotes from the report:

(+) In “Mental Health: The New Frontier for Labour Economics”, Richard Layard wrote that improving mental health is vital to both economic growth and happiness and “could be the most important single step forwards [economically and socially] in the 21st century” (Layard, 2013). Making Mental Health Count (OECD, 2014d) stressed the vast economic and social costs of mental ill-health and high unmet need for appropriate care. Sick on the Job? (OECD, 2012) – identified the main challenges posed by the interplay between mental health and work and argued the case for a structural shift in policy.

(+) In the European Union, a large-scale project run on a country-by-country and disease-by-disease basis estimated the total costs of mental illness at around 3.5% of GDP in 2010, (Figure 1.1, Panel A). Estimates for non-European countries such as Australia and the United States yield similar results. The European study found that indirect and intangible costs – higher benefit expenditure and falls in productivity – accounted for more than 50% of the estimated total (Gustavsson et al., 2011).

(+)Data show that many people with common mental illness struggle at work. For example, 69% of the people with moderate mental health complaints report having problems in job performance compared to 26% of the people without mental health complaints. There is a strong business case for addressing the issue, yet employers hold on to poor workplace practices.

(+) That most people with mental ill-health are cared for only by their GPs is a cause for concern, as many GPs have neither the time nor the training to treat mental health problems – a fact reflected, for example, in the clear preference of GPs in Australia (and other countries) for medication rather than psychological counseling.

(+) Denmark provides on-line courses on stress, anxiety and depression, while Austria and Australia offer more extensive extra-curricular training on mental health treatment. Governments have increased funding for psychological therapy consultations as an incentive for GPs to take up training and deliver mental health treatment. Australia pays GPs higher rates for consultations when they have completed their mental health training (Factsheet 3.4). In both Australia and Denmark, most of the GPs have taken up such training.

(+) Mental health problems are related to performance deficits and interpersonal problems in the workplace. Not all mental ill-health can be prevented and employers must manage sickness absences, return-to-work, and workplace conflicts. Small and medium-sized enterprises (SMEs) in particular have little scope to adjust and are often left to their own devices.

For public and private sector institutions seeking to better assess the impact of mental ill-health, this FREE report offers a wealth of data and policy advice. An overview is available FREE at http://www.oecd.org/employment/fit-mind-fit-job-9789264228283-en.htm. An embeddable version is also available, together with information about downloadable and print versions.

If even one life can be saved, this dispatch will have been worth the effort. Travel journalism that other publications can only talk about.