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5 Mar, 2015

OECD report cites “worrying” toll exacted by mental ill-health at workplace

Paris, (OECD media release) 04/03/2015 – Health and employment services should intervene earlier, involve key stakeholders and ensure they work together in order to help people with mental-health issues find work and stay in a job, according to a new OECD report.

Entitled “Fit Mind, Fit Job: From Evidence to Practice in Mental Health and Work,” the report says that around 30% to 40% of all sickness and disability caseloads in OECD countries are related to mental-health problems. The total cost of mental illness is estimated at around 3.5% of GDP in Europe.

The personal costs of mental ill-health are high. People with mild to moderate disorders, such as anxiety or depression, are twice as likely to become unemployed. They also run a much higher risk of living in poverty and social marginalisation.

“Mental health issues exact a high price on individuals, their families, employers and the economy,” said OECD Secretary-General Angel Gurría during a launch event in The Hague. “Policymakers have been too slow to act. Strong political leadership is needed to drive reform and tackle this issue.” (Read the full speech below).

Despite growing recognition of the issue in society, considerable social stigma around mental ill health remains. Intervening early is critical, yet in practice it can often take more than ten years between the onset of illness and the first treatment in most countries.

This is worrying, says the OECD, as under‑treatment rates are highest among young people and waiting times for counselling are longest. Any action taken in school or the workplace will have a better, more lasting impact than waiting until people have dropped out of education or the labour market. While a heavy workload and work related stress may add to mental health problems, the evidence shows that staying in school or at work is also part of the solution if appropriate support is provided.

At school, investing in mental health programmes and having professionals with psychological training is found to be effective. Waiting times in the health service for children and adolescents should be as short as possible.

The mismatch between the needs of people suffering from mental ill-health and the services provided to them is one of the biggest problems, according to the report. Current policies are often delivered in silos by health, employment and education services. Creating an integrated system would deliver much better, faster outcomes.

Countries have taken small steps towards an integrated delivery of health and employment services, but they have lacked direction. Better measurement and monitoring of policies and outcomes would enable policy makers to assess their impact more effectively.

Teachers, employers, general practitioners, social workers and employment service caseworkers are often best placed to identify people with mental health issues at an early stage. They need training and a clear pathway to access support from mental health professionals.

Stronger leadership at political and managerial level is needed: in most countries, guidelines and regulations exist but have little impact. Their use should be systematically monitored and non-compliance sanctioned.

Remarks by Angel Gurría, Secretary-General, OECD (as prepared for delivery)

The Hague, The Netherlands, 4 March 2015

Ministers, State Secretaries, Ladies and Gentlemen,

It is a great pleasure to welcome you all to the OECD Policy Forum on Mental Health and Work: Bridging Employment and Health Policies.

I am delighted to see so many policy makers and key stakeholders from such a wide variety of countries. In particular it is good news that we have an equal balance between senior officials representing the health side and the employment sides of government. This is a great start in breaking those ‘silos’ between institutions that stand in the way of delivering better policies and services for vulnerable people with mental ill-health.

Before I present you some of the striking facts from our study, let me first thank the Dutch Government for hosting this Forum, especially the Deputy Prime Minister and Minister of Social Affairs and Employment Mr Lodewijk Asscher as well as the Minister of Health Welfare and Sport Mrs Edith Schippers, and, of course, the Minister of Foreign Affairs Mr Bert Koenders for providing this wonderful venue. For the past 15 years, the Netherlands has been a great supporter of OECD’s studies on how poor health affects work, and what we should be doing about it. We sincerely thank you.

Considerable stigma prevails

Mental ill-health of the working-age population is a key issue for our economies and societies. Mental illness – whether mild, moderate, or severe – is widespread, with one in five of the population being affected at any one moment. Essentially, it could affect anyone of us. But considerable stigma prevails.

For far too long, our attitude towards people with poor mental health has been at best, to ignore their problems. At worst, we stigmatize their suffering. Poor mental health is not a sign of weakness. Clinical depression and anxiety are diseases. What is more, they are diseases that we can, in most cases, treat successfully. And with the right action taken by policy makers, employers, employment services, health systems, or work colleagues, we can minimise the economic losses coming with mental illness.

Most of mental health illness is mild-to-moderate and has received little attention in both health and employment policies. Health policy is mainly focused on severe mental illness only, while employment policy generally overlooks the implications of such frequent illnesses for the labour market.

The new OECD report which we are launching today “Fit Mind, Fit Job: From Evidence to Practice in Mental Health and Work” provides a policy framework to help us better deal with mental health and work.

Let me share with you some of the concrete findings of this report, whose conclusions derive from the in-depth analysis of nine country case studies.

The economic burden of mental ill-health

Mental health is costly for individuals concerned, for employers, and for the economy and society as a whole. People with poor mental health are much less likely to be in work: depending on the severity of the mental illness – the employment gap is 15 to 30 percentage points lower than for the rest of the population in the nine countries studied. People with mild to moderate mental illness are twice as likely to be unemployed. Jobless rates among people with severe disorders are, in many countries, four or five times higher than those with no mental health issues. Not surprisingly, and depending on the severity of the illness, people suffering from mental ill-heath are 30% to 100% more likely to be poor than the total population.

Societies invest a lot of resources to help all people on benefits look for work and upgrade their skills. But part of this effort is wasted if we do not recognise that many have mental health problems that are their main hindrance to employment and that need to be addressed.

That said, most people with mental health problems are in work but they struggle: 7 in 10 of them in 21 countries of the European Union report that they are underperforming at work. While a heavy workload and stress may add to mental health problems, the evidence shows that staying at work is also part of the solution if appropriate support is provided.

If we add up the costs of lost output and wages, together with the cost of benefit payments, then we find that the total cost of mental ill-health could be over 3.5% of GDP. This adds to the considerable human suffering of mental ill-health among those affected and their families, and the consequences on the social fabric.

We can do better

Our new report launched today, Fit Mind, Fit Job shows policy options to address these issues. We need to change the way we act when considering mental ill-health and the labour market: we need to do better to allow those affected by mental ill-health to find jobs, to be fully productive at work, to prevent them from going on sick leave when they would do better on the job, and in general terms, to avoid them being disconnected from the labour market. For all that, we need to change what we do and who does it.

First, when is the right time to intervene?

Intervening only when a person has been out of work for several months, or even years, as is often the case, is ineffective and almost always more costly than acting quickly. Employment and health services need to act fast when mental health problems are spotted or diagnosed.

Many OECD countries have made good progress in this direction. For example, sickness schemes in the Nordic countries have a strong focus on return to work. They support claimants as early as four weeks into their sickness spells and promote early contacts between employers, general practitioners and employees on sick leave. Some systems, like that in the Netherlands, where employers have to pay the costs of up to 2 years of sickness benefits, make employers more diligent to take care of employees’ mental health, through, for example, workplace and workflow adjustments. These policies have lowered absence rates and inflows into disability.

But there are some weak spots, too. Unemployment benefit offices and public employment services often lack the means and tools to identify and address jobseekers’ mental health problems. Belgium is an exception in its efforts to tackle the mental ill-health of jobseekers.

To intervene early also means helping vulnerable youth such as early school leavers and the “NEET” group achieve the best possible education outcomes and a successful transition into the labour market. This is critical because many mental illnesses, such clinical anxiety, have an onset very early in life. Catching this group and providing them with support is difficult. But failure to do so can push them out of society.

Second, what is the right way to intervene?

Mental health care and employment services continue to work in silos. Societies are in desperate need for some services, such as helping employers cope with employees with poor mental health. It is often not clear who has the mandate to develop such services. Worst of all is when the lack of strategic direction means that policies work against each other – for example, when sick notes are issued for people that might well be better off at work.

Countries can integrate services better. Examples range from better information sharing, to better co-ordination and even full integration of services like in the United Kingdom where employment advisors work together with health professionals to reduce the incidence of health-related job loss and facilitate early return to work.

There is no quick fix to getting services on the ground to work better. It will be a long, hard slog, which will require commitment and perseverance from all concerned, constant evaluation of practices and incentives for different stakeholders to work together. But it will be worth it.

Third, who is best placed to intervene?

Those who deal with students, workers, jobseekers, and patients with mental illness on a daily basis are best placed to spot problems early. We need teachers, line managers, employment counsellors and general practitioners to take appropriate actions where they can and to get people to mental health professionals where necessary.

Raising the awareness of mental health problems among such groups and developing their competence in dealing with mental health issues will be necessary.

Ladies and Gentlemen, let me conclude by emphasising the business case for policy change regarding employment and mental ill-health. Investments by employers and governments in mental health and work policies has a large pay-off, through higher employment, higher productivity, reduced benefit dependency, improved social cohesion and more inclusive growth. The stakes are high, but changes remain stubbornly slow.

Five hundred years ago, Nicolo Macchiavelli complained about how difficult it is to initiate a new order of things due to, he says, “the incredulity of mankind, who does not truly believe in anything new until they have had experience of it.”

We need to initiate a ‘new order of things’ to support employers in keeping people with mental health problems in work. We need teachers, labour unions, medics and above all, people with mental health problems themselves to batter on the doors of those who would rather stay comfortable in ignoring the problem. We have failed people with poor mental health for too long. They deserve better, and we cannot afford the old status quo.

This Policy Forum will allow us to share mutual experiences, to exchange ideas, and to learn from each other. I very much look forward to today’s discussions.

The OECD High-Level Policy Forum on Mental Health and Work will take place on Wednesday 4 March 2015 at the Ministry of Foreign Affairs, Bezuidenhoutseweg 67, The Hague, Netherlands. The forum will provide a unique opportunity for Ministers of Health and Employment and the key stakeholders to discuss how to design and implement coordinated health and employment policies to support workers with mental ill-health keep and find new quality jobs.

Time to act on mental health

The costs of poor mental health are high: the total cost of mental illness is estimated at around 3.5% of GDP. People with mild to moderate disorders, such as anxiety or depression, are twice as likely to be unemployed. They also run a much higher risk of living in poverty and social marginalisation. The facts are clear: it’s time to act.

Mental ill-health creates significant costs for people, employers and the economy at large by harming well-being, lowering employment, raising benefit dependency and generating substantial productivity losses.

Notwithstanding these substantial costs, policy action is lagging behind due to widespread stigma and preconceptions. Today both employment and health systems operate in isolation, even though there is a strong business case for better integrated policies and service delivery, with health being a key labour market barrier and work being a key factor in good and faster recovery from mental ill-health.