2. ©The Work Foundation Stephen Bevan Director, Centre for Workforce Effectiveness, The Work Foundation Honorary Professor, Lancaster University Mental Health at Work Still the Elephant in the Room?

3. The Work Foundation Established 1918 – acquired by Lancaster Uni in 2010 Programme of applied research & policy influence focused on workforce health & productivity Main Projects: Fit for Work – MSDs & Work (2007): Employment impact of Crohn’s & Colitis (2011) Working with Schizophrenia (2013) Ready to Work – Multiple Sclerosis (2011) Medical Devices & Employment effect (2011) Body & Soul – co-morbidity and employment (2010) Presenteeism & productivity (2011) Health Workforce Wellbeing & Patient Outcomes (2009) Health & Wellbeing of Knowledge Workers (2009) Each involves translating research findings into policy recommendations & guidance for practitioners

4. ©The Work Foundation Well-being at Work: The Problem

5. ©The Work Foundation Mental Health of the UK Workforce Serious mental illness ‘flat’ but devastating Trebling of depression & anxiety since early 1990’s In UK Mental Health accounts for 2% of GDP – at least as important economically as Poverty 16% of adults of working age have a mental illness, of whom up to a half are seriously ill Accounts for over 40% of the flow onto ESA Comorbidity, self-stigma & disclosure issues

6. MSDs in the EU Workforce Major cause of incapacity in the workforce Over 40m EU workers have MSDs MSDs – cause 49% of absence from work MSDs cost €240 bn each year – 2% of GDP Some workplace risks for MSDs growing Pre-existing MSDs & psycho-social factors understated Major & growing impact on productivity, labour market participation & social inclusion as the workforce ages & health spending is scrutinised

7. ©The Work Foundation Poor Workforce Health Reduced productivity More social exclusion & poverty Early labour market withdrawal Increased healthcare costs Reduced tax revenue Increased welfare spending Increased burden on families & carers Ageing Workforce Later Retirement More Chronic Illness

8. LTCs in the UK Working Age Population - 2030 ©The Work Foundation N=21.6mSource: Vaughan-Jones & Barham, 2009 Mental Health 7m MSDs 7m COPD 1.6m Cancer 800k CHD 1m Comorbidity

9. Co-morbidity and Work ©The Work Foundation

10. King’s Fund/CMH/LSE Review By interacting with and exacerbating physical illness, co-morbid mental health problems raise total health care costs by at least 45 per cent for each person with a long-term condition and co-morbid mental health problem Between 12 per cent and 18 per cent of all NHS expenditure on long-term conditions is linked to poor mental health and wellbeing – between £8 billion and £13 billion in England each year ©The Work Foundation

11. Musculoskeletal Disorders (MSDs) ©The Work Foundation 200 conditions affecting bones, joints & connective tissue Affect over 40m workers across the EU (240 bn Euros) Cause 49% of all lost working days About 25% of people with arthritis report a co-morbid mental health condition Co-morbidity can increase psychological barriers to functioning and increase absence from work Around 19% of absentees from work due to chronic pain have depression, whereas only 8% who are not absent are depressed

12. Cardiovascular Disease (CVD) ©The Work Foundation Conditions that impact the heart and blood vessels Includes heart attacks and strokes Major cause of disability and premature death One in five individuals with coronary heart disease reports major depression. Poor mental health is a risk factor for cardiovascular disease Women with coronary heart disease who lack social integration & have depressive symptoms are 4 times more likely to have a cardiac relapse within five years.

13. Chronic obstructive pulmonary disease (COPD) ©The Work Foundation A group of respiratory conditions that includes chronic bronchitis and emphysema Responsible for 9% of certified sickness absence in the UK People with COPD are more likely to have mental health conditions such as depression and anxiety. The combination of COPD and anxiety can impact quality of life and lead to greater disability Anxiety also increases the frequency of hospital admissions for COPD patients.

14. Diabetes ©The Work Foundation The umbrella term for the two types of diabetes: type 1 and type 2 Estimates suggest that diabetes deaths will double between 2005 & 2030 People with diabetes are 50% more likely to suffer from common mental health conditions Individuals may experience psychological distress related to maintaining tight glycemic control. Co-morbidity can result in less adequate glycemic control, more complications, increased service use and lower medication adherence

15. ©The Work Foundation The Role of Good Work

16. ©The Work Foundation A working definition of “Good Work” Employment security Control over the content & pace of work “Task discretion” and interesting/challenging work A proper balance between effort and reward Opportunities for learning & growth Procedural justice High trust relationships (“social capital”); collective and individual voice

17. Is Any Job a ‘Good’ Job? Being out of work is bad for income, self- esteem, dignity, social inclusion, relationships and health Being in even poor quality work which is boring, routine or represents under- employment is widely regarded as a good way for the workless to remain connected to the labour market and to keep the work ‘habit’ BUT… ©The Work Foundation

18. A Message from HILDA Household, Income and Labour Dynamics in Australia (HILDA) Survey Analysis (Butterworth et al, 2011) of seven waves of data from 7,155 respondents of working age (44,019 observations) from a national household panel survey. Longitudinal regression models evaluated the concurrent and prospective association between employment circumstances (unemployment and employment in jobs varying in psychosocial job quality) and mental health, assessed by the MHI-5 Butterworth, P., Leach, L. S., Strazdins, L., Olesen, S. C., Rodgers, B. et al. (2011). The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey. Occupational & Environmental Medicine, first published online on March 14, 2011, doi:10.1136/ oem.2010.059030

19. Psychosocial Job Quality (1) 1. My job is more stressful than I ever imagined 7. My job is complex and difficult 8. My job requires learning new skills 9. I use my skills in current job 10. I have freedom to decide how I do work 11. I have a lot of say about what happens 12. I have freedom to decide when I do work 4. I have a secure future in my job 5. Company I work for will be in business in 5yrs 6. I worry about the future of my job 3. I get paid fairly for the things I do in my job Job demands & complexity Job control Job security Effort- reward fairness Source: Butterworth et al, 2011

20. Psychosocial Job Quality (2) “As hypothesised, we found that those respondents who were unemployed had significantly poorer mental health than those who were employed. However, the mental health of those who were unemployed was comparable or more often superior to those in jobs of the poorest psychosocial quality.” Source: Butterworth et al, 2011

21. ©The Work Foundation Challenges The sustained impact of ‘good work’ & job design on health outcomes will always be better than lettuce! So what 21 st Century interventions will work? How to support personal ‘empowerment’ & healthy lifestyle choices? Work & non-work factors – we need realism about the ‘reach’ & impact of workplace interventions Interaction effects between physical and mental health must inform both interventions and evaluation How can clinicians, organisations & policy-makers embed the principles of ‘Good Work’ into interventions?

22. www.theworkfoundation.com ©The Work Foundation sbevan@theworkfoundation @StephenBevan