Can mental health be an asset in Europe’s drive for productivity growth
It has long been acknowledged that mental illness can have a devastating effect on individuals, families and communities across Europe. In recent years its impact on wider society, on productivity and economic growth have also been more widely recognised. Indeed, the challenges of deteriorating mental health in European countries where the financial crisis and high unemployment have hit hardest are still presenting challenges to policy-makers and healthcare professionals.
Yet talk of the ‘burden’ of mental illness – while correct in clinical terms – risks underplaying the asset which strong mental health and resilience may yet play in the push for inclusive economic growth across the European Union. Back in 2005 European Commission Green Paper Improving the Mental Health of the Population argued that:
‘The mental health of the European population is a resource … to put Europe back on the path to long-term prosperity’.
Of course Europe’s economic fortunes were somewhat more positive back in 2005. Today, 38 per cent of EU citizens are affected by mental illness and, despite the fact that only 25 per cent of them receive any treatment, the direct and indirect costs of mental illness across Europe is over €460bn – or 3.4 per cent of GDP. In some parts of Europe the quickest way to get acute medical care for a severe mental illness is to get arrested.
In the working age population mental illness is a major cause of sickness absence and lost productivity. The risk of developing a mental illness is elevated among the unemployed and among those in so-called ‘precarious’ work. Indeed, the notion of ‘more and better jobs’ being promoted by the European Commission has special resonance in the case of mental illness with jobs of poor psychosocial quality, in some cases, being worse for mental health than unemployment. Another challenge is that – across Europe and in other developed economies – there is considerable variability in the way healthcare, social welfare and employment regimes collaborate to improve both job retention and return to work for people living with a mental illness. The excellent ‘Mental Health & Work’ project currently being concluded by the OECD has shone a light on the strengths and weaknesses of nine countries’ approaches – with the UK doing relatively well on innovation if not always on implementation.
So, what more should European countries be doing to make further progress. This was the question I addressed in Brussels last week when I was very proud to accept the annual GAMIAN-Europe Personality Award for 2014. In acknowledging the undoubted progress that has been made across Europe in raising awareness of mental illness in the workforce and reducing stigma, I identified six challenges we must prioritise in the next decade.
Making the economic and social case for change. To grow and to thrive, economies across Europe will require workforces which are skilled, engaged and healthy – especially as they age and have to retire later. With healthcare spending under greater scrutiny, investments in early interventions which help working age EU citizens with poor physical or psychological wellbeing to remain active in the labour market are going to be essential if we are to raise labour productivity and avoid social exclusion.
Parity of Esteem. Mental illness is rarely given the priority that physical ill-health receives. In some member states somebody with a cancer diagnosis is rightly guaranteed to see a specialist within two weeks of diagnosis. For somebody with, for example, schizophrenia no such guarantees exist even though the evidence of the effectiveness of early intervention is just as solid as it is for cancer. Mental illness needs to achieve parity of esteem with physical illness – with parity of funding to match.
Quality of Work. During the financial crisis, with unemployment rising, a big challenge was to find a job for everyone who wanted one. Now, as more jobs begin to be created we also need to think about the quality of these jobs. We know that jobs with low control and discretion can be bad for psychosocial health and health inequalities. Professor Sir Michael Marmot and his colleagues at the Institute of Health Equity have prioritised ‘good work for all’ in their top six policy areas central to reducing health inequality. We need to make sure that as many of the new jobs we create as possible are of good quality, rather than precarious and insecure.
Comorbidity. Very often physical and mental illnesses go hand-in-hand. Among people with chronic musculoskeletal disorders (MSDs), for example, up to 30 per cent also have comorbid depression or anxiety. We know that comorbidity can increase healthcare costs by up to 45 per cent and that living with both a mental and physical illness can make staying in – or returning to – work, much more difficult to manage. As the workforce ages, healthcare systems, active labour market policy and employment practice will need to adapt to improve the management of employees with multiple health conditions including mental illness.
Models of Employment Support. The Work Foundation’s own research on the employment support needs of people in the UK and Germany living and working with Schizophrenia shows that there are a number of models in use across Europe. The evidence suggests that open, competitive employment (using models such as Individual Placement & Support – IPS) produces better, more sustained and cost-effective results than sheltered workshops or voluntary work. Yet we are far from achieving a consensus in Europe about which model we should adopt and, even if we can, how we manage the very difficult transition from one model to another.
Placing Service-Users at the Centre. We have seen some good progress towards genuine service-user involvement in the planning and delivery of healthcare in mental health. However, innovation in this area varies enormously across the EU and several countries still have challenges to overcome in addressing stigma. Even in the UK 30 per cent of employees say they would never work with someone who has a mental illness. The more we can make sure that those living with a mental illness are given the opportunity to have a strong voice in the way their working lives are managed, the less likely we are to see mental illness causing premature job loss or total withdrawal from the labour market. Much more progress – in attitudes and action – is needed here.
Over the next decade the challenges posed across the whole of Europe by declining health in an ageing population will occupy more resources and effort. Unless we recognise that the metal health of our working age populations can be an enormous asset in our drive to build competitive, productive and inclusive, knowledge-based economies, we will be guilty of presiding over a catastrophic and avoidable waste of our human resources.