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Mental health and sickness absence: Behind the stats

Authors: Karen Steadman Karen Steadman

25 February 2014

On the face if it, the sickness absence data from the ONS, released today (25 February), didn’t show much change in the world of sickness absence from the 2011 release - the number of sickness absence days remained static at 131 million (though there are more people in employment than ever before), and minor illness, musculoskeletal disorders (MSDs) and mental health are still the leading causes of absence. However, scrape beneath the surface a little and there are a number of interesting findings…

Number of working days lost due to sickness absence, 1993 to 2013, and the top reasons for
sickness absences in 2013, UK
Source: ONS


Take mental health, for example. We see a rise in sickness absence for common mental health conditions (such as stress, anxiety and depression) of two million days. Though obscured a little by the way ONS reports the data, there also appears to have been an increase in absence attributed to more severe mental health conditions, such as schizophrenia and manic depression, now reported as 1% of sickness absence. A portion of this could be attributed to improved awareness of mental health conditions and reductions in stigma (as led by campaigns like Time to Change) and this may have increased the number of people comfortable with reporting mental health problems.

Whilst positive in a sense, this should not take away the fact that this greater awareness has not led to wide-spread improvements to the management of mental health conditions in the workplace. The OECD report on Mental Health and Work provides several examples. Many larger companies are reliant on occupational health services (OHS) and Employee Assistance Programmes (EAP) - data from CIPD indicated that 79% of larger employers and 46% medium provide OHS, but this may not be enough – anecdotally I often hear that many staff are wary of such services, which are seen as too close to their employers. Signposting to external services as well might help, as should the proposed Health and Work Service, which will provide an alternative, independent source for recommendations. The ability to support people to remain in work is a huge concern for both individuals and the economy, especially given that four 4 out of 10 new claims for disability benefits are attributed to mental health.

What the ONS data does not tell us is the impact of comorbidities on sickness absence and the relationship between mental and physical health conditions. Of particular interest is how much sickness absence reported by employees as being for ‘minor illness’ and back, neck and muscular pain (the top two causes), is actually driven by a mental health concern. Medically Unexplained Symptoms (MUS), describe physical symptoms for which no reason can be established. Often presenting as things like sleeping problems, nausea and back pain, they are thought to be manifestations of psychological distress (Naylor 2012). MUS are startlingly common – thought to account for 25% of all hospital outpatient appointments. It is not a bold leap to assume that these types of conditions may also account for some sickness absence.

This connection between mental and physical health was recognised in the 2011 mental health policy - No Health Without Mental Health, where improving access to psychological therapies (the IAPT program) was vaunted as the answer. As the huge demand for IAPT services sees people left on waiting lists for months on end, we need to look for other solutions. Poor recognition of MUS among health care providers and patients means the root cause of poor health can be unwittingly obscured, while continuing stigma about mental ill health may prevent others from being honest about what they think the cause is. Increasing awareness of MUS, among health care professionals, employers, the Health and Work Service and among individuals, may allow us to better identify the actual cause, and allow treatment to begin – reducing sickness absence, and more importantly, improving individuals health and wellbeing. 

Read more about the OECD Mental Health and Work report launch.