Impact Assessment of Mental Health on Employment for Policy Development ESF 3.71 www.richmond.org.mt
Today as many as one in four (132 million) Europeans are affected by mental health problems each year, which the Mental Health Economics European Network (MHEEN) have estimated to cost every European household more than 2,200 per annum. CONTENTS Introduction...4 i. Why Mental Health?...4 ii. What is this Project About?...4 Research Results...5 i. Stress at Work...5 ii. General Perception & Understanding of Mental Health Problems...6 iii. Prevalence of Mental Health Problems...7 iv. Barriers to Employment...8 v. Lack of Awareness...9 Policy Recommendations... 11 i. Public Perception and Public Education... 12 ii. Developing Mental Health Friendly Job Environment... 12. iii. Career Guidance, Job Seeking, Rehabilitiation... 13 iv. Acceding to Legal Rights at the Workplace... 14 v. Government Policymaker s Roles... 15 These costs fall under many different budgets, but by far the most important of these is the lost productivity at the workplace, which by far exceeds the direct health and social care costs of mental health problems
Why Mental Health? Over these recent years Mental Health is increasingly becoming a vital concern, particularly in view of the increase in the incidence of people experiencing mental health problems. It is expected that mental health problems, particularly depression, will be the main cause for incapacity for work in 2020, and it is clear that mental health will be one of the most important subjects to address in the field of workplace health (Standing Committee of European Doctors - CPME, 2009). The European Commission has been discussing and raising the issue of the importance of Mental Health and has also agreed on a Pact for Mental Health. Among the five priority areas where action has been called for, are Mental Health in workplace settings and Combat Stigma & Social Exclusion What is this Project About? The project Impact Assessment of Mental Health on Employment for Policy Development (IAMHE) is a project partially funded by the European Social Fund (ESF). The objective of the project is to provide vital information to and its respective partners Employment & Training Corporation (ETC), Malta Employers Association (MEA) and Compagnie de Sporen to better understand and identify the main obstacles and labour market shortcomings which need particular attention, with the aim of developing, improving or changing employment policies and systems which contribute towards the access, integration, retention and progression in employment of persons with mental health problems or who are at risk of experiencing such problems. Research Results Stress at Work Research has shown that the total hours spent working in a typical week has a direct effect on the levels of stress one is likely to experience. For instance, among those respondents who work up to 60 hours a week, 71.5% consider their job to be either stressful or very stressful. Results also indicate that 36% of people in employment tend to work over 40 hours a week, and generally self-employed people work longer hours when compared to regular employees. Findings also show that over the last 5 years, 10.5% had to take leave of absence as a result of stress or burnout. In most of these cases - 75%, up to one week of leave was taken, whilst 14.6% took up to two weeks of leave, and the remaining 10.5% took leave for even longer periods of time. It is also worth noting that 20.3% stated that their work has in fact caused them some form of emotional or mental health problems. Among these, 50.5% said they experienced some degree of considerable stress. Another 44.1% stated that it led to anxiety issues, and 16.1% stated it led to some form of depression. It is expected that mental health problems, particularly depression, will be the main cause for incapacity for work in 2020 4 5
77%, also agree that people with mental health problems can get well and return to their normal lives as long as they receive the proper professional help General Perception & Understanding of Mental Health Problems The issue of stigma and discrimination was brought up throughout various stages of the study. Unfortunately, the research also shows that there is a widespread perception that people with mental health problems can be violent and unpredictable. Results show that 54% feel that people with chronic mental health problems can be by far more dangerous than the general population. This is reiterated when a total of 60% said they do agree that mentally ill individuals can be unpredictable and violent. On the other hand, the findings show that the vast majority (91.9%) do feel that anyone is susceptible to a mental illness, and therefore we are all at risk of experiencing mental health problems. A substantial percentage 77%, also agree that people with mental health problems can get well and return to their normal lives as long as they receive the proper professional help. When assessing the general attitude at the workplace towards people with mental health problems, it seems that contact with these people is avoided to some extent. An element of ridicule is also present, as is also some degree of discrimination towards these persons. In terms of job performance, however, 44% felt that most or all of the times, these persons would perform their tasks well, while 32% felt that this was only so occasionally. Prevalence of Mental Health Problems One of the objectives of the survey was to establish the prevalence of persons with mental health problems within the employment context. In this regard, the respondents were asked whether they had at any point experienced symptoms which led them to believe that they might be having some mental or emotional health problems. The research suggests that 24% of persons at work or willing to work have experienced such symptoms. Although respondents made reference to such symptoms, it was essential to identify whether the condition was actually diagnosed by a medical doctor, a psychiatrist or a psychologist in order to establish as far as possible the severity of the condition as well as its authenticity. It results that 72.5% of those people who said they experienced these symptoms were professionally diagnosed. This infers that in total, 13.2% of the targeted audience for this survey have at some point been diagnosed with some form or degree of mental health problems. The diagnosis was carried out by either a medical doctor, a psychologist, a psychiatrist or a combination of these. A substantial percentage of these people 20.5%, were not aware what their illness is actually called. The majority of these people - 29.5% - said they were diagnosed with anxiety problems, whilst another 26.9% were diagnosed with some form of stress problems and 24.4% with depression. One must keep in mind that from a clinical point of view, symptoms of stress and anxiety could at times be referring to the same type of mental health problems. The research suggests that 24% of persons at work or willing to work have experienced such symptoms 6 7
Barriers to Employment In-depth interviews with people with mental health problems revealed that generally their motivation to work is based on the fulfilment which work itself can offer. Other factors, such as giving the person an identity and making the person more responsible and independent, were also mentioned. Nonetheless, people who are experiencing mental health problems do encounter certain barriers when accessing employment. Reference was made to the need for a certain degree of work adaptation, which is often required by people who are experiencing mental health problems. Very often this consisted of some flexibility in the working hours of the person, or a reduction in the hours worked. In situations when such adaptation was not attainable, this could discourage a person from accessing employment. Lack of Awareness The lack of information has led to a certain degree of discrimination and stigma which has had a negative impact on people with mental health problems. The lack of awareness and information has also placed employers in a difficult position, particularly since often they are not capable or well equipped to deal with people with mental health problems when the need arises. Further research revealed that both service users as well as stakeholders tend to agree that there are needs which have to be addressed in order to provide a better support system for both people with mental health problems as well as for employers. In addition to this there is also the general lack of awareness, understanding and education across the population in aspects dealing with mental health. Findings also revealed that some people with mental health problems felt less confident on the job and their morale was affected too. One of the underlying causes of this was potentially the fear of stigma and discrimination among colleagues. The lack of training and support can also make it harder for a person with mental health problems to obtain employment. Findings have shown that in some cases training was effective in enabling the person to perform his job well and gain confidence on the job. It also increased their job possibilities. Supported employment was another factor which was very well spoken of and some interviewees felt that they would not have managed to find a job without this scheme. The benefits of the service were seen both in obtaining a job as well as in receiving adequate support to enable them to retain their job. 8 9
Policy Recommendations Good employment and good employment conditions improve mental health and quality of life which, in turn, contribute to the well-being of society as a whole. The aim of this publication dealing with such an important matter is to take the opportunity to launch a plan to improve mental health friendly employment in Malta. This would require the government s initiative and the full participation of the other actors in society. Leadership and a readiness for all round coordination will be needed for this to succeed. Funding and resourcing from various sources would be needed, from government, civil society and European sources. A preventive maintenance approach is vital when setting out to improve mental health at the workplace Based on the findings obtained throughout this study, a set of policy recommendations have been drawn up reflecting such findings. In drafting and implementing such measures one must bear in mind both the needs of the employee as well as those of the employer. The recommendations do not focus only on assisting persons with mental health problems in obtaining and retaining employment, but also on promoting an environment conducive to mental well-being at the workplace. Therefore a preventive maintenance approach is vital when setting out to improve mental health at the workplace. The promotion of a good work environment, as well as the prevention of and support around problems originating from outside the workplace, should be seen as effective ways to reduce the uptake of sick leave and upgrade job satisfaction and worker retention. A preventive maintenance approach is vital when setting out to improve mental health at the workplace 11
The following are a set of recommendations to be considered by employers, stakeholders, and policy makers alike, with the aim of reducing the main barriers encountered by persons with mental health problems when accessing, retaining or maintaining their employment. Public Perception and Public Education 1. A long-term strategy including a nationwide campaign is called for, in order to increase the level of awareness, information and education across the general public. 2. Support at the place of work should be in place to address the needs of individuals whose degree of severity of mental health problem can vary. 3. Effective policies need to be implemented to promote the inclusion of people with mental health problems enabling people to present themselves to society without fear of stigma, discrimination and prejudice. Developing Mental Health Friendly Job Environments 4. Stakeholders should join forces in a coordinated plan to promote mental health at, and through the workplace with the support of relevant government entities and civil society, including nongovernment organisations. 5. Existent support services for employees, potential employees and employers should be enhanced, refined and expanded. 6. Employers need to have adequate professional support to respond to employees who face particular barriers and limitations. 7. Occupational Health and Safety Authority is to take a lead by declaring clear and applicable standards for the reduction of avoidable risks and stresses on mental health at the workplace. 8. Solid government support, including funding, is essential for the expansion of services in support of mental health at the workplace. 9. Line managers and members of HR departments who have a crucial role in providing support to employees should be given the necessary training, advise and support. 10. A helpline for employers to ask for guidance in related problems that arise could be created as part of the drive for all workplaces to offer adequate support. Career Guidance, Job Seeking, Rehabilitation 11. Careful judgement should also be exercised in the guidance and support of such persons where a full-time or mainstream job seems beyond reach or undesirable. Flexible work arrangement and other occupation opportunities other than regular work need to be provided. 12. Adopt job first programs, in which first a job is obtained, following which the individual is coached and supported at work. 12 13
13. Models of profit-making work cooperatives and social enterprises should be supported. 1 14. Existent ability-assessment facilities should be upgraded through the improvement of know-how, training, use of known good practices and the bringing together of a wider range of professions, skills and backgrounds. under the mental health category. A duly qualified professional s certificate should be acknowledged as enough. 18. Stakeholders, including NGOs, advocacy groups and regulator institutions lawyers and law courts as well as employers and their associations are encouraged to do all they can for nondiscrimination and reasonable flexibility at the place of work. Acceding to Legal Rights at the Workplace 15. Employers, employees and their supporting organisations are encouraged to be aware, understand and make full use of the protection that legislation give at the workplace to people who experience mental health problems. Legislation such as the Occupational Health and Safety Authority Act, the Employment and Industrial Relations Act and Equal Opportunities (Persons With Disability) Act) can be useful. 16. Aspects of conditions at the workplace as assured by legislation, collective agreements and international labour conventions often protect psychological well-being. The assurance by employers, employees and government regulators of their observance is indispensable to the safeguarding of mental health. 17. Entitlement to special support from ETC should no longer be dependent on users being obliged to register as being disabled Government Policymakers Role 19. The government has to take the lead role in addressing this sector, in bringing all stakeholders together, promoting synergistic work, allocating adequate resources and ensuring quality services. 20. Government should lead in a review of the work of all hospitals, health, social work, psychological, guidance, counselling, job training and rehabilitation entities, as well as workplace support and practice, to ensure they work according to latest research & best practices. 21. Besides, all government regulatory bodies can enhance their advice, strengthen their dialogue and upgrade their enforcement to make the workplace and society particularly friendly to mental health. The government, though the Occupation Health and Safety Authority should give particular attention to issues such as excessive workload, employees sense of control over their work, role clarification and understanding, harassment and violence at the place of work 2, support and continuous development. 1 A cooperative is a business organization owned and operated by a group of individuals for their mutual benefit. Social enterprises are social mission driven organizations which apply marketbased strategies to achieve a social purpose. The movement includes both non-profits that use business models to pursue their mission and for-profits whose primary purposes are social. 2 There should be inter-agency collaboration and no duplication of work, especially if an issue is already being addressed by another entity which is the National Commission for the Promotion of Equality (NCPE) 14 15
22. Government is also encouraged to move steadily to a situation where vulnerable persons can appeal for the protection of their rights in the security that these are quite firmly embedded and reliably defended. 23. Finally, government should facilitate the application of funding for all the above improvements, ensuring that serious gaps in available funding, EU or otherwise, are filled by its own welltargeted funding to make possible the crucial services and provisions that are called for. 24. Mainstream the issue of mental health across all policies especially social, educational and economic policies. Such mainstreaming should be part of a national strategy on mental health addressing the promotion of mental health, prevention of mental illness and provision of adequate and holistic services. 16