Mental Health, Social Inclusion and the Workplace

Dr Jeanne Moore

Policy Analyst, NESC

NDA Seminar 13th May 2011

“If you broke your leg you’d be fairly confident that your company would stick by you and you’d still have your job to walk into when you’d be better again. If you’re off with depression, because there’s that whole ‘is he mental?’ thing about it, ‘is he a liability?’… that you would fear what your company will do when you get back..”

Employee, Dublin.

NESC

Key Points of Presentation

1. The NESF Project on Mental Health and Social Inclusion

3. Why Mental Health is Everyone’s Business4. The Role of the Workplace:

Millward Brown IMS Research 5. Towards an Integrated Approach:

Main Recommendations

NESC

National Economic and Social Forum (2007) Mental Health and Social Inclusion Report

NESF Project & Project Team– Chaired by Professor Cecily Kelleher, UCD.– Representatives from four strands of social

partners and included clinicians and service users. Aim of Project

• To increase the social inclusion of people with mental ill-health as well as identify broader strategies and actions for the promotion of mental well-being across Irish society.

NESC

Key Perspectives of NESF Report

Mental Health and Social Exclusion

• Mental health is used here to refer to “a state of well-being in which the individual realises his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community” (World Health Organisation, 2001:1).

• Those who are socially excluded have an increased incidence of mental ill-health and vice versa so that it can develop into a cycle of exclusion (Social Exclusion Unit, 2004).

NESC

Mental Health is ‘Everybody’s Business’ (WHO, 2005)• The societal costs of poor mental health are

enormous: reduced economic performance, human and social capital and increased health and social welfare costs (WHO, 2006).

• Not just about specialist services: The vast majority of mental health care in Ireland happens in primary care- 85% of GPs referred fewer than 5% of their patients to mental health specialists.

• Not just important for health policy: International good practice guidance makes clear that mental health should be an interdepartmental concern (Amnesty International, 2010).

NESC

The WHO European Ministerial Conference on Mental Health (2005) concluded that ‘mental health is central to the human, social and economic capital of nations and should therefore be considered an integral and essential part of other public policy areas such as human rights, social care, education and employment’.

E.g. Finnish Health in All Policies includes housing, transport, education etc. 2005- EC Green paper –Improving the Mental Health of the Population- EU strategy on mental health. 2008-European Pact for Mental Health and Well-being 2011- No Health without Mental Health (2011) A Cross Government Mental Health Outcomes Strategy (England)

Widening the Focus on Mental Health

Irish Policy Context• We have the vision. The blueprint for mental health policy development

in Ireland is ‘A Vision for Change’ (Department of Health and Children, 2006). Provides policy framework for an integrated approach.

• The Independent Monitoring Group (IMG) is monitoring progress. Implementation has been slow to date without a comprehensive implementation plan (2009). Mental Health Commission (2009) From Vision to Action: Analysis of the Implementation of A Vision for Change; and (2007) The Quality Framework for Mental Health Services in Ireland; Amnesty International (2010) The Missing Link: Co-ordinated Government Action on Mental Health.

• A welcome development has been the establishment of the Office for Disability and Mental Health which is driving implementation of this policy; the Mental Health Commission.

• Wider context: National Disability Strategy; National Action Strategy on Suicide Prevention; NAPS.

• Commitment in new (2010) Programme for Government for cross-departmental group.

NESC

Improving Mental Health: Co-ordinated Action Across Levels

Improving Mental Health

Why Work is Key

• Maintaining work can be critical for those experiencing mental ill-health (Fine-Davis et al, 2005). The risks of social exclusion greatly increase with loss of employment. Most people with severe and enduring mental ill-health are not in employment.

• Work is a gateway to civil and economic life of a community (Pavis et al, 2002). Many paths to recovery: work is a continuum from meaningful unpaid activity to paid employment.

• Retaining employment makes sense for everyone if supports are there.

• At the time of the project, little was know about attitudes in the workplace towards mental health issues.

NESC

Mental Health and the Workplace Millward Brown IMS Research

Lack of workplace policies – only 20% of employers had written policies in place but most wanted more information and guidance.

Mostly supportive of employees with mental ill-health but still some negative attitudes -54% agreed with the statement that they would be taking a significant risk when hiring someone with mental ill-health.

Disclosure- There is a fear of disclosing a mental health issue to employers and colleagues- 58% of employees would tell their employer and 43% would tell their colleagues.

16% of employees experienced mental ill-health in last 2 years.

NESC

Workplace Research Conclusions

• The stigma of mental health is in the workplace. Negative attitudes persist.

• Employers and employees need information, guidance and guidelines as to what to do if they face a mental health problem.

• At a policy level, the workplace’s role to support and foster positive mental health has not received sufficient attention.

Work, Training and Meaningful Occupation

• A range of schemes, programmes, rehabilitative training and workshops and supported employment exist.

• Shift towards placement in jobs rather than prevocational training increases people’s chance of genuine social inclusion.

• Early intervention is key.• A ‘virtual ramp’ for returning to employment (Hooper,

1996).• Aim is facilitate the delivery of ‘a seamless service’

through formal coordination structures (Vision for Change, 2006).

Six Pillars of Recommendations:

The Workplace and Employment

• A Health and Well-Being Framework Strategy for the workplace including:

–Guidelines and information on good employment;

–A code of practice for employers and employees on their statutory obligations and duties.

• An integrated strategic plan for the delivery of training, work and employment services.

• Integrated vocational support within mental health services a part of a Supported Employment model.

Final Conclusions

• Actions in mental health have to be considered across the breadth of all social, economic and health policy in Ireland. Constrained resources can be a driver for collaboration and stream-lining approaches.

• Responses have to be both at a strategic level, for everyone, and targeted at vulnerable groups and individuals.

• Policy implementation is complex and messy- requires organisational and cultural change as well as clear delivery plans, accountability, targets and a focus on outcomes. Lessons from NESF work on implementation of Child Literacy and Social Inclusion and Home Care Packages.

• Current work at NESC- Quality and Standards in Human Services

Contact Details

• For further information please contact:

Dr Jeanne MooreThe National Economic and Social CouncilDirect Line: 01 814 6366Email: Jeanne.Moore@nesc.ie

All references in this presentation are available in the Mental Health and Social Inclusion Report and this report alongside the Mental Health in the Workplace Report are still available to download from NESF website www.nesf.ie or hard copies are available from the NESC.

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