The new government is taking up the reins at a time when the topic of mental health and employment is high on the agenda. Recent years have seen concerning rises in economic inactivity due to long-term ill health, among which anxiety and depression form the largest proportion. Health-related benefit claims are likewise dominated by mental health conditions, a situation that has endured for well over a decade. Something clearly needs to be done to better support people experiencing mental health problems to retain, regain and sustain employment. But is the focus on mental health perhaps obscuring other important, influential structural factors that are contributing to these trends?
Ongoing research at the ESRC Centre for Society and Mental Health is taking a qualitative longitudinal approach to understanding work transitions over the lifecourse, for people who have experience of mental health problems. The aim is to understand more specifically how mental health shapes work trajectories, when placed in the wider context of people’s lives. Participants’ biographical narratives reveal the complex interplay of personal, interpersonal, economic and structural factors that operate in combination with a person’s mental health to determine employment outcomes. Distress undoubtedly affects people’s experiences in work, but the extent to which it acts as an independent or primary factor driving employment exits is more complicated.
When we look in close, contextualised detail at the circumstances and specifics of people’s work transitions, we see that at times of mental distress, it may well be unrelated factors that cause people to leave work. This is most apparent in the case of precarious or insecure employment. People may be struggling on in work, in spite of high levels of anxiety, depression or even psychosis. But their job ends due to redundancy, the end of a temporary contract, failing a probationary period, an employer closing down or being unable to offer work hours that are compatible with parenthood. Circumstances outside the workplace also affect both mental health and work capacity in tandem, for example caring for an ill or disabled family member, becoming homeless or escaping domestic violence.
Of course, the relationship is complex, and it is impossible to say what factor plays the biggest role for any given person at any given time. This is the point, really. We need to understand and address people’s situation in a contextualised and holistic way. Seen in this light, the current policy focus, which seems narrowly trained on mental health as the key issue to be tackled, risks missing the bigger picture – the broader social and structural factors that shape sustainability of work for people facing mental health difficulties.
In our research project, the absence of HR and occupational health from some participants’ narratives is striking. At times of distress, exits from work were sometimes abrupt, unpremeditated, and with no prior mention to colleagues or line managers that they were struggling in their personal lives. In some instances, people did not tell anyone at work, and simply walked away, ‘quit’ or stopped attending. The multiple, compounding socioeconomic, relational and material challenges underpinning their distress were not packaged up and presented to an employer as a ‘mental health condition’ to be addressed by HR or occupational health. Recollections of managers or HR personnel attempting to discourage the person from leaving, or supporting them to retain their job, were relatively rare among those in the most disadvantaged labour market positions.
The contrasting cases are people who were in secure jobs, often professional positions with longer tenure with the employer. At the time when their distress became most acute, they were ‘held in place’ by organisational safety nets of sick pay, occupational health intervention and arguably a degree of vocational identity connected with their employer and role, even if relations became strained over time. These people’s distress was no less impactful on their work capacity, but structural factors protected them from immediate unemployment and dependence on welfare benefits.
All that said, a blanket ban on zero-hours contracts may not be helpful for some people who live with long-term mental health problems. In a best-case scenario, these forms of ad hoc employment can offer beneficial flexibility to people who manage work around fluctuating symptoms. One participant in our study has worked on a zero-hours contract for the same employer for over seven years. He loves the work, feels at home in the environment, is able to work regular shifts when well, and decline shifts at times of lower mental health. In our most recent research conversation, a few days after the general election, he spontaneously raised his concerns about what might happen if his employer were forced to offer him a regular full-time or part-time contract. Another participant takes casual shifts in a role he enjoys, once or twice a week, allowing time for other pursuits that contribute to maintaining his overall wellbeing.
Overall, then, the situation is complex, and complexity is difficult for policy making. But continuing to take a narrow, medicalised framing of the ‘problem’ of mental health and worklessness is to overlook essential considerations around the quality and security of work, and the wider context of people’s lives. What statistics present as a rising curve of mental health-related incapacity may mask a more multifaced conglomeration of social, relational and structural factors, not least the precarity of insecure or poor-quality work. In short, we need approaches to employment support that take a holistic approach to people’s lives, with mental health an important but not sufficient framing through which to view these challenges.
Finally, our emerging findings suggest that current approaches to workplace mental health, focused on line manager awareness, supporting disclosure of mental health problems, and putting in place reasonable adjustments, may not be reaching those in the most marginal labour market positions. The policy, practice and research implication is that we may need a fresh look at what workplace mental health support needs to looks like, for people in precarious and insecure work.
Annie Irvine is a researcher and lecturer in Social Policy at the University of York and an affiliate of the ESRC Centre for Society and Mental Health, King’s College London.
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