Title
Contents
Acknowledgements 8
The Authors 9
Summary 10
1. Introduction 20
1.1 Policy background 20
1.2 Research questions 24
1.3 Research design and methods 26
1.3.1 Research with employers 26
1.3.2 Research with individuals 29
1.4 Structure of report 31
2. Understanding mental health 33
2.1 Individuals' understanding of mental health 33
2.1.1 Describing mental health conditions 34
2.1.2 History of mental health conditions 35
2.1.3 Recognition and acknowledgement of mental ill health 37
2.1.4 Conceptions of 'illness' 39
2.1.5 Relationships between work, mental health and Incapacity Benefit 41
2.1.6 Others' perceptions of mental health 44
2.2 Employers' understanding of mental health 46
2.2.1 Awareness of mental health conditions 46
2.2.2 Employers' knowledge of employees with mental health conditions 50
2.2.3 Advice, information and training 51
2.3 Conclusion 55
3. Mental health in work 57
3.1 Talking about mental health at work 58
3.1.1 Volunteering information about mental ill health 58
3.1.2 Not volunteering information about mental ill health 60
3.1.3 Employer-initiated discussion about mental ill health 63
3.2 Impacts of mental ill health in work 64
3.2.1 Impacts on performance 64
3.2.2 Impacts on attendance 65
3.2.3 Impacts on behaviour and attitudes at work 66
3.2.4 Impacts on work colleagues 67
3.2.5 Impacts on line managers 68
3.3 Absences and absence management 69
3.3.1 Employee experiences of absence and absence management 70
3.3.2 Employer experiences of absence and absence management 71
3.4 In-work adjustments for employees with mental health conditions 73
3.4.1 Employer perspectives on making adjustments for employees with mental health conditions 73
3.4.2 Types of adjustment made by employers for staff with mental health conditions 76
3.4.3 Individuals involved in supporting employees with mental health conditions 79
3.4.4 Employee experiences of in-work adjustments 82
3.5 Employer policies and the Disability Discrimination Act 83
3.5.1 Employer policies 84
3.5.2 Employer awareness and views on the DDA 85
3.5.3 Employee awareness and views on the DDA 87
3.6 The role of General Practitioners 88
3.6.1 Employee perspectives on GP involvement 89
3.6.2 Employer perspectives on GP involvement 90
3.7 Conclusion 92
4. Leaving work due to mental ill health 95
4.1 Transitions out of work due to mental ill health 95
4.1.1 Going off sick 96
4.1.2 Leaving work directly 97
4.2 The decision to leave 97
4.2.1 Employee decisions to leave 98
4.2.2 Mutual decisions to leave 99
4.2.3 Employer dismissals 101
4.2.4 Feelings about leaving work 103
4.3 Employees' reflections on preventing leaving work 103
4.3.1 Access to health services 103
4.3.2 Contact with employers and colleagues 104
4.3.3 Dealing with workplace bullying or harassment 104
4.3.4 Reducing 'job stress' 104
4.3.5 Constructive responses to personal life triggers of mental ill health 105
4.3.6 Self-awareness of mental health condition 105
4.3.7 Perceptions that no preventive action was possible 106
4.4 Conclusion 106
5. Mental health and entering work 109
5.1 Experiences of people returning to work 109
5.1.1 Influences on thoughts about a return to work 109
5.1.2 The role of medical practitioners 113
5.1.3 Support in seeking work 113
5.1.4 Recruitment 115
5.1.5 Entering work 115
5.1.6 Telling people at work about mental health conditions 117
5.1.7 Responses to learning about people's mental health condition 121
5.1.8 Employment pathways since entering work 122
5.2 Employers' experiences 122
5.2.1 Recruiting people with mental health conditions 123
5.2.2 Appointing people with mental health conditions 127
5.2.3 Job suitability and mental health conditions 129
5.3 Conclusion 133
6. Attachment to work 135
6.1 The meaning and value of work 135
6.2 Looking to the future 138
6.3 Challenges and support needs in returning to work 140
6.4 Conclusion 145
7. Conclusion and policy implications 147
7.1 Summary of main findings 148
7.1.1 Knowledge and understanding about mental health 148
7.1.2 Mental ill health in work 148
7.1.3 Mental health and transitions out of work 149
7.1.4 Transitions into work 150
7.2 Policy implications 151
7.2.1 Mental health literacy - increasing knowledge and understanding 151
7.2.2 Enhancing the role of employers in job retention 152
7.2.3 Mental health treatment services 154
7.2.4 The role of GPs 154
7.2.5 The role of Jobcentre Plus 155
7.3 Final comments 155
Appendix. Recent claimants of Incapacity Benefit with mental health conditions 157
References 171
Table 1.1 Main characteristics of the achieved employer sample 28
Table 1.2 Main characteristics of the achieved Incapacity Benefit claimant sample 30
Table 1.3 Research participant transitions 31
Table 2.1 Relationships between mental health and work 44
Table A1. Type of health condition now or in past 12 months 158
Table A2. Type of main health condition 158
Table A3. Whether health condition is constant or fluctuates over time 159
Table A4. Socio-demographic characteristics 160
Table A5. Work history 162
Table A6. Work situation or expectations 162
Table A7. Whether and when employees discussed their condition with their employer after it began to affect their ability to do the job 163
Table A8. Helpfulness of employer 164
Table A9. Whether employees had access to occupational health services via employer 164
Table A10. Whether employees discussed their condition with the occupational health service 165
Table A11. Whether changes were made at work to help accommodate employees' health condition or disability 165
Table A12. Whether other changes could have helped employees to keep working longer than might otherwise have been possible 166
Table A13. Whether employees consulted anyone apart from the employer about the effect of their condition(s) on their ability to do their job 167
Table A14. Whether employees were entitled to sick pay from their employer 168
Table A15. Whether employees discussed returning to work with their employer while they were off sick 168
Table A16. Whether employees discussed returning to work with their GP or other health professional while they were off sick 169
Table A17. Whether claimants felt their health was getting better or worse 170
Table A18. Whether claimants were on a waiting list for medical treatment 170
Figure 1.1 Employment and unemployment rates by main type of impairment: Great Britain, April-June 2006 22