Mental health and employment — a vicious cycle?

People with mental health difficulties need integrated advice to overcome entrenched barriers at work

Around 1 in 4 people in the UK will experience a mental health problem this year. Many of them will be working full time.

Last year, our research found 1 in 3 people with a long-term mental health condition experienced difficulties with their employment as a result — from making it into work and deteriorating relationships with colleagues to needing reduced hours.

But, despite increasing awareness of the relationship between disability and work, recent government reforms to provide support for people with mental health problems and employment do not go far enough.

We saw 6,540 employment clients with mental health problems last year — with 12,130 employment issues. Nearly half of those also came with benefits issues, and a sixth with debt-related issues.

The problems they face can be complex. On average, clients with mental health problems have 5.3 advice queries, compared to other clients who have 3.8 queries in a given year. Underlying the complex and interlinking issues faced by people with mental health problems, we have found a vicious cycle relating to employment.

It’s difficult to stay in employment. Mental health problems are often fluctuating, making them hard to explain to employers. Our research has found experiencing mental health problems made it eight times more likely that people would find it difficult to go to work, three times more likely that their relationship with colleagues would deteriorate and twice as likely to need to leave their job.

People are more likely to experience problems at work. In particular, people with mental health problems are more likely to experience discrimination at work. Of 250 advisers surveyed in September 2017, 48% had helped clients with mental health problems who had experienced employer discrimination in the last three months.

It’s harder to seek redress with employers. Our clients with mental health problems are 60% more likely to get advice on enforcing their employment rights than those without mental health problems. They are almost twice as likely to come to us with concerns about dispute resolution, and employment tribunals and appeals. They often lack awareness of their rights. More than 60% of advisers described this as the main reason people with mental health problems struggle to enforce them.

Disputing employment problems can make conditions worse. Seeking redress from employers is often a stressful process, particularly where evidence is contested or relationships sour. Many of our clients describe losing sleep while trying to resolve their workplace problem. Difficulty seeking redress tends to be at the point of leaving employment. This group was 26% more likely to come to us with a problem about dismissal and 33% more likely to come to us with a problem about resigning. This often pushes people towards leaving their job or resigning, either through difficulty managing a full time workload or through the stresses of engaging with unsympathetic employers.

I was worried… I was having trouble with my sleep… It was a nightmare. No support again, no HR department… They don’t understand my problem, they just see what’s on the surface… [I felt] physically drained, mentally drained.

Citizens Advice survey respondent 2017

People with mental health problems struggle to find new jobs. Nearly 5000 clients with mental health problems come to us each year with queries about applying for work. They often have anxieties about discrimination at the point of entering work. A recent survey we conducted with employers raised similar concerns. Nearly 80% told us they would find it very or fairly difficult to support an employee with a fluctuating health condition,. The three main challenges highlighted in employing disabled people and those with health conditions all related to business impact — losing staff time (35%), costs of adjustments (31%) and the difficulties of planning around people’s health (28%).

The negative feedback loop in mental health and employment

The consequence of this vicious cycle is the disability employment gap. Just 36% of working age people with a work-limiting mental health condition have a job compared to 49% of disabled people overall, and 80% of non-disabled people without health conditions. This makes people with mental health conditions one of the most disadvantaged groups in the labour market.

The government is committed to halving the disability employment gap by 2027. Our concern is that reforms don’t go far enough.

Current efforts to reduce the gap have centred on supporting people through grants, such as Access to Work, and targeted work-related health advice, called Fit for Work. In November, the Prime Minister promised a review of statutory sick pay (SSP), and additional training for JobCentre Plus employees around mental health. But these reforms are too little, too late for people struggling to manage their job alongside their mental health.

We have identified three main problems with these schemes:

1. People with mental health problems need a direct source of support. Recent reforms make changes for businesses, but it’s important that people with mental health problems are able to turn to a direct source of support.
2. A lack of awareness of the provision available. In a recent survey only a third (33%) of employers and line managers knew a ‘great deal or a fair amount’ about Access to Work, a key source of financial support when making adjustments for disabled employees. Some sectors are worse than others. Just 22% of line managers and employers in the hospitality sector know at least a fair amount about the scheme, compared to 41% of all employers and line managers.
3. The government’s proposals overlook the complexity of people’s lives. Support for people with mental health problems to access or stay in work must look beyond the immediate circumstances of their employment, Other problems, including housing, benefit or debt issues, can make managing employment and health significantly more difficult.

The solution? Integrated advice

The government clearly recognises that people with mental health problems need practical support. This lies behind their funding for Access to Work and investment of £39 million to double employment advice in mental health services. There’s no doubt that this is a step in the right direction. But these solutions do not address the complexity of problems faced by people with mental health issues.

By supporting integrated practical advice alongside mental health support as we have trialled in Liverpool, the government could more fundamentally address the challenges faced by people with mental health problems in the job market. We see integrated advice providing crucial additional support to people with mental health problems:

• It provides a direct source of support to deal with issues at every stage of their employment. Integrated advice can help people not just to access employment, but also to sustain it — helping resolve workplace issues, as well as challenge instances of discrimination.
• It supports more effective use of existing support services. The complex nexus of problems faced by people with mental health problems often leaves people struggling to find the right source of support. Integrated advice plays an important role in directing people towards schemes, such as Fit for Work, which might help them.
• It helps deal with the huge range of issues which might affect their employment. Our advisers provide practical support to clients for a huge range of issues; from contacting creditors, writing to housing associations or applying for disability benefits.

A holistic approach is central to breaking the vicious cycle — and ultimately — the disability employment gap.