depressed woman at work

commentary

(The RAND Blog)

January 20, 2014

Finding Work for Those with Common Mental Health Problems

by Christian Van Stolk and Joanna Hofman

At any point in time, one in six working age people in England has a mental health problem. This corresponds to around six million people. Furthermore, about 18 per cent of the working-age population may have a diagnosed or undiagnosed common mental health disorder such as depression, anxiety disorders or phobias.

Some estimates suggest mental health problems in England cost the Government, society and individuals more than £100 billion per year. A key challenge is to help people with common mental health problems to gain or to maintain employment. Employment has distinct health and wider personal benefits for this group and it is also associated with lower healthcare utilisation, benefit savings, and income tax gains for the Government.

Our study, which was commissioned through the Contestable Policy Fund, aims to understand how government services can improve the employment outcomes of individuals with common mental health problems. We propose a combination of proven initiatives to help those with mental health problems find and keep jobs, including individual placement and support, group therapy interventions, online assessment and support and telephone-based assistance.

There is a perception among senior policy makers that Government services are not as effective as they could be. Identification, assessment and diagnosis of individuals with common mental health problems is difficult, and too few end up receiving the help they need. When they do get help, their employment and mental health needs are rarely addressed at the same time. Existing health services often do not engage with the employment needs of an individual while employment services place too little emphasis on their mental health needs. Access to various assessments and what assistance is available in both the benefit and health systems is often fraught with delays, which can make mental health problems worse and move individuals further away from the labour market.

As part of this study we reviewed innovative evidence-based approaches that could improve service delivery to this group in the UK. These were typically approaches that had been successful elsewhere, but had not been tested in the UK or had not been widely used to help those with common mental health problems. Each approach that we considered combines addressing employment needs and mental health treatment, where relevant and necessary, and tries to provide early assessment.

We propose four policy options:

  1. A first option would aim to offer a specified and tested model for providing employment support for people with severe mental health problems called Individual Placement and Support. This service would be placed in primary care and offered to people with common mental health problems. In the few locations where this is already taking place the employment results are encouraging.

  2. A second option would offer a group therapy intervention called JOBS II to individuals with common mental health problems and employment needs. Evidence on JOBS II in the U.S., Finland and Ireland shows strong and sustained employment outcomes. Participants would be referred to the intervention through the employment service.

  3. A third option would provide online assessment and support. This intervention would be aimed at the general population and offer assessment and potentially computerised Cognitive Behavioural Therapy.

  4. A fourth option would be to offer a telephone-based assistance service, similar to an employee assistance programme, to a wider group of people with common mental health problems. This service would be accessed through the employment services. In certain locations where it has been used in the UK it has been shown to be effective.

These policy options are complementary with different aims and client groups. They have different estimated costs per participant and levels of effectiveness. For each of the options, we estimate that the monetisable benefits to Government for running these services will exceed the costs. However, we encourage the Government to pilot these options to see what the relative effectiveness of each is and as such the return on investment. Taking a strong evidence-based approach to improving the employment outcomes of people with mental health problems could make the UK a leader in developing new services in an area of concern for most industrialised nations.


Christian van Stolk is director of the Employment, Education, Social Policy & Population research programme, and Joanna Hofman is a senior analyst, at RAND Europe.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.