Pete Robertson
Lecturer/Programme Leader
Postgraduate Diploma in Career Guidance and Development

Incidence: 16 % + at any one time
Economic costs to business: £26 billion p.a.
– Under-performance & presenteeism
– Sickness absence
– Early withdrawal from workforce
Total costs to wider society: £ 115 billion p.a.
– As above plus...
– Medical and care costs
– Tax lost + welfare benefits costs incurred
(Foresight Mental Capital Project, 2008; Sainsbury Centre 2007; Friedli & Parsonage, 2007)

• Workload
• Hours/shiftwork
• Travel
• Physical risk
• Psycho-social risks
– Bullying
– Sexual harassment
– Discrimination
– Isolation
• Tasks
– Repetition
– Control
– Emotional labour
(Service sector)
• Uncertainty
– Ambiguity
– Restructuring
– Job insecurity
• Culture
– Performance management
– Use of alcohol/drugs

Career concerns are known to be a source of work stress
(e.g. Baruch, 2009)
• Metaphors of frustration
– Glass ceilings
– Golden cages
• Work/life balance
– Bi-directional conflict
• Older workers
– Network erosion
Hush...don’t tell your clients about the health risks...

“ Employment is nature's physician, and is essential to human happiness”
Galen of Pergamon, Greek physician, surgeon and philosopher, 172 AD
“ Working is, for most patients, a positive clinical outcome and can be an intervention in its own right”
Royal College of Psychiatrists

W.H.R. Rivers
Robert Graves

“ There is a strong evidence base showing that work is generally good for physical and mental health and well-being.
Worklessness is associated with poorer physical and mental health and well-being. Work can be therapeutic and can reverse the adverse health effects of unemployment. That is true for healthy people of working age, for many disabled people, for most people with common health problems and for social security beneficiaries...Work is generally good for health and well-being.”
(Waddell & Burton, 2006: ix).

To summarise so far...
Healthy workers encounter psycho-social health hazards at work that make them stressed or mentally ill !
Going to work helps unemployed people with mental health conditions get better !

Does unemployment cause mental health conditions ? o Yes, it is a very powerful causal factor but... o Some reverse causality (health selection for job loss or re-employment) o A minority are happily unemployed
Does work cause good health ?
o It tends to but is not a panacea o Poor quality work or insecure may have neutral or detrimental effects o Some individuals at certain times may be vulnerable to psycho-social health hazards

• Most accessible to unemployed with health conditions
• Insecure, temporary, low status, servile
• Underemployment
– pay, hours, qualifications, experience
• May lead to unemployment, not secure work
• Results in fractured employment biographies

 Locates responsibility for causes and management of distress within the individual
 Focus on anxiety ignores the complexity of emotion at work
 Implies work is usually pathenogenic
 Huge evidence base shows unemployment is associated with greater mental distress

• Michael Marmot & colleagues explored health in the British Civil Service
• Found a status/income gradient in physical and mental health
• Social inequality has health consequences
within organisations
• Control at work is a key issue e.g. Stansfeld et al (1999)

(WHO, 2004)
• No health without mental health
• Health is more than the absence of illness
• Requires a climate that respects and protects civil/political/economic/social/cultural rights
The workplace is a key arena for public mental health interventions

Recent research suggests a healthy workforce leads to enhanced productivity because of:
• Employee engagement and co-operation
• Sustainable performance e.g. Harter, Schmidt & Keyes (2002)

• Unemployment: usually more stressful than work
• The quality of work is very important
• Income/status gradients at work affect health
• Work is a key arena for mental health promotion
• Positive well-being may promote sustainable productivity

• Retention
• Flexible working
• Reasonable adjustments
• Training
• Support services:
– Employee assistance programmes (EAPs)
– Occupational health (OH)
– Vocational rehabilitation (VR)
– Occupational therapy (OT)
– JobCentre Plus/DWP services
– Executive coaching/mentoring
• Stigma, media and culture
• Organisational culture
– Performance management
– Bullying
– Attitudes to mental health
Lack of coherence in support services ?

Three thoughts about the potential for career related support to contribute to the management of mental health issues at work.

A holistic approach to career and mental health counselling may be desirable
(Zunker,
2008)
– Career and personal concerns overspill & interact
– Work dominates waking hours & defines identity

Stress management vs career guidance approaches
Strengthen the individual e.g. CBT based training
e.g. Culture change; Tackle bullying; Work design
Leave the job? Go part time ?
Work adjustment
Can I renegotiate my role ?
Can I develop through training ?

Future focus
=
=
Exploring work identity
Encourages networking offers hope strengths based approach promotes sense of agency rebuilding self-concept builds social capital
Career guidance has several features consistent with a
recovery based approach to mental health

Royal College of Psychiatrists
Work and mental health online resource: http://www.rcpsych.ac.uk/mentalhealthinfo/workandmentalhealth.aspx

BARUCH, Y. (2009) Stress and Careers. In C.L. Cooper, J. Campbell Quick & M.J. Schabracq (eds) International
Handbook of Work and Health Psychology 3 rd edition. Chichester: Wiley-Blackwell
FORESIGHT MENTAL CAPITAL AND WELLBEING PROJECT (2008) Final Report. London: The Government Office for Science.
FRIEDLI, L. AND PARSONAGE, M. (2007) Building an economic case for mental health promotion: part 1. Journal
of public mental health, 6, 3:14-23.
HARTER, J.K. SCHMIDT , F.L. & KETYES, C.L.M. (2002) Well-being in the workplace and its relationship to business outcomes: A review of the Gallup studies. In C.L.M. Keyes & J. Haidt (eds) Flourishing: The
positive person and the good life (pp205-224). Washington DC: Amercian Psychological Association.
SAINSBURY CENTRE FOR MENTAL HEALTH (2007) Work and wellbeing: developing primary mental health care
services London: SCMH
STANSFELD, S.A., FUHRER, R., SHIPLEY, M.J. & MARMOT, M.G. (1999) Work characteristics predict psychiatric disorder: prospective results from the Whitehall II study. Occupational and environmental medicine, 56,
5: 302-307.
WADDELL, G. & BURTON, A.K. (2006) Is work good for your health and well being ? London: Department for
Work and Pensions
WORLD HEALTH ORGANISATION (2004) Promoting mental health: concepts, emerging evidence, practice.
Summary report. Geneva: WHO.
ZUNKER, V. (2008) Career, work and mental health: integrating career and personal counselling. London: Sage.

p.robertson@napier.ac.uk