Mental Health, Social
Inclusion and the Workplace
Dr Jeanne Moore
Policy Analyst, NESC
NDA Seminar 13th May 2011
NESC
“If you broke your leg you’d be fairly confident
that your company would stick by you and
you’d still have your job to walk into when
you’d be better again. If you’re off with
depression, because there’s that whole ‘is he
mental?’ thing about it, ‘is he a liability?’…
that you would fear what your company will
do when you get back..”
Employee, Dublin.
NESC
Key Points of Presentation
1. The NESF Project on Mental Health and
Social Inclusion
3. Why Mental Health is Everyone’s Business
4. The Role of the Workplace:
Millward Brown IMS Research
5. Towards an Integrated Approach:
Main Recommendations
NESC
National Economic and Social Forum (2007)
Mental Health and Social Inclusion Report
NESF Project & Project Team
– Chaired by Professor Cecily Kelleher, UCD.
– Representatives from four strands of social partners
and included clinicians and service users.
Aim of Project
• To increase the social inclusion of people with mental
ill-health as well as identify broader strategies and
actions for the promotion of mental well-being across
Irish society.
Key Perspectives of NESF Report
Population
Health
Community
Social Model
Mental
Health
Health
Promotion
Central Role of
Service Users
Recovery
Approach
NESC
Mental Health and Social Exclusion
• Mental health is used here to refer to “a state of wellbeing in which the individual realises his or her abilities,
can cope with the normal stresses of life, can work
productively and fruitfully and is able to make a
contribution to his or her community” (World Health
Organisation, 2001:1).
• Those who are socially excluded have an increased
incidence of mental ill-health and vice versa so that it can
develop into a cycle of exclusion (Social Exclusion Unit,
2004).
NESC
Mental Health is ‘Everybody’s Business’ (WHO, 2005)
• The societal costs of poor mental health are
enormous: reduced economic performance, human
and social capital and increased health and social
welfare costs (WHO, 2006).
• Not just about specialist services: The vast majority
of mental health care in Ireland happens in primary
care- 85% of GPs referred fewer than 5% of their
patients to mental health specialists.
• Not just important for health policy: International
good practice guidance makes clear that mental
health should be an interdepartmental concern
(Amnesty International, 2010).
Widening the Focus on Mental Health
The WHO European Ministerial Conference on
Mental Health (2005) concluded that ‘mental
health is central to the human, social and
economic capital of nations and should therefore
be considered an integral and essential part of
other public policy areas such as human rights,
social care, education and employment’.
E.g. Finnish Health in All Policies includes housing,
transport, education etc.
2005- EC Green paper –Improving the Mental
Health of the Population- EU strategy on mental
health. 2008-European Pact for Mental Health and
Well-being
2011- No Health without Mental Health (2011) A
Cross Government Mental Health Outcomes
Strategy (England)
NESC
Irish Policy Context
• We have the vision. The blueprint for mental health policy development
in Ireland is ‘A Vision for Change’ (Department of Health and Children,
2006). Provides policy framework for an integrated approach.
• The Independent Monitoring Group (IMG) is monitoring progress.
Implementation has been slow to date without a comprehensive
implementation plan (2009). Mental Health Commission (2009) From
Vision to Action: Analysis of the Implementation of A Vision for Change;
and (2007) The Quality Framework for Mental Health Services in Ireland;
Amnesty International (2010) The Missing Link: Co-ordinated Government
Action on Mental Health.
• A welcome development has been the establishment of the Office for
Disability and Mental Health which is driving implementation of this
policy; the Mental Health Commission.
• Wider context: National Disability Strategy; National Action Strategy on
Suicide Prevention; NAPS.
• Commitment in new (2010) Programme for Government for crossdepartmental group.
Improving Mental Health: Co-ordinated Action
Across Levels
Improving Mental
Health
Work
Integrated
Services
Reducing
stigma
Community
Engagement
Social
support
NESC
Why Work is Key
• Maintaining work can be critical for those experiencing mental
ill-health (Fine-Davis et al, 2005). The risks of social exclusion
greatly increase with loss of employment. Most people with
severe and enduring mental ill-health are not in employment.
• Work is a gateway to civil and economic life of a community
(Pavis et al, 2002). Many paths to recovery: work is a continuum
from meaningful unpaid activity to paid employment.
• Retaining employment makes sense for everyone if supports
are there.
• At the time of the project, little was know about attitudes in the
workplace towards mental health issues.
NESC
Mental Health and the Workplace
Millward Brown IMS Research
Lack of workplace policies – only 20% of employers had written
policies in place but most wanted more information and guidance.
Mostly supportive of employees with mental ill-health but still some
negative attitudes -54% agreed with the statement that they
would be taking a significant risk when hiring someone with
mental ill-health.
Disclosure- There is a fear of disclosing a mental health issue to
employers and colleagues- 58% of employees would tell their
employer and 43% would tell their colleagues.
16% of employees experienced mental ill-health in last 2 years.
Workplace Research Conclusions
• The stigma of mental health is in the
workplace. Negative attitudes persist.
• Employers and employees need information,
guidance and guidelines as to what to do if
they face a mental health problem.
• At a policy level, the workplace’s role to
support and foster positive mental health has
not received sufficient attention.
Work, Training and Meaningful Occupation
• A range of schemes, programmes, rehabilitative
training and workshops and supported employment
exist.
• Shift towards placement in jobs rather than
prevocational training increases people’s chance of
genuine social inclusion.
• Early intervention is key.
• A ‘virtual ramp’ for returning to employment (Hooper,
1996).
• Aim is facilitate the delivery of ‘a seamless service’
through formal coordination structures (Vision for
Change, 2006).
Six Pillars of Recommendations:
Mental Health and Social Inclusion
Institutional
and
Budgetary
Issues
Raising
Awareness
Integrated
Services
The
Workplace
and
Employment
Community
Development
Young People
The Workplace and Employment
• A Health and Well-Being Framework Strategy for
the workplace including:
–Guidelines and information on good
employment;
–A code of practice for employers and
employees on their statutory obligations
and duties.
• An integrated strategic plan for the delivery of
training, work and employment services.
• Integrated vocational support within mental health
services a part of a Supported Employment model.
Final Conclusions
• Actions in mental health have to be considered across the
breadth of all social, economic and health policy in Ireland.
Constrained resources can be a driver for collaboration and
stream-lining approaches.
• Responses have to be both at a strategic level, for everyone,
and targeted at vulnerable groups and individuals.
• Policy implementation is complex and messy- requires
organisational and cultural change as well as clear delivery
plans, accountability, targets and a focus on outcomes.
Lessons from NESF work on implementation of Child Literacy
and Social Inclusion and Home Care Packages.
• Current work at NESC- Quality and Standards in Human
Services
Contact Details
• For further information please contact:
Dr Jeanne Moore
The National Economic and Social Council
Direct Line: 01 814 6366
Email: Jeanne.Moore@nesc.ie
All references in this presentation are available in the Mental Health and
Social Inclusion Report and this report alongside the Mental Health in the
Workplace Report are still available to download from NESF website
www.nesf.ie or hard copies are available from the NESC.
.