The stresses and strains of work and unemployment

When I ask Dr Adam Coutts what we know about the impact of unemployment on health, his response is blunt and to the point: “It’s very bad.”

There’s a pause before he goes on to say that we’ve known for more than half a century that unemployment is bad for mental health and wellbeing, and that this has a knock-on effect on our physical health. Where there is debate, though, is over why it is so bad. Studies suggest that work provides what he describes as “psychological vitamins or functions”, such as structure, routine, a sense of identity and the opportunity to meet people and socialise. “It’s not all about a wage,” he says.

Coutts has been on research placement from the Department of Sociology to the UK government’s Department for Work and Pensions (DWP) and the Department of Health and Social Care (DHSC) Work and Health Unit since June 2016. There, he has been looking to better understand the link between unemployment and mental health, particularly in the context of today’s Britain, and how policy can intervene to help.

He is studying an intervention that aims to get people back to work and to support their mental health needs. The programme is adapted from one developed by the Institute of Social Research at the University of Michigan and now being trialled by the DWP. Participants take part in a voluntary five-day course, during which they receive help with CV writing, social support, interview techniques and how to search for a job, including how to see the process from the viewpoint of an employer.

Coutts has been conducting an ethnographic study across five areas of England since the trial started in January 2017 to complement a large-scale randomised control trial evaluation. He has what he describes as “a ringside seat” of the policy process and has seen how the intervention has been designed, implemented and evaluated: a privileged point of access for any academic researcher. He observes course participants and facilitators, and staff at job centres – “everyone from the unemployed to senior civil servants” – to see how these policies actually work on the ground.

“We know these types of interventions have an effect on job search behaviours and a person’s health, but we don’t really know why and who is most responsive. I’m trying to tell a story of what it’s like to go through these programmes, be unemployed and cope with mental health issues in Britain today.”

If the evidence from previous trials in the USA is anything to go by, then the benefits from such an intervention would reach beyond the individual: as well as helping people get back to work, improving their mental health and wellbeing could save money for the NHS, as a result of less reliance on GP or mental health services.

But mental health issues are not just associated with unemployment. There is a growing recognition of the link between employment and our health and wellbeing, too. A recent report for government, entitled ‘Thriving at Work’, included some startling statistics for the UK: 15% of workers have a mental health condition and 300,000 people with long-term mental health problems lose their jobs each year. Mental health costs employers over £33 billion per year, the state over £24 billion and the whole economy over £73 billion.

“Employers need to understand that stress and anxiety, and mental ill health, is a large problem in terms of people not being at work, or being at work and not performing well,” says Professor Dame Carol Black, Principal of Newnham College, and author of several influential reports for government about work and health.

Black believes that training at line management level to identify and support workers with mental health issues is essential to tackling this problem; without this, measures to create healthier workplaces will amount to little more than papering over the cracks, Black says.

However, she has seen enough examples of good practice in companies such as BT, Unilever and Anglian Water to be optimistic that we can tackle this problem. “What you see are pockets of good practice, but I think we need a campaign to really get it out there and say we know this is what we all should be doing – it isn’t that difficult to do.”

Business leaders are beginning to pay attention. In an article earlier this year following the annual meeting of the World Economic Forum, Clifton Leaf, Editor-in-Chief at the influential business magazine Fortune, chose as number one of ‘7 Takeaways From Davos’: ‘The mental health disorder time bomb is upon us’.

One of the problems, however, is the lack of concrete evidence about what works. “People often ask ‘where’s the Cochrane-type evidence?’” says Black, referring to the ‘gold standard’ of evidence reviews in research. “It’s not easy to collect data in the workplace, but we would only have better evidence if more organisations collected data and were willing to share it.”

Dr Tine Van Bortel from the Cambridge Institute of Public Health is helping to build this evidence base. In fact, she was namechecked in Leaf’s article after he attended a mental health event at Davos that she co-presented with the international care consortium Kaiser Permanente.

As part of her mandate with the World Economic Forum Global Agenda Council on Mental Health, Van Bortel has been leading a study looking at policies used by major corporations aimed at improving the health and wellbeing of their workforce. “A lot of these corporations say that a combination of integrated and targeted approaches are really important,” she says.

An integrated approach might consist of providing access to a gym. Targeted interventions might include a willingness to make ‘reasonable adjustments’ such as moving an employee to less strenuous work or allowing
them to work part time.

While Van Bortel believes employers should take responsibility for ensuring the health and wellbeing of their employees, she is a passionate believer that government can – and should – think about our mental health.

“I firmly believe that government should ensure our workplaces are healthy and that we’re not being confronted with some of the stressful, unjust and – quite frankly – inhumane situations that we’re currently seeing.

“Think about zero-hours contracts, or people having to work three jobs to make ends meet, or wage discrepancies and other structural inequalities. This puts a lot of stress on persons, families and ultimately society, and can reflect on work and productivity. More can and should be done. After all, healthy and all-inclusive workforces make excellent business sense.”