Doctor’s notes: the serious impacts of mental ill health
I last wrote offering advice on mental health issues about a year ago. To be asked by the editor to contribute another article about this topic within such a short time scale suggests that this subject is of ongoing interest to readers. To re-iterate – mental health problems are common and costly.
According to a publication in 2015 by the Mental Health Foundation, total costs of mental health problems in the UK were between £70 – £100 billion. While it could be argued that the Mental Health Foundation has a vested interest in maximising the scale of the problem, it’s worthwhile noting that other publications report similar ‘ball park’ figures, although while compiled over varying time periods, some of the sources from which they draw their information are similar.
However, rather than merely re-iterate the contents of my previous effort, I will endeavour to approach this extensive topic from a different viewpoint.
Whilst some (myself included) have ‘Tut tutted’ and ‘harrumphed’ at the ‘snowflake generation’ it’s important to view the situation from the other extreme as well. People with serious mental health problems are more likely to die before their time.
A survey of over one million Americans diagnosed with schizophrenia who were of working age were followed up for seven years. They were more than 3.5x more likely to die than the general population of similar age, losing on average 28 years of life.
Suicide is the leading cause of death in men under 35, and about six percent of sufferers from eating disorders will die from the consequences of their illness.
However, despite the relentless increase in the burden of mental health problems, the proportion due to severe and enduring disease still remains at about one per cent, although it includes a disproportionately large number of long-term unemployed among its number.
Nonetheless, even the more common and less severe disorders, if they become chronic and significantly interfere with function, can be associated with job loss.
The likelihood of developing mental health problems depends on the interaction of a combination of personal predisposition and other environmental factors, some of which may arise in the work environment. In very rare cases, these will include exposure to substances like solvents or mercury.
Breathing in sufficient quantities of these vapours of these materials can give rise to bizarre behaviour. In workplaces where these materials are present, safety advisors will be able to exercise traditional skills to eliminate, or at least minimise the risk arising from these or other, more old-fashioned hazards such as being struck by falling objects which produce head injuries which may have mental health sequelae as a result of brain damage, or post-traumatic stress disorder.
Far much more commonly, employees present with disaffection, rather than disease which often arises as a result of the perceived.
Whatever the cause of the problem, I think it important that safety advisors concentrate on the functional aspects of mental health problems, rather than the detailed diagnosis. This will enable safety advisors to concentrate their thoughts about how best to remind those that they advise of the relevance of legislation, in particular the Disability Provisions of the Equality Act 2010.
This requires employers to make reasonable adjustments to enable employees with disabilities to perform the core duties of their jobs. The adjustment that most often springs to mind is to accept a higher rate of sickness absence.
Whilst this might be an option, it is important to remember the aim of the legislation is to facilitate productive work from these employees. It should not be regarded as a ‘Get out of jail free’ card to excuse poor attendance, for whatever reason.
Attention to functional aspects will also help to avoid the unnecessary medicalisation of issues that may best be solved by talking with others, devising a plan and acting on it. ‘Talking therapies’ are often as effective as medication in the treatment of mild to moderate depression and anxiety and can sometimes be delivered online.
However, potential users are probably best introduced to them following discussion with appropriately qualified and experienced professionals, since the user may well have to work hard to derive maximum benefit – the individual will not be magically transformed.
For sufferers who tend towards the more severe end of the spectrum, judicious use of medicines may buy time to bring symptoms under control and improve concentration.
Finally, to help employees move on, how easy is it for them to access impartial advice on problems such as debt and relationship problems, since financial and sexual disinhibition can sometimes feature as manifestations of mental disorders, producing damage that needs to be repaired once the clinical crisis is over?
Like most occupational physicians, a considerable minority of my mental health consultations involve work-related stressors. Of course, I often only hear one detailed account of events but often, unrealistic job design – perhaps as a result of ‘mission creep’ – or poor management – lie behind the problem.
While safety advisors should avoid being drawn in too deeply to individual cases, it is important to take notice of the overall business culture of the organisation, and the extent to which employees are involved in its development.
Given that working lives are lengthening, then it is essential that people WANT to come to work, so it would be essential to determine what makes employees thrive, rather than solely concentrating on damaging effects. Research in this area is likely to increase in future years.
Lastly, never forget the baleful effects of alcohol, and its potential to cause or exacerbate problems, in particular, the so-called ‘Boozer’s gloom’. Whenever anyone comes to see me, whether for sickness absence reasons, fitness for work, health surveillance or for medico-legal purposes, I always enquire about their alcohol consumption.
Most profess moderate consumption, although I suspect that some underestimate their intake. Some are more honest, but I do remember one who maintained that they only drank Bacardi at New Year, which prompted the spouse to add “Aye… not forgetting the Chinese/Jewish/Muslim/Hindu and Buddhist New Years as well!”
I was astounded to read that, based on the sales figures for alcohol, the average adult in Scotland consumes the equivalent of 41 bottles of vodka per year. This is the equivalent of over 20 units a week, and this in a nation where more than 20% claim to be teetotal!
I hope that these thoughts will prompt safety advisors into proactive considerations of ways of making the organisations with which they are involved safer and happier places in which to work.
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