Devil’s advocate: Coping with health reviews

After Working for a Healthier Tomorrow, and Improving Health and Work, we’re now Working Our Way Back to Better Mental Health. With an election pending, we may get more rhetoric, but there should be fewer reports to worry about this year.

This latest report to improve mental wellbeing draws together many existing activities into a single coherent framework. There are an impressive 65 commitments – some of these may even be new, but a great many aren’t. There would be hardly any commitments if the list omitted existing ones, such as the OH helpline pilots, the Equality Bill, and the notoriously non-clinical health and work co-ordinators.

The government “think around £2bn-4bn is likely to be paid [in statutory sick pay] because of mental ill health”. Think? The range of this estimate is enormous – £2bn-£4bn may roll off the pen, but the 100% variance emphasises the need for much better sickness absence data collection.

Yet again the data from the Labour Force Survey gets dragged out: “17% of the working population think their job is extremely or very stressful”. Thorough epidemiological research has long since highlighted the over-estimates in this survey. Unfortunately, there is no systematic and large-scale collection of data on work-related mental health issues.

The government “estimate that between £30bn-40bn can be attributed to mental ill health”. What’s £10bn between friends? As the former US senator Everett Dirksen once said: “A billion here, a billion there, and pretty soon you’re talking real money.” There just isn’t any rigorous approach to measuring the economic cost of poor mental health.

Despite the lack of good data, all are agreed that it is important to improve support for workers with mental health issues.

The report acknowledges that “GPs have traditionally received little or no training on the relationship between health and work”. This will be helped by “easier access to practical advice” through “an occupational health advice line”. Unfortunately, this is a time and funding-limited pilot provided locally by only nine NHS Trusts. Hopefully, the pilot will be an actual and a political success, and then extended across the UK in 2012.

GPs may pick up the phone to seek advice, but there is compelling evidence they won’t. Already they have the capacity to commission these kinds of support services to meet their patients’ needs through practice-based commissioning, but most commission very little at all and certainly no occupational health advice. The latest report says nothing to encourage this. While it notes “in particular” that NICE guidance “offers practical recommendations” for employers, it makes no comment about commissioners.

The NICE guidance on promoting mental wellbeing in the workplace is very clear on commissioning. Workers deserve access to support – it is both effective and cost-effective. We are all too familiar with the social cost of mental illness, not just in terms of lost production and benefit payments, but in terms of lost opportunity, hopelessness, and deprivation. In caring for workers with mental health issues, we also care for their families and communities. GP and PCT commissioners should not need further encouragement.

Dr Richard Preece is a consultant occupational physician.

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