Editor’s Note: This article is part of a series in which the PBS NewsHour and the Organisation for Economic Co-operation and Development, or OECD, explore how health care and health policy in OECD’s 34 member countries compare with the United States. Below, Christopher Prinz, a senior OECD policy analyst on employment, labour and social affairs, examines why employment policies and mental health policies should be integrated. Photo by Mark Bowden via Getty Images.
One American in two develops a mental illness at some point in their lives. At any moment in time, about 20 per cent of the population in developed countries has a mental illness.
We know surprisingly little about why so many people suffer depression, anxiety or addiction to drugs and alcohol. We do know, however, about the severe consequences on their social and economic lives.
In the U.S., people with a mental illness are two to three times more likely to be unemployed, and their employment rate is 15 percentage points lower than for those without mental health problems. They are also more likely to call-in sick, often for longer periods, and to under-perform at work. Similar patterns are found in other OECD countries.
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There is also a strong link between mental instability and poverty. In the U.S., the income of people with severe mental health problems is almost three times more likely than average to fall below the poverty threshold. This risk is much higher in the U.S. than in most European countries that have stronger social safety nets.
There are a number of political and social factors that contribute to the poor labor market outcomes and the high poverty risks of people with a mental illness:
The health system is poorly adapted to handle mental health problems. Because there is a stigma attached to mental illness, people often do not seek the help they need. Unlike physical health concerns, only about half of those with a severe mental disorder and less than a third of those with moderate disorders receive treatment. Even when they do seek help, treatment is often inappropriate. Doctors are more likely to prescribe medication than to offer therapy and patient compliance is low.
Job opportunities are limited. Employers cannot find the help they need to keep people with mental health problems on the job and social services don’t do enough to stop the unemployed from falling into depression. Work placement services are ill-prepared to assist clients with a mental illness because their profiling tools either do not identify mental illness as a barrier to the job market or they underestimate the employment potential of those with a diagnosed mental disorder.
- Employment and health systems don’t complement each other. People who need assistance with both mental health issues and finding or keeping a job are rarely well-served by ‘the system.’ Health care services treat the illness without considering workplace-related problems, and public employment services focus on jobs without considering the necessary medical treatment.
What needs to be done? Health care systems should ensure that people have access to adequate treatment, especially for common disorders such as anxiety and depression. Too often the long waiting times and high cost of psychological therapy prohibit people with lower socioeconomic status or without medical insurance from seeking help.
Employment services should modify their profiling and assessment tools as well as their labor market policy instruments to factor in the benefits that mentally ill people can bring to the work place. For example, continuous support for both employers who hire people with mental health problems and the mentally ill themselves should be provided more widely. Hiding people with a mental disorder away on long-term benefits is not a solution.
Integrating health and employment services will be a challenge. In federal states, they are often the responsibility of different levels of government. In the U.S., employment policy is a state affair, while health policy falls largely under the national domain. Countries are trying to improve cooperation across sectors by gathering people around the table or by cross-funding of services across sectors but the administrative and procedural costs are very high and the effect often limited.
An alternative approach would be to provide integrated services within each sector. The UK’s “fit-for-work services,” for example, tackles health and employment issues inside the health sector. General practitioners and other agents within the health sector help provide counselling on work and workplace related issues in parallel to treatment.
Conversely, employment service providers could employ mental health specialists to provide, or refer people to, the right treatment as and when necessary. Examples of such an integrated approach are still rare but slowly rising.
For more OECD research on mental health, visit www.oecd.org/els/disability.