Tackling mental ill-health among the working-age population is becoming a key issue for labour market and social policies in OECD countries. It is an issue that has been neglected for too long, reflecting widespread stigma, fears and taboos. Employment opportunities for people with mental ill-health are low, many of those who are employed struggle in their jobs, and disability caused by mental ill-health is frequent and rising. OECD governments increasingly recognise that this situation is not sustainable and that policy has a major role to play in improving it.

The costs of mental ill-health for the individuals concerned, employers and society at large are very large. A conservative estimate from the International Labour Organisation put them at 3-4% of gross domestic product in the European Union. Most of these costs do not occur within the health sector. Mental illness is responsible for a very significant loss of potential labour supply, high rates of unemployment, and a high incidence of sickness absence and reduced productivity at work.

This chapter reviews methodological and measurement issues and lays out the key policy questions to be addressed. Mental ill-health is measured from national health surveys which use a reliable mental health instrument. A transparent methodology is used to make results comparable across different instruments, taking advantage of findings from epidemiological studies on the prevalence of mental disorders. These suggest that at any one moment around 5% of the working-age population have a severe and another 15% a common mental disorder. Both groups should be targeted by policy makers. The chapter discusses the characteristics of mental illhealth, including e.g. the very early onset, and their implications for policy making. The key challenge to be addressed is the rising labour market exclusion attributable to mental ill-health despite no indication of an increase in the prevalence of such disorders. A framework for policy development is proposed, based on two dimensions, the severity of the mental disorder and the person’s labour force status.

This chapter investigates the connection between mental health and work and presents new evidence on the position of persons with mental health problems in the labour market in a number of OECD countries. The findings show that, despite the positive effects of employment on mental health, too many persons with a mental disorder are out of work. Persons with a severe mental disorder are 6-7 times more likely to be unemployed than people with no such disorder, and those with a common mental disorder 2-3 times. At the same time, however, the findings also suggest that more persons with a mental disorder are employed than is generally thought. This confirms the urgent need to address mental health issues at the workplace since many jobs or particular tasks can cause job strain and exacerbate mental illness. To ensure that workers with poor mental health can retain their jobs and work productively is therefore a key objective calling for policies to improve job quality, working conditions and management practices to prevent unnecessary exclusion from the labour market.

This chapter focuses on the links between treatment and employment of people with a mental disorder, both from the individual treatment perspective and a broader mental health care systems’ perspective. In the past decades, effective medical and psychological treatments and differentiated, community-based mental health care systems have been developed. However, these improvements have so far neither translated into a substantially broader inclusion of people with a mental disorder into the workforce nor to financial independence. The evidence points to manifold reasons for this, including the still severe under-treatment, or delayed treatment, of people with a mental disorder, some intrinsic characteristics of even milder disorders like co-morbidity, chronicity and the role of the personality, as well as the lack of collaboration between the health care system, the employers and other stakeholders. Finally, although most mental disorders are strongly influenced by socioeconomic factors, there is a prevailing neglect of employment issues in the treatment situation.

This chapter looks at the role of and developments in different parts of the benefit system and the take-up and effectiveness of labour market services. It finds that benefits other than disability benefit – mainly unemployment and social assistance benefits – play a large role, especially for people with common mental disorders. The functioning of these systems is therefore crucial for the overall outcomes, especially the ability of those systems to identify a client’s mental illness and the resulting support needs. For the disability benefit system the findings suggest that the rising share of claims caused by mental disorders is to a large extent the result of i) a work-limiting understanding of mental illness, and ii) the shift among people with co-morbid conditions towards taking the mental health condition as the primary cause for incapacity. On the effectiveness of employment services the chapter concludes that systems fail to ensure a timely delivery of services for people with a mental disorder.

This chapter addresses a number of key issues concerning the mental health of youth. The early onset of mental disorders – with a median age of onset across all types of illnesses of around 14 years – highlights the importance of prevention and early intervention to avoid that mental health problems affect the development and education of children and adolescents, and consequently their social and professional life as adults. The chapter discusses the potential of the education system in promoting good mental health and preventing mental ill-health, and the challenges for support systems that surround the transition from adolescence to adulthood and into employment. Lack of awareness and non-disclosure are key challenges for better intervention and improved rates of treatment at an early age. Another challenge in many countries is the large and rising flow of young adults onto the disability system, without or with only limited work experience. This underlines the importance of policy intervention that is multidisciplinary and wellco- ordinated across the education, health and labour market sectors.

This chapter summarises the main findings of the report, including new evidence which questions some of the myths and taboos around mental ill-health and work. People with a severe mental disorder are too often too far away from the labour market, and need help to find sustainable employment. The majority of people with a common mental disorder, however, are employed but struggling in their jobs. Neither are they receiving any treatment nor any supports in the workplace, thus being at high risk of job loss and permanent labour market exclusion. This implies a need for policy to shift away from severe to common mental disorders and subthreshold conditions; away from a focus on inactive people to more focus on those employed; and away from reactive to preventive strategies.