A New Era for Psychological Therapies: Returning People with Common Mental Health Problems to Work
Berge, Torkil
Vinderen Community Mental Health Center, Diakonhjemmet hospital, Oslo, Norway, Norway;
Employment is a crucial part of human life – providing financial security, meaning, identity and social participation. Even though most people with mental health problems want to work, and having a job has been shown to be highly beneficial for their physical and mental health, they have the lowest employment rate of all disabled groups. Sickness, absence from work, underperformance due to stress, depression and anxiety disorders are major public health and economic problems, resulting in an estimated annual four billion pound workplace loss in the United Kingdom.
Existing research has tended to focus on interventions for people with severe mental health problems such as vocational rehabilitation, but depression and anxiety affect 20% of the working population, especially people in non-manual jobs; teachers, nurses, police officers and medical practitioners.
The need for psychological services is enormous, and only a small proportion of individuals in need receive treatment. Efforts to make talk therapies available to these vast numbers of people has been described as the most radical re-think in mental health services since the large scale closure of psychiatric beds. In the Improving Access to Psychological Therapies (IAPT) Scheme, one million people in England will receive such help, delivered by more than a hundred treatment-centers.
A cognitive behavioural approach should include evidence based interventions for helping people cope with a wide range of workrelated factors contributing to stress, depression and anxiety – job insecurity, role conflict and ambiguity, work-family conflict, emotional exhaustion, organizational injustice, harassment and bullying. Interventions should also be informed by research on the identification and deployment of strenghts – work commitment and engagement, social support, coping strategies, self efficacy, resilience and positive emotions.
In Norway there are several projects inspired by the IAPT, designed to help people with depression or anxiety on sick leave or who are at risk of going on sick leave. The results are promising. It is exciting to have been given the opportunity of developing new ways of implementing a portfolio of psychological services; individual psychotherapy, coping with depression courses and guided self-help (bibliotherapy and computerized therapy in combination with therapeutic telephone interventions). Most people with common mental health problems are not being served. Current models of delivery need to be expanded to reduce the burden.