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Mental health
and work:
Impact, issues and
good practices
Mental Health Policy and Service Development
Department of Mental Health
and Substance Dependence
Noncommunicable Diseases and Mental Health
World Health Organization
Target Group Unit
InFocus Program on
Knowledge, Skills and Employability
International Labour Organisation
Mental health policy and service development team
Objectives and strategies
To strengthen mental health policies, legislation and plans through: increasing
awareness of the burden associated with mental health problems and the commitment
of governments to reduce this burden; helping to build up the technical capacity of
countries to create, review and develop mental health policies, legislation and plans;
and developing and disseminating advocacy and policy resources.
To improve the planning and development of services for mental health through:
strengthening the technical capacity of countries to plan and develop services;
supporting demonstration projects for mental health best practices; encouraging
operational research related to service delivery; and developing and disseminating
resources related to service development and delivery.
Financial support is provided from the Eli Lilly and Company Foundation, the Johnson and
Johnson European Philanthropy Committee, the Government of Italy, the Government of
Japan, the Government of Norway, the Government of Australia and the Brocher
Further information can be obtained by contacting:
Dr Michelle Funk
Mental health policy and service development (MPS)
Department of Mental Health and
Substance Dependence (MSD)
World Health Organization
CH - 1211 Geneva 27, Switzerland
E-mail: [email protected]
Telephone: (41) 22 791 3855
Fax: (41) 22 791 41 60
Mental health
and work:
Impact, issues and
good practices
Gaston Harnois
Phyllis Gabriel
Mental Health Policy and Service Development
Department of Mental Health
and Substance Dependence
Noncommunicable Diseases and Mental Health
World Health Organization
Target Group Unit
InFocus Program on
Knowledge, Skills and Employability
International Labour Organisation
ii Nations for Mental Health
WHO Library Cataloguing-in-Publication Data
Harnois, Gaston.
Mental health and work : impact, issues and good practices / Gaston Harnois, Phyllis Gabriel.
(Nations for mental health)
1.Mental health 2.Workplace 3.Mental disorders - therapy 4.Mental health services - standards
5.Occupational health services - standards 6.Benchmarking 7.Cost of illness
I.Gabriel, Phyllis. II.Title III.Series
ISBN 92 4 159037 8 (NLM classification: WA 495)
ISSN 1726-1155
This publication is a reprint of material originally distributed as WHO/MSD/MPS/00.2
This publication is a joint product of the World Health Organization and the
International Labour Organisation.
World Health Organization 2002
All rights reserved. Publications of the World Health Organization can be obtained from Marketing
and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel:
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should be addressed to Publications, at the above address (fax: +41 22 791 4806; email:
[email protected]).
The designations employed and the presentation of the material in this publication do not imply the
expression of any opinion whatsoever on the part of the World Health Organization or the
International Labour Organisation concerning the legal status of any country, territory, city or area
or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on
maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers' products does not imply that they
are endorsed or recommended by the World Health Organization or the International Labour
Organisation in preference to others of a similar nature that are not mentioned. Errors and
omissions excepted, the names of proprietary products are distinguished by initial capital letters.
The World Health Organization and the International Labour Organisation does not warrant that the
information contained in this publication is complete and correct and shall not be liable for any
damages incurred as a result of its use.
Printed in Switzerland. Layout by rsdesigns.com.
Mental health and work: Impact, issues and good practices iii
Preface vi
Chapter 1
1.1 Scope of the problem 1
1.2 Mental health problems cause disability 1
1.3 Using the workplace to prevent mental health problems and
provide solutions for referral and rehabilitation 3
Chapter 2
The importance of work to an individual's mental health
2.1 The workplace and mental well-being 5
2.2 Categories of psychological experience 5
Chapter 3
The workplace and mental health
3.1 Promotion of mental health in the workplace 6
Good Practice: Workplace activities for mental health United Kingdom 7
3.2 Job stress the stressful characteristics of work 6
3.3 Consequences of mental health problems in the workplace 8
3.4 Mental health and unemployment 9
Chapter 4
Mental health an imperative concern
4.1 Issues facing employers and managers 11
Good Practice: Promotion/prevention a case study on organizational stress 12
4.2 Country examples 13
4.2.1 United Kingdom the health of the nation 14
4.2.2 Mental health issues in Finnish workplaces 14
Good Practice: Total wellness programme, Finland 15
4.2.3 Targeted intervention to facilitate return to work in Canada 14
Good Practice: The use of group process to facilitate work reintegration 16
4.3 Action needed 15
4.3.1 Specific steps an employer can take to help an employee
return to work after treatment for a mental health
problem such as depression 15
4.3.2 Employee assistance programmes (EAPs) 16
4.3.3 Practical suggestions for small businesses 17
Good Practice: Employee Assistance Programme, USA 18
iv Nations for Mental Health
Chapter 5
Work as a mechanism for reintegrating persons with serious mental illness
5.1 Size and profile of this group 19
5.2 Historical perspective 19
5.2.1 Deinstitutionalization 19
5.2.2 Organization of services 21
5.2.3 Psychosocial rehabilitation 21
5.2.4 Developing work skills 22
5.3 Current context: changes in the nature of work 23
5.4 Overcoming obstacles affecting clients' ability to access work 24
5.4.1 Context 25
5.4.2 Overcoming obstacles linked to the illness 25
5.4.3 Overcoming obstacles linked to lack of
educational training and lack of work experience 26
Good Practice: Supported education in Boston Choose/Get/Keep 27
5.4.4 Overcoming obstacles linked to prejudice and stigma 28
5.4.5 Myths about mental illness and the workplace 29
5.4.6 Overcoming obstacles linked to government policy 30
5.4.7 Overcoming obstacles linked to the labour market 31
5.5 The perspective of international agencies 32
5.5.1 United Nations 32
5.5.2 World Bank and the Harvard Report 33
5.5.3 International Labour Organisation 34
5.5.4 World Health Organization 36
5.5.5 Nongovernmental organizations 37
5.5.6 Overseeing training and employment of persons with disabilities 37
Good Practice: Vocational rehabilitation for individuals with a psychiatric disability 38
the Australia experience
5.6 Rights of persons with serious mental health problems with
respect to access to work 39
5.7 International variations pertaining to culture, social structure and
economics that may exist in developing countries 39
5.7.1 Countries in transition 39
Good Practice: A cotton factory in Beijing, China 40
5.8 Promoting the employment of persons with mental health problems 41
5.8.1 Political will and legislation 41
Good Practice: Towards "reasonable accommodation" of persons with mental health problems 42
5.8.2 Quota system 43
5.8.3 Support 43
5.8.4 Coordinated action 43
Mental health and work: Impact, issues and good practices v
5.9 Research findings 44
5.9.1 Potential predictors of successful participation 44
5.9.2 Developing work skills 44
5.9.3 Costs 47
5.9.4 Useful research tools 47
5.10 Successful work programmes at the international level 48
5.10.1 Utilization of supported employment programmes 48
5.10.2 Finding a job on the regular market 48
5.10.3 Developing social firms 49
5.10.4 Utilizing the cooperative movement 51
5.10.5 Other international examples 52
Good Practice: An American Bank 52
Good Practice: Service Cooperative, Italy 53
Good Practice: A complete furniture factory, Spain 53
Good Practice: Gardening project in Milan, Italy 54
Good Practice: An Olympic task, Montreal, Canada 54
Good Practice: A Mental Health NGO in Northern Ireland 55
Chapter 6
Discussion 56
Chapter 7
Conclusion 60
References 61
vi Nations for Mental Health
All of us have the right to decent and productive work in conditions of freedom,
equity, security and human dignity. For persons with mental health problems,
achieving this right is particularly challenging. The importance of work in enhanc-
ing the economic and social integration of people with mental health problems is
highlighted in this monograph.
The International Labour Organisation (ILO) has long recognized the impor-
tance of documenting the extent of disabilities among the labour force and setting
up effective preventive and rehabilitative programmes. The ILO's activities pro-
mote the inclusion of individuals with disabilities in mainstream training and
employment structures. The importance of addressing specific issues related to the
employment of persons with mental health problems has also been recognized.
ILO promotes increased investment in human resource development, particularly
the human resource needs of vulnerable groups, including persons with mental
health problems. Employees' mental health problems and their impact on an
enterprise's productivity and disability/medical costs are critical human resource
issues. Increasingly, employers' organizations, trade unions and government poli-
cy-makers are realizing that the social and economic costs of mental health prob-
lems in the workplace cannot be ignored.
Because of the extent and pervasiveness of mental health problems, the World
Health Organization (WHO) recognizes mental health as a top priority.
Using instruments that allow us to see not how people die but rather how they
live (1), we now know that the problems of mental illness loom large around the
world. It accounts for 12% of all disability-adjusted life-years (DALYs), and 23%
in high-income countries.
Five of the 10 leading causes of disability worldwide are mental problems (major
depression, schizophrenia, bipolar disorders, alcohol use and obsessive-compul-
sive disorders). These disorders together with anxiety, depression and stress
have a definitive impact on any working population and should be addressed
within that context. They may also develop into long-term disorders with accom-
panying forms of disability.
Given the fact that numerous affordable interventions exist, the time has come to
challenge both the low priority given to mental health and the stigma that those
with mental ill-health still endure around the world.
We now know that when essential drugs, if needed, are made available and access
is offered to a psychosocial rehabilitation programme (including the access to
meaningful and realistic employment) many persons will be able to lead more
socially and personally satisfying lives.
Mental health and work: Impact, issues and good practices vii
WHO has made a renewed commitment to mental health in making it one of its
priorities. Mental health will be the theme of World Health Day 2001 and also
the World Health Report 2001. Given the multifaceted nature of the factors that
contribute to good mental health, WHO is ever mindful of the need to highlight
activities that foster good practices in mental health. In this monograph the issue
of work as it relates to mental health is addressed.
The publication of this document is particularly important because it has brought
together two large United Nations agencies involved in rehabilitation, namely
WHO and ILO. The document examines the importance of mental health in the
workplace in general, and suggests appropriate management for workers with
mental health problems. In addition, it takes a practical look at strategies to pro-
mote and sustain good mental health while highlighting examples of good prac-
The document was written jointly by Dr Gaston Harnois on behalf of WHO and
Phyllis Gabriel on behalf of ILO. Dr Harnois is Director of the Montreal WHO
Collaborating Centre at the Douglas Hospital in Montreal, Canada. He is also
Associate Professor of Psychiatry at McGill University, and former President of
the World Association for Psychosocial Rehabilitation. Phyllis Gabriel MPH, MA
is aVocational Rehabilitation Specialist at the ILO headquarters in Geneva. She
has worked as a Vocational Rehabilitation Counsellor in US community-based
social service agencies as well as in mental health care facilities.
It is hoped that this important document will assist employers and employees in
raising awareness of the benefits of good mental health practices and encourage
the implementation of strategies to maintain a healthy working environment.
Dr Benedetto Saraceno Mr Pekka Aro
Director Director
Department of Mental Health and InFocus Programme on
Substance Dependence (MSD) Knowledge, Skills and Employability
World Health Organization International Labour Organization
viii Nations for Mental Health
Mental health and work: Impact, issues and good practices 1
Chapter 1
1.1. Scope of the problem
There is growing evidence of the global impact of mental illness. Mental health
problems are among the most important contributors to the burden of disease and
disability worldwide. Five of the 10 leading causes of disability worldwide are men-
tal health problems. They are as relevant in low-income countries as they are in
rich ones, cutting across age, gender and social strata. Furthermore, all predictions
indicate that the future will see a dramatic increase in mental health problems (2).
The burden of mental health disorders on health and productivity has long been
underestimated. The United Kingdom Department of Health and the
Confederation of British Industry have estimated that 15-30% of workers will
experience some form of mental health problem during their working lives. In
fact, mental health problems are a leading cause of illness and disability (3). The
European Mental Health Agenda of the European Union (EU) has recognized
the prevalence and impact of mental health disorders in the workplace in EU
countries. It has been estimated that 20% of the adult working population has
some type of mental health problem at any given time (4). In the USA, it is esti-
mated that more than 40 million people have some type of mental health disor-
der and, of that number, 4-5 million adults are considered seriously mentally ill
(5). Depressive disorders, for example, represent one of the most common health
problems of adults in the United States workforce.
The impact of mental health problems in the workplace has serious consequences
not only for the individual but also for the productivity of the enterprise.
Employee performance, rates of illness, absenteeism, accidents and staff turnover
are all affected by employees' mental health status. In the United Kingdom, for
example, 80 million days are lost every year due to mental illnesses, costing
employers 1-2 billion each year (6). In the United States, estimates for national
spending on depression alone are US$ 30-40 billion, with an estimated 200 mil-
lion days lost from work each year (7, 8).
1.2 Mental health problems cause disability
As illustrated in this monograph, mental health problems affect functional and
working capacity in numerous ways. Depending on the age of onset of a mental
health disorder, an individual's working capacity may be significantly reduced.
Mental disorders are usually one of the three leading causes of disability, together
with cardiovascular disease and musculo-skeletal disorders. In the EU, for exam-
ple, mental health disorders are a major reason for granting disability pensions (9).
Disability not only affects individuals but also impacts on the entire community.
The cost to society of excluding people with disabilities from taking an active part
2 Nations for Mental Health
Costs of occupational and work-related diseases
Skin diseases
Respiratory disorders
Mental disorders
Heart disease
Source: Takala J. (ILO) Indicators of death, disability and disease at work. African Newsletter on
Occupational Health and Safety, December 1999, 9(3):60-65.
in community life is high. This exclusion often leads to diminished productivity
and losses in human potential. The United Nations estimates that 25% of the
world's population is adversely affected in one way or another as a result of dis-
abilities. The cost of disability has three components (10):
the direct cost of welfare services and treatment, including the costs of disabili-
ty benefits, travel and access, possible medication, etc;
the indirect cost to those who are not directly affected (carers);
the opportunity costs of income foregone as a result of incapacity.
For example, analysis of Tanzanian survey data has revealed that households with a
member who has a disability have a mean consumption less than 60% of that of the
average household. This leads the authors to conclude that disability is a hidden
aspect of African poverty (11).
People with disabilities, particularly psychiatric disabilities, face numerous barriers
in obtaining equal opportunities environmental, access, legal, institutional and
Mental health and work: Impact, issues and good practices 3
Social and cultural
exclusion and stigma Denial of opportunities
for economic, social and
human development
to poverty Poverty
and ill-health
Reduced participation in
decision-making, and denial Deficits in economic,
of civil and political rights social and cultural rights
Source: United Kingdom Department for International Development. Disability, Poverty and
Development, February 2000 (modified)
attitudinal barriers which cause social exclusion (12). For people with mental ill-
ness, social exclusion is often the hardest barrier to overcome and is usually associ-
ated with feelings of shame, fear and rejection.
It is clear that mental illness imposes a heavy burden in terms of human suffering,
social exclusion, stigmatization of the mentally ill and their families and economic
costs. Unfortunately, the burden is likely to grow over time as a result of ageing
of the global population and stresses resulting from social problems and unrest,
including violence, conflict and natural disasters (13).
1.3 Using the workplace to prevent mental health problems and provide
solutions for referral and rehabilitation
Globalization and interdependence have opened new opportunities for the growth
of the world economy and development. While globalization has been a powerful
and dynamic force for growth, work conditions and the labour market have
changed dramatically during the last two decades. The key elements in these
changes are increased automation and the rapid implementation of information
technology. Workers worldwide confront as never before an array of new organiza-
tional structures and processes downsizing, contingent employment and
increased workload.
Employers have tended to take the view that work and/or the workplace are not
etiological factors in mental health problems. However, whatever the causal fac-
tors, the prevalence of mental health problems in employees makes mental health
a pressing issue in its own right (14). Although, effective mental health services
are multidimensional, the workplace is an appropriate environment in which to
educate individuals about, and raise their awareness of, mental health problems.
For example, the workplace can promote good mental health practices and pro-
4 Nations for Mental Health
vide tools for recognition and early identification of mental health problems, and
can establish links with local mental health services for referral, treatment and
rehabilitation. Ultimately, these efforts will benefit all by reducing the social and
economic costs to society of mental health problems.
For people with mental health problems, finding work in the open labour market
or returning to work and retaining a job after treatment is often a challenge.
Stigma surrounds those with mental illness and the recovery process is often mis-
This monograph addresses these issues. It provides a practical guide and resource
for human resource managers, mental health professionals, rehabilitation work-
ers, policy-makers, trade unionists and other concerned individuals.
The central themes of this monograph are:
To examine the importance of mental health problems in the workplace.
To consider the role of the workplace in promoting good mental health prac-
tices for employees.
To examine the importance of work for persons with mental health problems.
To discuss the different vocational strategies and programmes for persons with
mental health problems.
To provide examples of good practices. These examples illustrate:
good mental health promotional practices in the workplace by employers;
how to handle an employee who becomes ill with a mental health problem,
such as depression;
vocational rehabilitation models/programmes for persons with long-term
mental health problems.
Mental health and work: Impact, issues and good practices 5
Chapter 2
The importance of work to an
individual's mental health
2.1 The workplace and mental well-being
The workplace is one of the key envi-
ronments that affect our mental well- Work is at the very core of
being and health. There is an contemporary life for most people,
acknowledgement and growing aware- providing financial security, personal
ness of the role of work in promoting or identity, and an opportunity to make a
hindering mental wellness and its corol- meaningful contribution to
lary mental illness. Although it is diffi- community life.
cult to quantify the impact of work Source: NAMI (15).
alone on personal identity, self-esteem
and social recognition, most mental
health professionals agree that the workplace environment can have a significant
impact on an individual's mental well-being.
2.2 Categories of psychological experience (16)
Employment provides five categories of psychological experience that promote
mental well-being:
time structure (an absence of time structure can be a major psychological burden);
social contact;
collective effort and purpose (employment offers a social context outside the family);
social identity (employment is an important element in defining oneself);
regular activity (organizing one's daily life).
Many large companies now realize that their employees' productivity is connect-
ed to their health and well-being. However, more emphasis has traditionally been
placed on physical health than on mental health and well-being.
Several factors at a workplace can promote employees' psychosocial well-being
and mental health. Especially important in this respect is the opportunity to be
included in planning and carrying out activities and events in the workplace (e.g.
the opportunity to decide and act in one's chosen way and the potential to pre-
dict the consequences of one's action). A related feature is the degree to which
the environment encourages or inhibits the utilization or development of skills.
Physical security, opportunity for interpersonal contact, and equitable pay are
also important.
6 Nations for Mental Health
Chapter 3
The workplace and mental health
3.1 Promotion of mental health in the workplace
Notions of mental health at work tend
to focus on the individual rather than "We at the CBI are convinced that the
the organization. A comprehensive poli- mental health of a company's
cy of mental health at work includes, employees can have an important
however, an assessment of the mental impact on business performance in
health of the organization itself. The the same way as do industrial
gain to both individuals and the organi- relations climate or inadequate
zation from promoting good mental training. That is why the CBI
health at work is reflected in increased continues to add its voice to the
presence, well-being and production. campaign to raise the profile of mental
health as a workplace issue."
The constant and unremitting rate of Howard Davies, Director General,
Confederation of British Industry.
change that affects all businesses today
is increasingly motivating employers to
address the health of their staff. Moreover, it is taking its toll on employees, some
of whom fail to cope with the changes and need support to help them avoid
under-performance and absenteeism. The global marketplace is forcing organiza-
tions to upgrade their efficiency and this, in turn, is encouraging employers to
seek ways of enhancing the performance of employees and to avoid losses associ-
ated with health and safety (see example of Marks & Spencer, UK on page 7).
3.2 Job stress stressful characteristics of work
Job stress can be defined as the harmful
physical and emotional response that The nature of work is changing at
occurs when the requirements of the job whirlwind speed. Perhaps now more
do not match the capabilities, resources than ever before, job stress poses a
or needs of the worker (18). Job stress threat to the health of workers and, in
can cause poor health and can increase turn, to the health of organizations.
rates of work-related injuries and acci- Source: National Institute for
dents. Some potential causes of work- Occupational Safety and Health, 1998.
related stress are overwork, lack of clear
instructions, unrealistic deadlines, lack of decision-making, job insecurity, isolated
working conditions, surveillance, and inadequate child-care arrangements (19) (see
examples on page 10). Although sexual harassment and discrimination are often
excluded from lists of traditional job stressors, they must be included in any compre-
hensive analysis of the causes of workplace stress. Sexual harassment is a stressor for
women in the workplace; and discrimination is a stronger predictor of health out-
comes, including mental ill-health, for ethnic minorities than traditional job stressors
(20). Some of the many effects of stress include numerous physical ailments as well as
mental health problems such as depression and increased rates of suicide (21).
Mental health and work: Impact, issues and good practices 7
Good practice: Workplace activities for mental health, United Kingdom
A large international retailer with 696 stores in many parts of the world including North
America, Asia and Europe employs some 56,000 people. Over 52,000 of these are employed
in stores. 83% of the workforce is female and 62% of these are part-time.
Their stated policy is to take the mental health of its workforce seriously: "We realize that
in ensuring the mental well-being of staff we benefit from an individual and company point
of view."
Strategy for health promotion
The strategy for overall health promotion, which includes mental health, is based on the
health education to raise awareness of factors affecting health and well-being;
screening programmes to detect risk factors or early signs of disease;
action programmes to do something about them.
The role of the occupational health service
The occupational health service works closely with personnel and line management regard-
ing all aspects of mental and physical health of employees. The occupational health team is
available to look at the effects of health on work or of work on health, to discuss with staff
any health problems they may have and to promote good health through health education,
screening and action programmes. The company believes that an occupational health serv-
ice can play a major role in helping:
to identify work problems caused by mental ill-health;
to take action to improve the health of employees;
to assist employers in modifying the work and work environment;
to enable employees to remain at work rather than withdraw.
The organization assists in preventing mental ill-health by giving people a good working
environment and a clearly defined job. Following absence, it is often essential to be able to
modify working hours during the rehabilitation period and to provide a gradual return to
usual working practices through a good sick pay scheme. Financial support at this time
allays anxiety and encourages a speedier return to work.
Regular honest appraisals are important and problems in performance should be discussed
when they occur, with an opportunity to follow up and review progress. People should feel
able to contribute to their development and feel accountable for their jobs.
On-site counselling facilities from personnel or health professionals are available, reducing
time away from work (17).
8 Nations for Mental Health
There is growing global concern about the impact of job stress, including issues
related to gender, ethnicity, sexual harassment, violence and mobbing at work,
family, and underemployment (22). Job stress is one of the most common work-
related health problems in EU countries. The Second European Survey on
Working Conditions indicated that 28% of workers reported that their work caus-
es stress. In Japan, the proportion of workers who report serious anxieties or
stress in relation to their working life increased from 53% in 1982 to 63% in
1997. In developing countries, there is increasing concern regarding the health
impact of job stress. For example, an increased risk of work-related illnesses and
accidents has been observed in South-east Asian countries that have experienced
rapid industrialization (23).
In most countries there is no specific legislation addressing the impact of job
stress. Most countries have at least minimum standards for safety and health fea-
tures of the workplace. These standards tend to focus on the physical aspects of
the workplace and do not explicitly include the psychological and/or mental
health aspects of working conditions. Notable exceptions include the
Netherlands and the Nordic countries (24).
3.3 Consequences of mental health problems in the workplace
The consequences of mental health problems in the workplace can be summarized
as follows (25):
increase in overall sickness absence, particularly frequent short periods of
poor health (depression, stress, burnout);
physical conditions (high blood pressure, heart disease, ulcers, sleeping disor-
ders, skin rashes, headache, neck- and backache, low resistance to infections).
Work performance
reduction in productivity and output;
increase in error rates;
increased amount of accidents;
poor decision-making;
deterioration in planning and control of work.
Staff attitude and behaviour
loss of motivation and commitment
Mental health and work: Impact, issues and good practices 9
staff working increasingly long hours but for diminishing returns
poor timekeeping
labour turnover (particularly expensive for companies at top levels of
Relationships at work
tension and conflicts between colleagues;
poor relationships with clients;
increase in disciplinary problems.
Workers' health is a separate goal in its own right. Addressing mental health
issues in the workplace means incorporating social responsibility in a firm's every-
day practices and routines.
3.4 Mental health and unemployment
Re-employment has been shown to be
one of the most effective ways of pro- Fact: The National Institute of Mental
moting the mental health of the unem- Health estimates that more than 3
ployed (26). million adults aged 18-69 have a
serious mental illness. Estimates of
A review of studies of the mental and unemployment among this group are
physical health effects of unemployment 70-90%, a rate higher than for any
and the mechanisms by which unem- other group of people with disabilities
ployment causes adverse health out- in the USA. Recent surveys report that
comes reveals a complex relationship. approximately 70% of those with
There has been a serious debate about psychiatric problems rank
the direction of causality. Does unem- employment as an important goal.
ployment cause deterioration in health, Source: NAMI (27).
both mental and physical? Are the sick
more likely to become unemployed?
In a study reported in the Journal of Community Psychology (28), an analysis of
employed respondents revealed that those who became unemployed had over
twice the risk of increased depressive sympt

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