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The OECD and SMEs: the great mental health divide - Professor Roy Sainsbury

Tuesday 18 February 2014

Things are stirring in the world of health, mental health and work. In the space of only a few days the Coalition government announced its new Health and Work Service offering occupational health assistance to people off sick for four weeks or more, and on Monday (10th February) a major new report from the OECD called Mental Health and Work - United Kingdom, was launched at an event hosted by the Work Foundation in London.
Professor Roy Sainsbury

Professor Roy Sainsbury

Professor Roy Sainsbury is Research Director at the Social Policy Research Unit, University of York.

In the first half of the event OECD Deputy Director Mark Pearson and report author Shruti Singh presented the report findings and recommendations to a highly engaged audience of 60 or so practitioners, campaigners, policy makers and academics. Mark reminded the audience of the multiple negative effects of high levels of mental ill-health. The costs to the UK economy amount to a staggering £70 billion pounds a year in lost productivity and health care costs, equivalent to 4.5% of GDP. People with mental health problems experience serious social disadvantage, reflected in low employment rates and high poverty risks. Nearly 4 in 10 new claims to disability benefits are based on mental health conditions, in addition to which DWP data show that 1 in 4 new claimants of Jobseekers Allowance also report mental ill-health.

This bleak picture is not the whole story though. Mark Pearson also reported a somewhat paradoxical finding from the OECD. On the one hand, and in its favour, he said that the UK was at the forefront of introducing policies to address mental ill-health, particularly in raising awareness of the issue at all levels and in integrating health and employment services. However, on the other hand, policy activity to date had failed to be reflected in any improvement in the employment statistics for people with mental health problems.

The OECD remedy is a range of policy prescriptions, including promoting early interventions for people experiencing mental ill health in work (through the new Health and Work Service), improving incentives within the Work Programme for providers to increase back-to-work support for this group, and making changes to the social security system.  Overall there is much to learn and think about from this well-presented and accessible report from the OECD. But....

...the astute (and possibly confused) reader will be wondering why there has been no mention yet in this blog about small and medium-sized enterprises (SMEs). The simple reason is that in the report there is only a handful references to them despite their importance for the UK economy.  And yet those few mentions alert us to a major challenge for health and employment policy:

"...a disproportionate number of people come from SMEs onto Employment and Support Allowance without first going on to sick pay".

"Currently few SMEs use Occupational Health Services - only 10% compared with 80% of large companies."

So, what does the OECD have to say further about SMEs? Very little indeed. In its recommendations it only says: "Help SMEs in addressing mental health problems". No one is arguing with that but the lack of anything more concrete shows the extent of the divide between an international organisation concerned with big, macro, structural and programme solutions and the reality for many SME employers and employees in the UK. This is not a criticism of the OECD; rather it identifies an urgent need for policy makers to consider the implications of the report for SMEs.

If disproportionate numbers of SME workers are flowing onto long term sickness benefits but few SMEs are using external services then something more than implementing the OECD proposals needs to be done. To begin with SMEs themselves need to be engaged and their experiences and views built upon. The OECD report is a welcome contribution to an important policy arena, but it's others who can now bridge the divide it has exposed.


  • Posted by Deborah C  |  30 January 2015, 8:41AM

    Mental Health Disability

    Apologies for not including my full name.  The reasons will become clear from my comment below.

    My brother has had long-term mental health problems including depression, OCD and some evidence of high-functioning autism.

    He is currently taking his last employer to tribunal after they terminated his employment without any noice or any indication that they were unhappy with his performance.  He had been there just under a year.   When he joined the company his medical form indicated that he ws on medication for mental health issues.

    The point I would like to make is that there is no benefit to including mental health as a disability in terms of employment law if the processes for employing such people are not clear and well-recognised.  Should his Line Manager have known about his disability? Should a well-briefed Mentor have been in place? Should Occupational Health have organised a regular review meeting with him to check how things were going and should his Line Manager been involved in some way?  Some clear guidelines to employers about how to work with people with mental disabilities would maybe have stopped him going through the trauma of being sacked which left him in such a state that he has been signed off from working for 8 months now.

    Equally importantly, what provision is being made to support people with mental disability when they do decide to use the law that was meant to protect them?  The tribunal route is long and difficult for anyone but if you are mentally disabled how are you supposed to cope?  Like many people with mental health problems, my brother has very little in terms of financial resources and legal bills are high.  Legal aid was not offered. The process is long and means he has had to revisit this trauma over and over again. He is now trying to manage his own case  as he has run out of money and this is surely not the best thing for people like him.

    So, what is ACAS doing to help people in his situation? 

    I would be  interested to hear what is planned both in terms of helping define what is best practice in terms of managing people with mental disability and in providing support when they decide to bring a case under Mental Health Disability Employment Law.


  • Posted by Adrian Wakeling, Acas  |  19 February 2014, 3:30PM

    Roy, I enjoyed the blog.

    It’s interesting that our solution to most problems in the workplace is to draw up a policy. As you say, the OECD report says that the UK is “at the forefront of introducing policies to address mental ill-health, particularly in raising awareness of the issue at all levels and in integrating health and employment services.”

    Policies are important – and Acas certainly advocates them – not least because they are often a sign of some consensus and joint working to get them drafted. Hopefully most policies won’t be needed but either way, they can provide a useful safety net to fall back on.

    If mental health policies are not the answer in themselves, then what? It’s hard to disagree with the OECD’s promotion of early intervention as one of a “range of policy prescriptions” to help improve our mental health.

    It seems counter-intuitive, but one might suppose that large organisations would be better at policies and smaller ones would find face-to-face interaction easier. If early intervention is based upon ‘early conversations’ then clearly small firms, like the rest of us, still have a long way to go.

    Perhaps we need to be a bit clear about what we mean by early intervention. The Health and Wellbeing Service will have a positive role to play, but getting people to talk about their problems is the starting point and this is not always easy.

    A recent report from the mental health charity Time for Change, revealed that although over 50% of people say they are ‘very likely’ to consult a GP about a mental health problem, 22% wait more than a year to talk to their GP. That still leaves 50% who may not even talk to their GP and will, therefore, not get a prescription, let alone an accurate diagnosis. And if they are not talking to their GP, how likely are they to talk to their line manager?

    One of Acas’ most popular training events in on ‘handling difficult conversations’ which tries to flesh out how you should sit down with people and tackle personal and emotional issues. We get a good cross-section of employers attending. Of course many problems are not confined to work or home but overlap, and it can be very challenging for any employer to disentangle the bits they feel they are responsible for.

    I agree that we need to try and encourage SMEs to access eternal services in order to improve the health of their staff. But I also think that we all need to get better at talking about mental health. A starting point might be to ensure that all workplaces provide a receptive and supportive environment if an employee decides to disclose that they have a problem and need help.





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