Helping patients with common mental health problems return to work

Paul J Nicholson; John CD Gration

doi:10.3399/bjgp18X695333

INTRODUCTION

Sickness absence tells us much about health and wellbeing at work. The two largest causes of sickness absence are, unsurprisingly, musculoskeletal disorders and common mental health problems (CMHP), that is, anxiety, depression, and stress. Much research has postulated how work and CMHP may be related. High levels of overall work attendance, despite the prevalence of CMHP in the population, suggests that trying to determine cause and effect may be futile — there being many variables. However, given the importance and prevalence of CMHP, we will consider recent research to help determine the main actions GPs can take to assist their patients.

BACKGROUND

In any year perhaps 1 in 4 people has a diagnosable mental health condition and 9 out of 10 adults with a CMHP are supported in primary care, with annual estimated related economic and social costs of £105 billion: about two-thirds of the NHS budget.¹ The cost to employers alone was estimated to be almost £35 billion last year.² Global data indicate that CMHP will account for more than half of the economic burden from all non-communicable diseases over the next 20 years and 35% of lost output.³ In 2016 CMHP accounted for 15.8 million lost working days: 11.5% of all UK sickness absence.⁴ In England, of almost 6 million fit notes that included a known diagnosis, more were issued for mental and behavioural disorders (31.3%) than for any other disorder, with certification for anxiety and stress up by 14% in the last year.⁵ Certification for CMHP is also more likely to exceed 12 weeks compared with all causes of sickness absence (21.5% compared with 14.7%).⁵ The cost of presenteeism (being at work …

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