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CMO's annual report: employment is good for mental health

Chief Medical Officer's report: the rising number of working days lost to mental illness creates personal suffering and costs the economy. 

  • concerns about 70 million working days lost to mental illness last year and £70 to £100 billion cost to the economy

  • calls for cost-benefit analysis to investigate possible fast-track mental health care for working people at risk of falling out of work

  • makes case for investment in children and young people’s mental health to prevent later life mental illness, unemployment and criminal behaviour

  • calls for piloting of psychiatry services integrated into primary care

The rising number of working days lost to mental illness creates huge personal suffering and huge costs to the economy. We need to do more to help people with mental illness stay in work, Chief Medical Officer Dame Sally Davies says today in her latest annual report focusing on the mental health of the nation.

With the number of working days lost to stress, depression and anxiety increasing by 24% since 2009, the CMO has called for NICE to analyse the cost benefit of fast-tracking access to treatment for working people who may fall out of work due to mental illness. Rapid access to treatment could improve people’s chances of staying in work.

The CMO also recommends simple changes to help people with mental illness stay in work by offering flexible working hours and employers making early and regular contact with employees on sick leave.

The report also finds that:

  • 75% of people with diagnosable mental illness receive no treatment at all. CMO reinforces calls for parity of funding with the acute sector for mental health services and for waiting time targets for mental health services to be developed by NHS England

  • there is a need for greater focus on mental health care for children and young people. 50% of adult mental illness starts before age 15 and 75% by age 18. Early treatment for young people can help to prevent costly later life problems including: unemployment; substance misuse; crime and antisocial behaviour.

  • there should also be a greater focus on the link between long-term physical conditions and mental illness. People with a chronic physical condition have a 2.6-fold increase in the odds of having a mental illness. In a Manchester study of heart conditions, 20% had depression with a further 21% developing depression in the following year.

  • the Chief Medical Officer recommends piloting integrated psychiatry services with primary care and the development of psychiatric expertise in primary care. She says this could prevent underlying issues escalating and developing into enduring mental illness.

Chief Medical Officer Professor Dame Sally Davies said:

The costs of mental illness to the economy are astounding. Through this report, I urge commissioners and decision-makers to treat mental health more like physical health.

The WHO model of mental health promotion, mental illness prevention and treatment and rehabilitation should be adopted in public mental health in England.

Anyone with mental illness deserves good quality support at the right time. One of the stark issues highlighted in this report is that 60 to 70% of people with common mental disorders such as depression and anxiety are in work, so it is crucial that we take action to help those people stay in employment to benefit their own health as well as the economy.

My report has also shown that investment in support for children and young people can help to prevent a multitude of problems in later life. Underinvestment in mental health services, particularly for young people, simply does not make sense economically.

Other issues discussed in the report include:

  • Health and Wellbeing Boards’ joint strategic needs assessments need to specifically include mental health

  • a person-centred approach should be taken to mental health, using the evidence for factors that are proven to have a negative impact such as: debt and living conditions in adults and loneliness in older adults

  • advances in technology, online psychological therapy and remote video consultation, mobile apps and gaming represent real opportunities for promoting mental health. To be prescribed they should be acceptable to the NHS

Professor Sir Simon Wessely, President of the Royal College of Psychiatrists said:

We warmly welcome the Chief Medical Officer’s (CMO) report, which is full of insights, key facts, and sensible conclusions.

We wish to emphasise three areas and associated recommendations. First - the importance of employment to good mental health. We endorse the CMO’s call for employment becoming a routine outcome indicator for mental health services – an outcome that has real world relevance and is simple to collect. We also agree that more support is needed to keep those who are at risk of losing their jobs from joining the ranks of the long term sick.

Second, we fully support her call for delivery on the promised expansion of the Foundation posts in psychiatry, and on more time for mental health training for general practitioners.

Third, the CMO echoes our call for agreed waiting times and access standards for mental health services

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