Jo Bibby, Director of Health, The Health Foundation

Employers should take up the fight for better mental health

10 March 2021

Fifteen years ago, I worked closely with the Institute for Healthcare Improvement (IHI) in the US. IHI were pioneers of approaches to improving the safety and reliability of health care but increasingly they started to work on the efficiency with which health care was delivered. In a cash constrained NHS this was an obvious area to swap notes. In doing so, what surprised me was the driver behind this interest. In contrast to the government led demands for greater health care efficiency in the UK, a significant driver in the US were the concerns of large employers.

Initially this puzzled me, but it was explained that as employers had to contribute to their employees healthcare cover, the rising costs of care were eating into their bottom lines and an increasing concern to them.

The mental health income gap

Since then I have often reflected on how our state funded NHS offers a significant advantage to employers in this country. That is until I took part in the Money and Mental Health Commission. The Commission examined the factors that were resulting in people with common mental health conditions typically earning £8,400 less than the rest of the population. Research shows income has a major impact on health, and this finding could be seen as insult to injury. And while the barriers to work experienced by people with mental health conditions are not new, they are certainly being exacerbated by the pandemic. With three in ten people with mental health problems having experienced an income drop —  causing many to cut back on essentials.

The report highlights that this situation is the result of a broad range of systemic factors: the barriers to employment and job progression that many people with mental health problems face — ranging from inflexible working practices to discrimination. The lack of adequate support through the social security system for those who need time off work due to mental illness, or who are unable to work full stop.

The Commission’s recommendations

Drawing on the insights of the many excellent commissioners, the report sets out some clear and targeted recommendations that provide a starting point to addressing the mental health income gap. It highlights the need for Statutory Sick Pay to be more generous and current eligibility criteria to be expanded to make it a basic employment right for all workers. For large companies to report on the pay gap between employees with and without mental health problems, to expose inequalities and discrimination.

It also looks at the role of in-work practices. The importance of all managers having mental health training, ensuring fairer recruitment, retention and progression practices. And ensuring that there are reasonable adjustments for employees experiencing mental health problems, aiding people to remain in work where possible.

The role of mental health services

However, one area that was out of scope of the Commission but cannot be ignored is the adequacy of our primary mental health services. For decades campaigners have spoken about the need for parity of esteem between mental and physical health services. They have highlighted the inadequacy of funding, the long and often hidden waiting times that exist for mental health services. And, while there is a welcome commitment to this agenda in recent policy papers, the anticipated consequences of the pandemic on people’s mental health must raise the question – is this enough?

Which takes me back to my time working with the IHI. In the face of under-investment in primary mental health services, is it right that we are expecting employers to fill the gap? Of course, employment practices need to be good for our mental wellbeing but if mental health  services aren’t available to people when they need them, how far can employers make up for this?

The report of the Mental Health and Income Commission has come at a critical time, it identifies practical and realistic actions that can be taken by employers and government. To this list, I would add one more. That employers start to advocate for greater investment in and access to the primary mental health services needed to help their employees stay well and in work.