Mental health policy and practice across Europe: an overview

294 Mental health policy and practice
service providers and to the individuals is generally greater than is the case for
a person who has acquired a disability at some time in their working career.
Here, the difficulties are essentially those of employability; that is, they relate to
the complement of skills and knowledge that the person has and their capacity
to undertake work in the open labour market. Crucially, individuals in this
situation do not have a relationship with a specific employer and from the
employers’ perspective they face the problems of hiring individuals who have
been long-term unemployed as well as those associated with their disability.
In practice, this group of people has proved to have the lowest success rate
in competing on the open labour market and despite regulations in many countries,
that for example apply minimum quotas to the employment of people
with disabilities, employment levels among this group remain very low. In part,
(especially for those with a mental illness), this is also a consequence of the
widespread stigma and discrimination that is just as likely to be found in
employers and in potential fellow workers as in the general population. Some
approaches to help return individuals with long-term mental health problems
to the workforce – for example, supported employment schemes – have been
more successful than others, and are discussed later in the chapter.
Mental health issues in the workplace
There are two main approaches to treating the issue of mental health in the
literature. The first stems broadly from the epidemiological approach; that is,
where studies have sought to identify factors existing in the workplace which
impact upon mental health. This type of research can be described as falling
within the health and safety tradition, i.e. in identifying workplace hazards to
mental health it seeks to provide the basis for the control of these hazards using
the tools of occupational health and safety.
However, there are a number of features of this type of research that should
be borne in mind. Firstly, it generally does not focus on clinical diagnoses
of psychiatric conditions; rather it more often focuses on general measures
of mental well-being. Secondly, its focus is generally on the identification
and measurement of workplace factors and mental well-being, rather than
on all of the factors that may contribute to an individual’s state of well-being.
This research is therefore of limited utility when addressing the broader issues
of mental health in a number of respects – it can be difficult to relate its findings
to general psychiatric diagnoses and also many of its findings have limited
relevance to the treatment or rehabilitation of people with psychiatric
disorders.
The second type of treatment of workplace and mental health issues can be
found in the rehabilitation literature. Here the main concern is with identifying
and improving methods of rehabilitation and with seeking to integrate people
with psychiatric problems into the workplace. The starting point in this literature
(and the practice of rehabilitation in reality) is the psychiatric diagnosis and
the measures that may be taken in relation to treatment and rehabilitation.
This literature is notable for the fact that often it is not explicitly concerned
with enabling the person with the psychiatric disability to re-enter the labour