Mental health policy and practice across Europe: an overview

Housing and employment 295
market; rather it is concerned with ensuring that the person has the skills and
attitudes which enable them to function personally and socially.
Though these are generalizations, and there is some recent work that
breaks these boundaries, the two general approaches typify the main practical
approaches to dealing with mental health issues and work. Within the health
and safety tradition, it can be argued that the focus of practice is mainly on
occupational disease and occupation-related disease, rather than on general
health per se. It is seen more as a means of meeting legal obligations not to harm
workers’ health and well-being, rather than as an instrument of public health.
As the links between workplace factors and psychiatric illness have not been
demonstrated to be strong, from the perspective of health and safety and that of
employers, psychiatric illness is something of a non-issue.
Equally, it might be argued that from the perspective of clinical practitioners
and rehabilitation professionals, this lack of an explicit and clear workplace link
to the major psychiatric disorders has meant that there is a limited focus on
reintegrating people with psychiatric illnesses into the workplace.
However, recent decades have seen the emergence of a phenomenon that
does not neatly fit into this generalization – the issue of stress, and particularly
occupational stress, has come to occupy the attention of both workplace health
professionals and non-professional actors.
Occupational stress and mental health
There has been a large and growing research effort into occupational stress over
the past 25 years. It is beyond the scope of this chapter to review this work in
detail but a short summary of some of the major findings is presented below.
For more detail on occupational stress and mental health, an ongoing EU
research project has undertaken detailed literature reviews in the area of stress
and mental health – see D’Amato and Zijlstra (2003), Joensuu and Lindstrom
(2003), Van den Bossche and Houtman (2003) and Clarkin and Wynne (2003).
A good general overview of the area of occupational stress is provided by Cox
et al. (2000).
Occupational stress has been found to be a multi-faceted phenomenon.
Workplace factors associated with higher levels of stress include:
• high job demands;
• low levels of control;
• ambiguity and lack of clarity about work roles;
• having responsibility for people;
• lack of participation in decision-making;
• quantitative and qualitative work overload;
• managerial style, e.g. lack of feedback of performance, persistent negative
feedback;
• poor workplace communications;
• long or irregular work hours;
• job insecurity.
In addition to these factors, the relationship between job stress and mental