Mental health policy and practice across Europe: an overview

Housing and employment 303
where regulations governing access to disability benefits can allow individuals
to retain high levels of benefit even when their income from employment may
be substantial. In one recent study of 12 countries, including 10 in western
Europe, expenditure on disability benefits was negatively associated with the
participation of people with schizophrenia in the labour force (Kilian and
Becker 2006).
In European countries with advanced economies, these disincentives are
perhaps greatest in the United Kingdom and least problematic in Italy (Warner
2000). There are also bureaucratic regulations to be overcome – for instance, if
an individual returns to work but then loses his or her job it may take a considerable
period of time to reclaim disability benefits, during which time significant
hardship may be endured (OECD 2003). Many national financial support
systems in Europe require reshaping to tackle this ‘benefit trap’ and encourage
more people to return to work while safeguarding the quality of life and income
of those who cannot obtain employment. One ongoing attempt to address
some of these barriers is the Pathways to Work initiative in England. This has
involved a proactive programme of support and advice on how to return to
work, training to enhance skills, as well as support while at work. In many
respects it is an approach consistent with IPS. In addition, in an attempt to
counter the benefit trap, a system of tax credits and additional return to work
credits paid as a supplement to earnings during the first year of work have been
introduced. Recent qualitative analysis suggests that this financial support, if
effective, is of key importance in getting people back to work; when payments
are delayed or not claimed financial problems occur quickly (Corden and Nice
2006). Further evaluation of this initiative and of those elsewhere in Europe that
address both the financial disincentive to work as well as some of the more
cumbersome aspects of entitlement regulations is required.
Conclusion
In conclusion, a number of points seem to be clear with regard to how mental
health issues are treated in the workplace. In general terms, mental health is still
not perceived to be an important workplace health issue by most workplace
stakeholders when compared to occupational health and safety. This is particularly
true in relation to mental health problems with no causative association
with the workplace.
Nevertheless, occupational stress and its effects on mental well-being are
gaining an increasing level of attention. This is occurring in two main contexts,
that of occupational health and safety, where preventing and managing stress
is obligatory under legislation, and also with respect to the return to work of
workers with stress-related disorders. Most workplace interventions that affect
mental well-being focus on occupational stress and most focus on the individual
worker. However, there is also a rise in workplace-based health education
programmes in relation to mental illness. In contrast, public health and
rehabilitation services, which deal with people with psychiatric illness, tend
to have weak links with the workplace. However, mental health issues are likely
to become more important to workplace stakeholders in the coming years;