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Mental ill health and fitness for work
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  1. Nick Glozier
  1. Correspondence to:
    Dr Nick Glozier, Epidemiology/WHO Collaborating Centre, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK;
    n.glozier{at}iop.kcl.ac.uk

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Mental ill health at work seems to be rising inexorably both in terms of self report (as shown by comparing surveys of work related illnesses throughout the 1990s), and as a cause of absenteeism, long term sickness, and early retirement. It is a burgeoning field for many professionals; human resource, medical, psychology, and, with the advent of anti-disability discrimination legislation, lawyers. “Fitness for work” is considered in two main areas: recruitment of new staff, and return to work of those who have been off sick. In many cases the issues are the same for employers, human resource, and occupational health staff: Is the person able to perform the job adequately? Do they pose health and safety risks? How likely are they to require future sick leave? The introduction of anti-discrimination legislation in several countries has also introduced the requirement to consider workplace adjustments that “enable” the disabled. Mental ill health poses particular problems when addressing these issues, as the impairments associated with such illness are difficult to distinguish from the cognitive and behavioural performance intrinsic to many jobs.

Summarising the effects of mental ill health on work (and vice versa) is complicated by the wide spectrum of “mental ill health” which tends to be covered by three different streams of research. Firstly, there is a literature, drawing predominantly from the fields of occupational psychology and health, examining the differing and interacting effects of workplace stressors and “stress” (or what will be termed here “common mental disorder”), performance, health, and absenteeism. Secondly, there are epidemiological studies demonstrating associations between functioning, often as “disability”, and psychiatric disorders. Finally, stemming from psychiatric and rehabilitation research is a body of work investigating the area of supported employment, training, and education for those people with serious mental illnesses, generally psychoses. There are enormous differences in …

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