Perry Rhodan 2821_ Im Unsteten - Marc A. Herren

Foreword
Table of Contents
Acronyms and abbreviations
Executive Summary
Chapter 1. Measuring Mental Health and its Links with Employment
	1.1. Introduction
	1.2. Defining and measuring mental health and ill-health
		The definition of good and poor mental health
		Identifying the population affected by mental ill-health
			Box 1.1. The main features of countries’ population surveys used for this report
			Figure 1.1. Mental health scores generally follow a left-skewed normal distribution
			Figure 1.2. The prevalence of mental disorders varies with age, gender and level of education
	1.3. Towards a better understanding of the characteristics of mental ill-health
		Early onset and disclosure
		Mental disorder and disability
			Table 1.1. The majority of mental disorders do not lead to disability
		Co-morbidity and diagnosis
			Table 1.2. Co-morbidity is very frequent
		Dynamics and chronicity
			Table 1.3. Mental ill-health status is very dynamic
	1.4. The rising mental ill-health challenge for the labour market
		What the evidence suggests
			Figure 1.3. People with a mental disorder face a considerable employment disadvantage
			Figure 1.4. People with a mental disorder have lower incomes and a much larger poverty risk
			Figure 1.5. Fast increases in disability benefit claims caused by mental ill-health
		The prevalence of mental ill-health has not changed
		The perception of mental health problems has changed
			Table 1.4. Stigma is still widespread but people know mental illness can be treated
		Policies and institutions are not addressing mental ill-health sufficiently
	1.5. Conclusion: a framework for analysis and policy development
	Notes
	References
Chapter 2. Work, Working Conditions and Worker Productivity
	2.1. Introduction: employment and the workplace are critical
	2.2. Employment, unemployment and the economic cycle
		The relationship between employment status and mental health
			Figure 2.1. Mental disorders are influenced by labour force activity and especially unemployment
			Figure 2.2. Not every unemployed person faces the same risk of poor mental health
			Box 2.1. Does unemployment causally affect individuals’ mental health?
			Figure 2.3. When leaving employment, mental health tends to worsen
		Labour market performance of people with a mental disorder
			Figure 2.4. Unemployment rates are much higher for people with a mental disorder
			Table 2.1. Employment gaps for people with a severe mental disorder are large for men, low-skilled and older workers
			Figure 2.5. The employment and unemployment gap of people with a mental disorder has increased
			Table 2.2. People with a severe mental disorder stay in unemployment for much longer
			Figure 2.6. Unemployed and inactive people with a mental disorder have much lower incomes
		Effect of the economic downturn on mental health problems
			Figure 2.7. Job insecurity is likely to worsen mental health, particularly for those in insecure employment
			Figure 2.8. People experiencing restructuring have lower job satisfaction
			Figure 2.9. Sensitivity of labour market performance of men and women with mental disorders to the business cycle
			Figure 2.10. Employment probabilities of youth and older workers with mental health problems are less sensitive to fluctuations in the business cycle
	2.3. The impact of working conditions
		The quality and structure of employment for workers with mental disorders
			Figure 2.11. Workers with mental disorders tend to work in jobs of slightly poorer quality
			Figure 2.12. Prevalence of mental disorders varies with different occupations
		The current work context
			Figure 2.13. Labour markets and working conditions continue to change across the OECD
		Work-related stress, job strain and mental health
			Box 2.2. Psychological demands and decision latitude
			Figure 2.14. Job strain has increased over the past decade in all European OECD countries
			Figure 2.15. Workers in low-skilled occupations are much more likely to experience job strain
			Figure 2.16. Job strain increases significantly the chances of having a mental disorder
			Table 2.3. Effect of job strain (demands/controls) on mental health
			Figure 2.17. Respect and recognition at work decrease with severity of a mental disorder
		Policies at the workplace
			Table 2.4. Work-related stress does not receive sufficient attention in workplace risk assessments
			Figure 2.18. Solving mental health problems in the workplace often leads to dismissing the worker
			Table 2.5. Dismissal regulations in regard to sick workers vary considerably across countries
			Table 2.6. In most countries increasing attention is given to awareness campaigns and initiatives
	2.4. Worker productivity as a key challenge
		Trends in sickness absence and presenteeism
			Figure 2.19. Absenteeism and presenteeism both increase sharply with poorer mental health
			Figure 2.20. Presenteeism has increased among all groups of the population
			Table 2.7. Absenteeism and presenteeism levels vary by country but mental health differentials are consistent
			Figure 2.21. Alternative measures of productivity loss all confirm these findings
		What are the key drivers for sickness absence?
			Figure 2.22. Severe mental disorders influence sickness absence days more than any other variable
			Table 2.8. Mental ill-health is a factor in short- as well as longer-term sick leave
	2.5. Conclusion: towards productive quality employment
	Notes
	References
Chapter 3. Mental Health Systems, Services and Supports
	3.1. Introduction: a multidimensional approach for complex problems
		Box 3.1. Mental disorders need a multidimensional health-care approach
	3.2. Mental disorders, work functioning and employment
		Severity, chronicity, diagnosis, and co-morbidity are crucial
			Figure 3.1. Clinical severity predicts negative outcomes ten years later
			Figure 3.2. Depression severity predicts disability one year later
			Figure 3.3. Benefit recipiency rates are much higher with co-morbidity
		Effects of work and vocational rehabilitation on mental health
			Box 3.2. Principles of supported employment services
	3.3. Under-treatment, adequate treatment and enhanced treatment
		Treatment can improve employment outcomes
		Under-treatment is still pervasive
			Figure 3.4. Treatment rates are extremely low among young adults and gradually increase with age
			Box 3.3. The increased prescription of antidepressant medication to treat mental disorders
				Antidepressant consumption, 2000-09
			Figure 3.5. Treatment rates vary with the type of benefit and are highest in welfare recipients
			Figure 3.6. People with a mental health problem who have work problems have higher treatment rates
			Figure 3.7. Workers reporting reduced productivity are increasingly seeking treatment
		In many cases treatment is inadequate
		Enhanced treatment approaches
			Figure 3.8. Readmissions are particularly frequent for schizophrenic and personality disorder
		The need for psychotherapy treatment
			Figure 3.9. Medication is significantly more frequent than psychotherapy in all mental disorders
			Figure 3.10. Only a minority of all patients receive combined medication-therapy treatment
			Figure 3.11. Medication is most frequent in the United Kingdom and psychotherapy in Sweden
			Figure 3.12. Treatment modalities in specialised mental health care differ vastly from primary care
	3.4. Mental health care system challenges
		From mental hospitals to community care
			Figure 3.13. Inpatient care has been declining gradually for about three decades
			Table 3.1. Typical providers, services and functions of well-developed mental health care systems
			Figure 3.14. The opportunity to seek specialist treatment varies considerably across countries
			Figure 3.15. The number of psychiatrists has increased everywhere and most in Switzerland
		The current role of mental health care concerning employment
			Table 3.2. The role of mental health care concerning employment objectives
			Figure 3.16. Competitive employment reduces the length of psychiatric inpatient stays
			Table 3.3. Mental health care performance indicators with relevance to work outcomes
	3.5. Conclusion: employment as a goal for the mental health system
	Notes
	References
Chapter 4. Benefit Systems and Labour Market Services
	4.1. Introduction: responding to the increase in disability benefit claims
	4.2. Disability benefits: understanding trends, questioning myths
		Mental diagnoses explode in proportion
			Figure 4.1. Fast trend increase in the share of disability benefit recipients with a mental disorder
			Figure 4.2. The risk of being on a disability benefit with a mental disorder also increased
		Trends in new claims show a multifaceted picture
			Figure 4.3. New disability benefit claims for mental disorders are increasing but not in all cases
			Figure 4.4. Co-morbidity of mental and somatic disorders is frequent in new benefit claims
		What do diagnosis-specific data show?
			Figure 4.5. Affective and neurotic disorders dominate in mental health diagnoses
		Full or partial, temporary or permanent benefit
			Figure 4.6. Swiss beneficiaries with a mental disorder usually receive a full disability benefit
			Figure 4.7. People with a mental disorder are more likely to be granted a temporary disability benefit
		Rejections, reassessments and benefit off-flows
			Figure 4.8. People with a mental disorder are less likely to be denied disability benefit
			Figure 4.9. People with a mental disorder are less likely to leave disability benefit
	4.3. Mental ill-health as a predictor of disability benefit awards later in life
		Pathways into disability benefit
			Figure 4.10. Mental health conditions are frequent among long-term absences and their share is increasing
			Table 4.1. Claimants with a mental disorder are further away from the labour market
		Is mental ill-health a major factor for disability benefit recipiency?
			Box 4.1. Estimating determinants of disability benefit recipiency (using cross-sectional data) and moves onto disability benefit (using longitudinal data)
			Table 4.2. Mental ill-health itself is a major determinant for disability benefit receipt
			Table 4.3. A worsening of mental health significantly influences moves onto disability benefit
		Findings from research across the OECD
			Table 4.4. Common and severe mental disorders as a predictor of disability benefit later in life: what does the literature tell us?
	4.4. The role of benefits for people with a mental disorder
		What benefit for which group of people?
			Figure 4.11. One in four people with a severe mental disorder receives a disability benefit
			Figure 4.12. Many people with a mental disorder receive unemployment benefit or social assistance
			Figure 4.13. Older people with a mental disorder depend on a range of different working-age benefits
		Benefit coverage and income security
			Figure 4.14. The higher poverty risks for people with a mental disorder result from higher benefit dependency
		Identification of people with mental ill-health
			Table 4.5. Assessing disability benefit eligibility for claimants with a mental disorder: what is required and how is this done?
			Table 4.6. Identifying and supporting people with a mental disorder in the unemployment system
	4.5. Labour market services for people with a mental disorder
		Participation in employment-oriented programmes
			Figure 4.15. The share of active labour market programme participants with a mental disorder varies across country and programme
		Predictors of return to work for people with mental ill-health
		Learning from programmes developed for muscular-skeletal conditions
		Learning from supported employment evaluations
		Challenges for providers of services
	4.6. Conclusion: towards co-ordinated action of the social security system
	Notes
	References
Chapter 5. Education Systems and the Transition to Employment
	5.1. Introduction: addressing the early onset of mental disorders
		Box 5.1. Risk and protective factors influencing mental health
	5.2. Mental health problems among children and youth
		Table 5.1. Most mental disorders typically have their onset in childhood or adolescence
		Prevalence of mental disorders among children increases with age
			Figure 5.1. Psychosomatic complaints among children are higher for girls and increase with age
			Figure 5.2. Psychosomatic complaints among children decrease with family affluence
		Mental disorders are more common among youth than among adults
			Figure 5.3. Around one in four young people have a mental disorder
			Figure 5.4. The prevalence of mental disorders is higher among youth than in the total population
	5.3. The education system
		School support services are often insufficient to meet youths’ needs
		Young people are reluctant to seek professional help
		Screening could contribute to the early identification of risk groups
		Unmet needs for services may lead to school drop-out
			Figure 5.5. Across the OECD, roughly one in six youth leaves the school system prematurely
			Figure 5.6. People with mental health problems are more likely to stop full-time education early
			Table 5.2. One in four youth with mental health problems leaves high school without a diploma
	5.4. Transition from adolescence to adulthood
		Evidence on higher education and labour market participation
			Figure 5.7. Youth with a severe mental disorder face lower employment but higher unemployment rates
			Figure 5.8. By age 20, more youth who had a mental health problem at age 18 have left education
			Table 5.3. By age 25, US youth with mental ill-health have lower earnings and more job changes
			Table 5.4. Few youth with a mental disorder have ever been diagnosed by a health professional
		Break in support and services during the transition into adulthood
			Figure 5.9. Youth with higher education do significantly better in the labour market
		Increasing rates of young adults on disability benefits
			Table 5.5. In many countries, youth can access disability benefits from a very early age
			Figure 5.10. Disability benefit claims for youth with a mental disability have increased in many countries
	5.5. Conclusion: helping school-leavers in their transition to work
	Notes
	References
Chapter 6. Summary and Conclusions
	6.1. Mental health as a new priority challenge for the labour market
		Mental ill-health is widespread, but prevalence is not increasing
		Most mental disorders are moderate or common disorders
		Mental illness commences very early in life
		Chronicity and co-morbidity lead to disability
		Policy will have to put more focus on moderate mental disorders
	6.2. Evidence on the interface between mental health and work
		Most people with mental disorders are in work
		Work is good for mental health but not under all work conditions
		Productivity losses through mental ill-health are large
		Employment is the best way to secure good incomes
		People with mental disorders often receive unemployment benefits
		The lack of action for the unemployed creates big challenges for the disability benefit system
		Better identification and better policy are hindered by non-disclosure
		Under-treatment is a key challenge for the mental health system
		Providing adequate treatment requires a clearer role for general practitioners
		The mental health system itself needs to change
	6.3. New directions for mental health and work policies
		Early intervention at various points in time
		Co-ordinated supports at all stages
		Efforts are needed to improve the evidence base which continues to be incomplete