The OECD and SMEs: the great mental health divide - Professor Roy Sainsbury
Tuesday 18 February 2014Things are stirring in the world of health, mental health and work. In the space of only a few days the Coalition government announced its new Health and Work Service offering occupational health assistance to people off sick for four weeks or more, and on Monday (10th February) a major new report from the OECD called Mental Health and Work - United Kingdom, was launched at an event hosted by the Work Foundation in London.
Professor Roy Sainsbury
Professor Roy Sainsbury is Research Director at the Social Policy Research Unit, University of York.
In the first half of the event OECD Deputy Director Mark Pearson and report author Shruti Singh presented the report findings and recommendations to a highly engaged audience of 60 or so practitioners, campaigners, policy makers and academics. Mark reminded the audience of the multiple negative effects of high levels of mental ill-health. The costs to the UK economy amount to a staggering £70 billion pounds a year in lost productivity and health care costs, equivalent to 4.5% of GDP. People with mental health problems experience serious social disadvantage, reflected in low employment rates and high poverty risks. Nearly 4 in 10 new claims to disability benefits are based on mental health conditions, in addition to which DWP data show that 1 in 4 new claimants of Jobseekers Allowance also report mental ill-health.
This bleak picture is not the whole story though. Mark Pearson also reported a somewhat paradoxical finding from the OECD. On the one hand, and in its favour, he said that the UK was at the forefront of introducing policies to address mental ill-health, particularly in raising awareness of the issue at all levels and in integrating health and employment services. However, on the other hand, policy activity to date had failed to be reflected in any improvement in the employment statistics for people with mental health problems.
The OECD remedy is a range of policy prescriptions, including promoting early interventions for people experiencing mental ill health in work (through the new Health and Work Service), improving incentives within the Work Programme for providers to increase back-to-work support for this group, and making changes to the social security system. Overall there is much to learn and think about from this well-presented and accessible report from the OECD. But....
...the astute (and possibly confused) reader will be wondering why there has been no mention yet in this blog about small and medium-sized enterprises (SMEs). The simple reason is that in the report there is only a handful references to them despite their importance for the UK economy. And yet those few mentions alert us to a major challenge for health and employment policy:
"...a disproportionate number of people come from SMEs onto Employment and Support Allowance without first going on to sick pay".
"Currently few SMEs use Occupational Health Services - only 10% compared with 80% of large companies."
So, what does the OECD have to say further about SMEs? Very little indeed. In its recommendations it only says: "Help SMEs in addressing mental health problems". No one is arguing with that but the lack of anything more concrete shows the extent of the divide between an international organisation concerned with big, macro, structural and programme solutions and the reality for many SME employers and employees in the UK. This is not a criticism of the OECD; rather it identifies an urgent need for policy makers to consider the implications of the report for SMEs.
If disproportionate numbers of SME workers are flowing onto long term sickness benefits but few SMEs are using external services then something more than implementing the OECD proposals needs to be done. To begin with SMEs themselves need to be engaged and their experiences and views built upon. The OECD report is a welcome contribution to an important policy arena, but it's others who can now bridge the divide it has exposed.