Depression is more than a personal issue - it is also an employment and economic issue, argues Danny McCoy
Ask most people to identify the biggest single cause of misery in our society. They would probably answer "poverty".
They would be wrong. Mental ill-health, particularly crippling depression and chronic anxiety, explains more current unhappiness than poverty does. There are few forms of deprivation worse than chronic mental illness. This is why the National Economic and Social Forum's (NESF) report published yesterday, Mental Health and Social Inclusion, deserves careful attention.
Of course poverty can be a contributing factor along with a multitude of other factors, but often more specifically the lack of a job is often the critical factor. Employment is the best protection against social exclusion, which is why a thriving competitive economy capable of providing employment is crucial.
But more than that is required given that it is estimated that only a fifth of people with enduring mental ill health are employed. As the NESF report points out, the consequences of mental ill health are far-reaching for Irish society, in terms of reduced economic performance along with increased health and social welfare expenditure.
To consider this issue in these terms is not to discount the personal cost of crippling mental pain suffered by thousands of people. It is an attempt to highlight a huge submerged problem that will affect over one in four people at some point in their lives and which fear of the stigma keeps under-acknowledged. Arguably, in an era of low unemployment, the single largest issue for the labour market in terms of the quantity of people impacted upon in wealthy societies like Ireland is depression.
Little is known about the economic impact of mental ill health in Ireland but we can be certain that it is considerable. The European Commission has put the figure at an estimated 3-4 per cent of Gross Domestic Product, mainly through lost productivity.
Prof Richard Layard at the London School of Economics argues that depression, anxiety and other forms of mental illness have overtaken unemployment as the greatest social problem in the UK.
The blueprint at present for mental health policy development in Ireland is A Vision for Change, the report of the Expert Group on Mental Health Policy published in 2006. With 160 recommendations, it provides a comprehensive overview and framework for mental health services.
Yet we are already hearing of unacceptable delays in the implementation of its recommendations, lack of cross-departmental co-ordination and inadequate resources. The problem is pervasive and international work on wellbeing would suggest that the Health Services Executive should prioritise the recommendations relating to early psychological interventions at a primary care level.
The greatest tragedy surrounding mental health is that there are evidence-based and cost effective psychological therapies that can lift many of those suffering from depression or chronic anxiety out of their illness. Yet, only a small fraction of patients receives any kind of treatment, whether medical or other. The rest continue to suffer with significant loss not just to the individual but society more generally and businesses in particular.
Given that mental illness could be costing the Irish economy up to €7 billion per annum, action is required. Indeed, enabling the employee suffering mental illness to continue to work could in many cases substantially reduce costs for businesses by avoiding the expensive income continuance options of incapacity.
Depression and anxiety can make it difficult, or sometimes impossible, to work and drives people on to incapacity benefits. While income is important, having a job (regardless of the type or its quality) can provide latent benefits for recovery by providing time structure; regular contact with people outside the nuclear family; involvement in shared goals; and a sense of identity.
The longer a person is away from a job, the less likely that he or she will ever return to a productive working life. The probability of returning to work for those absent between three to six months is reduced to less than 50 per cent and, for those who are absent for more than 12 months, is a mere 20 per cent.
There is also a vicious circle between work and treatment which can only be broken by action at both ends. On one side, the world of work has to become easier to re-enter and be supported by effective return to work programmes. On the other side, automatic signing of sick-notes fails to understand that work can often improve the quality of a patient's life.
These challenges are not insignificant, but neither are they insurmountable for a society that has shown a capacity to make remarkable behavioural changes in the last five years. I have yet to talk to anyone who does not have empathy with this issue, yet doesn't quite know what to do. Acknowledgment of the issue and the understanding that mental heath can be strengthened is the start.
The Irish population still honestly reports itself to be among the happiest in the world, the challenge is to ensure that we achieve that happiness for the greatest number.
Danny McCoy is director of policy at the employers' group, Ibec