Measuring the impact of mental health on employment in the UK

The relationship between health and work is a complicated one. An individual's health affects their work and work, or lack of it, can also have an impact on health. While it’s readily accepted that health can have a significant impact on working life, it becomes difficult to find ‘evidence’ of the effects when the health problems in question are mental rather than  physical. 

Professor Jennifer Roberts and her team investigated how we can better analyse large scale datasets to improve our understanding of the relationship between mental health and work across England and Wales. The team’s work aimed to provide reliable quantitative estimates of the effects of health status on the probability of being in employment, in order to estimate the real costs to the economy and to formulate appropriate policy tools to increase the employment rate of people with mental health problems. 

The project involved complex statistical and econometric analysis of the survey data to provide rich information on employment status, health and characteristics like age, gender, education, income and household circumstances. 

The benefits of complex, longitudinal data

Professor Roberts and the team used longitudinal data, which meant that individuals were followed over time to see how their circumstances changed. This allowed them to deal with the complex relationship between health and work, including the two-way effects and the fact that there will be many factors which affect both health and work that are not observable in the data.  

‘Primarily, we fill a number of important gaps in the evidence base,’ said Professor Roberts, a Research Fellow in the Faculty of Social Sciences, based in the Department of Economics, ‘by providing quantitative estimates of the effect of mental health on the employment of prime age adults. This is important evidence for social and economic policy across all countries. The vast majority of existing evidence on the relationship between health and work considers either physical health, or general measures of overall self-assessed health*. 

‘In contrast, we used measures of mental health derived from two psychometric instruments; the General Health Questionnaire and the Short Form-12 health survey. These measures are good proxies for the true mental health stock; they are designed to provide information on all aspects of mental health, and are less likely to suffer from the reporting biases that are present in simple overall evaluative measures**. 

‘Our estimates for England and Wales contribute to a very small pool of UK evidence, and will be valuable to decision makers given the current policy priority to increase the number of disabled people in work by one million over ten years.’***

An advancement on current statistics 

Professor Roberts’ research into the current evidence found that when it comes to health, policy makers and policy groups often rely on evidence or statistics that are descriptive and associative.

‘We all know that there’s a relationship between health and work and we all know that having good work makes you healthier and having too much work or stressful work makes you unhealthy,’ she said. ‘But it can also be the case that the less healthy you are, the less access you have to work, so it’s very much a two way relationship and can be really misleading. 

‘The team sees our role as trying to help policy makers to understand the complexity and manipulation of data, and that measuring the correlation between these two things is not necessarily the best way to help them plan what the best policy is.’ 

If policy makers and organisations can better understand the data, they can make smarter decisions that make real, significant change to the employment rate and impact on mental health in the workplace. 

‘It is a fact that those with mental health problems are much less likely to be in work than people without mental health problems,’ Professor Roberts said, ‘but what we are showing policy makers is that it isn’t really about changing mental health. 

‘We’ve found that if you change mental health, you’ll barely change the employment rate at all. Actually, it’s about the much more chronic differences between these two groups of people. People with poor mental health tend to come from more deprived areas; they have less education, they’ve had traumatic experiences in childhood and in improving their mental health now, you won’t change their employment rate and you won’t get them into work. The policy tools need to have a wider scope.’

A collaborative research project

Professor Roberts’ work falls into a wider research theme on ‘the causal impact of health status on labour market outcomes: consequences for individuals and households’ and is funded by The Health Foundation as part of their Social and Economic Value of Health programme. 

Along with her colleagues, including Dr Mark Bryan, Professor Nigel Rice, Professor Maarten Lindeboom, Dr Cristina Sechel and Dr Andrew Bryce, Roberts’ work spans across the themes of health, work and covid-19, health and sickness absence, disability and benefit claims, and presenteeism, as well as mental health and employment. 

Health and its impact on employment is an important issue for the UK economy. Work is a key route to financial security and wellbeing, but chronic health problems are increasing among the working age population, and health is often the catalyst for poor labour market outcomes or unemployment. This has implications that extend beyond individual and households to effects on firm performance, productivity levels and economic growth. 

The project engaged with employers and other stakeholders, including the government's Work and Health Unit and Public Health England, to ensure its policy relevance, and to establish the role of physical and mental health in determining individual labour outcomes such as employment, work hours and wages.

Read more on the impact of health on work

*See Ghatak (2010) for a review

**Bound 1991, Bound et al. 1999, Lindeboom & Kerkhofs 2009

***DWP 2017