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Return to Work as an Outcome - Good for Mental Health?

The recent report by the Mental Health Task Force chaired by Paul Farmer of Mind is the latest call for employment to be recognized as a "health outcome" - why is this such an important milestone?

Last week the HuffPo blogger, Kate Lee, wrote she was worried that the aspiration to get her well and back in work, work as a health outcome, was because the 'system', so to speak, wanted her back paying taxes. The NHS shouldn't aim get people back in work purely because of the health of the UK tax base, though we can't shy away from the pressures ill health does place on our welfare and health system. Paul Farmers report puts the cost of mental health to our economy at £105 billion a year - this is not a sustainable figure. But crucially, I would argue, that in this case the needs of the individual and the state are not at odds and that work as a health outcome is also about promoting good mental health in individuals.

When we ask what each of us hope for when we access the health care system, the evidence is that we want to see our health improved or restored. How often do we stop to ask ourselves why? What is our health and wellbeing for? It may seem obvious that it's not just the absence of illness or disease that we seek, but an improvement in our quality of our life, a restoration of function and of our ability do the things that we want to do.

One in four of us may find the question prompted by a mental health condition in our lifetime, and for one in eight of us that question may arise this year. For the 31million people who are working in the UK, one early relevant measure of the success of any health intervention in terms of restoring function, is our timely "return to work." We know that being in good work is associated with better health and well-being for ourselves and our families. Sadly, if it is a mental health condition that is the underlying reason for our absence, and the time we are away from work is more than 4 weeks, one in four of us may never return to work.

And yet return to work is not seen as a goal; the performance of health care systems and the success of medical interventions seldom assesses whether it helped a patient return to work. It is so under the radar, that in one study of US physicians, while 99% of records included patient age and gender, a job history was found in fewer than 30%. While it may be important to measure time spent in a hospital bed infection and readmission rates in terms of the quality and efficiency of a service, measuring return to work and return to function is long overdue, and until "return to work" is seen as an clinical outcome, clinicians are unlikely to see it as a goal.

Kate worryingly also wrote 'When I did return to being gainfully employed my care stopped'. This should not be the case and of course all support dropping out from under you when you go back to work, often a stressful situation in and of itself, isn't going to help you stay in work. Employers need to support employees if they are going to return to work successfully. Occupational Heath experts should have worked with Kate to understand her needs, make necessary adjustments and support her to stay well.

Occupational health specialists have a key role to play in bridging the gaps between the world of clinical care and the workplace for patients who all too easily fall between the cracks in the health and social care "system". There is an urgent need to make timely, high quality, highly trusted occupational health advice available to all people of working age, if return to work good work, and the ability to stay in good work is to be a reality, particularly for people with mental health conditions.

When we see "return to work" and return to function as measures of success for clinical interventions, it will be a great step forward and a catalyst for clinicians and occupational health specialists to see each other as partners in achieving patient centered outcomes.

Dr Richard Heron, President of the Faculty of Occupational Medicine

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