My brain is slowly chugging back into something akin to functioning mode – after just a few days away it is always surprising how quickly it is possible to switch off.
Fortunately (or not, as the case may be) I don’t have much of an opportunity to stand still as my working week starts with a 9am Mental Health Act Assessment which was set up for my return.
So I’m charging my work phone in order to check the messages so that I’ll know if I’m still needed.
In the meantime there seem to be a gaggle of stories worthy of comment of which I can only touch on a couple which link in a way to depression, work and stigma.
A report in The Independent yesterday notes that
The blight of depression affecting hundreds of thousands of people across Britain is costing the nation’s ailing economy £8.6bn a year, £3bn more than a decade ago
Of course, there is no doubt about the debilitating nature of depression but I was curious as to why the costs relating to depression should have increased so sharply.
The research quoted by the Independent, allays this figure not to increased costs for treatment of depression through the price of medication or treatment on in-patient wards but rather the cost of lost labour due to the difficulty of managing return to work although all those factors would contribute to an increased national cost.
The ‘New Horizons’ strategy which is due to be published later in the year is said to have a stronger focus on ‘public mental health’ and broader preventative measures and until anything is published it is hard to comment or critique any potential plans.
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Interestingly though, Margaret Wallace, the Chief Executive of SANE is quoted as saying
There has been continued loss of psychiatric beds for inpatient care, the closure of day centres and impoverishment of occupational therapies. While the Government is planning to increase the availability of cognitive behavioural therapy for those with mild to moderate depression, we are aware from the many thousands of people who contact Sane that there will continue to be many with complex diagnoses who may not be included in such programmes, and who continue to struggle without the necessary psychological support
It’s an interesting and useful insight into the measures that have been promoted by the government towards shifting money to more CBT (Cognitive Behavioural Therapy) and preventative work at the milder end of the ‘depression’ scale – but the gap remains with those who are suffering more acutely.
The trouble is that working in the secondary health care services, it’s always difficult to know about the people who you don’t see or know about – although there is no doubt that between mild and severe, is a large group of people who may be unable to work but not able to access sufficient support.
It leads me on to another story that had been rumbling in the background relating to Christine Laird – the Chief Executive of Cheltenham Borough Council – who, in the words of The Guardian, was taken to court by the council that
claimed Christine Laird fraudulently or negligently withheld details of a history of depressive illness when she became its managing director.
To sum up, Laird was employed in 2002, underwent significant stress at work including allegations of poor treatment at the hands of some in the and left in 2005 requiring a period of treatment at a psychiatric hospital.
The key to the case revolved around a medical questionnaire that Laird had completed when she applied for the job in the first place.
To the question: "Do you normally enjoy good health?" she replied "Yes". To: "Do you have a mental impairment?" she replied "No".
The court was told Laird suffered "three episodes of depression with associated anxiety" between 1997 and 2001. But she saw it as "stress-related illness and not depression" linked to "non-specific, non-recurrent events".
I wonder how much work-related stress and depression are linked to be honest. I know a few people personally who have what I would consider to have suffered from bouts of depression but have insisted that it is recorded as work-related stress on any documentation for work purposes. I suppose the hope that the stigma related to ‘depression’ is still too high but this case doesn’t really help matters.
The Court highlighted the ridiculous nature of those specific questions – ‘normally enjoying good health’ can be interpreted so broadly as to be largely insignificant. It is also a completely value-based judgement. As for asking about a mental impairment – again, is it asking for a legal definition in accordance with Section One of the Mental Health Act (1983 as amended 2007) or is it asking for an ‘average man on the street’ definition which would probably stigmatise ‘mental impairment’ to a much higher degree.
Laird won her case but was instructed to pay partial costs amounting to £190, 000 but leaving the council with a bill for £1.6 million.
Of course, it is always important to be truthful on medical questionnaires but it is possible to see where the discrimination can fall.
It is hard enough for work to be found at times without giving employers more reasons to refuse to employ someone with a history of mental ill-health. The questions were poorly structured and perhaps a more straightforward way of asking where no doubt could have incurred should be and probably is now, written into the application forms but I wonder how much influence they would have on the appointment of a perfect potential employee who has, in the past, suffered from a depressive episode.
Quite rightly, campaigning groups have welcomed the court ruling against Cheltenham Borough Council but I wonder how many councils will be more wary to employ someone with a similar background in the future – maybe reports from medical professionals will be relied on more strongly in these circumstances and a type of ‘well note’ will emerge where it is possible to explain what can be done rather than where problems lie although to be honest, that is a little fanciful.
Would an employer make this effort for a potential employee when there is another potential employee without a similar medical history? Realistically it is unlikely and that is a cause for sadness.
The ease at glossing over any past problems can be all too tempting in a culture that judges health and competence so narrowly.