Depression and Disclosure

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.

8 thoughts on “Depression and Disclosure

  1. Must admit, the Laird case is worrying for people like me- perfectly capable of working and doing a very good job, but with a mental illness lurking in the background, ready to rear it’s head at any time, with frightening unpredictability.
    Even though the GSCC and occupational health are usually quite happy to accept my medical history, it makes me even warier of being honest on application forms etc now- would any council/ health trust take the risk of employing me, given the risks this judgement makes very real?
    It leaves me two choices, both as unappealing as each other- to disclose and virtually deny myself the opportunity of working in the career for which I have trained and worked extremely hard, or not disclose and open myself to the possibility of being fired, or dragged through courts, should I even be found out.
    Not a good dilemma.

    • Yes, actually that is the nature of my discomfort with the decision – you either tell the truth and risk not being taken on in the first place or not disclose and risk what happened with her.
      Of course it’s easy to say ‘go for the truthful option’ but I’m not entirely sure I would, myself, if I were in that position.
      The ideal is for the stigma to reduce more generally so the truth can be told without fear of discrimination but I suspect we are still a way off..

  2. Surely the ideal would be the banning (or severe restriction) of pre-employment questionnaires on health, with post-appointment surveys to identify any needs for additional support? This is what organisations such as RADAR and Mind are arguing for.

    My usual way of dealing with health questions on job application forms is to say that I’d be happy to discuss any relevant issues in the interview if I’m shortlisted.

    • I think that would make a lot of sense. I am not anticipating any interviews soon but I like your approach. It is eminently sensible.

  3. Did the council not have access to occupational health?! You’d think such an organisation would do it that way, i.e. a confidential health questionnaire is sent from application to OH and they decide whether the candidate is “fit to work” WITHOUT disclosing any confidential details of their assessment. If you’re going to ask, that seems the fair way to do it.

    This kind of thing makes my head hurt for my future.

    • I agree and it’s worrying. I’d like to think they could at least shortlist before needing to know health details as Rachel suggests – then the job would be obtained by the best candidate and support offered if necessary.

  4. I’m glad to see that a local authority has been dealt with appropriately by the High Court. Next time the voters of Cheltenham go to the polls, they need to remember the £1.6M spent wasting everyone’s time.

    I knew Christine Laird, pre 2002; she was a dynamic, hard working, no nonsense woman who didn’t suffer fools gladly. I genuinely hope her mental health is restored.

  5. MEP – thanks for that. Of course, above all, I wish her well. I think the council have acted in an appalling manner.

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