This section considers the relationship between people’s work and their mental health condition, including the extent to which people felt their work had affected their mental health and vice versa. In considering these questions, we recognise that it is both complex and contestable to talk of causal relationships between work, mental health and other contextual factors. In the analysis that follows, any reference to ‘triggers’ or ‘exacerbating factors’ comes solely from the descriptions and understandings of the study participants. The analytic categories are those of the researchers.
As detailed in Chapter 1, the study group was designed to include 30 people with recent experience of moving from work to IB and 30 people who had recently moved off IB and into employment. Of course, many of the people in this latter group were also able to reflect on experiences of leaving work due to mental ill health. However, what the sample as a whole also demonstrated was that people who come to claim IB because of a mental health condition do not necessarily attribute their leaving work to this experience of mental ill health.
Around two-thirds of the study participants gave accounts where the emergence or exacerbation of mental ill health had been a main factor in their leaving work. A smaller number, around a fifth of the sample, explained that, although they had experienced mental ill health concurrently with being in employment, they did not see this as the reason for leaving their job. Instead, they cited reasons such as redundancy or the end of a temporary contract. However, some of these people believed that, given the effects of their mental health condition, they would probably have struggled to stay in their job for much longer anyway, had it not come to an end for some other reason. A small number of people said that they had left their most recent job before their experiences of mental ill health began. There were also a similar number of people who had not been in employment for some years prior to claiming IB and who did not talk in detail about their experiences of leaving their last job.
Among people who did talk about a period of being in work while experiencing a mental health condition, three main relationships between work and mental ill health were described. There were:
• work being a trigger of their mental health condition;
• a combination of work-related factors and circumstances in their personal life as contributing to experiences of mental ill health; and
• mental health condition arising independently of work.
Recalling the different ‘histories’ of mental health condition (see Section 2.1.2), it was notable that each of the three groups above included people who were experiencing their first episode of mental ill health and people who felt that a previous or long-standing mental health condition had been re-triggered or exacerbated by more recent events or influences. However, in constructing the three categories above, the analysis drew on people’s accounts of what they felt had triggered the recent episode of mental ill health that had preceded their leaving work. Thus, for example, there were people in the first group who recognised a long history of depression, or explained that an event in their personal lives some years earlier had triggered their first experiences of anxiety, but who at the time of leaving work more recently, felt that it had been solely workplace factors that had triggered the recurrence of mental ill health.
It should be noted that, across the study group, the boundaries around the three relationships between work and mental health were not always distinct and there were relatively few people who said with certainty that only work or only non-work factors were affecting their mental health. Many people described a combination of work and non-work factors, illustrating the complexity of circumstances which underlie the emergence or exacerbation of mental ill health. Some people who perceived influences from both areas of life also found it difficult to identify whether work or non-work factors were most influential in the decline in their mental health.
It is also notable that there were few examples of work being cited as the first and only reason underlying the emergence of a mental health condition. In most cases, people were either experiencing another stressor in their personal lives at the same time, or ‘job stress’ had exacerbated a condition that had been experienced in the past, initially triggered by non-work events. As will be discussed further in Chapter 7, this has important implications for employers who wish to retain their staff, in that they will need to be sensitive and responsive to events occurring in employees’ lives outside of work, as well as attending to mental health in the workplace, for example, through prevention or management of ‘job stress’. In describing how they arrived at a point where they felt they could no longer be at work, two types of scenario emerged from the study participants’ accounts. Firstly, there were people who had been feeling well and managing in their job, but experienced a sudden traumatic event after which they no longer felt they could stay in work. Secondly, there were people who had experienced a gradual
deterioration in their mental health culminating at a point where they felt they could no longer ‘cope with’ or ‘handle’ being at work. Among this second group, the ‘last straw’ in their leaving was sometimes a sudden event.
Work-related triggers
Some of the work-related triggers described by people in the study group were sudden and unforeseen events that had occurred in the course of carrying out their work, for example physical or verbal attack by a client in their care, receiving notification of redundancy or allegations of misconduct. On the other hand, there were also gradually developing situations where, for example, mounting ‘job stress’ or workplace bullying had intensified over time.
Non-work triggers
Non-work triggers identified by study participants were of two broad types. Firstly, some people talked about specific events or circumstances in their personal life having triggered an episode of mental ill health. In some cases, people described gradually mounting levels of stress or emotionally demanding situations which exacerbated depression or anxiety, until they reached a crisis point where their state of mental health meant they could not manage in work. Other people explained that a sudden event in their personal life had very quickly led to them feeling so distressed that they were unable to remain in work. Examples here included sudden and violent bereavement or unforeseen relationship breakdown.
Secondly, some people cited aspects of their mental health condition itself as having impacted on them at work. Some people who identified themselves as having a long-standing condition explained that its intrinsic effects had made work unmanageable. Examples included a low period in fluctuating depression (for which the individual felt there was no identifiable cause) or experiencing the physical effects of alcoholism or drug addiction. Some people also cited the effects of medication as making work difficult to manage.
Table 2.1 shows some examples of the various relationships between work and mental health experienced by people in the study group.
Table 2.1 Relationships between mental health and work
Changes in mental health
Influences on mental health
Gradual Sudden
Work factors alone Workplace bullying Unmanageable workload increasing over time
Verbal assault
Physical injury incurred in the course of duties
Combination of work and non-work factors
‘Job stress’ plus ...
... supporting a bereaved partner ... PTSD following severe physical injury
... sudden and violent bereavement
Non-work factors alone
Domestic violence leading to eventual relationship breakdown Long-standing fluctuating depression
Discovery of a partner’s infidelity Bereavement