A major systematic review and meta-analysis of papers comparing job
satisfaction and measures of physical and mental health showed
significant effect sizes the likes of which are very rarely seen in
meta-analyses in psychiatric research into treatments for mental
illness. In total 250,000 people were included in the 483 studies in the
meta-analysis. The effect sizes of around 3 compare to effect sizes
around 1 for psychiatric treatments.
Dame Carol Black speaking at a conference quoted Galen (a Greek/Roman
doctor who pioneered the understanding of the human body and brain),
"Employment is nature's physician" and clearly the research evidence
shows that work is good on mental and physical health measures. Work can
really help a person but it's the right sort of work.
I don't know the research on lack of job satisfaction and health. It's
clear giving people jobs which satisfy them should be something which
should be part of any government's cross departmental mental healthcare
strategy. The effect sizes alone are enough for it to make sense but
it's hard to see how this could be achieved.
Given the IAPT program is rolling up to £173 million a year for
provision of psychological therapies for everyone (it's currently
restricted to people with depression and anxiety but on the grapevine I
hear that sense has finally won the day and the scheme is being extended
to people with the severest conditions) is based on research which will
show effect sizes around 1 in high quality meta-analyses and has
economic arguments which initially got it commissioned (keeping people
working by offering CBT saved money in the long run).
Perhaps I'm talking about a work for health scheme. It's the solution
which solves the problems of the changes in the welfare system. The
changes to the welfare system in the UK will push people further into
poverty. People with severe mental illnesses are dying 20 years earlier
than people who don't have them and poverty is part of this. The current
plans mean more people will die earlier because they'll be even poorer
as they're denied the same rate as they were on before.
At the moment there's a global recession which means jobs are getting
scarce. At the moment most new job creation is for part time work which
benefits the mentally ill and many other disadvantages groups but people
who were once in full time employment (those who are losing their jobs
or have lost them already because of the recession and cuts in
government spending) will be forced to take those. The worst jobs will
be available to those forced onto the lowest level of welfare benefit or
those on job seekers allowance.
Disability means people lose their skills. They have huge gaps in their
employment history. They also have less experience. These problems are
obvious barriers presented by disability.
A work for health scheme could offer them employment, training and money
to supplement their benefits. Their benefits could still be secure and
they could make more money to live a longer life. They'd also be trained
and working.
They'll be able to gain professional skills, contribute and feel good
about what they do. The last part is essential I think to replicate the
significant benefits for physical and mental health.
The benefits to these reduce short term and long term healthcare costs
so there's a health economics argument which some expert could probably
add numbers to. A work for health scheme which created the right type of
jobs could save the country money in the long run if the work offered
high levels of job satisfaction because people would be mentally and
physically healthier. In the meta-analysis which I'm basing my rational
for the scheme there's a graph which looks at the other graphs and how
wide the spread of the results is, i.e. it made it possible to see
roughly how often high job satisfaction was associated with poorer
physical and mental health. It's possible but it's rare, far rarer than
a psychological treatment having a negative effect.
There's another obvious benefit to a work for health scheme: the work
done. Whatever is produced or achieved. In Keynesian economic theory, as
I understand it, a recession is primarily about reduced productivity. As
commerce and manufacture spend and employ less there is less consumption
and so less need for people to work. Something like that. I've probably
oversimplied it somewhat. The classic method to get out of a recession
is government spending on infrastructure projects. That's the classic
Keynesian way anyway. This creates productivity which primes the restart
of the consumption engine which returns people to producing stuff to be
consumed and used.
Many of welfare benefits are productive. Their work isn't recognised.
Some volunteer. Others are carers. What they do isn't often called work
but it's work nonetheless. If this was formalised and made a way for
people to get high levels of satisfaction and remuneration to relieve
the negative effects of poverty as well as reward those who work then it
creates the possibility of a work for health system. There's also other
things which peop0le with disabilities can do which provide value to GDP
and GDH (Gross Domestic Happiness - for those who having been keeping p
with international thinking on mental health and what governments are
meant to achieve).
It could create a new economy for people who once had no buying power or
recognition of the value which they provide. The work they do can
contribute to the economy and the nation's happiness. The scheme makes
people better and it relieves the effects of poverty as well as creating
value to society.
But only if the work is how, I think, Galen meant it when he said
"Employment is nature's physician, and is essential to human happiness."
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