RECENT REPORTS FROM the EU indicate that it expects the Irish economy to grow in the next year and the unemployment rate to fall. Although this is good news, it would still leave us with one of the highest rates of unemployment in Europe. Evidence from other countries suggest mental health rather than economic growth may be one of the key factors in helping people return to work. In this month of May, maybe we need to have a conversation about the role mental health will have in helping us turn the economic corner.
The idea that all we need to do to get people back to work is to create jobs, sadly misses all the evidence from previous recessions. When we look at the 1980s in Ireland, or the closing of the mines in Wales or the closing of heavy industry in Northern England, we can see that unemployment can quickly become generational and that it is only partly due the economic situation in the area. When an economy recovers, many people will just return to work. However, for a significant proportion it is not as straightforward.
When the London School of Economics looked at the issues that hold people in long-term unemployment, common mental health difficulties like anxiety and depression were the largest cause. This operates as feedback loop. The longer someone is out of work, the more likely they are to become depressed and the longer someone is depressed, the harder they find it to get back to work. This can cause long-term unemployment, independently of the economic situation. Initially this is an economic problem causing a mental health problem but, relatively quickly, it becomes a mental health problem causing an economic problem.
This is not a small issue. It is estimated that the cost of mental health difficulties in Ireland is around €3 billion euro per annum, 40% of all disability in Ireland today is due to mental health difficulties. The Royal College of Psychiatrists estimate that 90% of the economic cost of depression is due to work-related factors like unemployment, absenteeism or early retirement.
Other than a relationship difficulty, unemployment is the factor most likely to trigger a psychological depression. There is nothing too surprising in this. For over 30 years, we have seen research that describes a gradual increase in anxiety and depression and a gradual decrease in morale as the period of unemployment lengthens.
Marie Jahoda identified five categories which were vital to well-being. These are:
We can see that employment will often address each of these categories. We have a reason to get out of bed; we have a structure to the day; many jobs involve significant social contact; our identity is tied up with what we do (how many conversations start with ‘what do you work at?’ and how many conversations with friends and family start with: ‘how’s work?’) We can see that if we become unemployed that each of the categories would be significantly challenged. The basic structure of our day is torn up. Instead of meeting 20 people a day we might meet two. Our role, our social identity stops.
There is a sense of stigma about being unemployed. Despite the fact that there was a global financial crisis and a national recession, people still feel individually to blame if they lose their job. How many positive newspaper stories are there about people who are unemployed? Instead, political parties cue up to see who can be tougher on people who have lost their jobs. The language of cruelty pervades. Politicians, people with money, jobs and power, slam people without any, to score points with an electorate.
Everyone knows it is hard to get back to work, even if an economy starts to improve. There is months of searching the net and the jobs pages; re-thinking what you might do and how you might fit in a new jobs market; filling out applications; receiving rejections; attending the interviews. All of this takes motivation, drive, energy and optimism; all the attributes that are hammered by depression.
People have to be ready to work psychologically as well as technically. Our concept of who we are is very connected to what we do. What happens when there is a disconnect between how we see ourselves and the available jobs? If I previously earned €50,000 a year sitting a desk, what happens to my self-esteem when the only job available is €25,000 standing on my feet? Will the jobs be in the same area that the person has their experience in? Is a 50-year-old with years of experience in the construction industry able to do an entry level job in the service industry? These aren’t easy shifts psychologically, even without depression.
We need to see our health as an economic issue. 40% of disability in Ireland is caused by mental health difficulties but only 6% of the health budget is for mental health. There is a complete disconnect between the scale of the problem and resources there to meet it. The Government has the potential to tackle a vicious cycle between unemployment and depression now before it has a chronic mental health–unemployment deadlock throughout the next decade.
Dr Keith Gaynor is a Senior Clinical Psychologist with St John of God Outpatient Psychological Services, Stillorgan (2771440). For information see www.sjoghosp.ie
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