Supporting sustainable return to work

Dr Jo Yarker from the Department of Organizational Psychology shares her research into supporting employees who are returning to work following mental ill-health absence.

Around 15% of the working population suffer from common mental disorders (CMDs) such as depression, anxiety and adjustment disorder (OECD, 2014). For half of these, experience of mental ill-health will lead to a period of long-term sickness absence. In the UK alone, stress, anxiety or depression accounts for 57% of all working days lost to ill-health in 2017-2018 (HSE, 2018).

Sustainable return to work for workers with CMDs is therefore a major societal challenge in terms of scale and costs. A successful initial return to work is no guarantee for sustainable return to work, with research suggesting that approximately 19% of workers subsequently relapse and take further absence or exit the workforce (Koopmans, Bültmann, Roelen, Hoedeman, van der Klink, & Groothoff, 2011).

Relapse has significant consequences for sustaining work, with implications for employment prospects, productivity and wages (OECD, 2014). There is an urgent need to better understand how workers with CMDs can be better supported to return to, and stay in, productive work. Together with my colleague Professor Karina Nielsen from the University of Sheffield, I sought to find out how to support employees returning to work following mental ill-health absence.

Understanding the barriers to sustainable return to work

Our study was the first to our knowledge to follow workers post-return using a qualitative approach. We used the recently developed IGLOO framework in our research: examining the Individual, Group, Leader, Organisational and Overarching (IGLOO) contextual factors (Nielsen, Yarker, Munir & Bültmann, 2018) that influence workers with CMDs’ ability to remain in employment throughout working life.

We conducted interviews with 38 workers who had returned from long-term sick leave due to CMDs, the majority of whom we spoke to at multiple points following their return.  We’d originally planned to follow workers in the first months after return, however, after being contacted by workers who still experienced challenges long after return, we decided to include these too. We also spoke to twenty line managers with experience managing returning workers.

Our findings

Participants reported a number of resources, in and outside of work, that helped them stay and be productive at work.

Resources at work across the five IGLOO levels help employees stay and be productive at work:

  • Individual: Creating structure within their working day to help maintain focus and concentration.
  • Group: Gaining feedback on tasks from colleagues, help with challenging tasks and being treated as before, not as someone with a CMD.
  • Leader: Agreement of communication to colleagues, continued support and access to work adjustments, and signaling (and being) available but not intrusive.
  • Organisational: Flexible working practices and leave policies, accommodating absenteeism policies, work-focused counselling, and demonstrating care through support.
  • Overarching context: This level was not applicable as we only examined UK workplaces.

Resources at home across the five IGLOO levels help employees stay and be productive at work:

  • Individual: Prioritising self-care and the establishment of clear boundaries between work and leisure.
  • Group: Understanding and non-judgmental support from friends and family.
  • Links to services: Consistent point of contact and facilitation of links to external services and treatment.
  • Organisational: Access to work-focused counselling.
  • Overarching context: Those who were financially independent were able to make choices that better suited their needs; the majority reported the positive media attention around mental health enabled them to ask for help.

The main results of our study point to important avenues for future research and practice. Within the workplace, the findings highlight the need to:

  • Consider resources at all IGLOO levels and implement multi-level interventions.
  • Train returned workers in how to structure their day.
  • Train and support line managers, both in having difficult situations but also on how to support workers creating structure and support them manage their workload.
  • Develop more information about appropriate work adjustments that can be implemented and how these can be accessed.
  • Offer flexibility to the returning employee, in relation to work schedule, ad hoc flexibility when depleted to prevent further decline and aid recovery, and flexibility in tasks.
  • Adopt an individual approach as there is no off-shelf-style that works for all.
  • Adopt a long term approach, ensuring that employees are able to access adjustments in the months and years that follow.
  • Conduct further research to enable us to understand the contribution of these features and their synergistic effect on enabling returned employees to remain productive at work.

Outside the workplace, the findings highlight the need to:

  • Conduct further research to better model the impact of support received from friends and family, GP services and those within the voluntary sector.
  • Equip GP services with the skills and knowledge to support return to work.

We developed guidance for employees, colleagues, line managers and HR professionals to support returned workers to thrive at work. This and our full report can be found on the Affinity Health at Work website.

Further Information

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Austerity – it can really drive you Wilde…

Dr Sue Konzelmann, author of Austerity, discusses the long-term impact of a policy that places price before value.

Over the last decade, most of us have been on the receiving end of innumerable attempts to justify continued austerity in the UK, all of which have had one thing in common – they focus purely on money. There has been much talk of public deficits and debt – although at times, even our prime ministers have confused one with the other. The impression you get is that everything has a price; and when it comes to austerity, that’s all that matters. In the words of Oscar Wilde’s Lord Darlington, a cynic is “a man who knows the price of everything and the value of nothing.”

There has been a fair amount of cynicism in discussions about austerity. For example, the value of spending over £136bn in public funds bailing out the banks following the 2008 financial crisis would be questionable enough in itself, without then using it as an excuse to deprive so many tax payers of essential government support services – especially since, as described in my new book, Austerity, the case of Iceland had clearly shown that there was a viable policy alternative to austerity. But whilst it all came down to cash at Westminster, the vast majority of us were losing essential public services that we use, value and, in many cases, depend upon.

If this continues, our society will soon begin to unravel at an even more alarming rate, as we cut the ties that bind it together. Cuts to local authority spending have already had a drastic effect on the level and effectiveness of social services, whilst you hear a lot on the TV – on a daily basis – about the devastating effects of cuts to the police and emergency services.

The corrosive effects of multiple cuts, acting together, became all too clear whilst filming a video about austerity at the Euston food bank – but that’s something you hear a lot less about in the news.

Perhaps counterintuitively, the vast majority of people who have been forced to use the food bank since it was set up in 2010 are actually in work. But the government’s attempts to save money through changes in the benefit system, like Universal Credit, has meant that people claiming it would not get a payment for up to five weeks. How many of us would be comfortable about missing a month’s salary – or more? Not many, I suspect.

It also turns out that in order to avoid homelessness, many Euston food bank users are choosing to pay their rent, rather than buy food. This is probably rather less surprising, given that the average UK household income is around £28,000 – and renting a two bed flat anywhere in that part of London will cost around £2,000 a month. Cuts to social care have also resulted in rising homelessness – and another source of people reliant on food banks.

Austerity, as a single policy, is a very blunt instrument, that has focused on price, rather than value. As a result, it has critically impacted many inter-related policy areas. Undoing its damage will therefore mean not only sharply revising policies in such areas of affordable housing, employment, health, education and social services; it will also require changes in benefit structures and delivery – to ensure that they work together as seamlessly as possible.

In a world where it is, for some unknown reason, apparently impossible to integrate such obviously linked services as the NHS and social care, this vision might seem ambitious. It shouldn’t be. In the words of Oscar Wilde’s Lord Darlington once again, “we are all in the gutter, but some of us are looking at the stars.”

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Why do women favour working in the public sector?

Research carried out by Birkbeck’s Dr Pedro Gomes and Professor Zoë Kuehn from the Universidad Autónoma de Madrid aims to understand why women self-select to the public sector.

The public sector is a large employer, accounting for between 10 and 35 percent of total employment in OECD countries. In most countries, the public sector hires disproportionately more women than men. With my colleague Zoë Kuehn, I developed a model to try and understand this imbalance.

Through the lens of our model, we view the gender bias in public employment as driven by supply, meaning that it is not the government that acts explicitly to hire more women, but it is women that choose the public sector more so than men. Our objective was to better understand this selection, in particular, how much of it is explained by public sector job characteristics that are related to management, organization and human resource practices in the public sector.

We documented gender differences in employment, transition probabilities, hours, and wages in the public and private sector using microdata for the United States, the United Kingdom, France, and Spain. We then built a search and matching model where men and women could decide whether to participate and whether to enter private or public sector labor markets. Running counterfactual experiments, we quantified whether the selection of women into the public sector was driven by: (i) lower gender wage gaps and thus relatively higher wages for women in the public sector, (ii) possibilities of better conciliation of work and family life for public sector workers, (iii) greater job security in the public compared to the private sector, or (iv) intrinsic preferences for public sector occupations.

A natural explanation for the gender bias in public employment could be that certain types of jobs that are predominantly carried out by the government could be preferred by women. However, our research revealed that, for the US, the UK, and France, once we exclude health care and education, women’s public employment is still 20-50% higher than men’s. Interestingly enough, the gender bias is less pronounced within public health care and public education compared to other branches of public employment.

Regarding transition probabilities, we estimated that the probability of moving from employment to inactivity is higher for women, but we found this probability to be significantly lower for public sector workers.

We also provided evidence that gender wage gaps and working hours are lower in the public sector. Individuals holding full time jobs in the public sector work between 3-5% fewer hours compared to similar individuals holding full time jobs in the private sector. However, fewer working hours are just one aspect of a better work-life balance (next to additional sick days, holidays, flexibility to work from home, employer provided child care etc.). In our model we wanted to capture differences in work-life balance across sectors in an ample sense, and hence we do not use these estimates to identify any parameters. Nevertheless, our results on fewer working hours in the public sector support the claim of a better work-life balance in the public compared to the private sector.

The results of our research suggest that women’s preferences explain 20 percent of the gender bias in France, 45 percent in Spain, 80 percent in the US, and 95 percent in the UK. The remaining bias is explained by differences in public and private sector characteristics, in particular relatively higher wages for female public sector workers that explain around 30 percent in the US and Spain and 50 percent in France. Only for France and Spain do we find work-life balance to be an important driver that explains 20 to 30 percent of the gender bias. Higher job security in the public sector actually reduces the gender bias because it is valued more by men than by women.

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Physical fitness linked to lower cognitive impairment in dementia

Dr Eddy Davelaar from the Department of Psychological Sciences discusses the importance of physical fitness in offsetting cognitive impairment in adults with dementia.

 

Dementia and cognitive impairment cost the UK economy approximately £26 billion per year. The number of people with dementia in England and Wales has been projected to increase by 57% from 2016 to 2040, primarily because of extended life expectancy. Finding ways to slow its severity and progression could have life-changing effects for the 800,000 people estimated to be living with dementia in the UK.

With the increased incidence in dementia, people are interested to know whether it could be prevented through changes in their lifestyle, such as eating habits, exercise, and decreased environmental stress. Research does suggest that a healthy lifestyle lowers the risk of dementia. We were interested in physical fitness as one of the lifestyle factors. In our recent article published in Frontiers in Public Health, we asked the question of whether self-reported physical fitness is associated with cognitive, or thinking ability in people with dementia.

To assess this, we used a cross-sectional design with two groups. The first group was made up of 30 older individuals (aged 65+ years) with dementia, who were attending the Alzheimer’s café social events. Those people in the dementia group have lower cognitive performance than the 40 age-matched participants from our control group, who do not have dementia.

We tested everyone on a wide range of cognitive tests, such as verbal fluency, prospective memory, and clock drawing. We also administered a 15-item questionnaire on physical fitness, which asked about strength (eg. ability to lift things), balance, and aerobic conditioning (eg. taking a brisk walk or taking the stairs instead of lifts). Many studies have shown strong correlations between self-report and objective measures of physical fitness. In addition, this questionnaire is available to everyone for self-assessment.

Our findings showed that in the group of dementia patients, those with greater physical fitness also had a greater general cognitive ability. Even those patients with the best cognitive performance still performed worse than the healthy individuals, who did not show this link between physical and cognitive fitness. Thus, physical fitness seems to buffer dementia-related cognitive deterioration.

We ran a number of checks on the results and found that the association did not change when we controlled for the age of the participants, the number of years since dementia diagnosis, the type of dementia, or even whether the person used to be physically active when they were younger. The latter finding suggests that the current state of being physically fit and capable is key to observing this cognitive benefit.

There are at least two explanations for these findings. First, the cardiovascular hypothesis states that physical activity stimulates blood circulation in frontal-striatal circuits (neural pathways that connect frontal lobe regions with the basal ganglia that mediate motor, cognitive, and behavioural functions within the brain), that are critical in executive functioning, such as planning and reasoning.

A second hypothesis suggests that physical fitness measures, such as strength and balance, require efficient brain representations of motor plans. The processes by which these motor representations become more efficient also leads to enhanced cognitive representations. Both hypotheses underscore the expression, ‘what is good for the heart is good for the brain’.

We are currently in the process of addressing the question of whether physical fitness (using both self-report and objective measures) is associated with cognitive decline or cognitive impairment in the absence of dementia. This would assess whether greater physical fitness is associated with greater mental fitness in general, or with cognitive fitness specific in the context of dementia.

Future research could also extend this work using longitudinal study designs in order to address the question of whether a change in physical fitness is associated with a change in the risk of dementia, which has important implications for health policy and age-appropriate physical intervention programmes for both healthy individuals and dementia patients.

Read the original, peer-reviewed article: Increased Physical Fitness Is Associated with Higher Executive Functioning in People with Dementia (2017).

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