"Inadequate" work support for people with mental illness

EMPLOYMENT support for people with mental illness is woefully inadequate, an expert says, as new research reveals the uptake of disability support pensions (DSPs) for psychiatric illnesses ballooned over the past decade.

The study published in the MJA found that the prevalence of probable common mental disorders (CMDs), such as depression and anxiety, remained stable in Australia between 2001 and 2014, based on repeated national surveys using the 10-item Kessler Psychological Distress Scale (K10) self-report questionnaire. Paradoxically, however, the number of working-age individuals receiving DSPs for psychiatric conditions increased by about 50% over the same period – equivalent to one additional DSP for every 182 working-age Australian.

Led by Associate Professor Samuel Harvey of the Black Dog Institute, the authors said that their findings provided “robust evidence that the popular perception of an epidemic of CMDs in Australia is mistaken”.

Nevertheless, “functional impairment associated with mental health problems … continues to rise,” they wrote, suggesting that greater emphasis on improving occupational outcomes for people with mental illness was needed.

Associate Professor Harvey and colleagues posited four possible reasons for their paradoxical findings: practitioners may be increasingly labelling mental disorders as the cause of disability when they co-occurred with physical disorders; individuals may be increasingly applying for DSPs as eligibility rules changed for other income support programs; workplaces may be becoming less tolerant of people with mental illnesses; or the incidence of CMDs may have been rising, but has been offset by increased use of effective treatments to control symptoms.

The authors noted that K10 scores are designed to detect only symptoms of depression and anxiety, whereas DSPs are awarded for the full spectrum of mental disorders – a limitation of their study.

Professor Eóin Killackey, Head of Functional Recovery in Youth Mental Health Research at Orygen in Melbourne, said that the study’s findings most likely reflected an increase in help-seeking behaviours among people with mental illness as a result of destigmatising efforts over the past decade.

However, while it was good news that people were getting help, it was not necessarily the help that they needed, he said.

“Surveys consistently show that the vast majority of people with mental ill health actually want to work,” Professor Killackey said. “And yet, we know that the two most common exits off the DSP are the old age pension and death.”

“So, we have young people who primarily want to work, but once they go on the DSP they have more chance of dying or becoming 67 years old: that’s terrible.”

Associate Professor Killackey cited a government review showing that only 14% of people with a psychiatric disability receiving DSPs got a job that lasted at least 13 weeks.

“This is not an evidence-based intervention,” he said. “Our current disability employment system does a very bad job of helping people with mental illness to get back to work.”

Professor Killackey pointed to another model that shows promise – Individual Placement Support (IPS) – in which patients are matched with an employment specialist who provides up to 6 months of personalised support to help them get a job and keep it.

“An unpublished study [of ours] of 146 patients with psychosis found that 80% of those who received IPS were still employed at 18 months’ follow-up,” Professor Killackey said. A much larger federally-funded trial of IPS is set to begin across 15 headspace centres.

Professor Killackey said that while a small number of people with mental illness would struggle to work, most others would be able to work “with appropriate support most of the time, but potentially with intermittent periods of debilitating illness”.

“We need a system which is flexible, to support people with mental illness to live a life of dignity,” he said.

Professor Jane Hall, professor of Health Economics at the University of Technology Sydney Business School, said that the rising uptake of disability support pensions for psychiatric illnesses most likely reflected people switching from other types of income support as eligibility rules changed.

“It’s very hard to say whether the increasing number of people receiving the DSP for psychiatric illnesses is good or bad without knowing how long they’re spending on it, and whether they move off it,” she said.

Meanwhile, the Joint Parliamentary Standing Committee is currently examining the challenges posed by the National Disability Insurance Scheme for people with psychiatric disability.

In an MJA editorial, Professor Harvey Whiteford, of the Queensland Centre for Mental Health Research, said that the committee should also clarify the threshold for the allocation of DSPs and the type of support needed by people with psychiatric disability.

 

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