Occupational psychiatry

High rates of sickness absence and incapacity benefits constitute an increasing social and economic problem in most developed countries. Psychiatric disorders are now the leading reason for long-term sickness absence and incapacity benefits in the UK. Most of the work-associated costs of psychiatric disorder are due to common mental disorders such as depression and anxiety. Psychiatric disorders can also have a marked effect on workplace performance. Individuals suffering from mental illness are stigmatized in the workplace and often excluded from the various benefits paid employment can provide. There is good evidence that being in employment is associated with better mental health, including improved self-esteem and a lower risk of suicide. There is some evidence that an employee's perception of their workplace can be associated with an increased risk of psychiatric disorder, particularly if they perceive high job strain. It seems likely that some of this effect may be mediated via factors such as personality and individual perceptions. A good occupational history should be part of any full psychiatric assessment. There is limited evidence regarding work-focused interventions for common mental disorders. The apparent lack of an occupational effect of standard treatments for depression suggests that additional specific interventions addressing return-to-work issues may be needed. There is good evidence that Individual Placement and Support (IPS) programmes are effective in helping individuals with schizophrenia find paid employment. Early detection, prompt focused management, and evidence-based rehabilitation should reduce the occupational impact of any psychiatric disorder.