Writing Fit

Sunday (10 October 2010) was World Mental Health Day, and the theme is: ‘Mental Health and Chronic Physical Illnesses: The Need for Continued and Integrated Care.’ Along these lines, our new report, Body and Soul, examines the relationship between mental and physical health, including musculoskeletal disorders, and the impact of these conditions on productivity and work participation.

Having both a physical and mental health condition is common, and the prevalence of mental health conditions is higher among those with a chronic physical health conditions, and vice versa. The relationship between mental and physical health conditions is bi-directional – meaning the physical health impacts mental health and mental health impacts physical health. Often, when individuals have both mental and physical health conditions, their health and work outcomes are worse. For example, around 25% of people with arthritis report a co-morbid mental health condition, which can increase psychological barriers to functioning and the number of days out of role.

In addition to examining the relationship between mental and physical health conditions, Body and Soul explores interventions that seek to reduce the impact these conditions have on individuals and society. This year’s World Mental Health Day calls for continued and integrated care, which Body and Soul also recommends. More effort needs to be directed to integrating care for physical and mental health.

The report also provides recommendations for employers. We know that work, particularly good work, is good for health and can aid in recovery. Therefore, providing good quality jobs that offer flexibility, autonomy and control, can mitigate the effects of health conditions – mental and physical – on individuals, employers and society. Work provides a sense of normalcy, which is illustrated by the following quote highlighted in the report:

‘I felt that one thing that would really help was if I could keep on doing the stuff I did before as much as possible so my life wouldn’t be limited by the condition.’

Our report calls for stakeholders to improve recognition between physical and mental health and to identify, design and provide effective interventions that address both physical and mental health in the health care setting, as well as the workplace setting. In the coming years, the prevalence of mental and chronic physical health conditions is set to increase, which means that employers and health professionals will have to do more to reduce the impact of these conditions on the working age population. Already in the UK, one in six working-age individuals have a common mental health condition, and the costs of mental health conditions in England exceed £105 billion. Mental health and associated co-morbid physical health conditions remain an important issue for individuals, families, colleagues, line managers, health professionals and policy makers.

The launch today of the Spanish Fit for Work report coincided with the announcement of the latest Spanish unemployment figures. They make grim reading, as predicted in our report, they passed the 20 per cent threshold which now means Spain has a level of joblessness exactly twice the EU average. What is worse, youth unemployment is close to 40 per cent, again the worst in Europe. On of the core Fit for Work messages has been that we need to avoid people with long-term or chronic health conditions becoming the first victims of a depressed labour, yet that is what seems to be happening both in Spain and elsewhere.
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The launch today of the Spanish Fit for Work report coincided with the announcement of the latest Spanish unemployment figures. They make grim reading, as predicted in our report, they passed the 20 per cent threshold which now means Spain has a level of joblessness exactly twice the EU average. What is worse, youth unemployment is close to 40 per cent, again the worst in Europe. On of the core Fit for Work messages has been that we need to avoid people with long-term or chronic health conditions becoming the first victims of a depressed labour, yet that is what seems to be happening both in Spain and elsewhere. (more…)

Wow! What a trip. Last Wednesday, I went to Stockholm to present the pan-European Fit for Work report at the 1st Baltic & North Sea Conference on Physical and Rehabilitation Medicine. I was scheduled to return Thursday afternoon, but needless to say the volcano disrupted my return travel plans.

I presented the findings to the conference attendees before I learned about the volcano. The presentation focused on interventions available to facilitate retention and return to work, such as early identification, multidisciplinary and cognitive behavioural team-based approaches, targeted and tailored interventions, work-style interventions and reintegration approaches. The biopsychosocial and International Classification of Functioning, Disability and Health models underlined many of the approaches used in these interventions.

Britt Arrelöv (Sweden) chaired a panel discussion around the topics I presented. On the panel were Andrew Frank (United Kingdom), Jan Ekholm (Sweden), and Christoph Gutenbrunner (Germany), and I. One of the key questions to the panel was the definition of early. Early varies by condition and type of intervention but is very important to consider. For instance, most cases of back pain resolve themselves within four to six weeks, so once the case goes beyond this time period, it is time to begin implementing interventions to facilitate recovery and reduce the likelihood of prolonged absence. However, for other conditions such as rheumatoid arthritis or ankylosing spondylitis, outcomes are often better the earlier individuals receive appropriate treatment.

Other points of discussion reflected on the role of rehabilitation medicine and the role of good work, as well as the importance of individual motivation and the psychosocial factors related to recovery. All in all, the discussion was very interesting and well received.

A few hours after the presentation, I learned about the volcanic eruption delaying my flight back to the UK. I thought I might be delayed for a day at the most, but seven days later I finally returned to the UK. We now know a variety of ways to travel from Stockholm to London ranging from driving, taking a train, riding a ferry to a combination of all three! Thankfully, I was able to board one of the first flights back into London and that Stockholm is a nice place to be stuck for an unexpected visit.

Today I attended the first full meeting of the RMSD Interest Group in the European Parliament in Brussels. This group, initiated by EULAR, and chaired by Mrs Edite Estrela MEP (Portugal) was launched on World Arthritis Day in October this year. One of its aims is to raise the profile of Rheumatic conditions and MSDs in the Parliament and in the Commission and to help position EULAR as the authoritative source of clinical and patient voice.

The Group has a number of MEPs as members, including Jim Higgins (Ireland), Antoniya Parvanova (Bulgaria) and Marije Cornelissen (Netherlands). Senior figures from EULAR and EULAR-PARE represented included Professor Paul Emery, Professor Josef Smolen and Neil Betteridge.

The Group was addressed by Dr Gigorij Kogan, Scientific Officer from DG Research and a specialist in chronic disease. He described some of the research into rheumatic diseases and MSDs which the EU had funded during recent years and explained how research priorities were decided. The Group discussed whether rheumatic and musculoskeletal diseases were receiving enough priority given their prevalence and their economic and social impact.

The next meeting of the Group will be in March 2010 when the topic for discussion will be ‘Work’. The Fit for Work programme has been asked to provide input to this meeting and we will be working with EULAR to ensure that the content is both informative and provocative!

My colleague Tatiana Quadrello just attended the launch of the Working Joints and Muscles Toolkit in London.  She advised on the document, which provides practical guidance in promoting musculoskeletal health in companies as part of an integrated health and wellbeing programme.  Click here to follow the link to the BITC website and download the report.