High and increasing rates of health-related unemployment have made health and work a policy and service priority in high income societies (Harvey, Henderson, Lelliott, & Hotopf, 2009), particularly where the total cost of worklessness outstrips the total healthcare budget (Black, 2008). The majority of people who are unemployed due to poor mental health have depression and anxiety Schaufeli and Vanyperen (1993) and people unemployed due to physical health conditions often have unrecognised co-morbid mental health issues (Harvey et al., 2009). Long-term unemployment adversely affects physical and mental well-being (McKee-Ryan, Song, Wanberg, & Kinicki, 2005) and when poor health is the trigger for loss of work, a complex clinical picture emerges (Clay, Newstead, Watson, & McClure, 2010). Health related unemployment is conceptualised as a biopsychosocial phenomenon, whereby work readiness is restricted by the interplay of health condition, health related beliefs/attitudes and the social/cultural context Waddell, Aylward, and Sawney (2002).
Despite a strong desire to return to work amongst the health related unemployed (McQuilken et al., 2003), this group struggles to both attain and maintain employment and as a result has lower employment rates and earnings (Rigg, 2005). The likelihood of a return to work is only one-in-five after twelve months of incapacity welfare (DWP, 2002). The health related unemployed appear especially vulnerable to the negative effects of unemployment due to additional loss of life/social structure, personal purpose and work identity (Bennett, 1970; Grove, 2006). Length of time unemployed is associated with deteriorating psychological health (Freidl, Fazekas, Rami, Pretis, & Feistritzer, 2007), physical de-conditioning (Waisak, Verma, Pransky, & Webster, 2004) and on-going financial strain (Price, Choi, & Vinokur, 2002).
Conversely, the therapeutic nature of work can reverse the adverse health effects of unemployment (Sainsbury et al., 2008; Waddell & Burton, 2006; Winefield & Tiggemann, 1990). Work reverses physical de-conditioning (Waisak et al., 2004) and habituation to unemployment (Black, 2008) and provides fiscal and physical security, daily structure, improved control and skill use, interpersonal contact and social standing/sense of purpose (Creed & MacIntyre, 2001; Fryer, 1995; Jackson, 1999; Jahoda, 1982; Warr, 1987). Return to work from health related unemployment is complex however, as it entails enhanced symptom management, increased motivation and behaviour change often via sustained interaction across a number of agencies (Frank et al., 1996; Krause, Frank, Dasinger, Sullivan, & Sinclair, 2001). Rick, Carroll, Jagger, and Hillage (2008) noted that there were few firm conclusions to be drawn from the evidence-base comparing interventions to enable a return to work for recipients of health related unemployment welfare. This is due to the extant studies lacking credible methodologies and, in particular, failing to access long term employment outcomes.
The current study is unique as it focuses on identifying factors that predict return to work in both the short and the long term from a ‘low intensity’ cognitive-behavioural intervention for the health related unemployed, i.e. the provision of a group psychoeducational intervention by trained health professionals acting in a generic practitioner role within a ‘high volume, low contact’ service ethos and design (Brown, Cochrane, & Cardone, 1999). Low intensity psychological interventions are defined by less intensive treatments (such as brief therapies, group treatments, assisted self-help, biblio-therapy and computerized treatments) for mild to moderate clinical problems, that enable rapid access to evidenced-based psychological treatments delivered by para-professionals, peer supporters or psychological well-being practitioners (Bennett-Levy et al., 2010; Rodgers et al., 2012). The clinical aim of the current study was to investigate the effectiveness and durability of CM-CBT and study the relationship with return to work rates in short and long term. We hypothesized that (1) reliable improvements in psychological functioning following CM-CBT would be associated with return to work in both the short and long term, (2) remaining on welfare following CM-CBT would predict deteriorations in psychological health over time and (3) effective return to work would produce longitudinal psychological benefits.
