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The costs of mental ill-health for individuals, employers and society at large are enormous. Mental illness is responsible for a very significant loss of potential labour supply, high rates of unemployment, and a high incidence of sickness absence and reduced productivity at work. Following an introductory report (Sick on the Job: Myths and Realities about Mental Health and Work) and nine country reports, this final synthesis report summarizes the findings from the participating countries and makes the case for a stronger policy response.

Mental health is an important driver of labour market outcomes and thus affects economic growth and future development. In OECD countries, mental ill-health is responsible for between one-third and one-half of all long-term sickness and disability among the working-age population. It causes and exacerbates chronic physical illness, pushing up health care costs. And it lowers education outcomes – partly because those who are ill leave school early – so shutting off employment opportunities. Relatively to the mentally healthy, the employment rate of people who suffer from poor mental health is 15-30 percentage points lower and their unemployment rate is twice as high. They are also twice as likely to live in poor households. In the workplace, employees who suffer from mental ill-health tend to underperform and their low productivity is probably the single biggest cost factor, borne to a large extent by employers.

People with mental ill-health need timely, adequate treatment in order to prevent a deterioration of their situation. Under-treatment is a persistent problem, since only about 50% of people with severe mental illness and about 30% of the people with moderate mental health conditions receive treatment. Moreover, targeting the right form and intensity of treatment at the right people remains a challenge in many OECD countries. Fostering the labour market participation of people who suffer from poor mental health requires policy action. Co-ordination between the health and employment sectors is crucial to that end.

Childhood and adolescence are crucial periods for promoting good mental health. Every second mental illness has its onset before the age of 14. Those suffering from mental ill-health are more likely to leave school early with poorer education outcomes and consequently have greater difficulty accessing the labour market. Education systems have a key role to play in identifying and supporting children with mental health issues at an early stage. Policies to prevent early school leaving and enable smooth transitions from school to work are essential if young people’s education outcomes and adult working lives are not to be adversely affected.

Mental ill-health exacts a high price – on individuals, employers, and the economy. Apart from the distress they suffer individually, people with mental health problems also suffer economically through lower employment, higher unemployment and a high risk of poverty. Employers struggle with significant losses in productivity at work and high rates of sickness absence. And the economy at large bears the costs in the form of elevated social and health care expenditures.

Employers are ideally placed to help their employees deal with mental health problems and retain their jobs. Workers who suffer from mental ill-health take sick leave more frequently and are absent for longer than those who are mentally healthy. At the same time they also report reduced productivity at work more often. Stress prevention in the workplace is both a necessary and effective means of tackling existing mental health issues. However, the pervasiveness of mental health stigma complicates the solution of work problems that are related to mental health problems. If managers are to be able to identify mental health problems, they need adequate training and support.

Mental health is costly for individuals concerned, for employers, for the labour market, for the social protection system and for the economy as a whole. This is explained by the high prevalence of mental ill-health, the early onset of mental illness that affects education and the labour market transition, high levels of under-treatment and unmet health care needs, and significant stigma associated with mental ill-health especially in the workplace.

The ability of benefit systems to identify clients’ mental illness is crucial to helping them back into the labour market quickly and sustainably. Mental ill-health is highly prevalent not only among disability benefit recipients, but also among unemployment and social assistance recipients. Across OECD countries, between one-third and one-half of all benefit recipients suffer from mental ill-health. Activation policies can assure fast return to work for those people and prevent high caseloads in the disability benefit scheme.

Mental ill-health is a key issue for labour market and social policies in OECD countries; an issue that has been long neglected also because of the widespread stigma and preconceptions. Yet mental ill-health exacts high costs on the people affected, businesses, and the economy as a whole. Things are beginning to change, however. OECD governments are increasingly coming to recognise that policy has a major role to play; it can help improve education outcomes and employment opportunities for people who suffer from mental ill-health; help those who are employed but struggling in their jobs; and prevent long-term sickness, unemployment and disability.