Health is wealth: How mental health issues lock people out of jobs

This pandemic has brought many issues about the workplace into the spotlight, one of them being mental health and traditional workspaces. I wrote about it for Careers Magazine‘s May edition. Check out the full edition here. Support good journalism.

The global pandemic has threatened the foundations of the capitalist economy on which we are built – a shaky one with fattest at the top, poised to crumble when the ones below are getting thinner. The systemic injustices that are faced by the poor, disabled, and elderly are now being faced collectively. 

In South Africa, approximately 1 800 people committed suicide during the lockdown, increasingly experiencing depression, anxiety, and other illnesses due to financial burdens and stress brought about by the pandemic and lockdown, according to Health Minister Zweli Mkhize. Experts say the virus and its implications have sparked panic and exhaustion. This has an intrinsic effect on how people enter and exist within the job market. 

It’s harder to get a job when you have a mental disability – an illness that prevents certain facets of daily life – and being “shut out of the jobs market” in numbers due to discrimination throughout the recruitment process. According to EU research, 38% of recruiters are concerned that people with mental illnesses are a “risky” hire. A UK government survey showed only 6% of people living with a mental illness are employed full-time.

These stats being unavailable for South Africa shows a lack of concern by both government and in health research. Ilze* was fired after being admitted to a psychiatric clinic, her manager saying, “We’re not certain you’re capable of doing this job with your sickness.” She said their attitude was dismissive and they were not prepared to understand her illness. The CCMA commissioner sided with the company, stating Ilze had not previously disclosed her illness even though this requirement is an unfair labour practice in terms of the Labour Relations Act. 

Once in the job market, it’s still a battle to stay there. The conditions needed to aid people with mental illnesses are not that difficult to achieve but most employers choose to see these illnesses as personal failings rather than medical conditions. In the first instance, mental health needs to be seen as any other chronic condition needing medication and therapy. In conversation with the South African Depression and Anxiety Group, a healthy workplace with sufficient light, air, and ample breaks can contribute to the mental health of employees. Good management practices where employees are valued and respected is much less likely to create, contribute to, or intensify mental health problems. 

A work environment that is adapted or created to fit a particular individual’s disability is safer and more efficient for all employees – especially those who need the concessions of sometimes working from home can work wonders for a healthy workspace. Introducing labour laws that require employers to provide concessions and paid days for mental wellbeing is ideal. Mental illnesses are not homogenous so communication is key to developing a healthy environment for all involved; especially when the person who needs the help asks for it.

With the corporate world working from home, I think about how the economics of disability – especially mental illness – has panned out during this time. More often than not, the job does not allow for disability except to check the employment equity box. “We have [x] people with disabilities on our team”, they say but the reality is that they are still treated as if they are burdens on the system, constantly being made to feel like the employer is doing them a favour by “so graciously giving [them] a job that [they] otherwise wouldn’t have given our circumstances” – this being verbatim from a meeting with a former employer. And the CCMA doesn’t help either, in most cases of ill-treatment of disabled folk, with one case saying, “Your boss has a point.” With so many cases like this coming out of the CCMA, there seems to be little recourse even though the constitution is meant to protect people with disabilities. 

In a 2017 report called Dying from Inequality, a worldwide mental health support organisation, the Samaritans, say: “People living in the poorest, most disadvantaged communities face the highest risk of dying by suicide.” The group found that financial instability and poverty can increase the risk of suicide and is a major inequality issue, not just a mental health one. In the face of unmanageable debt, unemployment, poor housing conditions, and other socio-economic factors contribute to high suicide rates. The report says tackling this inequality should be central to suicide prevention. 

Treating these disorders would boost national GDPs by an average of some 4% and psychological treatment can reduce a person’s annual physical health care costs by 20%, according to the World Health Organisation. Absence from work due to mental illness is due to the work atmosphere being uninhabitable or not disability-friendly. Working from home has given some of us the freedom to exist freely within our disabilities and work within our own limits.

Those with disabilities whose grants, increasing by a mere R30 (1.6%) a month, cannot afford this luxury and grants are effectively decreasing over the next three years, which the finance minister surreptitiously hid in among the numbers. Furthermore, the COVID-19 Special Relief of Distress grant is ending, pulling the plug on a lifeline for many. In a country where so many do not have access to the most basic of amenities, it is nigh impossible to monitor mental health statistics, let alone formulate a national mental health plan.

Substantial research has revealed that people who experience unemployment, impoverishment, and family disruptions have a significantly greater risk of mental health problems than their unaffected counterparts – more than 4% of reported cases in the EU – and that social protection responses are crucial in mitigating mental health in the economic crisis. In South Africa, informal work is where the majority of the country earn their living and these places of work shut down during lockdown, leaving families without an income for months, relying on the failing grant system.

People with medical conditions do not have to disclose these to their employer. The South African Labour Guide says our law does not place this obligation on employees. However, an employer has an obligation to provide a safe working environment for any medical needs – including chronic mental illnesses. 

It is important to know that employers are required by law to allow employees to work from home should the work environment not be safe or conducive to illnesses, and if the work allows for remote execution. Unfortunately, there is no way to prove unlawful dismissal if the employer claims the employee did not meet KPIs – even if it is due to a disability and if the prospective employer is open about their disability, we cannot know for sure that a rejection of employment has to do with their condition. Such is the nature of the negative outlook toward mental health. We can, however, place more pressure on workplaces to educate themselves on mental illnesses and push for regulations of how interviews with people with disabilities are conducted. 

Key policies on mental health still obscure the link between social and economic inequality and poor mental health and ignores socio-economic contributors. This may be in part an inability to grasp mental health. When we think of a healthy society, we see one that provides for people in all aspects. Yet my year in a developed, socialist country showed me that mental illness is still taboo; if you suffer from a mental illness, the common conception is that there’s something wrong with you, as a person. 

In a developing nation, it’s easy to see why this would be a roadblock; the visible problems are the ones we have the power to treat. While for more physical diseases, we separate the illness from the person, in case of mental disease it’s more difficult to do so. Mental health is perceived as a luxury. It means you’re just whiny with all your basic needs satisfied. There’s nothing more false, yet it’s worryingly common. This invisible issue has tangible consequences with a ripple effect. 

Some research suggests mental health is the most neglected health problem in the developing world and depression is the single most prevalent mental illness. Depression affects women at twice the rate of men. In Africa, depression affects 1 in 4 women and, of these women, the overwhelming majority – 85% – have no access to treatment. Even nit considering the poorest of the poor, mental health treatment is expensive even for those who can afford general healthcare. Without access to affordable treatment, many have a hard time holding down a job yet do not qualify as formally disabled, thus leaving them locked out from insurance coverage and the job market – creating this endless loop of exclusion from society.

Untreated mental illness can result in deteriorating physical health, which can manifest as chronic pain, a lowered immune system, and internal organ issues, and can lead a person to damaging actions without explanation or therapeutic and legal recourse. This could result in losing a job or incarceration. It’s a vicious cycle that eats at the person suffering. The affordability of mental health treatment – or lack thereof – is but one roadblock in a long line of increasingly difficult hurdles. If you have health insurance or some sort of medical assistance, it would be much easier, would it not? Aye, there’s the problem. 

Where do we even begin to tackle the issues presented by both poverty and mental illness? How do we stop this cycle of illness, neglect, and destitution? I don’t have the answers. But I am willing to have these conversations again and again until we do.