THE government is proposing to turn the GP’s “sick note” into a “well note”, as part of its efforts to reduce the numbers on incapacity benefit – currently 2.6m people. That GPs may soon have to advise on a phased return to work for the long-term sick has rather delighted business.

GPs are regarded as an obstacle by many firms grappling with long-term sickness absence, estimated to be costing industry billions in addition to the billions it costs in incapacity benefit, when long periods off work turn into long-term unemployment.

The Chartered Institute of Personnel and Development found recently that 40% of its members rated GP support on long-term sickness as very or fairly poor. It thinks the well note and an acceptance of the benefits of a phased return to work, particularly in cases of mental ill-health, could drastically cut the costs of long-term illness to business.

Mental ill-health – from mild depression and stress through to bipolar disorder and schizophre-nia – is the second-biggest cause of long-term sickness absence in Britain; only musculoskeletal problems cause people to take more time off work.

Gail Scott, head of the occupa-tional-health team at HSBC, is enthusiastic about the well notes plan. “We often write and ask a GP for the prognosis of an employee on long-term sickness absence,” she said. “You seldom get a response. I think the GPs feel compromised. They only hear the patient’s side – they have nothing else to go on. Sometimes they don’t see the bigger picture that work could provide and they don’t always appreciate the part that work can play in rehabilitation – particularly for those with mental-health problems. The mindset of GPs really has to change.”

Scott argues that severe mental illnesses such as schizophre-nia are relatively easy for company occupational-health departments to deal with and need not stop a person from working pretty much as normal: occasional “episodes” can be accommodated and colleagues educated to understand.

Far more difficult, however, are the more common mental-health problems such as stress – 35% of the cases that HSBC occupational health deals with are “psychological”, but only 5% of them are recognised psychiatric conditions.

“Some people are just unhappy in what they are doing,” said Scott. “In their hearts they know the job isn’t for them but they can’t face the need to change – sometimes because they have got used to the salary.

“They go to the GP with aches and pains, and unhappiness, and the GP signs them off, but that just compounds their problems. One of the questions I always ask people referred to me is how happy are you in your job?”

Scott believes that if work is sometimes the problem, it can also help with solutions. Occupational health will sometimes reduce sick employees’ hours so they can think about what they really want to do. “We can provide breathing space,” she said.

Scott sees HSBC as a supportive employer, keen to foster and maintain good health in its workforce through a range of initiatives – including a counselling service.

But not all companies are as supportive, or enlightened. And, of course, an employer’s and employee’s interests are not the same, particularly when the employer thinks the employee is faking it or taking advantage.

Jonathan Naess, a director in a City corporate finance house, is one of the few high-flyers brave enough to admit he has mental-health problems. He “came out” last year as a sufferer of manic depression (or bipolar disorder), which is characterised by excitable, erratic highs in mood following by terrible lows, but can be controlled by medication.

Naess was arrested in his pin-striped suit a couple of years ago during a manic “episode”, when he was spotted behaving oddly while on his lunch break. Despite being sectioned, he went on to make a successful return to work – and not in some reduced role, but in the same, very senior post.

Despite the support he received from his colleagues, he is acutely aware that the reality in too many companies is that they can’t get rid of someone in mental distress quickly enough.

Naess recently set up the charity Stand to Reason and hopes it will do for mental illness what the gay pressure group Stone-wall did for homosexuality. One in four people will have a mental-health problem at some stage in life, and Naess wants to work with companies to keep employees in work while they recover. Work, he believes, is crucial to recovery.

“About 90% of people who have mental-health problems and who are out of work want to return,” said Naess. “But only 20% of people with mental-health problems are actually in work. The fact is that after some months on sickness absence, it’s unlikely the individual will ever return to work. Being out of work is very dangerous, particularly in young men because of the high suicide risk.”

Naess warns that businesses that don’t face up to the reality of the prevalence of mental distress in the workforce – whatever its causes – will continue to lose in terms of sickness absence, staff turnover and presenteeism. Naess argues that people struggling with mental-health problems often just manage to get to work every day but achieve little when they get there.

Research suggests many businesses are oblivious to the prevalence of mental ill-health. Tim Cooper, of the Shaw Trust charity, said a recent trust investigation discovered that almost half of employers surveyed thought that none of their employees would ever have a mental-health problem, nine out ten employers did not know anyone in their organisation with a mental-health issue and eight out of ten companies did not have a specific mental-health policy.

“There’s an alarming lack of awareness,” said Cooper. He and Naess are convinced that work, so often regarded as the problem in mental-health issues, is actually part of the solution.

GPs had better prepare to meet the pressure building behind the sick to well note proposal.

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