It is often said that you have to understand the root cause of a problem before you try to fix it. I’m not convinced. Take the unexpected trend in the UK of people dropping out of the workforce in recent years — something that hasn’t happened in nearby countries such as France and Germany. It has led to endless debate over what’s gone wrong. It seems to me it has become a sort of Rorschach test, in which people blame the phenomenon on whichever issue they are already cross about: austerity, say, or welfare dependency or wealthy baby boomers. I include myself here, having argued that part of the blame lies with bad-quality jobs.
But you can disagree about the root causes of a problem while still coming up with some sensible, practical ideas that could make it better. Here’s one: occupational therapists, and lots of them.
Regardless of the reasons, we know Britons have become sicker. New working-age disability claimants doubled between 2021 and 2022 — “at essentially every age and for most major conditions, from mental illness to arthritis and back pain”, as economist Sam Ray-Chaudhuri at the Institute for Fiscal Studies has put it. The number of people receiving at least one prescription item for antidepressant drugs in England rose 22 per cent between 2015/16 and 2021/22 to 8.3mn. Also growing is the number saying they are too ill to work. Plenty of others are unwell but still working — at least for now.
In an essay to be published this week, Kayley Hignell, head of policy for families, welfare and work at Citizens Advice, argues that “sustained investment in occupational therapy” could make a huge difference. I think she’s right.
Occupational therapists are trained in both physical and mental health, which they combine with a practical approach that focuses on helping people to adapt and live well — whether that is by making physical adjustments to someone’s house, connecting them to community groups or helping to negotiate changes to their job so they can stay in work or return to it.
“When you look at the bigger picture, the outcomes tend to be better,” says Jodie Hall, an occupational therapist in Sheffield. “We’re very goal oriented, we set goals and care plans, and review as we go along. We’re looking at ‘where do you want to be, is it achievable, are we working towards it?’.”
There are about 41,000 occupational therapists in the UK, the majority of whom work for the NHS. But most people don’t come into contact with them until they have become really quite unwell — for example, they may see one if they are being discharged from hospital. There are nascent moves to get more of them into GP surgeries, so they can reach people much earlier, such as when they first get signed off from work.
“Getting in early at that point would prevent people being in this cycle where they are in work and off work,” says Karin Orman, director of practice and innovation at the Royal College of Occupational Therapists. There are about 6,500 GP surgeries in England, but currently only 200 occupational therapists are attached to them.
Jodie Hall in Sheffield is part of a mental health service that is integrated into GP surgeries. She and her team also connect people with all kinds of other support, from benefits advisers to an employment service.
One woman, for example, was a cleaner in a gym but it was such a busy site it was worsening her anxiety. Someone went along with her and helped her speak to the employer to explore if she could move to a different site or an earlier shift. “Until then, the employer hadn’t really heard what the challenge was.”
Employers who want to support their staff could even think about hiring an in-house occupational therapist. Orman says this is rare in the private sector, but there is no reason why more companies shouldn’t do it.
One problem is supply. In comparison with other countries, the UK actually has quite a lot of occupational therapists: only the US, Japan and Germany have more, according to data from the World Federation of Occupational Therapists. But they were still added to the Home Office “shortage occupation list” in 2019 because — a familiar story, this — the country doesn’t train enough people to meet rising demand.
Putting more occupational therapists in GP surgeries isn’t going to solve all Britain’s problems. But it would pay dividends to give people some help when they first start to struggle — rather than waiting until they really unravel. That goes for the economy too.