Improving the mental and physical health of unemployed people: why and how?

Unemployment has been a recurring social problem throughout this century, and a permanent feature of economic life in Australia and other industrialised countries since the early to mid 1970s. Our current unemployment rate hovers between 8% and 9%,¹ although the Australian Council of Social Services estimates that there could be just as many "hidden unemployed", who do not feature in official statistics.² The "hidden unemployed" comprise two main groups: those who do not register for work because of illness or for personal reasons or who have given up job-seeking (discouraged workers), and those who hold part-time and casual jobs but would prefer full-time work (the underemployed).³ The official unemployment rate equates to some 800,000 people out of work, with about a third of these being long-term unemployed (ie, out of work for 12 months or more).¹

It is now well documented that for many the experience of unemployment brings with it physical and mental health problems. Furthermore, longitudinal studies have shown that the negative effects of unemployment have largely resulted from people moving from being employed to being unemployed, and are not associated with workers with few skills or inadequate personal resources "drifting" into joblessness.⁴

Not all groups in our community are equally affected by unemployment. Australian Aboriginals, people from non-English-speaking backgrounds, especially recent migrants, and people with disabilities are especially vulnerable. Young people are another seriously disadvantaged group.

Three articles in consecutive issues of the Journal will highlight the health problems faced by unemployed people. The first will review the evidence for the detrimental effects of unemployment on health (see Mathers and Schofield in this issue of the Journal);⁵ the second will address the particular problems of young unemployed people (Morrell et al, MJA 1998; 2 March);⁶ and the third will look at how the health system can respond to the health problems of unemployed people (Harris et al, MJA 1998; 16 March).⁷

Satisfactory employment has many benefits that unemployed people are denied. These benefits are firstly financial, but equally important are the assignment of identity and status, the increased social contact, being part of a collective purpose and joint effort, and being able to engage in regular activity.⁸ The substantial cuts to income that most unemployed people face are associated with real and relative deprivation that, in itself, can be psychologically destructive. Poverty clearly affects physical and psychological well-being. It also reduces confidence and restricts personal agency and empowerment.⁹ Loss of income and resulting poverty can be especially psychologically destructive for adults, as they are likely to have financial and family commitments. For young people, failure to find satisfactory employment may adversely affect their psychological development and have negative long term consequences.

The lowered self-confidence associated with unemployment¹⁰ can reduce the number and types of jobs applied for, restrict the uptake of training, and inhibit engagement in self-employment or cottage/craft industries. Furthermore, lack of confidence also means that low levels of commitment, motivation and effort will be brought to bear, perseverance will be low, and, in particular, the capacity to persist with an activity in the face of setbacks or adversity will be greatly reduced. Unemployed people with poor self-confidence will timidly pursue occupational possibilities, and are likely to desist altogether in the face of repeated failures. This pattern will repeat itself in other areas of these people's lives, impinging on their ability to cope with their financial commitments and their social and family life.

Not only does unemployment reach beyond those who are jobless, and put at risk the well-being of their partners and children,^11,12 but there is also growing evidence that high levels of unemployment have an adverse effect on those in the workforce, with job insecurity being associated with elevated stress levels.¹³ The picture is further complicated by increasing numbers of people who, on the one hand, are underemployed, and those who, on the other hand, are in full-time employment but are required to work ever-longer hours to maintain their jobs. Little is known about the health effects on these two groups.

Despite the evidence of the detrimental effects of unemployment on health, there is little debate in the community about these issues. The assumption remains that it is a temporary problem and that the emphasis should be on encouraging people to enter training or to find work. This is despite the fact that unemployment and underemployment are now long-standing and near-universal problems. This assumption has resulted in too few resources being expended on the development and evaluation of interventions to reduce the adverse effects of unemployment. Harris et al, in the final article in this series, document the few interventions that have been tried, and outline possible strategies to address this problem.⁷

It is important to reduce the negative effects of unemployment to minimise individual misery of unemployed people, as well as to benefit their families and the commun ity in general. While this task does include the development and implementation of individual health and well-being programs, the solution also lies in our responses to the changing nature of work and how we will structure our major institutions in the next century. We need to develop policies and strategies to reduce the stigma of joblessness. The right of all to be able to engage in meaningful and community-sanctioned activities that bring with them opportunities for financial security is central to reducing the debilitating effects of unemployment.

Unemployment is a long-standing problem. It is not likely to disappear in the short to medium term. Income support from government sources will inevitably continue, and could do so without the stigma with which it is currently associated and at levels that ensure that unemployed people do not live in poverty. This, together with an expansion of reciprocal relationships between the community and unemployed people (as is currently being tested under the "work-for-the-dole scheme" which commenced in December 1997), offer some scope for setting a new agenda in this area.

Peter A Creed
Lecturer, School of Applied Psychology Griffith University, Gold Coast, QLD

1. Australian Bureau of Statistics. 1997 Year Book Australia. No 97. Canberra: AGPS; 1997 (Catalogue No. 1301.0.).
2. Spiers R. Growing problem of long term unemployed. Financial Review (Sydney) 1991; 11 Mar: 6.
3. Canadian Public Health Association. 1996 Discussion paper on the health impact of unemployment.
4. Winefield AH, Tiggemann M, Winefield HR. Growing up with unemployment: longitudinal study of its psychological impact. London: Routledge, 1993.
5. Mathers CD, Schofield DJ. Health consequences of unemployment: the evidence. Med J Aust 1998; 168: 178-182.
6. Morrell S, Taylor R, Kerr C. Unemployment and young people's health. Med J Aust 1998; 168. In press.
7. Harris E, Webster I, Harris M, Lee P. Unemployment and health -- the healthcare system's role. Med J Aust 1998; 168. In press.
8. Jahoda M. Work, employment and unemployment: values theories and approaches in social research. Am Psychol 1981; 36: 184-191.
9. Fryer D. Benefit agency? Labour market disadvantage, deprivation and mental health. Psychologist 1995; 8: 265-272.
10. Bandura A. Self efficacy: the exercise of control. New York: Freeman, 1997.
11. McLoyd VC. Socialization and development in a changing economy: the effects of paternal job loss on children. Am Psychol 1989; 44: 293-302.
12. McKee L, Bell C. His unemployment, her problem: the domestic and marital consequences of male unemployment. In: Allen S, Watson S, Purcell K, Wood S, editors. The experience of unemployment. Basingstoke: Macmillan 1986: 134-149.
13. Winefield AH. Unemployment, occupational stress and psychological distress. In: Hicks R, Creed P, Patton W, Tomlinson J, editors. Unemployment: developments and transitions. Brisbane: Australian Academic Press, 1995: 77-88.