Focusing on employment in primary mental health care: a scoping review

BACKGROUND: People with mental health issues usually access primary health care services but employment status and/or return to work is not typically an explicit focus of a general practice consultation. OBJECTIVE: This scoping review aims to investigate the broad range of interventions used in primary health care to effectively support people with mental health issues to choose, get, or keep employment. METHODS: A literature search was conducted using five electronic databases. Peer reviewed research articles published between 1996 and February 2016 were included in the review. RESULTS: Twelve studies explored work related interventions for people with mental health issues in the primary health care context. The most commonly used intervention was sickness certification, other interventions that show promise were identified but there is limited empirical evidence to show their effectiveness in relation to improving employment outcomes. General practitioners identified a range of barriers in terms of focusing on employment outcomes for patients including knowledge and confidence in understanding the impact of work on symptoms and limited access to advice or services to refer patients to. CONCLUSIONS: This review suggests that work focused interventions situated in primary health care settings appear to be a promising approach for people with mental health issues. However, various barriers impact the implementation of an employment approach, with limited comparisons between different effective interventions. In the context of increasing numbers of people presenting with mental health issues, future research should address the implementation and effectiveness of work-focused interventions based in primary health care.