Availability of psychological therapies and workforce participation of individuals with long-term mental health problems: a retrospective observational study

BACKGROUND: In response to the global prevalence and societal impact of mental health problems, innovative healthcare policies have improved access to psychological therapy interventions. Yet, the indirect effects of these access policies on labour force participation gaps related to mental health problems remain unclear. This study assessed the relationship between one of the first major policies to improve access to psychological therapies, the NHS Talking Therapies service, and the economic activity of individuals with long-term mental health problems. METHODS: In this retrospective observational study, we derived a national sample of the English working-age population from Annual Population Survey data for the period 2015-2020 (N = 535068). Data included information on economic activity and health status, but not the use of healthcare services. The outcome of the study was labour force participation. The volume of appointments per referral received by NHS Talking Therapies services across healthcare commissioning regions in England was used to measure the regional supply of psychological therapy interventions. We used linear regression models, adjusting for a comprehensive set of individual and area-level controls, to estimate the association between the regional supply of psychological therapy interventions and labour force participation for those with and without a long-term mental health problem at the population level. RESULTS: We find a labour force participation gap of 36% between individuals reporting long-term mental health problems and otherwise similar individuals with no reported mental health problems. Holding all else equal, we find an increase in the regional supply of NHS Talking Therapies of one appointment per referral is associated with a 0·92 percentage point (CI: 0·0018 - 0·0165) reduction in the probability of labour force participation gap. Results of sub-sample analyses suggest this association was driven by individuals who were not claiming benefits, aged between 45 and 65, and reported male gender. CONCLUSIONS: Policymakers should consider the indirect effects of policies that improve access to psychological therapy interventions as a potential moderator of the labour force participation gap related to long-term mental health problems.