It may not always be apparent to all of the 1 million plus staff of the NHS, but being in employment is a major determinant of good health.

As Dame Carol Black's report on health and work set out last month, being out of work is as bad for your health as the more widely recognised public health threats of smoking and obesity.

The report, Working for a Healthier Tomorrow, puts forward a series of proposals to reinforce the links between work and health. It calls for a change to sickness certification that would enable the use of "fitness notes". These would state what a person can and cannot do and allow them to stay in work while receiving support from their GP and employer. It also advocates the creation of a new "fit for work" service, which would intervene early when someone became unwell at work, as well as a boost to occupational health provision and its status as a profession.

These represent major changes, both to the way primary care supports people in their working lives and to the way ill health is managed in workplaces. These changes will require significant investment: a fully functioning fit for work service would need a capable workforce skilled in managing people's health and in understanding the needs of employers.

Social cost

That such change is needed is hard to deny. According to Working for a Healthier Tomorrow, ill health costs the economy£100bn a year. A Sainsbury Centre estimate of the costs of mental ill health alone in UK workplaces concluded that it amounted to£1,035 for every employee in the country.

The extent of mental ill health in UK workplaces is grossly underestimated. Half of employers think that none of their workers will ever experience mental ill health. Yet in reality one in six have a mental health problem at any one time.

This is partly a reflection of the continued stigma and ignorance surrounding mental distress. What should be seen as a normal part of human life is rarely acknowledged and less often dealt with adequately.

One result is that people experience distress for long periods without getting help: more than half of the cost of mental ill health at work is accounted for by "presenteeism". Another is that people who do take time off sick get neglected by their colleagues and end up out of work, at a high cost to all involved.

Leading the way

For the NHS, this is an issue that should be ignored no longer. The cost to the NHS of mental distress among its workers is a staggering£1.3bn: equal to more than a quarter of its entire mental health services budget.

About a third of this could be prevented through better management of mental health at work. Simple steps can be taken to make NHS workplaces more mentally healthy, for example by giving staff a better sense of control over how they work.

Line managers play a crucial role in recognising distress among the people they supervise and responding in the right way. This can make all the difference, especially where an early and effective response leads to timely treatment, for example through a proven psychological therapy. For those who do need time off for ill health, a managed return with ongoing support can be effective in getting them back to work in a timely manner.

The benefits of this approach to the NHS are evident. But they extend further still. By showing what can be done, NHS organisations can lead by example in their localities, demonstrating to other employers how to create a mentally healthy workplace and the gains that accrue from it.

A few NHS bodies have already shown what can be achieved. Most notable among them is South West London and St George's trust through its pioneering user employment programme.

The time has surely come for all of the NHS to make health at work a real priority and lead the way in making working for the NHS mentally healthy for all staff.

More information

Dame Carol Black's report on health and work

Mental ill health costs UK employers£25billion, says new report

User employment programme at South West London and St George's trust