"Conventional" wisdom claims that work is beneficial for our mental health. It gives us a sense of meaning and purpose. If I see someone for the first time and ask them what their goals are for therapy they will often refer to getting back to work. However, what if work is the problem rather than the solution?

The equation that an unhealthy work environment can make a worker physically unwell does not seem to be there for mental health problems but the diagnostic inclusion of burnout may be the first step in making that link.

Although the people I see will often cite work as a goal, it may also be the case that work has been the trigger behind the decline in their mental health. For people with longer term mental health problems, the pressure to get a job can be too much. One highly publicised case involved my namesake, Michael O’Sullivan, a man with a long history of mental health problems who took his own life due to the pressure to find work following fitness to work assessments from the Department for Work and Pensions (DWP).

Currently if someone is sick because of work related stress, their “sickness” will be seen as some variation of either anxiety or depression. Within Cognitive Behavioural Therapy (CBT) and other psychotherapies, this sickness will be seen as a reflection of that person’s individual vulnerability. If their work played any kind of role, it will be as the trigger and nothing more.  But there are times when work is the very thing causing the difficulties. There may be a straw in the wind that says that attitudes may be changing in relation to the causes of mental health.

Diagnostic inclusion

The ICD (International Classification of Diseases) is the document that classifies different types of mental health conditions. The new ICD-11 has a section on burnout. Burnout is the term used to describe chronic work place stress which has not been successfully managed. It has three characteristics: exhaustion, a growing sense of distance between the worker and the job, and a reduced sense of self-efficacy.  ICD-11 does not describe burnout as an illness but rather an “occupational phenomenon”. Nevertheless, its inclusion is interesting because classifying an illness in this way has legal as well as clinical implications.

Unhealthy work environments which make people unwell are in danger of breaking the law because employers are required to provide safe working conditions. For example, nurses who develop back problems are not unwell because of their individual vulnerability; they are unwell because the lack of equipment, training, or the conditions at work. The equation that an unhealthy work environment can make a worker physically unwell does not seem to be there for mental health problems but the diagnostic inclusion of burnout may be the first step in making that link.

The connection between the work environment and stress was underlined in Ken Loach’s latest film “Sorry We Missed You”. We see how the mental health of its main character Ricky, deteriorates because of the work conditions of the gig economy. Ricky falls into the trap that we all fall into. His stress is due to him and his personal failings rather than the system of work in the gig economy.  

In truth, the reality of why anyone “burns out” will be a mixture of factors related to the person and the work environment.  Nevertheless, the inclusion of burnout in the ICD is a modest but significant start through stating that if you feel stressed at work it may not necessarily be all your fault. ​


Michael O'Sullivan is a Cognitive Behavioural Therapist in the Derbyshire Healthcare Foundation Trust.

Buy Michael's book "A Practical Guide to Working with Depression: A cognitive behavioural approach for mental health workers"