10 CHAPTER 1 1 GENERAL INTRODUCTION Mental health issues and illnesses (MHI), including substance use disorders, are very common. Globally, the lifetime prevalence of mental illness has been estimated to be 29% (1). A recent study in the Netherlands showed that the lifetime prevalence of mental illness has increased to 48% (2). At any given moment, approximately 20% of the working-age population experiences a mental illness (3). These numbers don’t even include stress-related mental health issues, such as burnout, which are common in the work setting, and responsible for a large share of sick leave. A recent survey among Dutch employees showed that about 1.3 million employees suffered from burnout complaints and that 37% of the employees on sick leave indicated stress-related issues as the main reason for their absence (4). As compared to workers without MHI, workers with these health problems have a significantly higher risk for sick leave, early retirement, exiting the workforce via disability benefits, or unemployment (5, 6). However, people with MHI can benefit from the positive aspects of employment, such as social participation and inclusion (7, 8). In previous research, job loss has been shown to lead to decreased health, while reemployment after unemployment has been shown to lead to increased health (9-11). This highlights the importance of investing in sustainable employment and well-being at work of workers with MHI. Additionally, due to the aging working population in Western countries, the current shortage of workers in many industries is likely to increase further in the coming decades (12, 13). This makes the topic of how society and especially employers can support sustainable employment of employees with MHI, a top priority. Stigma as a barrier to sustainable employment and well-being at work An important barrier to sustainable employment and well-being at work for workers with MHI is mental health stigma (9, 14). Many people with MHI describe stigma as even ‘worse than the condition itself’ (15). Under the influence of the previously dominant biomedical paradigm, it was assumed that people with disabilities do not participate optimally in the workforce primarily because of their disease, and consequently, the important role of non-disease-related factors (16), such as stigma, have been underresearched. The word stigma originates from the Greek language and means burn. It refers to specific people, for example, slaves or criminals, being branded to show others that this person was of lower status (17). A theory on stigma by Link and Phelan (18) proposes that ‘stigma exists when elements of labeling, stereotyping, separation, status loss, and discrimination occur together in a power situation that allows them’. According to this theory, the stigma process is made up of four different components: (1) Distinguishing
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