It is a surprising in some ways that the interaction between employment and mental health or illness has not been subject to greater scrutiny, considering the amount of time the average person spends at work in his lifetime and the risks to mental health that the working environment provides. Probably the stigma of mental illness from the point of view of the employee, and the financial concerns about liability from the point of view of the employer, link together to hinder the exploration of the topic. Nevertheless, contemporary views of health promotion (WHO, 1986) and the Social Determinants of Health (CSDH, 2011) recognise the impact of employment on health and mental health and various strategies like Health Promoting Workplaces suggest ways of ameliorating the risks and improving employee health overall. It is however necessary to consider a wide definition of employee health to encompass (a) the health of individuals who perform work for a living, (b) the average forty year period of the life span in which employees are in the work environment, (c) the traditional concerns of work related injury but is not restricted to this, and (d) the health promotion aims of quality of life or state of optimum health and striving to reach one's potential. This chapter explores employment and mental illness with this definition of employee health in mind. The main discussion areas are: employment and its link to the burden of mental illness, risks within contemporary employment, and social relationships in the workplace. The key points that will be made are that employment must be considered in the genesis and treatment strategies of mental illness, and that dialogue about mental illness will need to play a greater part in the employer-employee master narrative.

This research is part of a wider study into the impact of adversity on a person's identity. This research asked people who had experienced very significant psychological trauma at work to tell their story about the way they were affected and how they have come to understand the experience as time had gone on. How adversity at work impacts on identity is important for understanding mental health and designing interventions.

Quality in health care is an important contemporary topic because of rising consumer expectations of health care amidst constrained health care budgets. Historically mental health services have been the poor cousin of health care services generally, and acute health care services specifically. At this time when quality in health care is occupying more space in the health care literature, it is opportune to review what inroads have been made as far as quality in delivery of mental health services. This chapter will examine the movement towards quality management in health care and explore the divide between quality in general health care and quality in mental health care. After this, what is considered quality in delivery of mental health services is discussed and finally the challenges to quality in delivery of mental health services and methods to overcome these challenges are analysed.