The cost of excluding people with mental health difficulties from an active role in community life is high. Exclusion often leads to diminished productivity and losses in human potential. People with mental health difficulties face environmental, institutional and attitudinal barriers in finding mainstream employment or returning to work and retaining jobs after treatment. Attitudinal barriers and social exclusion are often the hardest obstacles to overcome and usually are associated with feelings of shame, fear, and rejection. 4 Stigma surrounds people with mental health difficulties, and the recovery process is often misunderstood.
Stigmatisation can negatively affect the success of vocational efforts.
For example, it has been reported that many professional workers who either resign a job or take a medical leave related to a mental illness episode, such as depression, experience difficulty maintaining a stigma-free relationship with their employers. Those returning to the same work environment find that performance and behavioural difficulties, which initially interrupted their work, have altered their employers' and co-workers' perception of their professional abilities. It is clear that mental health problems can impose a heavy burden in terms of social exclusion, stigmatisation, and economic costs for people with mental health difficulties and their families. Unfortunately, the future burden is likely to grow over time as a result of the ageing of the population and stresses resulting from social problems and unrest, including violence, conflict, and natural disasters. In many countries, however, policy makers and service providers have recognised the need to take steps to prevent problems from arising and to respond more effectively to the growing need for mental health care services.