Intended for healthcare professionals

Feature First Person

Metropolitan Police blues: protracted sickness absence, ill health retirement, and the occupational psychiatrist

BMJ 2011; 342 doi: (Published 19 April 2011) Cite this as: BMJ 2011;342:d2127
  1. Derek Summerfield, honorary senior lecturer
  1. 1 Institute of Psychiatry, King’s College, London SE5 8BB, UK
  1. derek.summerfield{at}

Reflecting on his time as consultant occupational psychiatrist to the Metropolitan Police Service, Derek Summerfield finds that sickness absence on mental health grounds has roots both in organisational culture and in broader cultural trends across society

I was consultant occupational psychiatrist to the Metropolitan Police Service from 2001 to 2004 and assessed around 600 officers and 300 civilian staff. Around half of the 600 officer assessments concerned retirement on grounds of ill health, and many of these cases were protracted and contentious. Here I use these 300 cases to highlight the dynamics of fitness for work, entitlement to ill health pensions, general practitioner certification, and the role of mental health services for police officers and other occupational groups.

Role of wider culture

As with all patients, what a police officer brings to the doctor is shaped by wider culture. A big feature of 20th century Western culture has been the rise in the authority assigned to medicotherapeutic ways of understanding the trials of life. Arguably, the contemporary concept of a person emphasises not resilience, as it once did, but vulnerability.1 A widening range of everyday experiences, including work, have come to be viewed as capable of inducing illness. “Stress,” until recently a folk category, has now gained the medical imprimatur of a real ailment: “work stress” is the number one cause of sickness absence in the United Kingdom.2

The number of people of employable age receiving incapacity benefit for longer than six months quadrupled to two million between 1981 and 2002. The Department of Work and Pensions states that 70% of patients receiving long term disability benefits have medically unexplained symptoms.3 Certification on mental health grounds is the leading cause of sickness absence in most high income countries, accounting for around 40% of lost time, with average time off sick for …

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