Everywhere work is central to the lives of women and men. They are affected whether they are unemployed or underemployed or overworked; by the social and physical environment of work; by the loss of work, by the level of security they might count on when they cannot work. Work takes on another dimension when mental health issues are involved. People with problems may have to stop working - or, as you know only too well, they may go on working without being able to acknowledge the situation. Prejudices may bar them from work or working conditions may be part of the problem.

I firmly believe that the bottom line of economic activity is how it translates into the quality of people's lives. Work is about people and it depends on people so that mental health and illness are workplace issues.

And for the ILO, mental health and mental illness are, more specifically, "decent work" issues. Our view is that there is a glaring deficit of decent work in today's global economy. What does this mean? First, that we need more work through which people can earn a decent living. It must also be work which respects human dignity by respecting their basic rights - freedom of association and collective bargaining, freedom from forced labour and child labour and, not least, freedom from discrimination which is so pertinent to these discussions. Decent work also means giving people protection against contingency and vulnerability when they cannot work, as well as protection at work. And finally they must be able to engage in dialogue about the issues that affect their work lives. Decent work reflects people's aspirations - for people with mental health difficulties, as for everyone else, decent work is a fundamental concern.

People with mental health difficulties may also bear a social burden. Again, you know this better than anyone else. Mental illness often carries a social stigma that reaches into the workplace. Those with difficulties face greater problems getting and keeping jobs compared to people with other types of disability. They may be excluded from the job market because of prejudices about their capacity to work even when they have recovered or when their disability is perfectly under control. In real terms - that is to say, in terms of people's lives - this means that they frequently end up isolated and impoverished, suffering from low morale, persistent anxiety and stress.

But we all know that the effects go beyond the individual and his or her family. Employers feel the costs in terms of low productivity, absenteeism, high rates of staff turnover, increased costs of recruiting and training and, ultimately, reduced profits. Where the person in difficulty is the owner, especially of a small enterprise, the ultimate price may be business collapse. For governments, there are the costs of health care and insurance payments and the loss of income at the national level.

Our research in countries such as the United States, the United Kingdom, Germany and Finland shows that what we are dealing with is not at all a marginal phenomenon. On the contrary, it is a significant and growing problem which needs to be checked. The human cost is high enough in the countries I mentioned - but imagine what the situation is like where there are no disability pensions, no protection against such contingencies, no social support systems. The majority of working age people do not have access to the kind of assistance and institutions that may be available in the developed world. I think that we must also deal with the realities of developing countries which are equally touched by these problems.

Today, we are operating in a particularly challenging environment for work and mental health. The global economy has triggered a widespread malaise. There is a sense of insecurity and uncertainty and these feelings are often connected to work. People are having to deal with issues such as the informalization of employment, the loss of jobs, the precariousness of new jobs or the plain absence of new jobs. The opportunities opened up by new technology also come with new stress factors. At the same time, old social protection mechanisms are coming under threat.

We have a situation in which open markets and open societies and new information and communication technologies are undoubtedly bringing benefits. But, at the same time, insecurity and uncertainty are also increasing. People who are well-off are not spared. I believe that a key element of what is happening is that issues of economic growth, and even employment, are being separated from very human concerns about certainty and security for the future. This has major repercussions at the household and family level as well as in the workplace, which is our concern today. A lot of the violence that we see - domestic violence, violence against children - is linked to workplace concerns, whether in the inner cities of the North or shanty towns of the South. But to find answers we have to go beyond the workplace and question the way the global economy is working today.

We see decent work for all as a major means of making the global economy work for people, of getting to grips with insecurity and uncertainty.

We approach mental health from different perspectives through decent work:

• We seek to promote a healthy workplace for all workers.
• Good productivity and performance are linked to physical and mental well-being which also helps to reduce pressure on health, welfare and social security systems.
• We also see it as a question of fundamental rights at work to prevent discrimination against those with mental health difficulties.
• We are concerned about promoting opportunities for decent work for all.
• And finally, the ILO is concerned about the security provided for those who are unable to work.

We deal with work and mental health issues through programmes such as our SafeWork Programme on Safety, Health and the Environment and the Conditions of Work Programme. The disability programme promotes decent work for people with disabilities based on equality of opportunity and equal treatment. Our whole approach rests on a strong foundation of social dialogue.

A concern with work and mental health is part of a decent work agenda. But it is also the concern of a decent society. The extent and consequences of mental health problems also show that it is in the interest of everyone to promote mental health in and through work and to support, not penalize, those with problems. This is an area in which really productive partnerships can be formed as your debates have shown. The ILO, with its tripartite structure, is ready to be part of such initiatives. Thank you for being here and for helping to define the way forward. To end, let me reiterate that the bottom line must be about people. Sound institutions and policies are indispensable but they must rest on an understanding of the human dimension of the issues that we are dealing with. The policy eye must be guided by a caring eye.