Cost-effective and promising interventions relative to mental health of the health workforce and their delivery conditions

Abstract

Abstract EXPH members and Opinion collaborators Effective interventions to protect mental health of the health workforceare likely to be complex and multi-faceted, addressing modifiable risk factors to be implemented across multiple levels. In the context of the Opinion development, evidence from multiple sources, encompassing best practices, guidelines, toolkits, among others, was reviewed. This allowed for the identification of coordinated integrated approaches. Due to potential stigma and discrimination, efforts in the workplace to support mental health should be accompanied by due consideration of legal and ethical responsibilities. The excess burden of mental health issues in the health workforce is well-described, however assessing cost-effectiveness of interventions to address them remains complex given the challenges in quantifying the impacts to assess (economic, societal, ethical, etc.). Organisational delivery conditions are conceptualized in this Opinion using an implementation science framework, which posits that the success of implementation depends on how its delivery is organised and is context dependent. Contextual factors such workplace culture and leadership can largely influence implementation outcomes, whereas resource constraints and barriers, as well as facilitators are also examined. Specifically, we identified several core conditions for the delivery of mental health services. With respect to the intervention, meeting and adapting to evolving user needs is important, as well as assessing the role of stigma, whilst ensuring those with a history of mental health and/or pre-disposing factors are not targeted. Many delivery conditions focused on the workplace and included ensuring safe space and processes (e.g., for help-seeking) and fostering an environment of trust; training in mental health assessment and key delivery conditions for occupational health practitioners and managers while emphasising that there should be no adverse consequences for help-seeking behaviour; and driving transformation in organisational culture towards one of acceptance of the continuum of mental health issues. To support workplace interventions, a clear and comprehensive regulatory and financial structure and mechanisms of support are required. Attention to public and private sector organisations, including multinational corporations (MCNs) and small- and medium-sized enterprises (SMEs) is needed. These enabling structures should encompass sustainable support for long-term prevention and treatment programs, and research and development of innovative approaches, such as de-stigmatization, care re-organization, regulatory frameworks, and data collection and harmonization.