Improving mental health in the workplace

Abstract

In 1700, Italian physician Bernardino Ramazzini penned De Morbis Artificum Diatriba (Diseases of Workers), the first medical text to describe the ways environmental conditions or hazards associated with various livelihoods could present risks for health. Famously, Ramazzini is cited for encouraging physicians to extend the Hippocratic inquiry of patients to include: “What is your occupation?” Although workers' experiences in the modern world are very different from those in the 17th century, occupational medicine is built on the same fundamental ideals—preventing and treating job-related injury and illness and maintaining health in the workplace. That focus has expanded with the increasing need to consider mental health within the remit of occupational medicine. WHO estimates some 300 million people around the world experience depression. The Global Burden of Disease studies also demonstrate that year after year and across countries, depression and common mental disorders are a leading cause of disability, especially among middle-aged adults. Despite the broad, context-independent implications of so many people suffering from potentially treatable illness, it is essential to also focus on country-level systems that affect workers to better understand the scope of the problem, the costs to individuals and society, and how to address them in unique settings. One such example is, Thriving at work: the Stevenson/Farmer review of mental health and employers, released on Oct 26. The report, commissioned by Prime Minister Theresa May after announcing efforts toward transforming mental health support in the UK, in January, 2017, was conducted by Lord Dennis Stevenson, campaigner for mental health reform, and Paul Farmer, chief executive of the mental health charity Mind and chair of the NHS Mental Health Task Force. The report speaks to a troubling reality. In the UK, one in four people report experiencing a mental health problem each year but only one in eight of those with an illness are being treated. The cost to the government, by providing benefits, National Health Service (NHS) costs, and reduced tax revenue, is £24–27 billion. Employers shoulder enormous costs as well (£33–42 billion), from lost productivity due to absenteeism and presenteeism (working while ill). The human costs of poor mental health are correspondingly steep. Not only are individuals with long-term mental health disorders much less likely to find work, but an estimated 300 000 lose their jobs every year. The report notes so-called green shoots of good practice and evidence that shape its recommendations, converging on a set of enhanced mental health core standards, includ-ing better internal and external reporting, improved disclosure processes, and providing tailored, in-house support and signposting to connect workers to clinical help. The changes where the authors see government exerting influence are ambitious, specifically through exploring incentives for employers to adopt the standards, making statutory sick pay more flexible for mental health, and ensuring that NHS-provided mental health support is accessible around work. The recommendations for employers require commitment but are straightforward and practical, including encouraging the implementation of mental health work plans and routine monitoring of employee health and wellbeing. They underscore the important and singular role that managers can play in the process of regularising checking in on workers and reducing stigma by opening lines of communication. Complementing the recommendations, a cluster randomised controlled trial published in The Lancet Psychiatry in October found that a brief mental health training programme for managers emphasising early and consistent contact with supportive communication and practical help reduced the amount of work-related sick leave taken by employees and a modest return on investment for each pound spent on the training. Although, the findings need to be replicated in other samples, it provides an intriguing direction for creating future workplace intervention programmes predicated on empowering managers to be agents for connecting workers with care. Achieving parity between mental and physical health care is too large a task for medics alone. It will require creative solutions to bridge access and bring occupational medicine into the workplace by encouraging open dia-logue, prioritising healthy work environments, providing self-care toolkits, web and smart phone technology, and wellbeing initiatives that include strong mental health care components. At the fulcrum of improving mental health for workers is the recognition that a workplace can be both a source of stress and a formidable support system. Importantly, the first step might simply be to ask, “What can we do to help?” Workplace mental health training for managers and its effect on sick leave in employees: a cluster randomised controlled trialA 4-h manager mental health training programme could lead to a significant reduction in work-related sickness absence, with an associated return on investment of £9.98 for each pound spent on such training. Further research is needed to confirm these findings and test their applicability in other work settings. Full-Text PDF