Mental health: proactive and practical measures

Mental ill health in the workplace is a risk like any other, says Tim Marsh CFIOSH, who encourages organisations to address the psychological health of employees proactively, objectively and practically.

In recent years, the world of safety and health has begun to seriously address mental health issues. This has been controversial, with some believing that initiatives focused on mental health in the workplace might be admirable but should remain largely the domain of occupational health and charities. 

COVID-19 has changed, perhaps forever, the way we consider mental health. It was often assumed that most causes of mental health issues were physiological and/or related to factors outside of work, and simply no business of an employer. There was also a concern that suggesting a link between mental health and safety might lead to active discrimination, and impact learning by making employees wary of being open about any issues in the workplace. More than that, it was argued that with life-changing accidents and fatalities plateauing, there was still plenty of pressing safety-based work still to do, even in the UK, a world leader in OSH. 

Many people spend more of their waking hours at work than they do at home with family and friends. By taking a holistic and integrated approach to human error generally, we should treat day-to-day mental health issues as contributing to risk in the same way as fatigue, lack of resources, lack of training and a poor safety culture may do.

We simply need to reduce the risk by addressing it objectively, systemically and with practical tools. The good news is that the world of safety, health and environment already has proven experience of using many of these tools, and vast experience of the classic pitfalls organisations make when seeking to address ‘people’ issues. 

A huge issue

How many colleagues are ‘struggling’ with their mental health? It depends how you define it of course, but Mind says one in six in any given week and one in four in a year (see Resources). Whatever the actual ratio, in the UK alone that accounts for millions of people on any given day. At the sharp end, more than 5000 people in England and Wales took their lives in 2019. Compared with current workplace fatalities in Great Britain (142 in 2019) that’s a ratio of more than 40 to 1 (see Resources). And it’s getting worse, with the effects of the pandemic and of COVID itself impacting substantially on mental health. 

Good work is good for you, and people who enjoy or get meaning from their work can often be psychologically healthier than those that don’t need to work at all

Before the pandemic, self-harm in young adults was at record levels, as were eating disorders. In recent years, more UK students have taken their own lives than workers have been killed in the workplace, according to the Office for National Statistics (ONS) (see Resources). Young adult mental health services in the UK were already in crisis before COVID-19. These young people are the next wave of workers heading straight for our organisations. 

Problems in the workplace

My message to organisations: mental health in the workplace is a huge problem, it’s getting bigger and you’re probably going to get very little governmental help. 

The best organisations will see wellbeing initiatives and mental health first aid as just two – relatively unimportant – elements of what should mostly be a proactive, holistic and integrated approach to human error risk management. Here is an illustration of that assertion:

In the late 1970s, at 16 years old, I worked at Llanwern steelworks. I actually rode there on a moped, but I want you to imagine I was dropped off by my mum who was told: ‘Mrs Marsh, it’s true we have molten metal splashing about, a range of noxious gases, forklift trucks charging around like it’s a grand prix and a horrible, bullying, toxic culture – but be assured young Tim will be OK with us as we have no fewer than three highly trained first aiders…

Blue pies

A ‘blue pies’ model of human error seeks to simplify the issue for organisations (see Figure 1) to illustrate that people have good days and bad days, with errors of all sorts even more likely on a bad day. Mentally struggling contributes to a bad day just as fatigue, lack of time and resource, a toxic culture and disempowerment do. 

Overall, three behavioural issues seem to link to mental health and accident and emergency admissions (see Resources):

1.  A lack of focus and situational awareness: more likely to be oblivious to risk
2. An increased fatalism and disengagement: less likely to care about risk
3. An increased impetuosity and lack of control: more likely to actively create risk. 

But it’s not as simple as saying depressed people are more likely to be fatalistic and anxious people more likely to be distracted, because anxious people can be hypervigilant (although sometimes about relatively trivial issues – distracting them from real risks). And many sad people know that helping others makes them feel better.

There’s very little consensus in the data, but an Australian study of 60,000 workers by Hilton and Whiteford suggests that incidents increase by between 50% and 150% depending on the situation and the severity of the issues being faced. It suggests that individuals are only 70% as likely to contribute ‘successful’ behaviours to the organisation when they are faced with mental health issues. Successful behaviours are classed as discretionary behaviours that contribute to positive ‘culture creation’, such as creativity, looking out for new starts or volunteering. Then there’s the truism that ‘compliance itself is often discretionary’ (see Resources). 

I suggest a very rough rule of thumb is that ‘struggling’ workers could be twice as likely to have an accident and half as likely to contribute ‘discretionary’ effort in a positive way. 

I’m not asserting this to blame individuals in any way but to encourage organisations to address this widespread risk issue proactively, objectively and practically. 

A culture of care

The first opportunity is to draw on the safety world’s experience and expertise. Any good safety professional knows that ‘culture is king’, and that excellence is based on an objective, analytical, empowering and dialogue-rich ‘just’ culture, with leadership and emotional intelligence to the fore. Applying a range of practical methodologies based on these principles has enabled the UK, for example, to post world-class safety figures (while remaining very average in terms of mental health and wellbeing). 

We know, for example, that the question ‘Why did you switch down?’ often means ‘You had better have a good reason for that!’ But the question ‘Why did you think it was safe to switch back on?’ assumes you do, with all your operational experience, and so is asking: ‘What happened and are we assured it’s under control?’ It’s a matter of mindset. Mind emphasises that we shouldn’t automatically say, ‘You have to be able to handle stress to work here’ – as this suggests it’s all about personal resilience. Better, it suggests, to have a mindset that says, ‘Despite our best efforts, things can get quite stressful.’ This points the organisation’s mindset at a more holistic and proactive approach (see Resources).

Some people actively seek out highly pressured occupations because they relish the challenge or have confidence their resilience levels can deal with almost anything. However, many find they have overestimated their resilience. The majority of the risk issues faced by organisations relate to people with average levels of resilience who find themselves in need of above average resilience.

Mental health first aiders can be a key element of a holistic approach but they are largely working reactively. Not only must they be part of a holistic approach – if what is widely known as a genuine ‘culture of care’ is driven through line management then they are not necessarily needed at all. As Duncan Spencer, IOSH head of advice and practice, says: ‘This culture of care must include systematically identifying the daily stressors caused by operational demand, and putting in measures to relieve that pressure. It must also include the sharing of common values.’

To paraphrase the classic Safety Differently question, a company that frequently asks its workers ‘We want you to thrive and flourish here. What do you need?’ won’t be going far wrong. 

A just and objective culture

An objective, analytical and just approach to error delivers more accurate analysis and a more effective response. This is described in perhaps the best safety book of the last few decades, Matthew Syed’s Black box thinking: the surprising truth about success. 

It also motivates and empowers those involved in the process and is central to the concepts of Carol Dweck’s work on mindsets and Amy Edmondson’s concept of psychological safety. These multi-million-pound selling books weren’t written with mental health in mind, but profit, sustainability and organisational resilience. 

Virtuous circles

Finding yourself angry, bored, disengaged and under-resourced at work is not ideal. Bad work is bad for you and it’s easy to imagine a row, some self-medication and a bad night’s sleep being more likely. 

The flipside is that good work is good for you, and people who enjoy and get meaning from their work can often be psychologically healthier than those that don’t need to work at all. So we return home smiling, and virtuous circles are more likely to follow. 

Soldiers, for example, have relatively normal suicide figures, according to the ONS, but that’s not true of ex-soldiers who find they miss the camaraderie of their profession (see Resources). To rework James Reason’s Swiss cheese model (see Figure 2), when soldiers hang up their uniform, it can remove an impenetrable cheese slice. 

Warr’s vitamin model

In 1987, Peter Warr’s vitamin model suggested 12 characteristics that are key to mental health at work. These include control, variety, significance and clarity. The model suggests we can have too much of a good thing. For example, some have such a strong need for autonomy they can only function as self-employed. Others, given that level of autonomy, would never sleep at night. Likewise, some people like a lot of interpersonal contact and others a little. But we all want it to be good quality and most organisations have a big opportunity to enhance the emotional intelligence skill-set of its managers and supervisors.

Warr’s model suggests a range of simple questions that can be asked to help tweak a role to best suit an individual. By ensuring that individuals are suited to roles, and roles to people, it is possible to reduce the risk of workers struggling with some types of mental health in the workplace. 

Ask ‘How are you?’ twice

In my book, Talking safety (see Resources), I suggest asking ‘How are you?’ as an ice-breaker before getting into analysis and coaching. Of course, the answer to this social nicety is nearly always, ‘I’m fine, thank you.’ However, once some rapport has been developed it’s worth asking it a second time with eye contact and empathy. You may again well get ‘I’m fine’ from someone who isn’t fine at all, but you may well start a conversation that saves a life.

We can’t all enjoy the camaraderie of military units but we can share their professional satisfaction. We can work in organisations where task-based issues such as the amount of autonomy and control and skill development is tweaked to best suit the individual. As we emerge from COVID-19, with every fatigue and mental health metric heading steeply in the wrong direction, it’s in the best interest of all organisations to proactively address these issues. Work may be only one element in the equation – and sometimes only a small
element – but on many occasions we can help break the chain of vicious circles and set up virtuous ones, and that can make all the difference in the world. 

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