The 21st century has heralded a change in the type of occupational hazards that dominate workplaces. Psychological issues are now the key factors affecting people's health in the modern workforce as incidences of stress, anxiety and depression increase.
That jump may reflect the public debate around giving more workers confidence to disclose their conditions.
The Health and Safety Executive (HSE) statistics for 2017-18 show 595,000 workers had episodes of work-related stress, depression or anxiety. Statistically, this was not significantly different from the previous period but the incidences of those three conditions have shown signs of increasing in recent years.
Making the business case
Sometimes there are quick wins in mental health programmes but often the problems are complex and require an investment of resources, including time. To justify funding, you will probably have to produce a business case to help the senior team to recognise the impact of poor mental health on productivity and how you plan to address this. Senior teams may see only that tackling poor mental health will cost them money, so it is important to show how much they can save. It is important to talk about specific actions and their likely outcomes in bringing about improvements. For instance, you could offer financial advice workshops if you know that some staff are stressed by struggling to make ends meet. Try to emphasise the impact on the bottom line. Be specific about how you will measure and demonstrate the improvement. Later, these improvement metrics will provide you with justification for further investment.
Many employees with mental health conditions will remain at work rather than take sickness absence to avoid disclosing the problem to their employers. But research shows that employees who take this course of action will go off sick eventually and are away for far longer than those who take leave earlier. Many are unable to return at all.
The impact of mental health problems is far-reaching. As well as their impact on mood and willingness to socialise, they also damage confidence, and an individual's ability to make decisions is also affected. They can lead to an increased risk of physical ill health, including heart complications, diabetes and obesity.
A good starting point is to identify the areas of the organisation where employees are prone to mental ill health and the factors that contribute to them. This will help you to focus efforts and set a baseline against which to measure the success of interventions.
The main sources of information are:
Sickness absence data. This will provide information about mental health absence and whether there are clusters in a team, division or location.
Presenteeism data. Few organisations deliberately measure presenteeism but there may still be some information that you can glean from staff surveys, especially if you can seed questions about whether employees have gone into work when they were feeling ill instead of taking sickness absence.
Attitude/engagement surveys. These will give you an insight into how staff feel about the organisation and its leadership, practices and processes.
Grievance and disciplinary records. Often grievance and disciplinary information can provide insights into how employees are feeling and what factors might be having a negative impact on their mental health.
Turnover figures. These allow you to see where staff churn is higher than average for the organisation and which particular departments or teams have higher levels of turnover, which could indicate a problem.
Exit interviews. Data from these may provide useful information about why people are leaving and the reasons for this, all of which could be factors that affect mental wellbeing.
For richer data, it is worth holding focus groups with employees to find out how they are feeling, and which aspects of the workplace have a negative impact on their mental health.
Reviewing data from these sources will help you to decide the best types of interventions, along with areas where evidence of bigger problems make them a priority for action. Insight into the nature and scope of the factors that influence mental health will help you to set performance indicators for initiatives. It will also help you to make a strong business case (see box above).
Play the long game
The range of options that claim to improve mental health can be bewildering. Organisations may be tempted to offer subsidised gym sessions or lunchtime mindfulness classes in the hope that they will make a difference -- and these will not make a significant dent on the balance sheet. The research shows that, if you are serious about improving staff mental health, you must address a range of organisational and individual factors. These fall into three categories:
Primary -- organisational factors
Secondary -- building employee resources
Tertiary -- putting support in place.
Tertiary-level interventions are reactive and the most straightforward. They involve supporting employees who already have mental health problems. That support varies from basic mental health first aid -- directing employees to health specialists -- to counselling and cognitive behavioural therapy or other interventions. This type of professional support is helpful but only after a problem has eventuated.
Secondary-level interventions take us into preventive territory and involve initiatives that help individual employees to cope better with pressure. Stress management, mindfulness and emotional resilience training are all promoted as helping to maintain good mental health, but some are more effective than others. If you offer a secondary-level intervention, check it will be effective. The UK government Home Office's lead told the Health and Wellbeing at Work conference in Birmingham in March 2018 that her research review had found no evidence in published studies for the efficacy of mindfulness training.
The data that you collect at the start will give you a benchmark against which to measure your efforts
The main problem with secondary and tertiary interventions is that they do not address the organisational factors that affect the mental health of employees, including poor HR policies, bad management practices and unrealistic workloads.
Organisational factors tend to have the biggest impact on mental health, so it is essential to identify them. The HSE's stress management standards provide a helpful framework that you can use to start exploring these factors.
The standards identify six areas of organisational life that, when implemented well, result in improved mental health and higher productivity. These areas are:
Demands -- workload and work patterns
Control -- the degree of autonomy that employees experience
Support -- the resources and encouragement that employees receive
Relationships -- managing conflict and dealing with unacceptable behaviour
Role -- ensuring that employees have role clarity
Change -- how organisational change is managed and communicated.
Primary-level interventions are the most complex and involve addressing the above six areas of organisational life to create an organisational culture that enables good mental health. Interventions could include:
Minimising the negative impact of HR policies
Promoting good leadership styles that are supportive to staff
Positively influencing work practices and workloads
Training managers to understand and manage mental health
Creating an organisational culture that encourages social justice
Making people feel valued
Offering work flexibility
Making sure that the impact on staff mental health is considered at the outset of any change process
Making work meaningful
Promoting social cohesion.
This is not an exhaustive list but should give a flavour of the interventions that are possible, depending on organisational need. The research shows that, if you are serious about making a difference to mental health, you have to deliver primary-level interventions alongside secondary and tertiary ones.
Organisations tend to differ on who has responsibility for managing mental health. But it is clear that, whether it is HR or occupational health (OH), they will not be able to tackle it alone. Everyone in an organisation has a role to play in cultivating good mental health, from the CEO to the most junior employee.
To enable a positive mental health culture, it is important that all key stakeholders work collaboratively, including OH, HR, managers, leaders, the senior team and any third-party providers of employee assistance programmes (p 44). This will ensure a greater impact and that mental health interventions become integrated into day-to-day business activity.
Employers also need to be able to evaluate the return on investment for their mental health interventions. To prove they have been effective and secure further funding for mental health support, employers need to show these interventions have had a positive impact. The data that you collect at the start of the process will give you a benchmark against which to measure your efforts. Measuring the impact of interventions to improve mental health is not always easy and often requires a more strategic, long-term approach to demonstrate, for example, a reduction in sickness absence.
When you start to intervene on mental health, sickness absence figures can increase in the short term as employees realise that it is OK to talk about these issues and to take time off rather than remain in work but not be productive (presenteeism). As a result, you'll need to consider carefully how to measure the impact of any interventions and the timescales that are needed to show a positive impact.