World Mental Health Day: identifying three priority areas for employer action
Today is World Mental Health Day and one thing is sure — you will have a wide choice of excellent blogs, tweets, articles and think pieces to dip into as the day unfolds. Some of these will be written from the ‘lived experience’ perspective, some from eminent clinicians, some from policymakers and some from specialists in counselling, therapy, technology, education and employment.
Some, however, will feel a little like what a rather cynical former colleague of mine once called ‘problem admiration’. By this she meant setting out what the size and nature of the challenge is without offering many solutions. I am less cynical about this kind of effort, but then I like data and I think it’s important to ensure we’re all clear about the scale and scope of the mental health tests we face. Too many people still take these less seriously than they should.
However, ‘problem admiration’ alone can be unhelpful if all we do is wring our hands about the growing prevalence of depression anxiety, and do nothing innovative, impactful and lasting to prevent, improve or resolve the often-devastating consequences of mental illness. My worry has been that, in the case of workforce mental health, the paucity of robust and evidence-based solutions has meant that it has been easier to sound the alarm about the problems than to address them. This is frustrating given the encouraging numbers of employers who genuinely want to do something impactful about mental wellbeing at work, but who struggle to do much more than treat the symptoms. In this blog I hope to engage in some ‘problem elucidation’ and to highlight a few promising solutions.
We got a new contribution to the debate just a few days ago when the World Health Organisation (WHO) published guidance on mental health in the workplace. To its credit, the WHO have worked hard to both quantify the problem and to offer some solutions. They added some new and scary global numbers too. For example, they estimate that, in 2019, 15 per cent of all working age adults had a mental disorder, that 12 billion working days are lost to depression and anxiety each year and that half of the total costs to society (including healthcare) are driven by indirect cost such as lost productivity.
To add some more pre-pandemic figures, about 38 per cent of Europeans reported living with a mental illness in 2017, and the total annual cost of mental illness in the EU has been estimated at €240bn, over half of which (€136bn) is attributable to lost productivity. Over half of workers living with depression or anxiety make at least one unsuccessful attempt to return to work. Among those who do return, almost 70 per cent have less responsibility than previously, they work fewer hours and are paid less than before. Indeed, the annual income of workers affected by depression can be lower by 10 per cent compared with healthy colleagues doing the same job. The pandemic has amplified these problems and the imperative to act is even more urgent. Only last week, analysis by the Financial Times showed that mental illness accounted for a significant number of workers leaving the labour market altogether, reducing the productive capacity of the UK economy still further.
Of course, only a proportion of the mental illness experienced by workers is attributable to work. However, employers have a duty of care which involves ensuring that, as far as possible, the psychosocial work environment does not cause or exacerbate mental illness in the workforce. Here the WHO guidance helpfully points to three priority areas for action which each have a growing evidence base to back up their use.
The first is ‘prevention’ — the area where many employers still do too little. One of the simplest ways of making progress here is through risk assessment and the Health and Safety Executive (HSE) ‘Stress Management Standards’ remain a solid way of highlighting workers, types of jobs or work environments which may indicate an elevated risk of harm to mental health. Another helpful tool is the Job Demands-Resources model which says that stress is more likely if the demands of a job exceed the psychological resources the employee can deploy to meet those demands. In such cases, innovative approaches to job redesign and ‘job-crafting’ can made a big difference.
The second area highlighted by the WHO is ‘promote and protect’. This focuses on efforts to reduce stigma and improve the skills of managers and others to identify mental distress and to ‘signpost’ employees to professional support. Here, evidence-based guidance published earlier this year by NICE (to which IES contributed) is very helpful, as is the research which my colleague Dr Sally Wilson led looking at line manager training in the UK Rail Industry. One area where we remain less convinced is the way that Mental Health First Aid (MHFA) is being used in an increasing number of organisations. Part of our concern (explained in this blog post) lies in the ways that MHFA can crowd out more evidence-based interventions.
The third WHO priority is ‘support’. Here they call for more effort to support working age adults to remain in and return to work recognising, as they do, that good quality jobs have mental health benefits. It is really important to support those who are at work but struggling to make temporary adjustments to their work to help them overcome work pressure. The Access to Work scheme, funded by the UK government offers free specialist mental health support to employees who need it — and many employers have found it to be a valuable support. The support offered by UK charities such as Mind are also well-researched and practical. It is also worth mentioning the importance of programmes such as Individual Placement and Support (IPS) in helping unemployed people with mental illness to get back to work. This approach, using intensive supported employment by skilled case workers, is being expanded in the UK and has some notable successes.
The WHO document is part of a package of guidance for both employers and policy makers, and its approach is very welcome at a time when many of the tools being used by some employers are eye-catching but less robust. As the mental health challenges for people in and out of work intensify, the more support that we can direct towards employers the more likely they will be to introduce workplace programmes which have a lasting impact.
Any views expressed are those of the author and not necessarily those of the Institute as a whole.