For some time now we have been aware of how work can impact negatively on our physical health, however, only recently have we started to recognise how the work environment impacts on our mental health and wellbeing. The World Health Organisation (WHO) has published a number of reports and resources that highlight the importance of mental health in the workplace.
In the United Kingdom, Lord Dennis Stevenson, mental health campaigner, and Paul Farmer, CEO of the mental health charity MIND published the findings from the Thriving at Work review in October 2017. This review considered the ways in which employers can better support all employees, including those with poor mental health and wellbeing, to remain in and thrive at work. They regard mental health as something everyone has and recognise that over time it may fluctuate between thriving, struggling and being ill. They suggest six core mental health standards:
• Developing and disseminating mental health at work plans.
• Increasing mental health awareness.
• Encouraging open conversations about mental health.
• Ensuring good working conditions, development opportunities and work life balance.
• Promoting effective people management.
• Monitoring employee mental health and wellbeing.
The recently published Taylor Good Work review is based in the premise that all work should be fair with realistic potential for personal development. Highlighting the importance of quality of work, the report recognises that better designed jobs improve health, wellbeing and productivity and emphasises the importance of ensuring that workers feel trusted, enabled and respected.
Resources for employers
Public Health England recognises the importance of good work for health and wellbeing and has developed a mental health toolkit for employers. This provides practical ways in which employers can develop a workplace culture that prioritises mental health, including:
• Identifying a mental health champion who is responsible for mental health policy at work.
• Providing mental health awareness training for line managers.
• Signing the Time to Change pledge.
The mindful employer initiative also supports employers to safeguard the mental health of their staff.
Other useful resources for employers include the National Institute for Health and Care Excellence (NICE) guidelines on Workplace Health. These guidelines also emphasise the importance of organisational culture and the role of line managers to ensure good employment conditions that are conducive to good mental health and wellbeing. The mental health charity ‘Mind’ developed an Introduction to mentally health workplaces resource providing a simple checklist and examples of best practice.
A multi-faceted approach
Workplace wellbeing requires an integrated approach comprised of interventions at the organizational (e.g. building organizational resilience through good management, addressing poor pay, improving working conditions and tackling workplace bullying) and individual level (e.g. improving lifestyles, reducing stress and promoting a work life balance).
At the individual level, a recent review of research studies has found that implementing Mindfulness-Based Stress Reduction interventions in the workplace had a positive impact on workers’ mental health and wellbeing including reduced levels of occupational stress, psychological distress, depression and anxiety.
As wellbeing is a composite construct with mental, social and physical aspects employers have a key role to play in promoting a healthy lifestyle amongst employees. This is important given the clear link between mental health and lifestyle factors such as sleep, diet, physical activity, and alcohol consumption. Other key strategies in promoting mentally healthy workplaces include promoting early help-seeking and supporting return to work.
Employees experiencing multiple stressors (i.e. situations or life events that lead to stress) may need additional support to remain mentally well at work. For example, the Mental Health Foundation report describes how ‘stressors’ are more frequently reported amongst some groups such as people living in more disadvantaged circumstances, individuals from black or minority ethnic communities and those with long term health conditions.
Public Health England has partnered with Business in the Community to develop a domestic abuse toolkit which can assist employers to support employees who may be a victim of domestic abuse.
The workplace is potentially an important place in which to reach out to individuals and groups who don’t traditionally engage with mental health and wellbeing initiatives e.g. men and those people from minority ethnic groups.
Protecting the protectors
A recent experimental study found that people who combine paid work with informal caregiving are more likely to experience stress and that a self-help intervention can reduce their levels of stress. In light of an ever ageing workforce, the mental health of older workers should be a particular focus of work places given that they are more likely to be managing a long term health condition of their own as well as caring for younger and older generations at the same time.
In addition to informal caregivers, the mental health of those whose job it is to care for others needs to be protected and nourished. The Kings Fund highlights the high levels of work-related stress amongst NHS staff. Research shows that group interventions for nurses aged 45 and over can be effective in improving mental health outcomes. This may be particularly important for those working shifts with research suggesting a detrimental effect of disruptive sleep patterns on mental health and wellbeing.
A culture of good mental health
Public Health professionals are ideally placed to lead by example, they must take steps to understand and recognise the mental health and wellbeing needs of the workforce and promote a culture of good mental health for employees in the settings they work as well across other settings. Other professionals e.g. HR, organisational development have an important role and working in partnership can achieve the most substantial changes.
A number of London local authorities have signed up to the London Healthy Workplace Charter and local councillors across the country are being trained as mental health champions. In response to the ever increasing pressures faced by public sector workers, the Mental Health Foundation has recommended “mental health days” to be rolled out across the public sector. Moreover, it is hoped that such a step would send a clear message and encourage the uptake of this initiative more broadly (i.e. within the private and third sector). The Scottish Fair Work Convention developed a framework setting out how working conditions and subsequently the health and well-being of employees can be improved.
Preventing and tackling bullying and harassment in the workplace is crucial to improving the mental health of employees. The TUC found in 2015 that almost one third of people are bullied at work. More recently, the British Medical Association found that amongst Doctors and Dentists, 22% experienced bullying, harassment or abuse from other staff.
Alongside interventions aimed at the individual level, the social determinants of mental health must be addressed in order to improve and sustain mental health and wellbeing amongst workers. For example, the Joseph Rowntree Foundation have campaigned for the eradication of in-work poverty in the United Kingdom and the money and mental health policy institute clearly demonstrate the links between mental health and debt. Promoting the real Living Wage is one way in which in-work poverty can be addressed. The Faculty of Public Health in Scotland recommends in their report Healthy Lives, Fairer Futures that the real Living Wage becomes the national minimum wage.
Authored by: Claire Mawditt, Marylou Murray, Christina Gray and Mike McHugh.