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The Need For Mental Health Promotion In The Workplace

In the recent past there has been a raging debate on the large sums of money that have been paid out by the National Insurance Scheme for sickness claims; and the inference by some is that some sickness claims may be feigned. We submit, however, that workplace illnesses and absences go beyond the accusations of illnesses being contrived by workers. On too many occasions we hear such statements about worker absenteeism being loosely made by some speakers without there being any empirical evidence to substantiate their claims. The evidence before us which we have gleaned from research carried out in Barbados and in the developed world by credible sources, inform that the reason for much of the workplace illness and absence result from the working environment. In Barbados, research by The Productivity Council clearly shows that workplace accidents are burdensome to the enterprise and the local economy; and we have also come to realise that public health issues such as non-communicable diseases, e.g. and infectious diseases have been having a tremendous negative impact on the workforce and the economy.

Even if we think that the institutions in Barbados do not undertake the level of relevant research to inform our publics, the fact is that we do have agencies and institutions from which we can garner information on issues dealing with workplace health. And whilst we are aware that there are many issues that influence workplace illnesses and absences, we do know that research that has been carried out internationally shows that much of the workplace absence and illness result from mental ill-health among the workforce and that mental health issues are generally under recognized.

So, let us examine the issue of Mental health in the workplace, a subject to which we pay little heed.

The European Agency for Safety and Health at Work, in a publication on the subject, “Mental Health Promotion in The Workplace – A Good Practice Report”, states that the world of work continues to adapt to the changes of the global marketplace (EU-OSHA, 2007). Across a number of EU member states there is an observed trend of increasing absenteeism and early retirement due to mental health problems; particularly in relation to stress and depression (McDaid, Curran, and Knapp, 2005). An estimated 20% of the working population will experience some form of mental health problems during their working lives (STAKES, 1999), costing an estimated 3 to 4% respectively of the European Gross National Product (McDaid, Curran, and Knapp, 2005). In general, mental health issues – especially on relation to the workplace – have remained a salient issue and an under recognised problem (The Safety Sainsbury Centre for Mental Health, 2004).

With regard to the point made that mental health in the workplace is a salient issue, a study conducted by Shaw Trust (2006) surveyed 550 senior managers about their knowledge and awareness of work-related mental ill-health and problems. The study revealed that, overall, half of the managers thought that none of their workers would ever suffer from a mental health problem during their working life; and that over 66 per cent of employers, when asked to estimate the prevalence of mental ill-health in the workplace, thought it to be 1 in 20 (STAKES, 1999); whilst current estimates are closer to 1 in 5 workers.

So, what is mental health and what is it not?

The World Health Organization (WHO) and the Ottawa Charter for Health Promotion (1986) define health as:

“…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Ottawa Charter for Health Promotion, 1986)

This definition provides a comprehensive and holistic understanding of health including and supported by the interconnected areas: physical, mental and social health. This holistic definition of health has two basic assumptions: (1) there is no health without mental health; and (2) health cannot – and should not – be viewed as merely the absence of illness or disease; but rather as a state of positive physical, mental and social wellbeing. The World Health Organization (2005) suggests that mental health should be conceptualized as ‘a state of well-being’ in which an individual:

  •  realises his or her own abilities
  • can cope with the normal stresses of life
  • can work productively; and
  • is able to make a contribution to his or her community

Mental health and, conversely, mental ill-health have been conceptualised and understood as a spectrum: ranging from ‘positive mental well-being’ to mental ill-health and clinical problems.

The European Agency for safety and Health at Work stated that evidence indicates that work can both contribute to the development of mental ill-health through poor working conditions and, conversely, can provide individuals with purpose, financial resources and a source of identity, which have been shown to promote increased positive mental well-being (McDaid, Curran, and Knapp, 2005)). It also stated that there is growing recognition across the European Union and moreover globally, of the economic and social impact of mental ill health; and in turn, of the relative importance of promoting mental well-being and preventing the onset of mental disorders in society-at-large (World Health Organisation, 2005). The workplace has been identified as one important as one important social context in which to address mental health promote employee positive mental health and well-being. The workplace has been highlighted, both at a policy and practive-level, as an important setting for mental health promotion strategies and initiatives (Leka and Cox, 2008; Cox, Leka, Ivanov and Kortum, 2004). More specifically, workplace mental health promotion has been highlighted in a number of recent policy documents and initiatives within the European Union in a number of strategies much as the Commission White Paper “Together for Health “ (2208-2013) and the Framework Agreement on Work-related Stress”.

As it relates to the issue of Mental ill-health in the workplace, a study carried out in 2009 estimated that mental ill-health was estimated to cost the European Union EU 136 billion EUR. Estimates back in 2009 suggested that 25% if European citizens would experience a mental health problem in their lifetimes and approximately 10% of long-term health problems and disabilities could then be linked to mental and emotional disorders (ENWHP, 2009).

Across the European Union levels of absenteeism, unemployment and long-term disability claims due to work related stress and mental health problems are increasing (McDaid, 2008). For example in 2007, 40% of all long term disability benefit payments in Great Britain (England, Wales and Scotland) were due to mental or behavioral disorders (Sainsbury et al, 2008). In Austria the total number of days of sick leave was found to be decreasing between 1993 and 2002; but there has been an overall increase of 56% in sickness absence due to mental ill-health (Zechmeister, 2004).

Particularly for depression a trend across the European Union of increasing absenteeism and early retirement for both men and women has been observed (Wynne and MacAnaney, 2004) This trend has been observed across a number of EU Member states (McDaid, Curran and Knapp, 2005) and wit is predicted that by 20120, depression is forecast to be the second most important cause of disability globally (WHO, 2005). And we should take note that the consequences of mental ill-health have been linked to numerous negative consequences for the organisation: such as employees’ diminished performance levels, and increased rates of absenteeism, accident and staff turnover (Hamois and Gabriel, 2000).

In assessing the role of work on mental health and mental ill-health, the Report states that, without a doubt, one of the key areas that affect our mental health is the work environment. The report states that work can be beneficial to mental health through an increased sense of social inclusion, status, and identity and by providing a time structure (Hamois, and Gabriel, 2000). Conversely, many psychosocial risk factors at work have bee found to increase the risk of anxiety, depression and burn-out.

The International Labour Organization (ILO) defines psychosocial hazards as an integral element in the stress process in terms of the interaction among job content, work organization, work management and environmental condition on the one hand, and the employees competencies and needs on the other (ILO, 1986). Workers’ physical, mental and social health can be impacted by their work and environmental conditions via two pathways: a direct and indirect manner. A direct physical pathway can be observed between physical work environment and its associated risks and workers’ health. In addition, bad physical working conditions can have an indirect impact by causing tress. Moreover there is a large body of evidence to indicate the relationship between the psychosocial working emnvirnonmtn and health of worker. This pathway is also mediated by the experience of stress by the individual (Cox, Griffiths, and Rial-Gonzalez, 2000). It is important to note that negative physical negative physical  and psychosocial  working conditions have detrimental impact on the healthiness of organizations and the employees’ availability for and performance at work.

Mitchie and Williams (2003) conducted a systematic review of the psychosocial work factors that were found to be associated with mental ill health and sickness absence. The review found the following work and organizational factors to be associated with mental ill-health and sickness absence: long working hours, work overload and pressure, lack of control over work, lack of participation in decision making, poor social support and unclear management and work role. Harnois and Gabriel (2000) found several consequence that are commonly related to mental ill-health among workers, including absenteeism, reduction in productivity, increase in error rates, loss of motivation and commitment, poor timekeeping, increase in turnover and tension and conflicts between colleagues.