This post is by Monica Velici of Sparta Health
Introduction
According to World Health Organization (WHO), around 264 million people suffer from depression, one of the leading causes of sickness absence and long-term work disability, with many of these individuals also experiencing symptoms of anxiety. In the UK, 14.7% people experience mental illness in the workplace and 12.7% of all sickness absence days are attributed to mental health disorders (mentalhealth.org.uk). The majority of mental health disorders are, in most cases, preventable and treatable (Mykletun & Harvey, 2012). People experiencing such mental illnesses are protected against discrimination under The Equality Act 2010, making it unlawful for employers to ask for details of an applicant’s health status before a job has been offered (Lockwood, Henderson & Thornicroft, 2012).
For businesses, mental illness poses serious challenges. Previous research states that mental conditions impact both direct (e.g. health care) and indirect (e.g. lost productivity) expenses that exceed billions of dollars per year (Greenberg, Fournier, Sisitsky, Pike, & Kessler, 2015). This is supported by one of the most recent WHO studies, that estimated that anxiety and depression disorders affect the global economy by costing US$1 trillion in lost productivity (World Health Organisation, WHO, 2019).
What Is Mental Illness?
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, APA, 2013) comprises more than 200 mental disorders, and refers to those psychological disorders that can be diagnosed and are “characterized by dysregulation of mood, thought, and/or behaviour” (APA, 2013). For example, depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviours are considered mental illnesses. They range in continuity and severity (within and across disorders) and once diagnosed, individuals may stay susceptible to the disorder throughout their life.
However, mental illnesses and mental health are not the same concepts but are also not mutually exclusive. According to the dual continuity model (Keyes, 2005), they are, although correlated, distinct constructs. The model argues that one continuum denotes the existence or lack of positive mental health, while the other continuum represents the existence or absence of psychiatric disorders. Thus, a person might experience low levels of mental illness and at the same time be experiencing low levels of mental health. In the same way, an individual with a diagnosed psychiatric disorder can sustain functional levels of mental health at any given point in time (Follmer and Jones, 2018). This shows the need for regarding mental illnesses independently from mental health, as individuals with mental illnesses are very much capable of functioning and accomplishing well-being.
Causes / Risk Factors
WHO recognises the following risk factors to mental health:
- Inefficient health and safety policies
- Poor management practices and communication
- Low control or restricted participation in decision-making over an employee’s area of work
- Low levels of employer support
- Strict work hours
- Vague tasks or organizational goals
However, there are also psychological factors contributing towards mental illness. One of the most recent systematic reviews in the field, proposed a unified model of psychological risk factors in the workplace (see image to the right). The model was divided into three overlapping clusters: imbalanced job design; occupational uncertainty, and lack of value and respect in the workplace. Each of these clusters contain shared elements, such as job control, procedural justice, effort-reward imbalance, and occupational social support. All of these elements have been shown to impose a certain level of psychological distress on employees and for some of them to contribute to mental illness (Harvey et al., 2017).
Management and Support
The National Institute for Health and Care Excellence (NICE, 2009) recommend four approaches for managing mental health in the workplace:
- Strategic and coordinated approach to promoting employees’ mental wellbeing – this approach focusses on promoting mental wellbeing within the organisation, working in partnership with its employees. Organisations should aim to promote a culture of mental health awareness, fairness, equality, and participation that is based on open communication.
- Assessing opportunities for promoting employees’ mental wellbeing and managing risks – all organisations should have in place systems to monitor and assess employees’ mental wellbeing so that areas for improvement can be identified. Assessment can be done through surveys and information relating to absence rates of staff, but also through frameworks such as the Health and Safety Executive (HSE) management standards for work-related stress. This approach also takes into account the responsibility of any organisation to respond to the needs of its employees who might be at risk of work-related stress due to working conditions, or to those employees who might experience mental health difficulties for other reasons. Once such employees are identified, the organisation should provide access to mental health support, for example, counselling, stress management techniques
- Flexible working – Organisations should provide flexible working hours and conditions for its employees, based on each individual employee needs and aspirations taking into account both their work and personal life. Some example are home working, part-time working, flexitime, and job sharing. By doing so, organisations can enhance employees’ sense of control and promote engagement and job satisfaction. In the same way, this approach aims to address employees’ concerns and enable managers to respond to such concerns by seeking to accommodate appropriate requests for flexible working.
- The role of line managers – all organisations should insure they promote coaching, mentoring, participation, constructive feedback, and delegation. Line managers should aim to motivate employees and provide them with the training and support they require. Managers should also be able to identify and respond to employees’ symptoms of mental health difficulties and/or emotional concerns. This approach integrates guidance by HSE and Investors in People, a tool for management development created by the Chartered Institute of Personnel and Development.
A Take Home Message
It is clear that evidence suggests that investment in healthy working systems, together with caring for the health and wellbeing of employees improves productivity and is cost effective for businesses and wider society (Coats & Max, 2005). Therefore, it appears logical that businesses which promote and support the mental wellbeing of its employees, will see increased commitment and job satisfaction, staff retention, improved performance, and reduced staff absence.
About Monica Velici
Monica joined Sparta Health in February 2020 as part of the rehabilitation service support team. She has a degree in Psychology, an MSc in Clinical Neurodevelopmental Sciences, and a keen interest in dementia and mental health. Monica aims to become a fully accredited therapist.
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013
Coats, D. & Max, C. (2005). Healthy work: productive workplaces. London: The London Health Commission
Follmer, K. B. & Jones, K. S. (2018). Mental Illness in the Workplace: An interdisciplinary review and organizational research agenda. Journal of Management. 44 (1), 325 – 351. doi: 10.1177/0149206317741194
Greenberg, P. E., Fournier, A., Sisitsky, T., Pike, C. T., & Kessler, R. C. (2015). The economic burden of adults with major depressive disorder in the United States (2005 and 2010). Journal of Clinical Psychiatry. 76: 155-162.
Harvey, S.B., Modini, M., Joyce, S., Milligan-Saville, J. J., Tan, L., Mykletun, A., Bryant, R. A., Christensen, H. & Mitchell, P. B. (2017). Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems. Journal of Occupational and Environmental Medicine. 0. 1-10. doi: 10.1136/oemed-2016-104015
Keyes, C. L. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology. 73: 539-548
Lockwood, G., Henderson, C. & Thornicroft, G. (2012). The Equality Act 2010 and mental health. The British Journal of Psychiatry. 200, 182–183. doi: 10.1192/bjp.bp.111.097790
Mykletun A, Harvey SB (2012). Prevention of mental disorders: a new era for workplace mental health. Occupational & Environmental Medicine. 69, 868–869
National Institute for Health and Care Excellence. (2019). Public health guideline. Mental wellbeing at work. Retrieved from https://www.nice.org.uk/guidance/ph22
World Health Organisation. (2019, May). Mental health in the workplace. Retrieved from https://www.who.int/mental_health/in_the_workplace/en/