Workplaces have habitually been seen as key settings for a range of health promotion initiatives targeted at working people.
Programmes that assist, for example, employees to reduce or give up smoking, eat more healthily or improve their fitness are common. However, the published research shows that there are few evidence-based interventions carried out in or by workplaces to address common mental health problems among employees.
The research literature on programmes that address the mental health of employees has been dominated by interventions targeted either at the whole population of employees, for example stress inoculation, or at those deemed to be at high risk of stress-related disorders, for example stress reduction or management.
These approaches mirror physical health interventions aimed at individual behaviour change and do not offer a model for organisational approaches to these issues.
2.0 The Workplace and Employers
While evidence tells us that workplaces are not the sole or principal setting for delivering interventions for people with common mental health problems, employers nevertheless remain key partners.
They do, after all, have a contractual and personal relationship with their employees, as well as statutory health, safety and disability accommodation duties.
The focus of employers’ role in the management of common mental health problems among employees should be to ensure that the working environment supports retention and rehabilitation. Recent policy recommendations have highlighted this responsibility.
For example, the National Institute for Health and Clinical Excellence (NICE) reviewed some of the literature on mental health and work, as suggested by experts in the field. In the absence of randomised control trials (RCT’s) on the topic under review, Workplace Mental Health suggests that employers take a strategic and co-ordinated approach to workplace wellbeing; that employers provide opportunities for flexible working; and that line managers promote and support wellbeing among staff (NICE, 2009).
The NHS Health and Wellbeing Review (DH, 2009) acknowledged not only that some employees are likely to have existing common mental health problems, but also that the nature of the working environment can sometimes have a negative impact on staff mental wellbeing. Among the review’s recommendations were that all NHS bodies should ensure that their management practices adhered to the Health and Safety Executive’s management standards for the control of work-related stress; that more investment was needed to attract people to take up occupational medicine; that all managers are trained in the management of people with mental health problems; and that all NHS bodies give priority to the implementation of the NICE guidance on workplace mental health in order to signal their commitment to staff health and wellbeing (NICE, 2009).
A parallel piece of work complemented the NHS Health and Wellbeing Review and described findings from the Practitioner Health Programme. The intervention is targeted at doctors and dentists with health problems who might be reluctant to seek help through usual channels. In its first year, a total of 184 practitioners within the M25 area had accessed the service: 57% with mental health problems and 23% with addiction issues (Crawford et al., 2009; Ipsos MORI, 2009; Smauel et al., 2009; DH, 2010).
The UK Government’s Foresight scientific review on Mental Capital and Wellbeing (Foresight, 2008) included a chapter devoted to work (Dewe & Kompier, 2008), recommending that employers foster work environments conducive to good mental wellbeing and the enhancement of mental capital, for example, by extending the right to flexible working. The chapter also highlighted the importance of:
- Integrating occupational health professionals with primary care;
- The collection of wellbeing data against Key Performance Indicators; and
- Annual wellbeing audits.
All of these recommendations mirror the findings of a longitudinal cohort study on workplace factors that may help to reduce depressive symptoms (Brenninkmeijer et al., 2008). Work resumption, partial and full, and the employer changing the employee’s tasks, promoted a more favourable outcome. However, these findings emerged from the Netherlands, where the employer and employee have a legal obligation to sit together and discuss solutions to obstacles preventing return to work, an important factor associated with the decrease in long-term disability in that country (Reijenga et al., 2006). Perhaps a policy shift will be necessary to allow workplaces in the UK to play a central role in the management of common mental health problems.
Brenninkmeijer, V., Houtman, I. & Blonk, R. (2008) Depressed and absent from work: predicting prolonged depressive symptomatology among employees. Occupational Medicine. 58, pp.295-301.
Crawford, J., Shafrir, A. et al. (2009) A Systematic Review of the Health of Health Practitioners. Edinburgh: Institute of Occupational Medicine. Available from World Wide Web: http://www.iom-world.org. [Accessed: 24 November, 2019].
Dewe, P. & Kompier, M. (2008) Foresight Mental Capital and Wellbeing Project. Wellbeing and Work: Future challenges. London: The Government Office for Science. Available from World Wide Web: http://www.foresight.gov.uk/Mental_Capital/Wellbeing_and_work.pdf. [Accessed: 24 November, 2019].
DH (Department of Health). (2009) NHS Health and Wellbeing Review. Interim Report. London: Department of Health. Available from World Wide Web: http://www.nhshealthandwellbeing.org/InterimReport.html. [Accessed: 24 November, 2019].
DH (Department of Health). (2010) Invisible Patients: Report of the working group on the health of health professionals. London: Department of Health. Available from World Wide Web: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113540. [Accessed: 24 November, 2019].
Foresight. (2008) Mental Capital and Wellbeing Project. Final Project Report. Available from World Wide Web: http://www.foresight.gov.uk/Mental_Capital/Mental_capital_&_wellbeing_Exec_Sum.pdf. [Accessed: 24 November, 2019].
Ipsos MORI (2009) Fitness to Practice: The health of healthcare professionals. London.
NICE (2009a) Workplace Mental Health. Available from World Wide Web: http://guidance.nice.org.uk/PHG/Wave12/82. [Accessed: 24 November, 2019].
Reijenga , F.A., Veerman, T. & van den Berg, N. (2006) Evaluation Law Gatekeeper Improvement. Report 363. Gravenhage: Ministerie van Sociale Zaken en Werkgelegenheid NL.
Samuel, B., Harvey, S.B., Laird, B. et al. (2009) The Mental Health of Health Care Professionals: A review for the Department of Health. London: King’s College London.