Mental health in the workplace

Work can contribute to the development of mental ill health through poor working conditions and work organization issues. However conversely, employment can provide individuals with purpose, financial resources and a source of identify; which has been shown to promote increased positive mental wellbeing . 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 wellbeing and preventing the onset of mental disorders in society-at-large . The cost of depression is thought amount to an estimated €118 billion in Europe and $83.1 billion in the USA . A systematic review of data and statistics from community studies in European Union (EU) countries, Iceland, Norway and Switzerland show that 27% of the adult population (defined as aged 18–65) had experienced at least one of a series of mental disorders in the past year (including, problems arising from substance use, psychoses, depression, anxiety, and eating disorders ). In November 2005, the European Commission published a Green paper – Promoting the Mental Health of the Population. Towards a mental health strategy for the EU as a first response to the WHO mental health declaration for Europe. It stipulates that more than 27% of adult Europeans are estimated to experience at least one form of mental ill health during any one year; and that by the year 2020 depression is expected to be the highest ranking cause of disease in the developed world The workplace has been identified as one of the most important social context in which to address mental health problems, and promote mental health and wellbeing. This article will examine these issues in more detail.

Understanding mental health and mental ill health

Mental Health

The World Health Organisation (WHO) and the Ottawa Charter for Health Promotion define health as: “… a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” . This definition provides a comprehensive and holistic understanding of the concept of health, including and supported by three 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 WHO  suggests mental health should be conceptualised as ‘a complete state of wellbeing’ in which the individual: realises his or her own abilities; can cope with the normal stresses of life; is able to establish and maintain social relationships; and can contribute to society by being productive.

Mental disorders and mental ill health

Mental disorders are clinically significant conditions characterised by altered thoughts, emotions or behaviours with associated distress and impaired functioning . Mental disorders are assessed using a standardised diagnostic manual either the International Classification of Diseases 10th Revision (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders 5th revision (DSM-V). The ICD-10 is a book published by the WHO, and aims to provide a standardised diagnostic manual for mental disorders. The DSM-V, published by the American Psychiatric Association, is another commonly used diagnostic manual for mental disorders. These manuals provide a classification system that aims to separate mental illness into diagnostic categories based on the description of the individual’s symptoms and the course of the illness. Mental disorders are categorised as follows:

• organic mental disorders (e.g., dementia);
• psychoactive substance use (e.g., harmful use of alcohol);
• schizophrenia and associated disorders (e.g., delusional disorders);
• mood disorders (e.g., depression, bipolar affective disorder);
• neurotic, stress-related and somatoform disorders (e.g., anxiety disorder);
• behavioural syndromes;
• disorders of adult personality;
• mental retardation;
• disorders of psychological development (e.g., autism);
• and child and adolescent disorders (e.g., conduct disorders).

Estimates of severe mental disorders (such as severe depression, bipolar disorder or schizophrenia), are between 1-2% of the working population . Severe mental disorders should be treated and assessed by a trained healthcare professional, and will often require a specialist (such as, a Psychiatrists). The British National Office of Statistics estimates that an additional 20% of the working population have been found to have symptoms that by virtue of their nature, severity, and duration do meet the diagnostic criteria  and therefore would be classified as a mental disorder; but would not be viewed as severe. These disorders are often referred to as ‘common mental health problems (CMHP)’. CMHP are those that are most frequent and prevalent. In the United Kingdom, for example, CMHP are often successfully treated in primary care settings (e.g, GPs), rather than by specialists (e.g., Psychiatrists). The most common of CMHP are depression, anxiety, or a mix of the two .

Many individuals may experience symptoms of emotional distress, which may not be of sufficient severity to warrant a diagnosis of a mental disorder, but nevertheless result in a significant degree of personal suffering, distress, and decreased productivity . These are often referred to as ‘sub-clinical’ disorders, which are highly prevalent among the working population. The British National Office of Statistic  estimate that 20% of the working age population will experience symptoms associated with mental ill health (such as, sleep problems, fatigue, irritability and worry), but do not meet the diagnostic criteria of a mental disorder. However, these symptoms are associated with mental ill health can have a real and significant impact on the individual’s quality of life and ability to function adequately.

The impact and costs of mental health problems

The impact of mental health problems in the workplace has serious consequences not only for the individual employee, but also for the productivity of the enterprise. Employee performance, rates of illness, absenteeism, accidents and staff turnover are all affected by employee’s mental health status. For the interested reader, a report from 2014 by EU-OSHA ^[17] provides an overview of the literature examining the costs associated with work-related stress and psychosocial risks.

Absenteeism, unemployment and long-term disability

Across the EU levels of absenteeism, unemployment and long term disability claims due to work-related stress and mental health problems are increasing . For example in 2007, 40% of all long term disability benefit payments in Great Britain (England, Wales and Scotland) were due to mental or behavioural disorders . 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 . In the Netherlands, in 1998, mental disorders were the main cause of incapacity (32%) and the cost of psychological illness was estimated to be 2.26 million EUR a year . According to the British Broadcasting Corporation (BBC) a number of hospital staff being off sick with anxiety, stress and depression in the UK has almost doubled to 41,112 in 2014 from 20,207 in 2010 .

Presenteeism and productivity

Mental health problems can often cause fatigue and impaired concentration, and poor memory. A two year longitudinal study found a positive relationship between mental health and work performance. More specifically, as mental health improved so did performance; conversely, as mental health declined so did performance . One large study found depression had a greater negative impact on time management and productivity than any other health problem ; and was found to be equivalent to rheumatoid arthritis in its impact on physical tasks . Sickness presenteeism refers to being physically present at work, but mentally/ cognitively absent. An association between sickness presenteeism and mental health problems has been observed. A large Swedish study of 3801 workers found presenteeism to be related to musculoskeletal pain , fatigue and slight depression . In 2007, Sainsbury Centre for Mental Health estimated that impaired work efficiency due to mental ill health, costs £15.1 billion or £605 for every employee in the UK, which is almost double the estimated annual costs of absenteeism (£8.1 million) . Moreover, according to the Organisation for Economic Co-operation and Development (OECD) the cost of mental health problems to businesses is estimated to be £1,035 for every employee in the UK workforce . Some US studies estimate the costs of impaired presenteeism due to mental health problems are nearly four to five times the costs of absenteeism . Table one provides a concise overview of the estimated costs to British employers due to mental ill health in the workplace.