Managing mental health

The British Occupational Health Research Foundation (BOHRF) launched an evidence review of Workplace Interventions for People with Common Mental Health Problems at an event held in September at the Royal College of Physicians. The research was funded by the BOHRF, and health and wellbeing solutions provider FirstAssist sponsored the evidence review.

An impressive representation of all sectors of the OH market were in attendance to share the best practice findings of this work. It shows that 15% to 20% of employees are likely to have a mental health problem of some kind caused by various work-life issues, and 91 million days are lost each year due to mental health problems.

It revealed that most mental health problems are relatively mild in their effects, and are dealt with by family doctor and primary healthcare services without professional psychiatric help.

Whereas severe mental health problems such as manic depression only affect between 1% to 3% of the working population, common mental health problems such as depression and anxiety affect between one in six and one in four of the working population. These mild to moderate mental health problems were the focus of the review.

The research identified important prevention, retention and rehabilitation solutions that reduce the risks associated with common mental health conditions and the possible loss of skilled staff – issues which ultimately impact upon productivity in the workplace. It looks at:

  • the prevention of common mental health problems
  • help with rehabilitation and return-to-work initiatives for employees who have had periods of sickness/absence due to mental ill health.

For those with common mental health problems that affect their working life, evidence has highlighted various proactive measures that are of benefit. Brief cognitive behavioural therapy (CBT) and physical exercise are suggested, along with educational techniques that give workers a better understanding of how the body responds to stress.

Training for supervisors and management in employee support mechanisms build a collaborative approach to enable flexibility in rehabilitation and return-to-work programmes.

Because the review shows the role of employment as central to recovery, the approach taken by the worker’s GP in terms of signing them off work should be considered when planning return-to-work and support programmes.

The review also examines an International Labour Organization (ILO) study of mental ill health in other countries, and cites a multinational study of workplace mental ill health. In all five countries examined – Finland, Germany, Poland, the US and the UK – the prevalence of mental health problems among the workforce and the related costs were found to have risen over the past decade. The increase in cases of depression, in particular, was considered by the ILO to be alarming. Clearly, this epidemic of mental ill health is not just a UK issue.

The conclusions of this review focus on three areas:

  • Prevention: stress management training is recommended for those with no symptoms and who are at low risk of psychological ill health. This life-skills training and identification of stressors is of benefit across the work-life spectrum, although the extent of the benefit is difficult to quantify.
  • Retention: for those at risk, individual rather than organisational approaches are more effective. Those in this category may be in stressful jobs or have a previous history of mental ill health.
  • Rehabilitation: for those already experiencing common mental health problems at work, the treatment of choice is brief individual CBT. This may be face-to-face or via a computer programme. However, the latter method would benefit from a corroborative study due to the short, but promising work that has been conducted so far.

This review will give many organisations and individuals the confidence and ability to tackle common mental health issues in the workplace, but further work is still necessary to build on existing studies. According to the review, recommendations for further research are:

  • Randomised controlled trials on effectiveness and cost benefit analysis of various cognitive approaches to mental ill health, such as group versus personal CBT, and computer-aided and interpersonal counselling
  • Case management approaches to retention and rehabilitation by health professionals or management/supervisory staff
  • Organisational level interventions focusing on the individual
  • Preventative studies of employment practices and management style.

Ten years ago, it was evident that mental ill health at work was increasing at an alarming rate. It has now reached epidemic status. Why has it taken so long to take this issue seriously and get the most very basic evidence to start addressing the issue? And why is the psychological health of so many workers deteriorating in so many countries?

There are still many questions to answer and much research to do, but the BOHRF has ‘kick-started’ the process. While many of the recommendations in this review have already become accepted practice, the review sets the foundation for more in-depth research.

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Sharon Horan is an occupational health consultant and chair of the Society of Occupational Health Nurses

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