Mental Health: Concept and Significance
Mental health is finally beginning to gain the recognition it merits, including within the work context, after having been a taboo issue in many cultures all over the world for centuries. These days, there is a much deeper understanding of both the impact of mental illness, and the causes – though many would argue we still have a long way to go on the latter.
There is nothing like financial impact to make people take notice, and according to the UK organisation, Mental Health at Work, poor mental health at work costs £1652 a year per employee. That adds up to an eye-watering sum in many organisations and a hugely disruptive impact in any organisation. And here’s another startling statistic from the same source about the impact of mental health at work: 57% of the working days lost to illness/sickness are mental health related.
A quick word about terminology. While the shorthand phrase generally used is mental health, the concept can be more fully described as “mental and emotional health”. Mental and emotional responses are usually closely intertwined, though not always (e.g., a “gut reaction”). Mental health is seen as the counterpart to physical health, though again these two domains are intertwined. Our developing knowledge of neurology, hormonal functions, sensorial capacities, social anthropology and other areas is helping us to understand and rethink many previously held Cartesian or dualist assumptions (though modern rationalism is certainly no nearer understanding the nature of the soul!). Mental illness can also have physical manifestations and consequences, not only for the sufferer but also for those with which they come into contact.
To understand mental health in the round, we can be guided by the WHO’s statement on mental health: “Mental health is an integral part of health; indeed, there is no health without mental health.” A key point to bear to mind is that just because someone does not have any mental disorders or illness, it does not necessarily mean they are mentally healthy. Mental well-being is a positive and productive state of being that enables us to actively contribute to society, develop resilience and achieve self-realisation.
The WHO’s definition of mental health, which is widely accepted internationally, including by the OECD and other international and national organisations states that:
“Mental health is a state of well-being in which an individual realizes 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”. So productive work and making a contribution are key ingredients of good mental health; indeed, the workplace has a central role to play in facilitating and supporting mental health in people.
Mental illness: a shared issue
The organisation Mental Health at Work states that “9 out 10 adults have been touched by a mental health issue in the last year”. The Covid-19 pandemic has had a significant impact on mental health, as we shall discuss later, yet this statement is not specific to the pandemic. Humans are social beings, so mental illness is often a psychosocial issue, i.e., both psychological and social, and can be triggered or exacerbated by social phenomena such as peer pressure, magnified through group dynamics and social media.
Mental illness, like some forms of abuse (physical, substance, sexual), can be self-perpetuating among families and social groups. This is due to influential circumstantial/environmental factors (for example work-related stress or behavioural norms experienced/suffered in family settings where a parent has a mental illness) and/or to genetic/physiological predisposition/age-related factors (e.g., bipolar, dementia). Often, it is due to a combination of both (psychosocial disorders e.g., substance related, schizophrenia, anxiety, ADHD, body image problems, eating disorders, phobias and some neurological conditions).
With socio-environmental or psychosocial disorders for example, those who live with or suffer the effects of someone else’s mental illness often suffer trauma themselves, which can in turn compromise their own mental health. Specifically, the behaviours of someone who has suffered serious abuse (whether physical, mental, sexual or substance-related) can damage those who live with them, especially if those behaviours are a familiar pattern associated with release or control. In this way mental illness can be self-perpetuating.
According to the UK Mental Health Foundation, the prevalence of mental illnesses tends to be higher among certain socially and economically disadvantaged or vulnerable minorities specifically: refugees and asylum seekers; black, Asian and minority ethnic groups; people with physical health conditions;, victims of domestic violence; substance misusers; carers; LGBTIQ+; homeless people. As we can see, this non-exhaustive list covers an extremely wide range of people and backgrounds.
HR personnel, managers and leaders in the workplace (whether that is in an office, factory, remote or hybrid etc) need to be aware of such basic information on mental health and need to understand how widespread mental health issues are. It stands to reason that a management attitude and organisational culture that prioritises and actively supports diversity and inclusion, backed up by enabling policies and good practices, is a fundamental factor in supporting mental health and wellbeing at work.
Mental Health and Current Work Context
The pandemic
10 October was World Mental Health Day in 2022: mental health is now a highly topical issue. I would suggest for three broad reasons for this. In part it is due to advances in our understanding of the field and in large part due to the effects of the change, uncertainty and volatility we are experiencing in the 21st century. But what has really brought mental health issues to the fore is the Covid-19 pandemic, and its many and various effects on society, including a disproportionate impact on the vulnerable.
There are many studies in progress on the effects of the pandemic on mental health, but the World Health Organisation sums it up thus: “The COVID-19 pandemic has created a global crisis for mental health, fuelling short- and long-term stresses and undermining the mental health of millions. Estimates put the rise in both anxiety and depressive disorders at more than 25% during the first year of the pandemic. At the same time, mental health services have been severely disrupted and the treatment gap for mental health conditions has widened.” The problems caused by long covid – an estimated 17 million cases in Europe – is a major factor.
Disruption to support services is a widespread example of the collateral damage of the pandemic, and those with pre-existing physical or mental health conditions have suffered greatly in that respect, as well as experiencing higher level of anxiety and depression. While the restrictions on movement that many public health authorities imposed to curb the spread of the virus were contributing factors to depression and frustration, especially among the young people, equally the effects of the lifting of restrictions, specifically being amongst crowds and in crowded places, was major trigger for anxiety for two thirds of those surveyed in a recent UK study, whether they have pre-existing conditions or not.
Transformed work patterns
The biggest shift in work patterns, accelerated by the pandemic, has been in the massively increased proportion of remote and hybrid workers. Remote working can bring significant benefits and efficiencies for both the individual workers and the employer, but if not carefully managed by both in a clear, secure and mutually respectful collaboration, can harm workers’ mental health. Only now are organisations and employees working out how to manage, incentivise and balance this relatively new but radical transformation in work patterns; it is, after all, the responsibility of both parties.
Digital working brings immense flexibility and connectivity, as well as efficiencies, but equally “over-connection” can result in “technostress”, and when combined with isolation, can result in mental health issues. In recognition of this, the European Parliament recently passed a resolution agreeing measures for Protecting mental health in the digital workspace. The measures are as yet undefined but there is a widespread call from MEPs for an EU Mental Health Strategy. There was also recognition in the same forum that digital exclusion can have a negative effect on mental health too.
The CIPD noted in 2019 that “the main risks to employee health are now psychological”. This trend has continued as organisations in 2022 make “mental health the most common focus of their well-being activity”. Typically, they provide counselling and employee assistance services plus a range of other support, e.g., for carers, the bereaved, but there remain gaps in provision for menstrual health, menopause transition and men’s health, amongst other areas.
As we have already noted, the pandemic has been the major driver of developments in mental health at work. However, there are a number of other major trends which are also contributing to mental health issues such as anxiety and depression, in particular related to the precariousness of many jobs. Automation, digitalisation and advanced technology has reduced the number of boring, limited and repetitive tasks, especially in manufacturing environments, and has also brought the opportunity to work from anywhere, and more opportunities for individuals to work autonomously.
At the same time, however, the same inexorable forces have hastened the relatively new problem, especially in dynamic and volatile economies like the UK and the US, of precarious work, manifest not so much, as originally feared, in “machine replaced my job” but more in the uncertainty of the “gig economy”, of zero hours contracts, “available all hours” working and economic volatility. According to Public Health England, “people with mental health conditions are more likely to work in precarious roles with part-time or temporary hours, high turnover, and low pay”.
The Work Foundation at Lancaster University (UK) has identified “insecure work”, based on workers’ contractual status, financial situation and access to employment rights and entitlements. The Foundation’s analysis and Insecure Work Index found that 6.2 million workers in the UK in 2021 experienced “severely insecure work” (multiple forms of job insecurity simultaneously). Such a vast number with a severely insecure work status in a highly developed economy like the UK generates some alarm, not least because of the proven links to mental ill health and persistent poverty.
Precarious work is therefore a recognised labour market issue, which affects some groups, such as the low-paid, women and migrants more than others. An authoritative UK study in 2020 found that “between 2009-2018, approximately 8.5-9.5% of the UK workforce…..could be considered precarious workers”. The report highlighted that labour-market non-compliance (breaches of labour market rules and regulations) often goes hand in hand with precarious work and that this often has a direct impact on precarious workers’ “physical and psychological well-being”.
For the individual, the additional mental stress and strain of precarious work is to some extent due to the sense that their locus of control over their work and job has diminished, as the stability of jobs of the past has been replaced with volatility, unreliability and constant change. Indeed in some cases, e.g., in some very large multinationals, terms and conditions now minimise the employer’s responsibility to provide reliable work but retain the worker as a resource to be used as and when required.
In the technology-driven economy, smaller organisations also struggle to provide a locus of control, as they are increasingly dependent on the large multinationals for many of their enterprise functions, since core enterprise solutions tend to be provided by by a limited number of multinationals. Similarly, supply chain dependencies tie the fortunes of suppliers to those they supply inevitably, and the related market volatility.
Factors Supporting Mental Health at Work
Meeting fundamental human needs
This context of changing work patterns, the pandemic, volatility and ambiguity, precarious work, and overlapping spheres of work and life are combining to generate in many people a reappraisal of the traditional role of work in their lives. This is evident in the increasing employee turnover rates, especially in the US and Australia. As part of this reappraisal, we are also facing questions of identity.
In the twentieth century people were often defined by their (more stable) jobs or position in society (unjustly in many cases), and the question “What do you do?” meant ‘what is your work?’. Now, it is much harder for people to answer that question, not only for women trying to balance careers with motherhood, but the majority living in this context. If work no longer defines us, then the rest of our lives comes under more scrutiny and it becomes a question of identity, doubts over which can affect our mental health.
Manfred Max-Neef identified 9 fundamental human needs, and three of these are needs that we traditionally associate with work: identity, subsistence and protection. However, there two others which are equally fundamental, but often neglected in the work context: participation and creation. A sense of belonging is the foundation for rewarding participation for many and a key aspect of identity at work. James Routledge has written openly and eloquently about his own sense of belonging experiences at work.
As humans, the need to participate and contribute is intertwined with our self-esteem, our sense of where we fit in society and our sense of purpose. Lack of opportunities to participate (in work teams, projects, decisions, discussions events etc.) and to contribute meaningfully at work can result in a sense of futility, low self-worth and even resentment. Unemployment is the most damaging kind of non-participation and often has a direct negative impact on mental health. Since we live in a material world and we need to fund accommodation, bills, children etc., paid employment is a necessity for most of us.
“Good work”, as defined below, certainly contributes directly to mental health and secure employment. From a purely mental health point of view, however, employment can include voluntary work or work on art, music, technology or research projects, for example, as long as the work is constructive, engaging and contributing something of value. It is the contribution and the recognition of it that is rewarding; the opportunity to make an impact. This can be transformative for people suffering mental/emotional fragility.
Balance
Work and mental health can be mutually reinforcing. A great many people find purpose, stimulation and fulfilment through their work, and many of us will have experienced the situation in which good work helps us to soften, keep in proportion and overcome personal disappointments or sad events. The sad events may not disappear, but our mental and emotional balance is supported by stimulating, interesting work in which we have a real opportunity to contribute and make a difference.
Here, the keyword – and indeed the key word for this article in general – is balance. Overdependence on work when we have emotional or mental issues to address can easily tip us into high levels of stress and simply obscuring the issues usually exacerbates them. Striking the right balance often depends on two things: firstly, how well we know and look after ourselves, and secondly how supportive the employer or working environment is.
Good work
“Good Work”, as the CIPD has demonstrated, can have a positive impact on mental health, just as a poor work experience can exacerbate or generate mental health problems. “Good work”, promoted in a 2018 UK Report led by Matthew Taylor, and globally recognised as “decent work” by the International Labour Organisation, means fair work with opportunities for development. It is underpinned by 5 principles: Satisfaction; Fair pay; Participation and progression: Well-being, safety and security; Voice and autonomy (freedom to work in a way that suits the individual). Based on this, the Institute for the Future of Work has developed a Good Work Charter. This has many applications, not least as an effective framework for supporting mental health at work.
Health and Wellbeing Strategy
To quote the CIPD, “employers have a fundamental duty of care for the health, safety and welfare of their workers”. Research has shown that a holistic health and wellbeing strategy, rather than lots of disconnected initiatives, is the most effective way of enacting this duty of care. A regular risk assessment on work-related stress is also advisable as part of the Health and Well-being Strategy, and the availability of a Counselling or Employee Assistance Service is a fundamental component. Financial health is generally under-valued and poorly supported; while there may not be any immediate solutions, recognition and support from the organisation is important since “…the financially stressed are more likely to suffer conditions such as fatigue and heart attacks as well as alcohol and drug abuse.”
The CIPD also advises employers to analyse causes of unhealthy trends such as “presenteeism” or “leavism”, and factors that contribute to depression and anxiety such as long hours culture, remote worker isolation, worker surveillance, unrealistic workloads, insecure contracts and senior leaders role-modelling inappropriate behaviour. Diversity, Inclusion and Equality Policies and practices have proven to be preventative in minimising alienation and the sense of vulnerability that leads to mental and emotional stress.
We need to recognise that generally people want to perform well at work, especially as this has a direct impact on their development and reward prospects, and their sense of fulfilment. Though it varies across cultures, the competitive pressure to impress and show commitment at work is substantial and can drive people towards being ever-present, being available all hours regardless of their own well-being, as well as, unfortunately, towards destructive behaviours such as striving to make others look worse in comparison. The negative effect on mental health of these behaviours is well-documented so organisations need to be vigilant in preventing them through supporting workers’ welfare and in providing constructive opportunities for productive engagement, collaboration and development.
Open culture, space for listening and understanding behavioural signals
In open and inclusive cultures, people can talk about mental health issues without fear of reprisals, judgement, or marginalisation. Unfortunately, few cultures internationally can claim to be genuinely open in this respect, and the current rapid rate of change and uncertainty, combined with misinformation and disinformation, is making such openness doubly challenging.
To counter this, a good reason for raising awareness about mental health in organisations and the workforce is that it is an indicator and a barometer of potentially severe consequences. Mental health issues, such as depression, anxiety, circumstance-induced mental illness (e.g., vulnerable minorities and disadvantaged groups) are the primary cause of self-harm and suicide.
In some cultures, such is the pressure to keep up appearances at work that colleagues may never know when someone has a serious mental health problem. There is unspoken social resistance to being open and talking about one’s feelings, especially in the professional context, and particularly if it involves admitting weaknesses or vulnerabilities. Over the last 70 years, work culture has prized efficiency, productivity and the bottom line, the organised pursuit of which leaves little space for considerations of ill health.
Indeed, in Japan, South Korea and the US, all countries where suicide rates are relatively high (between 14 and 25 per 100,000 people per year according to recent figures), cultural tendencies, societal and workplace expectations together with economic pressures often combine to dissuade people from talking about their vulnerabilities and negative feelings, so that they take action when it is too late, with fatal results. In the UK, suicide rates among men are rising (approximately 17 per 100,000 males for 2021).
But mental health problems can just as easily result in harm to others, not only harm to oneself. There are many cases in the US and elsewhere where disgruntled employees have vented their frustrations on colleagues with devasting consequences. Such cases cannot be dismissed as one-off mental health issues; rather, they reflect serious mental and emotional vulnerabilities created by more systemic problems (leaving aside the widely acknowledged issue of the availability of firearms). These include: not addressing issues of isolation, bullying or stigmatising before they get out of hand for fear of causing bad PR, social media amplification, poor employee management and inadequate line management recognition of behaviours that can signal such acts of violence.
Supportive Line Management
Good management is vital: clear objectives, good communication and regular, constructive feedback.
Sensitivity towards others is not a popular concept in the competitive corridors of many businesses, but it is an utterly essential quality for a good manager. Naturally it needs to be combined with clarity, firmness and pragmatism, but line managers must be vigilant towards nascent mental health issues before they become major problems and affect the individual’s performance, other staff and productivity; they must be willing to use flexibility when health and wellbeing issues are at stake – to combine empathy and professionalism.
In reality, according to a CIPD 2022 Health and Well-being at Work Report, “Line managers play a pivotal role but often lack the skills required”. The CIPD Survey found that “Less than two-fifths (38%) of HR respondents agree that managers are confident to have sensitive discussions and signpost people to expert sources of help when needed; even fewer (29%) believe they are confident and competent to spot the early warning signs of mental ill health. This isn’t surprising given that just over two-fifths (44%) of organisations are training managers to support staff with mental ill health.”
How Learning Can Help
The case for specific training in mental health for managers, as part of a holistic Health and Well-being Strategy, is undeniably a strong one. Apart from recognising some of the behavioural signs that warn of mental health issues, managers need to be well-informed about the symptoms, risks and support practices, both individually and at the organisational level. Such training, focussed on managers but involving staff too, would have the additional benefit of enhancing their people management knowledge and skills, honing their empathy and advancing their staff development abilities, as they would be better able to spot signs of problematic or constructive behaviours. Many organisations now recognise that managers need to be trained to provide Mental First Aid, so they provide courses in the key support and guidance accordingly.
But mental health management is not just about preventing and managing mental illness. It is also about actively supporting and developing mental well-being as a positive and productive force that enables us to actively contribute to our organisations and society, to develop resilience and achieve self-realisation.
Amid the maelstrom of change of the 21st century, a supportive culture at work (wherever work is) is a vital basis for security, stability and protection. A worker who has some stability, a sense of security and protection is then in a position to contribute constructively to the organisation, to collaborate effectively and to help solve problems and create opportunities.
Indeed “life skills”, or 21st century transversal competencies, are the foundation for a healthy, productive and rewarding experience at work. In particular, building staff resilience is an important objective for learning and development in supporting mental well-being. Resilience requires learning agility, the ability to learn from experience, and the agility to bend and not break when under pressure or amid change and uncertainty. L&D certainly has a major role to play in developing strategically supported mental well-being.
Finally, one other quality is essential at work for supporting mental health: kindness – both to oneself and to others. This does not mean indulging people (or oneself), but being sensitive, respectful and giving recognition towards others’ feelings.