Mental illnesses, and in particular Common Mental Disorders (CMDs) such as depression and anxiety, are among the most frequent causes of occupational disability. The burden of CMDs is under-recognised in developing countries, despite strong evidence regarding its social impact.
Depression is expected to be the second most common disorder across the world behind ischaemic heart disease by 2020 and is expected to account for 15% of the total disease burden. Despite this, several population-based studies in developed countries have demonstrated that CMDs are under-recognised and under-treated.
Globalisation and workplace mental health
As a result of the liberalisation of trade and the exchange of goods and services between countries, globalisation has had a significant impact on social equity. Globalisation has led to a widening gap between the rich and the poor, and workers in developing countries in particular have been marginalised. Furthermore, changes in the nature of work as a result of globalisation have resulted in additional demands on individuals with regards to skills and training, creating additional barriers to employment for those vulnerable to CMDs.
Globalisation has created an enormous drive to keep labour costs low . This has led to the exploitation of employees who are not rewarded financially and are often victims of cost-cutting by their employers, leading to them working in hazardous conditions. In many developing countries, occupational health is not a significant government priority and hence the beneficiaries of globalisation are able to continue to exploit these vulnerable workers.
The processes of modernisation and industrialisation that has accompanied globalisation have led to a maldistribution of poverty and income levels . In particular, 89% of workers in sub-Saharan Africa and South Asia earn less than US$2 per day. There is a higher representation of workers in the informal economy in developing countries, which comprises 47% of the workforce, compared with only 15% in developing counties.
Workplace factors may precipitate illness as well as perpetuate disability associated with mental illness. There is good evidence that certain kinds of workplace stress are associated with a higher risk of psychiatric morbidity.
It could be expected that the incidence of such workplace stress is higher in developing countries. Thus far, social attention has focused primarily on the impact of harsh working environments on people’s human rights, rather than their emotional wellbeing specifically. It is increasingly being recognized that the mental health of employees is a crucial determinant in their overall health and that poor mental health and stressors at the workplace can be a contributory factor to a range of physical illnesses like hypertension, diabetes and cardiovascular conditions, amongst others. In addition, poor mental health can also lead to burn-out amongst employees, seriously affecting their ability to contribute meaningfully in both their personal and professional lives.
Data from different countries around the world indicate that mental health problems are a cause of a number of employees dropping out of work. In the Netherlands, around 58% of the work-related disabilities are related to mental health. In the UK, it is estimated that around 30–40% of the sickness absence is attributable to some form of mental illness.
Mental health problems have an impact on employers and businesses directly through increased absenteeism, negative impact on productivity and profits, as well as an increase in costs to deal with the issue.
In addition, they impact employee morale adversely.
Work-related stress is a major cause of occupational ill health, poor productivity and human error. This means increased sickness absence, high staff turnover and poor performance in the organization and a possible increase in accidents due to human error. Work-related stress could also manifest as heart disease, back pain, headaches, gastrointestinal disturbances or various minor illnesses; as well as psychological effects such as anxiety and depression, loss of concentration and poor decision making.
Stress is the adverse reaction people have to excessive pressures or other types of demands placed upon them. There is a clear distinction between pressure, which can be a motivating factor, and stress, which can occur when this pressure becomes excessive.
Some occupations are at more risk of mental health problems than others. A study in the Netherlands mapped skill levels against the pace of work to have an idea about the risk for stress levels and mental ill health for different occupations. Higher stress levels correlated with a higher risk for mental ill health.
Figure 1 maps the risks for stress and mental ill health for a range of occupations, based on work pace and skills.
Risk for stress and mental ill health for different occupational groups, as determined by the combined effects of work pace and skill discretion (Source: ILO Encyclopaedia of Occupational Health and Safety 4 Edition, Edited by Jeanne Mager Stellman, ILO Geneva, 1998)
MEASURING AND CONTROLLING WORK – RELATED STRESS AND IMPROVING MENTAL WELL-BEING AT THE WORKPLACE
A tool to evaluate the level of work-related stress and the measures to be taken thereof to control the same have been extensively used. This tool which is known as the Work Stress Scale (WSS) allows individuals to assess for themselves the degree of stress faced in the following broad domains:
Relationship problems with superiors
work family conflict;
relationship problems with colleagues;
performance pressure and
poor job prospects.
Relationship problems with superiors
The most common reason for office stress is dealing with difficult boss. But this may be far easier to solve by improving communication skills. Having a sincere conversation may make a difference. Sometimes, the boss may set unreal targets, where an honest discussion can bring out what deadlines can be met.
Tasks that are not part of an employee role or skill set can also cause stress. Companies often make employees multitask but this could potentially affect their ability to deliver. Communicating with superiors about this matter at the earliest is the best way to resolve this. One area that presents an opportunity for conflict for the personality-disordered individual concerns the hierarchical nature of organizations.
Relationship problems with colleagues
Another reason could be difficult colleagues or co-workers. Dealing with a difficult co-worker can be a bit more difficult as their performance is often pitted against oneself. This again has to be resolved by an amicable discussion, concluded by a mutual agreement. One can explain to the colleague as how a team can have far more benefits than indulging in rivalry. But if things are getting out of hand, it should be brought to the notice of the superior concerned.
Work family conflict
Families are struggling to cope with an increasingly complex world. Individuals are struggling to find the right balance between work and family responsibility. Domestic issues can affect work where balancing work and home by allotting adequate time for both can help reduce stress.
High demand for performance
Unrealistic expectations, especially in the time of corporate reorganizations, which, sometimes, puts unhealthy and unreasonable pressures on the employee, can be a tremendous source of stress and suffering. Increased workload, extremely long work hours and intense pressure to perform at peak levels all the time for the same pay, can actually leave an employee physically and emotionally drained. Excessive travel and too much time away from family also contribute to an employee’s stressors.
Organized workplaces are going through metamorphic changes under intense economic transformations and consequent pressures. Reorganizations, takeovers, mergers, rightsizing and other changes have become major stressors for employees, as companies try to live up to the competition to survive. These reformations have put demand on everyone, from a CEO to a line manager.
However, they are likely to serve as constraints and stress for managers. Other job stressors include uncomfortable working conditions, job overload, lack of control over the work process and sheer monotony. Decreasing work role ambiguity would reduce job strain and work-related psychological disorders including anxiety disorders.
Companies would do well to address mental wellness at the workplace through a clearly articulated workplace policy on mental health. A prototype of such a policy encompassing the vision, the values and principles and the objectives is appended.
Employees are our most valuable asset. We will provide adequate support services to employees to benefit from counseling and other interventions to ensure positive mental health.
We will ensure that employees have access to treatment for mental health problems where needed.
We will periodically assess workplace stress through appropriate surveys conducted ethically.
Based on our internal workplace stress surveys, we will initiate programs to cover the following:
♦ information and awareness campaigns;
♦ employee and manager training;
♦ promoting mental health through our “agile working” initiative;
♦ addressing harassment at the workplace;
♦ specific interventions for identified stressors at the workplace;
♦ training in resilience techniques and coping strategies;
♦ specifically address the prevention, identification and management of depression and anxiety at the workplace;
♦ supporting individuals with mental health problems; and
recruitment and retention practices which do not discriminate against people with mental health problems.
Objectives of the policy
We will evaluate and control organizational factors that could potentially contribute to work-related stress.
We will implement stress and burn-out prevention and management programs for employees at risk as well as early detection and support programs to deal with alcohol or mental health problems once they have occurred to ensure that an employee can contribute meaningfully to himself, his family and at the workplace.
We seek to enhance the productivity of the business by providing adequate support to employees following any mental health deviations.
We will minimize disability amongst employees by providing specific interventions against conditions like depression and anxiety.
The development and implementation of a workplace mental health policy and program will benefit the health of employees, increase the productivity of the company and will contribute to the well-being of the community at large. It has been found that psychosocial intervention courses along with stress management training and health promotion interventions have a positive impact on mental well-being.
A healthy population is an economically productive population and it is in the benefit of companies to safeguard public health. Given the heavy contributions of the private sector to the economy, employee wellness programs are not only a strategic priority for India but also an economic imperative for corporations.
Steps Towards Maximum Productivity, Across Your Life
People can’t do two things at once. Productivity coach Nicole Bandes encourages what she calls “multipurposing” accomplishing one focused task and one routine task at the same time.
Listen to that skills-building podcast while you’re shopping for groceries.
Instead of eating lunch alone, grab a bite with a colleague and have a work meeting.
Schedule a conference call as you’re commuting (but not driving!) in the morning.
“It’s about getting multiple benefits out of one task,” she says. “You can complete two things if it doesn’t require having you to focus in two different directions.”
For years, Kaitlin Bitting aimed to schedule a workout into her day, but the Philadelphia public relations professional could never find the time. Finally, about a year ago, the natural night owl started setting her alarm for 6 a.m. to get to the gym first thing.
“I can sleep with the best of them,” she said. “But I needed to find uninterrupted time to exercise.”
While she started the workouts to improve her health, Bitting quickly noticed another payoff: She was far more productive at work.
Work out in the morning or at lunch, when you still have work left to do it can help you do more during the day.
Get a standing desk. “Sitting is the new smoking,” says Dr. Stephanie Faubion, director of executive and international medicine at the Mayo Clinic. “So even getting a workstation where you can stand up can help.”
Take the stairs as much as you can, and get up and go for a walk during a work break.
Bitting became so productive, she found time to start moonlighting as a health and wellness coach.
“I feel best when I’m motivated and energized to do what I need to do during the day,” says Bitting. “It’s taken time, but I now know my body and how to increase my productivity.”
Go to Sleep
Working sleep-deprived can be akin to working drunk.
“People have failed sobriety tests when they don’t get enough sleep,” Faubion says. “Our brains don’t work well when we’re tired.”
Getting seven to eight hours is a must, she says. Easier said than done, right?
Go to bed and get up the same time every day. Studies have shown this reinforces your circadian rhythm and helps keep sleep quality consistent.
Get a real alarm clock, and leave the phone in the other room. “If you wake up in the middle of the night and start looking at email, you’ll train yourself to get up at night,” Faubion says. And don’t look at the phone at least an hour before it’s time to go to sleep. The light from your phone can delay your body’s release of melatonin, which helps invite your body to sleep, according to the National Sleep Foundation.
Don’t drink anything two hours before bedtime so your body won’t want to get up and go to the bathroom in the middle of the night and keep you up afterward, Faubion says.
Try a sleep mask and a white noise machine to combat noise and light distractions.
Treat Food as Fue.
Healthier eating habits can give us more energy during the day, which in turn, makes us more productive.
While some of these programs take time to learn and set up, they can ultimately help make your work more efficient and “free up time to do the things that help you meet your goals and move you in the direction you want to go,” Bandes says.
And for the moments when you feel like you’re running on empty, there are meditation apps like Headspace and Calm, that can help restore the mind and bring back focus.
Workplace mental health interventions in the developing world
Whilst health promotion in workplace settings has received attention in the developed world, the focus on mental health promotion has been on stress in general and the identification and treatment of individuals with CMDs has not been a specific focus. Employers in developing countries may be more likely to enforce attendance of employees when unwell; hence it could be expected that higher rates of mental illness and a greater level of presenteeism may contribute to even lower productivity.
In developed countries, the welfare system provides a public “safety net”, as a result of which the burden of unemployment is shared by the government. In the absence of a welfare system that may protect individuals who are unable to work as a result of their mental illness, workers in developing countries are likely to continue to work despite their disability.
The impact on workplace productivity in developing countries is hence magnified, and goes beyond the direct costs as a result of impairment in the workplace. Given the evidence for the effectiveness of workplace interventions, workplace interventions in developing countries ought to be seen as an investment in social capital. It could hence be argued that the workplace provides a critical setting for health promotion, screening of individuals with CMDs as well as a focal point for the provision of interventions and identifying individuals who would benefit from referral to mental health professionals for further management.
However advocacy is critical to improve working conditions in impoverished settings in order to prevent psychiatric morbidity and to improve the quality of life of workers.
The economic benefits that may arise from improving workplace conditions and reducing the burden of mental illness in the workplace are substantial, and it is highly likely that demonstration of the cost effectiveness of such programs to employers in developing countries would improve their uptake.
It is interesting to note that the focus of employers in developed countries has been on the retention of the ageing workforce, and creating incentives for individuals to remain in employment, rather than alternatives such as taking early retirement. In the absence of adequate welfare systems and the lack of opportunities for life beyond retirement age, the focus of employers in developing countries is clearly a different matter. Advocacy for improving workplace mental health must focus on fundamental changes in labour market reform and further control over informal working conditions that are so prevalent in developing countries . Such reform may in turn lead to a happier and more productive workforce.
Workplace reform interventions must be empowering and involve multidisciplinary and multi sectoral cooperation. There is a need for collaboration between the primary health care sector and employers in particular. Incentive systems provided by governments to employers to improve the effort-reward imbalance may reduce the psychological stress experienced by employees. In addition, collaboration between government departments and other stakeholders responsible for health, welfare and the labour workforce is necessary to reduce inefficiencies by pooling resources to coordinate mental health promotion activities in the workforce and the promotion of work-life balance.
The interaction between mental illness and workplace environment is complex and multifaceted. CMDs have a negative impact on workplace productivity and adverse workplace environments are associated with a higher prevalence of CMDs. Studies thus far have focused on mental health promotion and interventions to treat CMDs in the workplace, primarily in developed countries. However by contrast there are stark differences in workplace environment and standards in the developing world. In the current era of globalisation, greater attention is required to address the imbalance between workplace standards in the developed and developing worlds. Advocacy and research in mental health promotion and interventions to address CMDs in the workplace setting in developing countries is an urgent priority.