By Melissa Mariano, BA, OMS-III; University of New England College of Osteopathic Medicine and Kenji Saito MD, JD, FACOEM; Chair, Specialty Medicine, Regulatory Liaison & Medical Director, Workplace Health, Wellness, Teaching Kitchen and EAP, Regulatory Liaison; MaineGeneral Health
Mental wellness can profoundly impact an individual’s participation, safety, and productivity in the workplace. According to the World Health Organization’s (WHO) Mental Health Action Plan 2013-2020, mental health is defined as “…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”.
While employment can be good for mental health, a negative working environment can lead to physical and mental health problems. Work factors that adversely affect mental health include mental disorders (depression, anxiety), harassment or bullying, and burnout.
The Job Accommodation Network (JAN) reports approximately one in four adults experience a mental health impairment (MHI). That means 25% of people have difficulty coping with the demands of ordinary life, specifically with regards to regulating emotion, cognition, and behavior.
Employees who suffer from MHI are less likely to participate in the workforce and more likely to require assistance recovering from setbacks such as injury or illness. Additionally, safety-sensitive occupations such as commercial motor vehicle drivers, pilots, healthcare workers, etc. could cause serious harm to others if they are not healthy enough to perform their duties safely.
Furthermore, MHIs can result in significant costs to the individual and employer. Depression and anxiety are estimated to cost the global economy one trillion USD per year in lost productivity.
Mental health is an important indicator of health status and can impact one’s ability to safely and fruitfully contribute to work and communities.
What Is Our Role and How Do We Identify an Individual’s Needs? It can be challenging to identify which employees require assistance with MHI, especially in the context of a workplace injury. Each person has different abilities to cope with barriers in their work environment. Some people actively mask their symptoms to avoid negative repercussions. Recent studies have suggested useful instruments for identifying psychosocial risk factors and potential needs for intervention in the workplace setting.
These studies explored how clinical clues, also known as “flags,” can help clinicians investigate which factors may limit an employee’s ability to return to work after a musculoskeletal injury:
- Red flags: Biomedical factors such as serious pathology (fracture, tumor, laceration)
- Orange flags: Psychiatric symptoms such as clinical depression or personality disorder
- Yellow flags: Psychosocial/behavioral factors such as fear, beliefs in the severity of health conditions, catastrophizing, or poor problem-solving
- Blue flags: Interpretation of the relationship between work and health such as low return-to-work expectancies and lack of confidence in performing work-related activities
- Black flags: System/context (occupational, socioeconomic) such as conflict with insurance staff over injury claim, little opportunity for modified duty
Supervisors and co-workers can play an essential role in identifying these flags and referring cases from the community to specialists for further assessment. Some of the tools used in these studies include two short questionnaires called the Örebro Musculoskeletal Pain Screening Questionnaire and the STarT Back Screening Tool. Once these flags have been identified and employees are referred to medical examiners, the employee can be assessed for potential impairment or incapacitation in the near or distant future. Examiners must use their medical knowledge and current clinical best practice guidelines to determine whether an employee is fit for duty or what kind of work modifications may be required. These screening forms could allow for faster intervention and better outcomes in workplace injuries, namely improved ability to cope with the incident as evidenced by decreased absenteeism, increased engagement with a provider, and better perceived health status.
What Can We Do to Improve Mental Health in the Workplace?
The WHO calls for a community-based delivery of mental health services that emphasizes support of individuals to achieve their aspirations and goals. On an individual level, employees may be able to regain control of their lives through the use of internal motivation and external support. Employers should be involved in the rehabilitation process, and rehabilitation professionals should seek to strengthen the employee’s ability to manage work-related stress. Rehabilitation professionals, such as medical and mental health providers, should actively support employees to ensure meaningful cooperation across the multidisciplinary disciplines involved in the rehabilitation process. Some of these actions include:
- Listening and responding to an individual’s understanding of their condition and what helps them to recover
- Working with people as equal partners in their care
- Offering choice of treatment and therapies in terms of who provides care
- Using peer workers and supports who provide each other with encouragement, a sense of belonging, and expertise
JD, FACOEM
Broader techniques for improving mental health in the workplace include education and de-stigmatization training. Mental health first aid training blends live and online learning to help persons developing a mental health problem, experiencing a worsening of a mental health problem, or a mental health crisis (e.g. at immediate risk of suicide) until appropriate professional treatment is received or until the crisis resolves. Workplace training can also help with attitudes and behavioral intentions surrounding mental health impairment.
In conclusion, mental health can influence the wellbeing and function of individuals at work. For every $1 USD put into scaled-up treatment for common mental disorders, there is a return of $4 USD in improved health and productivity. Making the effort to improve mental health in the workplace could result in increased participation, improved safety for workers and others, and better productivity at work.
