Department of Health (1995) ABC of Health Promotion in the Workplace. Health Information Service. London: Department of Health.
Kogan, H. (ed.) (1997) The Corporate Healthcare Handbook. London: Kogan Page.
Developing a mental health policy:
an outline
Ann Fingret
CHAPTER 5
Introduction
This chapter, written from the perspective of an occupational health practitioner, presents an outline of where we are in relation to mental health in the workplace and a strategy for maintaining a healthy workforce. It is important to develop a structured approach to mental health in the workplace, not least because occupational health prac-titioners have frequently been guilty of interventions that may have been poorly researched and inappropriate. We have often been willing participants in unscientific approaches to resolving workplace problems.
As occupational health professionals, the research data that we have available is at odds with our personal experience in the workplace. This may be due to a lack of objectivity on our part or to fundamental flaws in the models applied. What is clear is that workplace stress is an increasing problem which produces many personal tragedies.
Prevailing cultures and management theories rely heavily on the commitment of the individual. One might think, therefore, that it is good business to nourish and preserve the individual employee. I have no doubt that if organisations are to survive and prosper they need to accept that paying attention to the psychological environment is essential. Occupational health practitioners have a part to play in ensuring that individual organisational environments are properly assessed and that appropriate interventions are prescribed and audited.
Incidence of work-related stress
In the 1990 Labour Force Survey in England and Wales (Office of Population Censuses and Surveys, 1992), 182 700 cases of stress related to work were reported. In the 1995 Survey of Self-Reported Work-Related Ill Health (Jones et al, 1998), 500 000 people in Great Britain reported that they were suffering from work-related stress, anxiety or
depression, these causes collectively being second only to musculo-skeletal disorders. This suggests a 200% increase between 1990 and 1995, although this apparent increase may be due to better recognition or greater currency (Smith, 2000).
A survey of 500 members of the Institute of Directors in 1998 showed that 40% considered stress to be a big problem in their organisation (Smith, 2000).
The Bristol Stress and Health at Work Study used a random community sample to estimate the scale of occupational stress. Of the respondents, 10% reported that they were not stressed at all; 25–30%
were mildly stressed; 40–45% reported moderate stress; and 15–20%
described themselves as very stressed (Smith, 2000).
Absence for mental ill health and associated illness is estimated as 80 million working days (15% and 26% of all absence for men and women, respectively), at an estimated cost of £5.3 billion per year.
However, the true cost of mental health problems to an organisation goes far beyond that of sickness absence and includes the impact of stress-related performance problems in those who are not off sick.
Occupational medicine practitioners have only slowly begun to address mental health problems in the workplace. A few landmarks of the developing interest are listed in Table 5.1. Although the list is undoubtedly idiosyncratic, it does follow the parallel development of management and occupational health responses to mental health problems.
The practice of occupational medicine has changed in response to these workplace transformations. This is borne out by a 1997 Faculty of Occupational Medicine survey which confirmed that psychological issues now take up a major part of the occupational physician’s time
Table 5.1 Landmarks of the developing interest in occupational mental health
Year Landmark
1914–18 Observations of health and performance in munitions workers 1939–45 The psychological assessment of mentally ill servicemen 1966 Formation of the Occupational Mental Health Discussion Group 1970 to date The work of Cary Cooper at UMIST
1974 Health and Safety at Work Act
1990 The Health and Safety Executive publishes Mental Health at Work 1992 Management of Health and Safety at Work etc. Act
1994 The Health of the Nation
1994 Walker v. Northumbria County Council
1995 The Health and Safety Executive publishes Stress at Work Guidelines 1997 Disability Discrimination Act
1997 Faculty of Occupational Medicine’s survey of members’ occupational mental health experience and needs
FINGRET
(Miller, 1998). In many organisations it is occupational health departments which are leading the response to the psychological challenges of the workplace.
Statutory requirements and legal precedents have strengthened the case for intervention. The 1974 Health and Safety at Work Act established employers’ responsibility for the health and safety of their employees. In 1992 the Management of Health and Safety at Work Regulations outlined more detailed responsibilities for employee health.
However, organisations have been slow to develop consistent policies to protect the mental health of their staff.
The landmark case of Walker v. Northumbria County Council (see Chapter 4, Box 4.2, p. 30) proved to be a watershed in terms of employers’ responses to the problems of stress at work. Walker, a senior social worker, obtained a judgement against his employers for breach of duty of care in failing to take reasonable steps to avoid exposing him to a health-endangering workload. The judgement emphasised that there was no reason why risk of psychiatric damage should be excluded from the scope of an employer’s duty of care. Subsequent similar cases have resulted in substantial financial penalties.
The Disability Discrimination Act 1995 has provided a further stimulus to employers in this respect, as employees with a psychiatric condition recognised by a psychiatrist, or those who have a history of such a condition, are covered by it. The Act requires employers to consider the nature of the job in relation to the individual’s ability and, where reasonably practicable, to modify the job requirements to enable an employee with a disability to work.
In addition to statutory requirements and legal precedents, the government has reaffirmed the need to address mental well-being in the workplace. One of the targets outlined in Saving Lives: Our Healthier Nation (Department of Health, 1999) was to ‘Encourage employers to address stress at work’.