Mental Health in the Workplace

the Synergist

Tips for Supporting Workers’ Mental Well-being

BY LIZ HILL AND MERAIAH MARVEL

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As occupational and environmental health and safety professionals have grappled with COVID-19, another crisis is affecting workers around the world. Increased stress and isolation related to the pandemic have highlighted mental health as an important workplace safety and health concern, and many people have made public the struggles they previously managed in private.

Supporting mental health in the workplace has become a critical issue for both workers and employers. The American Psychological Association’s February 2021 “Stress in America” survey found that Americans’ high levels of stress—reported by respondents to be directly linked to the pandemic—is seriously affecting their mental and physical health, including through unwanted changes in weight, sleep, and alcohol use.

In 2019, prior to the pandemic, a survey across workforces found that while almost 60 percent of workers had experienced symptoms of a mental health condition in the preceding year, about the same percentage did not talk about their condition at work. Some mental health disorders are underreported due to recall error. Many studies have also noted that people experiencing mental illness are stigmatized, which could impact willingness to report mental illness or seek treatment. It is common for mental health disorders to go untreated: a 2007 study that examined mental health care across 17 countries found that in every country studied, at least two thirds of people who are mentally ill received no treatment.

These often-untreated mental health conditions are not separate from individuals’ work lives but influence it and are influenced by work in turn. About 63 percent of respondents to a Mental Health America survey conducted between 2015 and 2017 reported that workplace stress significantly affected their mental and behavioral health. This survey also found that 33 percent of respondents reported missing work due to workplace stress. Additional research conducted in 2010, using 2001–2002 National Comorbidity Survey-Replication data, shows that worker depression across the entire U.S. workforce cost nearly $2 billion annually due to lost productivity—roughly $2.5 billion in 2021 currency. Mental health also affects businesses throughout the rest of the world: the World Health Organization states that depression and anxiety cost the global economy $1 trillion per year in lost productivity. Accordingly, more employers are recognizing that supporting mental health leads to better occupational safety and health outcomes, and OEHS and public health professionals are identifying the many workplace factors that affect mental health. OEHS PROFESSIONALS’ ROLE IN MENTAL HEALTH “As advocates for behavioral change and safety culture,” said Bernard Fontaine, CIH, CSP, FAIHA, “industrial hygienists must identify stressors that affect both mental health and psychosocial disorders in the workplace and collaborate with business partners and stakeholders to help make change.” Fontaine was calling for IHs and OEHS professionals to expand the range of exposures they consider to include psychological stressors. Fontaine’s suggested approach demonstrates growing awareness in the OEHS field of issues related to mental health in the workplace. This approach expands the focus of traditional OEHS practice and is consistent with NIOSH’s Total Worker Health (TWH) framework. TWH accounts for multiple factors that influence worker health and well-being, going beyond exposures to chemical, physical, or biological agents. These factors include changing demographic profiles, increasing rates of chronic diseases and mental health conditions, varying employment arrangements, increasing work demands, increasing psychosocial hazards, and changing work environments. The OEHS profession should not be considered wholly responsible for addressing these factors; however, the profession does occupy a unique and influential space. Mental health is more than just an absence of mental illness; there are individual, social, work, and nonwork factors to consider such as genetics, chronic conditions, and substance use. While the relationship between mental health and occupational health may be ambiguous, several organizations have attempted to clarify matters. The recently published standard ISO 45003, Occupational Health and Safety Management—Psychological Health and Safety at Work: Guidelines for Managing Psychosocial Risks, defines well-being at work as fulfillment of the workers’ physical, mental, and cognitive needs and expectations related to their work. In addition, the standard notes that well-being at work relates to all aspects of working life, including work organization, social factors at work, work environment, equipment, and hazardous tasks. It can also contribute to quality of life outside of work. In the paper “Expanding the Paradigm of Occupational Safety and Health: A New Framework for Worker Well-Being,” a joint team from NIOSH and the RAND Corporation defines worker well-being as “an integrative concept that characterizes quality of life with respect to an individual’s health and work-related environmental, organizational, and psychosocial factors.” The authors elaborate that well-being combines positive perceptions with the presence of constructive conditions in and outside of the workplace that support workers to achieve their full potential. In both definitions, there is plenty of space for OEHS professionals to support mental well-being by examining work conditions, equipment, hazards, and controls. OEHS professionals should consider mental health implications as they relate to environmental, biological, and psychological stressors. For example, each of the following scenarios may contribute to an individual worker’s stress, anxiety, and mental well-being: returning to a construction work site during or after the COVID-19 pandemic, drinking water from repaired pipes that were formerly contaminated with lead, and returning to work while caring for high-risk family members. COVID-19 is not the only cause of U.S. workers’ poor mental well-being. Employees also frequently have concerns related to water quality, air quality, and personal safety. OEHS professionals need to account for these concerns in risk planning and mitigation.

Ergonomic hazards, noisy environments, air pollution, lighting, temperature extremes, and crowding all merit attention as causes of stress.

ENVIRONMENTAL IMPACTS ON MENTAL HEALTH Environmental factors, including infectious agents, air, water, soil, synthetic materials, prescription drugs, food, lifestyle, stress, chemicals in electronics, and cosmetics, affect people’s abilities to lead healthier lives. People are exposed to environmental agents in the workplace, at home, and in other settings.

In February 2021, the National Academies of Sciences, Engineering, and Medicine (NAS) hosted an online workshop that presented evidence linking environmental exposures to lead and other metals, pesticides, and air pollutants—especially particulate matter and nitrogen oxides—to adverse mental health outcomes. Studies discussed during the workshop show correlation between childhood blood lead levels with psychopathology in adults. Other studies—referred to and cited in the workshop—have found mental health issues to be associated with daily exposure to air pollutants and links between suicide and exposure to specific pesticides.

Environmental exposures do not occur in isolation, but rather in conjunction with other exposures that make up an individual’s exposome. The exposome can be understood as the measure of all the exposures an individual experiences in a lifetime and how they relate to his or her health. An individual’s exposome begins even before birth. To support workers’ mental well-being, it is practical for OEHS professionals to consider the totality of workers’ exposures and the possibility of interactions between occupational exposures, environmental exposures occurring outside of work, and other individual susceptibilities.

Understanding the effects of environmental exposures on mental health may also improve the treatment of mental illness by reducing stigma. While presenting at the NAS workshop, Erika Manczak, an assistant professor in the University of Denver’s Department of Psychology, said, “By highlighting the ways in which external forces can act on mental health, I believe we have the opportunity to change these problematic narratives in ways that can reduce shame and burden.”

MANAGING STRESS AND PSYCHOSOCIAL HAZARDS Workplace stressors—that is, stimuli or conditions that cause stress—contribute to mental and physical stress responses. Workplace stressors negatively affect health when environmental demands exceed an individual’s ability to cope, thus increasing the likelihood of disease. Ergonomic hazards, noisy environments, air pollution, lighting, temperature extremes, and crowding all merit attention as causes of stress. Controlling stressors will not only lessen adverse mental health impacts but could also be protective.

OEHS professionals should also consider psychosocial hazards or risks. ISO 45003 provides details on how psychosocial hazards relate to work organization, social factors at work, aspects of the work environment, equipment, and hazardous tasks. Examples of psychosocial hazards include workplace exposures that are inadequately controlled, lack of worker control over job makeup and schedule, unsatisfactory relationships between coworkers and supervisors, interpersonal conflicts, job insecurity, lack of autonomy, and work-life imbalance. Psychosocial hazards can be challenging to identify because they are based on individuals’ appraisals of the hazard, which evolve over time and can be affected by additional stressors and environmental factors. An event that warranted no response previously may generate a response later due to additional stressors and workers’ coping mechanisms.

Psychosocial risks affect health, safety, and well-being at work more broadly. Some studies discuss the intimate connection between the mind and body and demonstrate how mental health is inseparable from physical health. Addressing mental health can lead to positive physical health conditions, while leaving mental illnesses untreated can have negative consequences for physical health.

Negative physical health outcomes for workers exposed to psychosocial hazards can include conditions such as cardiovascular disease, musculoskeletal disorders, diabetes, anxiety, depression, and sleep disorders. Behaviors associated with psychosocial hazard exposures include substance misuse, unhealthy eating, reduced job satisfaction, lack of commitment, and lessened productivity.

Effective management of psychosocial risk can lead to improved worker engagement, enhanced productivity, increased innovation, organizational sustainability, improved stress levels, better emotional well-being, and other benefits. To effectively manage psychosocial risks, organizations must understand the work environment, possible exposures, and current mental states of their employees.

ADDRESSING MENTAL HEALTH IN THE WORKPLACE There will not be a “one-size-fits-all” approach to controlling psychosocial risks at work: organizations in different industries and disciplines will need to modify their approaches to best support their employees. In general, however, some of the most effective tools for stress assessment are adjective checklists, questionnaires, and personal interviews. Life event inventories or checklists can establish a mental health baseline, compile information on focus areas within the organization, and help identify acute and chronic stressors and coping capacities. Evaluation tools, such as wearables that gauge heart and respiration rates, can indicate real-time stress and may be valuable for certain workplaces.

An organization’s most valuable resources are the people it employs, and building a framework to effectively support mental health provides exceptional value on investment. A 2018 article in Harvard Business Review argues that “feeling authentic and open at work leads to better performance, engagement, employee retention, and overall wellbeing.” WHO states that workplaces that support mental health and people with mental disorders are likely to be more productive and experience less absenteeism.

OEHS professionals can serve as powerful advocates for an organizational culture that embraces psychological safety. Such efforts use the profession’s time-honored toolkit—consisting of anticipation, recognition, evaluation, control, and confirmation—to protect workers from exposures that affect mental health.

One effective OEHS practice for improving mental health in the workplace is to destigmatize mental health issues and communicate to employees about intervention or assistance programs. An individual’s perception of mental health and the stigmas associated with mental illness may interfere with his or her decision whether to seek care. Recognizing workers’ mental health struggles and offering resources to those seeking assistance can help employees navigate mental health. Simple ways to start destigmatizing matters associated with mental health include matter-of-fact discussions in familiar settings such as team and toolbox meetings, organizational communication, small-group conversations about individuals’ experiences, using employee assistance programs (EAPs), or sharing strategies to support mental well-being.

OEHS professionals can also support mental health by recruiting organizational leadership. It may be effective to educate managers, supervisors, and workers on recognizing the signs of mental illness and connecting with employee benefits, other resources, and treatment providers. Courses such as Mental Health First Aid, Mental Health Awareness Training, and Question, Persuade, Refer help participants build skills in listening and talking to struggling employees and connecting to effective help.

Education and practice in supportive supervision, such as the Safety and Health Improvement Program (SHIP) developed by Leslie Hammer of the Oregon Institute of Occupational Health Sciences, have been shown to help reduce stress due to competing work and personal demands, lower individuals’ blood pressure, and improve team effectiveness.

Organizations can consider creating cross-functional teams and task forces, consisting of human resources, occupational health, and OEHS professionals and other participants, to engage workers in finding solutions to exposures that affect mental well-being. The Healthy Workplace Participatory Program from the Center for the Promotion of Health in the New England Workplace, a TWH Center of Excellence, is designed to foster employee engagement. To support employees’ mental well-being and allow them to seek additional care and improve their coping skills, organizations can also provide mental health benefits on parity with physical health benefits, paid sick leave, vacation time, and EAPs.

MENTAL HEALTH DURING AND AFTER THE PANDEMIC The SARS-CoV-2 vaccine rollout has somewhat improved workplace safety during the pandemic; however, it has not addressed all concerns related to staying illness free in the work environment, and concerns about mental health in the workplace predate COVID-19. The prevalence of mental health issues over time and around the globe means that mental health will continue to be an important workplace issue even after the pandemic.

LIZ HILL, MPH, CIH, CSP, is a Total Worker Health adviser at SAIF Corporation, the past chair of AIHA’s Safety Committee, and a member of the AIHA Total Exposure Health/Total Worker Health Advisory Group.

MERAIAH MARVEL, CSP, is a safety, health, and environment director at Parsons Corporation and a member of the AIHA Safety Committee.

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RESOURCES

Administration and Policy in Mental Health and Mental Health Services Research: “Public Stigma of Mental Illness in the United States: A Systematic Literature Review” (2013).

American Heart Association: “Mental Health is Important to Overall Health, and Heart Disease Prevention and Treatment” (January 2021).

American Psychological Association: “One Year Later, A New Wave of Pandemic Health Concerns” (March 2021).

BJPsych Bulletin: “Perceptions of Work Stress Causes and Effective Interventions in Employees Working in Public, Private, and Non-Governmental Organizations: A Qualitative Study” (December 2016).

Depression & Anxiety: “Employer Burden of Mild, Moderate, and Sever Major Depressive Disorder: Mental Health Services Utilization and Costs, and Work Performance” (June 2009).

Harvard Business Review: “We Need to Talk More About Mental Health at Work” (November 2018).

Journal of Occupational and Environmental Medicine: “Expanding the Paradigm of Occupational Safety and Health: A New Framework for Worker Well-Being” (July 2018).

The Lancet: “Most People with Mental Illness Are Not Treated” (September 2007).

Mental Health America: “Mind in the Workplace – MHA Workplace Health Survey 2017” (PDF, 2017).

Mental Health First Aid.

The National Academies of Sciences, Engineering, and Medicine: “The Interplay Between Environmental Exposures and Mental Health Outcomes – A Workshop” (February 2021).

Oregon Health and Science University: “Safety and Health Improvement Program.”

QPR Institute: “Question, Persuade, Refer.”

University of Massachusetts Lowell: “Healthy Workplace Participatory Program.”

World Health Organization: “Mental Health and Substance Use – Mental Health in the Workplace.”

Yale Scientific: “Major Depressive Disorders Are Underreported and Prone to Recall Error, New Study by the Yale School of Public Health Finds” (November 2020).