Mental health issues - no longer something to hide?

Artist impression of mental health
Stopping the stigma

Employers and other stakeholders are increasingly working together to overcome stigma and tackle mental illness in the workplace. Robin Gauldie reports

A new mental health report produced by Benenden, a British non-profit group of healthcare organisations, reports that while 70 per cent employees had experienced conditions related to mental health, fewer than one in 10 would confide in their employer if they were suffering from mental health problems, and 15 per cent feared dismissal, disciplinary action or demotion if they did so.
Mental health policies are becoming more prevalent in British workplaces, but only 20 per cent of those surveyed said their employer regularly engaged with them on mental health and one in 10 said their company’s policy was not enforced. Increased workload, financial worries and workplace bullying were cited as the top three causes of mental health issues, with stress emerging as the most commonly reported condition.
The problem is not unique to the UK. According to the 2017 EU Compass for Action on Mental Health and Well-being report Mental Health in the Workplace in Europe, figures suggest almost 40 per cent of the population suffers from a mental health disorder each year. Anxiety and depression were identified as the most common and disabling conditions. The report notes that ‘no substantial country variations have been identified in the prevalence of mental disorders’. “A growing incidence of work-related mental diseases has been observed, as well as increased absence from work and early retirement due to mental illness in most European countries,” says the report. “Promoting mental health at work has become a vital response to these challenges since the workplace is both a major factor in the development of mental and physical health problems but also a platform for the introduction and development of appropriate preventive measures.”
However, the increase in reported mental illness in the workplace may in fact be an indication of more positive attitudes to the problem. The report cites EU-wide statistics from Eurobarometer, which show that in 2010, European citizens felt more negatively about the issue than they did in 2005/06. But, it says: “The increase is thought to be due to reduced social stigma and discrimination against people with mental illness, leading to greater recognition of previously hidden problems, rather than a true increase in prevalence.”

Counting the cost
Mental illness is also costly for employers, health insurers and private and public sector health care providers. In the US, depression in the workplace costs employers about $210 billion each year in direct healthcare costs, lost productivity, absenteeism, suboptimal performance and high rates of disability, according to the American Psychiatric Association, and results in 120,000 deaths and nearly $190 billion in healthcare costs.

In the US, depression in the workplace costs employers about $210 billion each year … and results in 120,000 deaths

On the other side of the Atlantic, treating work-related depression costs the healthcare systems of EU nations €60 billion a year, and employers lose €270 billion due to absenteeism and presenteeism, the EU Compass report estimates. It is unsurprising, then, that it concludes that mental health now represents a priority in the EU. In 2016 the EU introduced the Joint Action on Mental Health and Well-being, aimed at helping individual organisations to develop infrastructures to support mental health diagnosis and treatment, and the European Framework for Action on Mental Health and Wellbeing, intended to bring together key stakeholder networks across the EU.

Identifying solutions
The report also identifies examples of good practice at national level, such as Finland’s Well-being Guild of Entrepeneurs, a project which supports mental health in small and medium-sized enterprises; Germany’s PsyGA (Psychische Gesundheit in der Arbeitswelt), which targets human resources managers, company medical officers and work council managers; the Dutch SP@W (Stress Prevention at Work) programme, aimed at providing a roadmap to help companies identify and deal with workplace stress; and the UK’s Individual Placement and Support Programme, aimed at getting people with mental health problems into work through partnership between clinical teams and employment specialists. In Sweden, new provisions within the Swedish Work Environment Act came into effect in March 2016.
In the US, the American Psychiatric Association’s Center for Workplace Mental Health has collaborated with a group of employers, business groups on health and other stakeholders to develop a Working Well Toolkit of practical advice for employers on how to lead a mentally healthy workplace. The Center’s website also has turnkey programmes for employers to start the conversation about mental health in the workplace, notes Darcy Gruttadaro, Director of the centre.

Going postal
Even seemingly low-stress jobs can be taxing, and bullying and loss of esteem have been identified as major causes of workplace mental health issues. ‘Going postal’ has been common slang for cracking up, with violent results, since the 1990s. It was coined, supposedly, after a series of workplace shootings by employees of the US Postal Service, driven over the edge by the everyday pressure of work.
Around eight million Americans live with post-traumatic stress disorder (PTSD), according to the American Psychiatric Association. However, while employers can take steps to support employees with PTSD, there are limits to what they can do. US employers may not legally ask applicants whether they have PTSD or any other medical condition, notes the APA’s Centre for Workplace Mental Health: “Workplace settings are not treatment settings, and organisations should not try to replicate the role of a mental health service provider.”   
It seems possible that increased acceptance of PTSD as a genuine form of mental illness has been led by its recognition, especially in the US, as a common problem among military veterans, police officers and other professionals who are exposed to overwhelming levels of stress – for example, in combat situations – but who, until relatively recently, were expected simply to cope.    
“The prevalence of PTSD in the US military and veteran population has significantly raised the visibility of the condition,” said Darcy Gruttadaro. “The alarmingly high rates of suicide in the military and veteran population has also raised the visibility of PTSD as public officials and national leaders search for effective approaches to early identification, early intervention and linking individuals with mental health care.”

Mental health remains taboo
The Benenden Mental Health Report found that only eight per cent of British employees would confide in their employer about mental health issues. In the US, the figure is higher, but stigma continues to be a barrier to employees seeking mental health care, according to Gruttadaro. “Research shows that one in five employees experiences a mental health condition, yet about 70 per cent conceal their mental health condition from their employers. Engagement is essential and many employers in the US are looking at innovative approaches to improving engagement.”

The more we talk about mental health – in the workplace, in community settings, with family and friends – the more we normalise and open the topic

However, as in the UK, many employees experiencing mental health conditions are not coming forward to seek treatment, Gruttadaro said, for fear that coming forward may result in losing their jobs, damage relationships with co- workers and put their future employment at risk. “Employers will likely continue to focus on effective engagement to encourage employees to seek mental health care when needed because mental health conditions, like depression, are costly.”
Over-work was the biggest cause of mental health-related illnesses, according to the Benenden survey, and healthcare workers find it no easier to open up to line managers and colleagues than do employees in other sectors.
Hospitals are, of course, themselves high-pressure working environments, and doctors, surgeons and other medical staff are not immune to stress, depression and trauma. In 2013, following a survey that showed that many doctors in Australia were ‘burnt out, subject to psychological stress and suicidal thoughts, and drinking too much alcohol’, Dr Steve Hambleton, then President of the Australian Medical Association, said the medical profession needed to do more to provide supportive workplaces for doctors and medical students. He said awareness of doctors’ mental and other health issues was increasing, with changing attitudes among younger doctors and a greater focus among medical practitioners on their own health and the health of their colleagues in hospitals and in private practice.

Improvements across the profession
Five years on from Dr Hambleton’s intervention, the AMA is spearheading a drive to help doctors recognise and respond to mental illness in themselves and their colleagues. Doctors’ Health Services, formed by the AMA in 2015 to establish Australia’s first national health programme for doctors, is working to increase efforts to support colleagues with mental health issues and those exposed to ‘critical and distressing incidents’.
AMA Vice-President Dr Tony Bartone said not enough doctors engage in preventive healthcare such as healthy lifestyle, proper work-life balance, and regular check-ups. “These simple, yet vital, actions can keep stress and depression at bay,” said Dr Bartone. “The stress can build up over time and, in worst-case scenarios, can lead to self-harm and suicide.”
“Across the profession, we have to get better at seeing the signs when matters like ageing, burnout, compassion fatigue, traumatic events, bullying, and harassment are eating away at our colleagues and ourselves,” said Professor Simon Willcock, Clinical Director of Primary Care at the Macquarie University Health Sciences Centre and facilitator of the AMA forum. “These things affect our health and wellbeing and our effectiveness as doctors, and ultimately can affect the quality of care we are providing our patients.”

Let’s de-stigmatise mental illness as we did with cancer

Ending stigma, increasing recognition of mental health conditions as real illnesses, enabling people with mental illnesses to approach their employers, and above all educating stakeholders to recognise the very real costs of mental illness to business, are the keys to addressing an issue that affects businesses and workers worldwide.
“The more we talk about mental health – in the workplace, in community settings, with family and friends – the more we normalise and open the topic,” said Darcy Gruttarado. “Mental health remains a taboo topic for many. We can change that by proactively starting conversations about mental health in the workforce and beyond. Remember when cancer was the ‘C’ word? That’s no longer true, so let’s make that same change with mental health.”
And if the healthcare sector cannot itself lead the way on this issue, who can?