Protecting, promoting and supporting mental health at work

Launched today, the World Health Organization’s Guidelines on Mental Health at Work provide a fresh and comprehensive review of the available evidence for specific intervention strategies to protect and promote mental health at work. The WHO follows a published process for guideline development, involving leading international experts from the field and stakeholder consultation, and featuring systematic review evidence. In the WHO’s words: “Recommendations are based on a systematic and comprehensive assessment of the balance of a policy’s or intervention’s potential benefits and harms and explicit consideration of other relevant factors.”  The groundwork for the guideline published today began in 2019 and the project was formally launched in 2020.

The guidelines present a series of evidence reviews grouped into the following six intervention areas: 1) organisational, 2) manger and worker training, 3) individual interventions, 4) return to work programs, 5) vocational support programs, and 6) screening programs.

The Guideline Development Group (GDG) made twelve recommendations across these six areas. Each recommendation was qualified by a statement on the strength of the recommendation and the certainty of the evidence on which it was based. Most recommendations were “Conditional” due to low certainty of the available evidence. The exceptions were “Strong” recommendations in favour of a) implementing reasonable accommodations for workers with mental health conditions and b) training managers to support their workers’ mental health. In short, there was adequate evidence to recommend a number of specific intervention strategies to protect and promote workplace mental health (see the Guidelines document for details), acknowledging that further research is needed to inform rapidly evolving policy and practice in this area.

Notably the GDG was not able to make a recommendation for or against screening programmes during employment, because it is unclear whether the potential benefits of screening programmes outweigh potential harms. However, this statement does not apply to screening which may be required by necessity of regulation in some occupations, or screening when workers have been exposed to potential hazards to (mental) health.  The guidelines include information on principles and safeguards to have in place if screening takes place at work (e.g. by necessity of regulations).

A joint ILO/WHO policy brief on mental health at work was released along with the WHO Guidelines. The brief complements the Guidelines with further practical guidance information, and is organised under three overarching strategies: 1) Prevent mental health conditions by reshaping work environments to reduce psychosocial risk, 2) Protect and promote worker mental by strengthening awareness, skills and opportunities for recognising and acting early on mental health issues, and 3) Support workers with mental health conditions to access, continue working, and thrive at work.

While this new material adds substantial value in terms of knowledge synthesis and communication, the guidelines need to be implemented in the context of a framework or an overarching strategy. The joint ILO/WHO Policy Brief’s three strategies align closely with the integrated approach to workplace mental health that was first articulated in 2014, and has also been adapted in the Australian National Workplace Initiative that was recently launched by the Australian National Mental Health Commission.  This framework states, simply, that there are three main action area that need to be addressed in any workplace mental health strategy:

• preventing harm, i.e. protecting mental health by reducing risk factors for mental disorders and mental health problems,
• promoting the positive, i.e. promoting mental health and well-being by developing the positive aspects of work and worker strengths and positive capacities, and
• responding to problems, by responding to potential mental health problems or disorders as they manifest in work contexts. This framework addresses both work- and non-work-related mental health.

The specific intervention strategies documented in the WHO guidelines should be considered as candidates for inclusion in an overarching organisation- or context-specific strategy (e.g. a sector wide, such as for construction or emergency responders), ensuring that these three key areas are addressed.  Importantly, there are other intervention strategies that can be considered as well.  Indeed, many are outlined in the joint ILO/WHO Policy Brief.  Notably, there is relatively little emphasis in either the WHO or WHO/ILO documents on promoting the positive, which is the newest and most rapidly evolving area in workplace mental health.  This reflects the illness focus of the WHO Guidelines and the occupational health and safety focus of the ILO.  This is not a criticism of the WHO and ILO documents, but rather a reminder that most contributions in this area come with limitations and ‘workplace mental health’ is a very large and complex topic.  There is much further conceptual work, research, and policy & practice development ahead.

These recent documents from the WHO and ILO provide valuable new resources in the continuing efforts to improve workplace mental health for all.  The GDG hopes that they will be used extensively.  Future work in this area slated by the WHO includes developing manager training programs and possibly a community of practice on implementation. Watch this space.

Anthony (Tony) LaMontagne is Professor of Work, Health & Wellbeing at Deakin University’s Institute for Health Transformation.  He was invited by WHO as a Subject Matter Expert to serve on the Guideline Development Group and has been involved in this project since its inception in 2019.