‘It’s not an easy conversation’: Mental health in the workplace

We hear a lot about the mind-body connection in our everyday lives. Once relegated to the fringes of medical establishments that treated the mind and body as separate, the idea that our mental health affects our physical well-being is now widely accepted.

So it seems logical that more attention is being paid to the importance of mental health in the workplace.

But this new focus is not without controversy – especially when it comes to asking safety professionals to play a role. Some laud this as an overdue recognition of a major contributor to worker health and safety, while others lament it as an impractical – or even dangerous – distraction from the primary responsibilities of injury prevention.

When Safety+Health asked readers in an online poll, Should mental health in the workplace be part of the safety pro’s responsibility? the two factions were about evenly divided: 51 percent no, 49 percent yes. 

Why is mental health relevant?

Many people making the case for attention to mental health in the workplace cite the need to look at workers’ health and safety more holistically, addressing not only physical welfare but mental and emotional well-being as well.

“It really is a win-win for the organization and the worker when you invest in the well-being of workers more comprehensively,” said L. Casey Chosewood, director of the Office for Total Worker Health at NIOSH. “The best companies invest in the health and well-being of their workers throughout the day. Workers bring that additional health back to the job the next morning in the form of increased productivity, decreased injury and illness risk, decreased health care spending, and more engagement with their work.”

Those who agree add that addressing the matter is necessary because:

Mental health concerns are both common and long-lasting. About 18 percent of the U.S. adult population (44.7 million, or nearly 1 in 5) has a mental illness in any given year, according to 2016 data from the Substance Abuse and Mental Health Services Administration. “This is not limited to blue-collar jobs or white-collar jobs,” Chosewood said. “Depression and anxiety cross every industry and occupation, every socioeconomic status, every race and ethnicity.”

Chosewood also said that because of their early onset and persistence, mental health conditions carry long-term consequences. “Unlike other chronic conditions that usually don’t start in workers until their 40s, 50s or even 60s, mental health concerns typically present in a worker’s 20s or 30s and can last throughout almost the entire working career.”

Mental health affects worker productivity and the bottom line. Significant evidence supports the connection between individuals’ mental well-being and their ability to function at work.

For example, a study published in the Journal of the American Medical Association in 2003 found that depression costs U.S. employers about $31 billion a year in lost productivity, and that’s not counting costs associated with long- or short-term disability.

Another 2003 study, published in the Journal of Clinical Psychiatry, estimated the annual cost of depression in the U.S. workplace to be $51.5 billion.

“Increasingly, we are hearing from employers that mental illness is one of the leading causes of disability in their workplaces, and we know that it is one of the most expensive,” Chosewood said. “Mental illness also tends to worsen other underlying conditions. For instance, if someone gets injured at work and they also have an overlying anxiety or depressive illness, their likelihood of returning to work quickly goes down significantly and the cost of recovery goes up.”

Workplace stress contributes to poor physical and mental outcomes. The damage stress causes to both physical and mental health is well-documented. A 2015 meta-analysis of 228 studies, conducted by researchers from Stanford University and the Harvard Business School, found that common workplace stressors increase individuals’ risk of self-rated poor health, self-rated mental illnesses, physician-reported illnesses and even mortality. This suggests that less severe mental health concerns such as stress can trigger larger problems.

“There is a growing evidence base that shows a connection between workplace stress and the development of depression and anxiety disorders,” Chosewood said. “More research needs to be done in this area, but there is a clear connection between the hazards and stressors that come from the high demands of work and chronic mental health conditions.”

Valerie Echter experienced this firsthand during her 12 years as a civil engineer in the oil and gas construction industry.

“I really enjoyed my job, but I didn’t know how to manage the stresses that came along with it,” she said. “I started suffering from anxiety and panic attacks, but I didn’t want a mental health issue to impact my career, so I kept it quiet. I actually fainted in the office one day in front of some co-workers, and after I was checked out and cleared, my physician told me that it was definitely caused by stress.”

Conversations with others who silently endured similar long-term mental health issues spurred Echter to co-found Get Good LLC, a coaching and consulting business that specializes in stress management, particularly as a method of prevention. “I share the tools, techniques and data to help mitigate that stress component before it develops into a mental health issue or crisis,” she said.

Mental health can affect worker safety. Even if no actual illness is diagnosed, it’s easy to imagine how a worker’s mental state might affect his or her ability to make good decisions and recognize potential hazards.

“The mind drives the activity of the body,” said Larry Masotti, director of strategic relationships for Workplace Safety & Prevention Services, a Mississauga, Ontario-based workplace health and safety association. “We’ve seen movements all around the world on mindfulness – people being aware of what they’re doing and present in the moment. To work safely, people need to be mindful of what they’re doing, and that’s part of the conversation on mental health.”

Kelli Smith, occupational health director for Cummins Inc. – a global corporation that designs, manufactures, distributes and services a range of power technologies – said she has witnessed the importance of mental focus and clarity within her company’s safety systems.

“We are seeing incidents related to how people are making decisions, where distraction is coming into play,” Smith said. “If you can work with employees to eliminate those things that are causing them stress or just taking their minds off-task, that can contribute to a safe work environment.”

A 2014 study published in the Journal of Occupational and Environmental Medicine suggested that depression is associated with an increased risk of injury among workers. Similarly, studies published in the March 2015, March 2016 and October 2017 issues of the journal found links between occupational injury and psychosocial hazards in the workplace, such as job insecurity, work-family imbalance and a hostile work environment.

Not everyone agrees. Dominic Cooper is founder of the safety consultancy B-Safe Management Solutions; author of several books on behavioral safety, safety culture and safety leadership; and a former professor of safety and industrial/organizational psychology at Indiana University. Cooper casts doubt on the scientific merit of evidence linking workplace injury to psychosocial risk factors.

“I have never seen an accident report that said workplace stress was the root cause,” Cooper said. “It is impossible to prove one way or another.”

He also voiced concerns about the validity of workplace stress surveys, noting that they tend to be validated against each other rather than by outcomes such as physician referrals.

Chosewood said more research is needed to establish a connection between mental health and workplace injury.

“It’s not a very well-studied area,” he said. “We need a deeper understanding of all the underlying issues at play. What we do know is that workplace stress is often the result of very clear hazards and harmful job demands like long hours of work, little autonomy or control by workers, inconsistent supervisory practices, and a poor safety climate. These are all well-correlated with worker injury.”

What is the safety pro’s role?

Skeptics fear the prospect of safety pros acting as “armchair psychiatrists,” scanning workers’ faces for signs of disturbance and attempting to diagnose and treat mental disorders. But this is a far cry from the modest role advocates propose.

“Mental health is different from mental illness,” Masotti said. “A safety professional would only deal with the idea of mental health – preventing mental harm, helping people to understand that it’s OK to talk about it. Mental illness has to be routed to a professional in that field; that is not something a safety professional can handle.”

Masotti believes safety professionsals should approach mental health risks similar to how they deal with physical risks.

“We don’t diagnose or treat physical conditions in the workplace (first aid situations aside), but we do talk about physical health, teach physical health and listen to concerns affecting workers’ physical health,” he said.

Experts interviewed by S+H suggest that safety personnel could:

• Begin by educating themselves on workplace mental health (see “Recommended research.”). 
• Raise workers’ awareness of mental health issues and the importance of caring for their own mental well-being, possibly by hosting expert-led talks or training. 
• Encourage conversations around mental health, thus weakening stigmas that keep workers from addressing potential issues. 
• Foster a company culture that values mental health by providing information to senior leadership. 
• Connect workers with resources within or outside the company (such as an employee assistance program). 
• Partner with workers to mitigate job-related stressors that may contribute to mental health concerns. “That would mean attention to things like better, healthier supervision; more realistic work demands; providing resources to workers; adequate attention to hours; rest breaks – the sort of work organization elements that safety officers are quite attuned to already,” Chosewood said.

Safety pros also may play a role in peer support programs, such as Cummins’ “Live It, Lead It,” which is driven by environmental, safety and health personnel. “We believe that social support is important to overall emotional well-being,” Smith said. “The theme of the program is how we can develop an interdependent culture where everybody cares and looks out for one another, and where employees feel comfortable approaching one another with issues – including mental health.”

It should be noted that encouraging this kind of peer conversation requires careful attention to privacy considerations. “It’s not difficult for the company to maintain confidentiality, because we have good processes in place,” Smith said. “The challenge is where you have employees talking informally with one another, to make sure the person on the listening side understands what they have permission to share and what they don’t.”

A necessary progression or a diversion?

Workers’ mental well-being traditionally has been addressed through human resources, management and third-party resources such as employee assistance programs. So why should occupational safety and health pros get involved?

Some experts see them as singularly qualified members of the team.

“Safety professionals develop a unique ability to balance technical aspects of their respective workplaces with the interpersonal skills needed to influence the workforce they collaborate with,” Masotti said. “As we know, safety professionals usually do not have an authoritarian stance. They don’t tell you what to do – they collaborate, they influence, they teach.”

Masotti characterizes safety pro involvement in mental health as part of a natural, and necessary, progression.

“One of the most important facets of worker safety is that it’s constantly evolving in response to technological, societal and organizational changes,” he said. “The best example for me is the study of ergonomics. All of us had a bit of difficulty incorporating that into our work a decade or so ago, because it was soft tissue injury and we didn’t understand it as well. It was difficult for many safety professionals to speak about it and to embrace the idea of repetitive strain injuries. But now we’ve normalized the idea that ergonomics fits within the mandate of a safety professional.”

However, some worry that by directing attention to mental safety, safety pros will lose focus on the more pressing responsibilities of physical safety. For example, Cooper questioned whether their time and energy would be lost on quests to eliminate mental distractions, pointing out that distractions can come from a variety of sources, including loud noises, mobile machinery or co-workers.

“HSE folks are already being overwhelmed with their core tasks of controlling safety, particularly in organizations where there are only one or two safety professionals,” he said. “I am extremely concerned that the focus on mental health will lead to many more workplace deaths and serious injuries. Currently, we cannot collectively eliminate or control those – let alone try to control this nebulous aspect of workplace stress.”

Safety still comes first

Even those in favor of addressing mental health agree that prevention of physical injury should remain the top priority for safety pros.

“Ideally, safety and health pros work toward eliminating workplace safety and health hazards first, and then changing workplace systems to improve the physical and mental health of workers,” Chosewood said.

He also cautions that attention to mental risk factors never should translate to a “blame the worker” mentality.

“Really, we need to look at organizational fixes as opposed to just individual fixes,” Chosewood said. “It’s important that the work itself be designed to be safe, even for people who are struggling with distraction or mental health concerns. That’s why we build in multiple levels of protection.”

Proponents say their aim is not to transform safety pros into mental health providers or distract from the profession’s traditional focus on physical safety. Rather, they hope to draw attention to an aspect of worker health and safety that often is overlooked or even avoided.

“It’s not an easy conversation,” Masotti said. “People are busy protecting themselves, not wanting to talk about certain things because they’re worried about being isolated or singled out. Ideally, we’re trying to create an environment where people are open to talking about mental health.”