A current analysis of mental health in the workplace

Dr Florence Baingana, Regional Advisor, Mental, Neurological, and Substance Use Disorders, World Health Organization (WHO) African Region, provides an update on mental health in the workplace

Mental health in the workplace is a growing issue of concern due to the COVID-19 pandemic. Early in the pandemic, parents of school-going children often had to work at home while supervising classes or looking after children who would otherwise have been at school or in a daycare facility. Healthcare workers experienced the stress of working under high-risk situations for a prolonged period, as well as witnessing severely sick and dying patients in more numbers than they had ever had to deal with. As a result, there is an increased incidence of anxiety, depression, and PTSD, as well as increased suicidal thoughts and completed suicides among the general population, especially young people, and healthcare workers.

The World Health Organization (WHO), in collaboration with the International Labour Organization (ILO), released a policy brief titled “Mental Health in the Workplace” in September 2022. The policy brief aims to prevent work- related mental health conditions; protect and promote mental health at work; support workers with mental health conditions; and create an enabling environment to improve mental health at work.

Open Access Government spoke with Dr Florence Baingana, Regional Advisor, Mental, Neurological and Substance Use Disorders, World Health Organization (WHO) African Region, to find out more about mental health in the workplace.

To what extent can a negative working environment lead to physical and mental health problems, harmful use of substances or alcohol, absenteeism and lost productivity?

A negative work environment can include precarious employment, such as working with short-term or no contracts. This may also involve working under high pressure, with little control and unclear roles. It may also include discrimination in the workplace, for instance, for women, for LGBTQI+ individuals, and sometimes even discrimination concerning race, disability, social origin, age and migrants. Inequalities may also be risk factors, including in relation to wages, opportunities and respect in the workplace. Violence and harassment at work, including bullying, are also risk factors.

Other risks include unsafe working environments, where healthcare workers could be at risk of contracting COVID-19, HIV, TB and other infectious disorders if adequate protective equipment is not provided. Working long hours or working without leave or rest and recuperation days can also be a risk factor.

In the view of WHO, to what degree is mental health an integral component of the COVID-19 response?

Mental health is an integral component of the COVID-19 response. Mental health and psychosocial support (MHPSS) are part of the clinical guidelines developed soon after the pandemic began. In addition, mental health is included in the surveys that are done routinely to track the delivery of essential health services. Various guidelines have also been developed to support the MHPSS response, including Doing What Matters in Times of Stress.

What are your thoughts on the biopsychosocial model, that mental health results from many forces occurring at different levels which have a cumulative effect on the individual?

Mental health is not just a medical condition caused by biological processes alone. This is very well explained in the World Mental Health Report, released in June 2022. The spheres of influence include individual psychological and biological factors, family and community, and structural factors such as the sociocultural, geopolitical and environmental surroundings.

What important role does mental health play in achieving global development goals, as illustrated by the inclusion of mental health in the Sustainable Development Goals?

Mental health has a role to play in achieving the Sustainable Development Goals. Mental health is a part of overall health, so health cannot be complete unless mental health is realised. In addition, mental health is integral to achieving other areas of health; as an example, the mental health of the mother is critical to the health, nutrition and educational outcomes of her children. Mental health conditions are often co-morbid with infectious disorders such as HIV and TB, as well as with non-communicable disorders, such as cancers, stroke, diabetes and cardiovascular disorders. Studies have found poor adherence to treatment and poorer outcomes when co-morbid mental health conditions are not treated.

Concerning the other SDGs, if the mental well-being of children is not addressed, then the educational outcomes may not be achieved as well, with children repeating classes or dropping out of school. In addition, there is a link to sexual and gender-based violence and mental health conditions. Climate change and weather-related events are also associated with increased mental health conditions.

While many mental health conditions can be effectively treated at relatively low cost, is the gap between people needing care and those with access to care remaining substantial?

Yes, the gap between people needing care and those with access to services is substantial. In addition, it is vital to first state that there is a considerable cost to doing nothing. The World Economic Forum estimated approximately US $1.7 trillion was lost economic productivity in 2010 due to untreated mental health conditions.

Gaps are in information, governance, resources, and services. In relation to information, mental health data is not routinely collected or analysed within the Health Management Information Systems (HMIS). When it is included, the healthcare workers who make the diagnosis often do not use a standard diagnostic system such as DSM or ICD. In addition, there is a massive imbalance between where the burden of disease is and the amount of funding for mental health research in these regions.

Governments, especially in low- and middle-income countries, allocate less than the recommended US $2 (two) per capita per year to mental health. In the African Region, the average allocation is US $0.46 per capita per year, less than half a dollar. This translates to scant human resources and poor quality services, concentrated in the capital cities, with limited to no services at the community levels.

What are the priorities for investment in mental health in the future?

The priorities for investment in mental health in the African Region include strengthening community and primary care services. This includes supporting countries to determine the package of essential services to be delivered at this level of care, determining the human resources and essential psychotropic medications required to deliver these services, and then designing and implementing the rollout of the services. In line with the people-centred approach, a strategy is also to integrate into other programs, such as for Child and Adolescent Health, Maternal Health, NCDs, TB, HIV and NTDs, among others.

Another priority will be strengthening child and adolescent mental health services. The strategy will include determining what the delivery platforms could be. For example, Rwanda and Liberia have programs where the child and adolescent mental health delivery platforms are the schools.