Mental health at work
4.3 Models of Best Practice
Process and Methods
Each of the national partners contacted relevant organisations (for example trade unions, universities, health insurance companies, non-governmental organisations) to identify models of best practice for the promotion of mental health and the preven-tion of mental ill health and to acquire informapreven-tion on best practice. Contact was made with enterprises of different sizes and branches which were already known to have established projects or services concerning the promotion of employees’ mental health.
90
The enterprises provided short descriptions of their models / projects, which were then screened according to some basic criteria, such as how they focus on mental health, their duration, number of participants etc. Enterprises that presented good models were contacted again and asked to fill in a detailed questionnaire (annexed,
‘Questionnaire II’) to provide as much relevant information as possible about the project/service (for example concerning target group, number of participants, actions undertaken/ interventions, their duration, outcomes, evaluation). Based on this infor-mation the final selection of the models of best practice was made.
A broad discussion took place on the models of best practice that had been selected, since many interesting and good examples had been identified. A checklist of rele-vant criteria referring to quality aspects had been drawn up beforehand during sev-eral meetings of experts with interdisciplinary professional knowledge who helped in selecting the models of best practice. The team responsible for the sector on ‘work-ing adults’ chose projects which came as closely as possible to meet‘work-ing the follow‘work-ing criteria which are also in line with the Quality Criteria drawn up by the European Net-work Workplace Health Promotion. The criteria set out below reflect the ideal case, which in reality may differ.
Good practice should:
· Include early detection (early warning system)
· Involve the participants in every stage of the project management
· Be integrated in the management philosophy
· Include interventions on different levels, i.e. affecting the individual, the social en-vironment and the working conditions
· Focus on mental health promotion in relation to prevention of anxiety and depres-sion but also to other phenomena like stress, bullying, moral harassment, burn-out, intimidation etc.
· Cover different levels: promotion, primary prevention and secondary prevention
· Be designed and implemented by a multi-professional team
· Apply to a multifaceted target group (i.e. different occupational groups or hierar-chical levels)
· Include various actions, for example training, counselling, surveys and
· be proven to be effective.
After several discussions it was agreed not to select scientifically evaluated projects alone. There are many reasons why it is not easy to evaluate the effectiveness of projects at company level. Many projects are still running; there are sometimes no concrete definitions of indicators for a positive outcome; an external evaluating proc-ess is cost-intensive and has to be carried out by an expert; more often than not the effects cannot be seen directly because the interventions take effect over the long term; sometimes companies do not consider confounding aspects (e.g. restructuring) during the project phase. It was therefore decided that positive feedback from the employees for example, or the continuous participation in projects could also be an indicator for the effectiveness of a project. It must also be mentioned that the models that were chosen are not necessarily “better” than the others. It was also considered very important to choose different types of projects from different branches and of different styles. Unfortunately there were a limited number of models chosen. Appar-ently some worthwhile projects had to be left out.
Analysis of the models of best practices
The sector on ‘working adults’ collected a total of 64 models from 15 countries in-cluding Austria, Belgium, Denmark, Finland, France, Germany, Italy, Iceland, Ireland, Luxembourg, Netherlands, Norway, Spain, Sweden, United Kingdom. There were a number of reasons why it was not possible to recruit partners from all the member states.
In selecting the models of good practice it was decided to focus mainly on enterprise level for the selection of models of best practice and to take local, regional and na-tional programmes into account when drawing conclusions and making recommen-dations during the Mental Health project. Most of the questionnaires collected de-scribe internal company services or projects, only a few refer to regional or national campaigns. The Mental Health project team selected 20 models of best practice from 64 models (50 were described according to Questionnaire II), according to the criteria mentioned above.
92
The selected models come from the following countries: Austria (2), Belgium (1), Denmark (1), Finland (3), France (1), Germany (2), Iceland (3), Ireland (1), Luxem-bourg (1), Netherlands (1), Spain (2), Sweden (1), UK (1).
There are obviously substantial differences between the models, but they can be broadly classified according to their intervention levels, which to some extent tend to overlap:
- individual level: for example improving coping skills to prevent stress and burnout, enabling people to manage transition periods and interpersonal relationships, so-cial environment: for example creating soso-cial supportive structures (corporate culture), developing policies to combat bullying or moral harassmentworking con-ditions: for example reducing risk-factors, altering workplace design and work or-ganisation (for example supportive structures for women in combining work and child-care)
The following projects have therefore been selected as models of best practice 11:
Austria:
Innovative health promotion for women (SPAGAT):
The project raises awareness to the fact that working women are a group that face an above average risk of suffering from stress and other mental disorders, mainly due to the potential home-work-conflict. Because it has been acknowledged that a woman’s family and working life cannot be looked upon as separate entities the proj-ect aims to find appropriate solutions.
work stress - help through self-management:
The project aims to reduce working stress, to increase general well-being and to im-prove job satisfaction and the working climate by promoting coping strategies where stressful situations exist at work.
Belgium:
Mental workload and white collar employees in the metal industry in Flanders:
Establishing a prevention policy on psychosocial factors at work is not possible with-out active employee participation. A training programme is in place and a risk
11 Annexed you’ll find detailed descriptions of the selected programmes.
sis (questionnaires) is carried out so that employees can learn more about stress and how to improve their coping skills. They are actively involved in their company’s pre-vention policy to improve the work organisation and the working conditions.
Denmark:
Assessment of burnout and its causes (PUMA):
Working conditions can lead to burnout. This can be a source of emotional exhaus-tion, depersonalisation and diminished work accomplishment on an individual level.
On an organisational level it can cause absenteeism and labour turnover etc. Burnout therefore needs to be prevented by implementing control cycles, i.e. risk analyses, evaluation of the risk potential, planning and implementing adequate promotion and prevention strategies as well as controlling and evaluating the efficiency of the strategies.
Finland:
Empowerment-culture in improving work life & well-being:
This project specifically assesses the possibilities of empowerment-culture, promot-ing the employee’s well-bepromot-ing and individual growth, i.e. improvement of individual resources and locus of control at work. Personnel in elder care – community working capacity: Lifelong learning is fundamental for coping with demands that result from changing environments. The provision of training as well as social support leads to the improvement of personal competencies, coping strategies and work capacity.
The development project of Riihimäki Region Health Centre:
Specially trained multipliers in the field of workplace health promotion can function as role models for other health care workers and also peer support groups by enhancing social comparisons and providing different experiences with work-related problems.
This can lead to various possible approaches in problem solving abilities, preventing for example burnout.
France:
Actions to prevent relapses into anxiety disorders and depression (APRAND):
This project is one of the few explicitly aiming to decrease anxiety disorders and de-pression and provides (among other elements) training and health education for im-proving diagnosis and treatment and deepening the knowledge of symptoms, causes
94
and consequences of mental health problems. The better the diagnosis and advice, the more successful the battle against mental ill health.
Germany:
Collecting & detecting physical & psychological stressors: Directing the em-ployees’ attention to potential stressors in the physical and psychosocial workplace environment by requesting an evaluation on the stressors and transferring responsi-bility to the workforce for remedial action leads to better acceptance, a higher level of engagement and success of workplace health promotion activities. Self-competence and self-responsibility – methods for optimising resources (SERO):The project aims at reducing work-related stress and increasing job satisfaction and commitment by enhancing self-responsibility and self-initiative on aspects of health and safety at work for example and also by increasing coping skills with special regard to organ-isational changes.
Iceland:
Career development programme:
The project is increasing employees’ self-esteem and knowledge of the company’s operations and improving their professional skills through specially tailored interven-tion methods such as training of skills according to individual needs which were as-sessed beforehand.
Health promotion of employees in pre-schools in Reykjavik:
The project aims to promote the general health and well-being of staff in Reykjavik´s pre-schools in view of the special job demands. It seeks to improve the physical work environment and to provide education which also results in benefits to mental health.
Retirement - a new future:
Retirement is a major change in a persons life and also means a loss of a particular social role. By preparing for retirement a person can avoid becoming anxious or de-pressed. This project offers support to employees during this difficult transition pe-riod.
Ireland:
Preventing teacher stress in 2nd level schools:
Preventing stress in teachers is important in combating stress related illnesses. It is therefore necessary to detect the sources of stress and to find appropriate solutions to the problems. Tools for stress prevention such as those used in this project, set value on the active participation of the target group. Among other positive outcomes this has led to a high level of engagement with the project, has improved communi-cations between teachers in the school and has also increased levels of mutual sup-port for teachers.
Luxembourg:
PREvention DIAgnostic action for European SMEs (PREDIASME):
Stress not only results from factors in the social environment or aspects of work content, but also from the physical environment. Creating ergonomic and safe physi-cal working conditions therefore also promotes the employees’ (mental) well-being.
Netherlands
:Training programme to help shop floor employees:
Employees are trained to face the challenges arising from increased job demands more positively and to reduce work stress by increasing their professional skills. With the implementation of this training programme it has become obvious that stress management aims too often at decreasing the effects of stress (secondary and terti-ary prevention) rather than minimising the risk factors caused by the working condi-tions (primary prevention). It also demonstrates that preventative intervencondi-tions are often provided without an objective diagnosis having been carried out beforehand.
Furthermore, stress management programmes lack a qualitative evaluation in terms of effectiveness, costs and benefits.
Spain:
Counselling and consulting programme:
Since absenteeism due to mental ill health can be reduced, it is worthwhile detecting stress risk factors at an early stage and to provide supportive services at work where work-related problems exist. To be successful, the workers need to have confidence
96
in the prevention service. As a success factor, it stresses the importance of both the individual and the collective/ organisational interventions.
Integral care programmes for sick health professionals (PAIMM):
Health care work involves a high level of emotional stress for the personnel, through having to often face severe injuries, death etc. In this project the main aim is to pro-vide support for sick health care professionals (secondary prevention), but also to promote the awareness of risks at work. Co-operation and agreement between dif-ferent kinds of institutions are essential in order to extend initiatives similar to PAIMM to other target groups or other countries. The involvement of the health authorities is crucial not only from a financial point of view, but from the confidentiality aspect.
Sweden:
Education of managers influencing employee health:
The project aims to counteract the potential negative effects of organisational changes, focusing on job demands and levels of control at work, corporate culture and leadership with a top-down approach. The main lesson learned from this project is that educating managers on psychosocial issues, if well planned and undertaken in small steps over a relatively long period of time can be a feasible and economic way to achieve tangible improvements in occupational health in an organisation.
United Kingdom
WorkWell:
Improved relationships at work and productivity have resulted in fewer cases of work-related mental ill-health as a result of teaching cognitive behavioural skills and providing workplace counselling etc.
4.4 Outcomes
Recommendations
In drawing up recommendations three stakeholders should be considered: the repre-sentatives at policy level, the reprerepre-sentatives of organisations (enterprise level) and the employees. They are all interwoven, the different parties and their individual in-terests are inter-connected and all influence each other. A continuous exchange of
information and information on individual needs in terms of mental health is therefore essential.
Most often there is one single underlying problem, but because of the perspective of different parties (i.e. by politicians, management board, employees) and by stakeholders (health and safety experts), different problem-related consequences are focused, for example the stress experience by many people due to work overload. In such a case, the resulting problem is that the employees find that the quality of their working and private life is impaired. Occupational physicians may find that there is an increase in the employees’ unspecified health complaints. The works council may receive a large number of reports from employees’ on their grievances. The man-agement will probably detect an increase in absenteeism and a negative working at-mosphere.
The following recommendations should be used as a starting point for creating a specific policy on mental health at work. Mental health promotion should be inte-grated in already established company structures and should be a plain managerial responsibility. Existing structures, such as Occupational Health Services and Pre-vention Services for example, should be used to identify, assess, and evaluate and manage mental ill health and its causes. This calls for co-operation between several interdisciplinary, well-trained experts in the field of mental health promotion who will take the different approaches into account.
It should also be considered that although companies do agree that problems such as stress, bullying, harassment and violence exist at work, they normally do not make any effort to deal with matters as serious as anxiety disorders or depression. The terms ‘anxiety’ and ‘depression’ are still taboo issues and are seldom discussed at the enterprise level. Bearing this in mind, “marketing” activities carried out to dis-seminate information on mental health and to encourage the implementation of proj-ects in enterprises based on the “models of best practice” should refer to issues like stress etc., which are closely related to depression and anxiety.
To achieve an effective and successful mental health policy at work the policy should be in line with the enterprise’s management philosophy and the employees should be
98
involved in the whole process. A combination of approaches is advisable. The top-down process initiated by the managing board should focus on optimising the work-ing conditions (physical, organisational, psychosocial) primarily to promote mental health and prevent mental ill-health. But before implementing this process, for exam-ple by imexam-plementing specific company princiexam-ples, the management should also con-sider the bottom-up process. This means active employee involvement and assigning responsibility to the employees in issues relevant to themselves, such as mental health promotion at work. Employee involvement should in the long term lead to an increase of job satisfaction, motivation and self-esteem and to them accepting changes in the company made in the interest of promoting mental health.
The solution to counteracting mental ill-health is not always simply to ‘remove’ the risk factors at work (corrective job design), but to combine more basic and proactive changes at different levels (in society and in the enterprise) to create a more stimu-lating (prospective job design) and healthier (preventative job design) working life in general.
The following recommendations are backed up by findings in the literature review (see paragraph 1.2) and also based on the information acquired from the models of best practice.
The most important aspect is to raise awareness on ‘mental health’ issues among politicians, the general population, employers and employees. Before taking action on preventing anxiety disorders and depression people must be informed about the prevalence, the causes, the indicators for mental health problems and the conse-quences. Education and information are essential from the start.
For society as a whole the following activities are recommended:
· Provide and facilitate access to comparable data on national and European level by developing an adequate monitoring system relating to the occurrence, preva-lence and potential causes of mental health problems at work (risk analysis: iden-tification, assessment, management, evaluation).
· Prevent mental disorders in people in emotionally taxing occupations who run an above-average risk of suffering from mental health problems, by providing special
social supportive structures to groups involved in human service work (e.g. health care professionals and teachers).
· Increase understanding and reduce stigmatisation by providing information to the broader public on mental health, for example on protection and risk factors.
· Give equal coverage to health planning for mental health services as those for physical health care.
On enterprise level the following methods are recommended 12:
· Reduce anxiety and depression in employees by using strategies to enhance their internal locus of control (the belief that they can control their own destinies), to fa-cilitate their participation and to promote social inclusion by training and informing health agents and personnel. (e.g. the French project ‘APRAND’)
· Promote good mental health and well-being by designing work processes and workplaces to match the employees’ abilities and needs from both a physical and psychological point of view. This can also be achieved by strengthening individual hard and soft skills (i.e. professional skills and social competencies) as well as coping strategies. (e.g. the Icelandic project ‘Health promotion of employees in pre-schools in Reykjavik’, the Dutch project ‘Training programme to help shop floor employees’, the Finish project ‘Empowerment-culture in improving work life &
well-being’ or the Icelandic project ‘Career development programme’)
· Increase general well-being by implementing risk management (i.e. assessment of stressors, removing risks, monitoring effectiveness) to combat such phenom-ena as stress and burnout (compare for example the following projects: ‘Assess-ment of burnout and its causes’ - Denmark, ‘PREDIASME’ - Luxembourg, ‘Pre-venting teacher stress in 2nd level schools’ – Ireland or ‘Collecting & detecting of physical & psychological stressors’ - Germany’).
· Take the whole lifestyle (work and private life) into consideration when setting up
· Take the whole lifestyle (work and private life) into consideration when setting up