10 October 2017

Nigeria: Scaling Up Mental Health in Workplace

Photo: Olu Eletu/Unsplash
Man with newspaper and briefcase.

Today is World Mental Health Day (WMHD) 2017. WMHD is observed on October 10 every year with the overall objective of raising awareness of mental health issues and mobilizing efforts in support of better mental health. The theme of WMHD 2017 is "Mental Health in The Workplace."

In recent times there has been increased focus on mental health and its effect on socio economic situation of an individual and indeed the nation.

According to psychiatrists, poor mental health includes commonly experienced conditions such as poor sleep, feeling stressed, poor concentration, anxiety, through to clinically recognised disorders such as depression, generalised anxiety disorder, panic attacks, obsessive-compulsive disorder and even psychosis. Illicit drug use and misuse of prescribed psychotropic medications are also common mental health conditions that may result from issues at the workplace.

Several studies have shown that depression and anxiety disorders are common mental disorders that have an impact on our ability to work, and to work productively.

According to a recent study published in The Lancet, depression and anxiety disorders are highly prevalent and disabling disorders, which result not only in an enormous amount of human misery and lost health, but also lost economic output. The study is titled "Scaling-up treatment of depression and anxiety: a global return on investment analysis."

Globally, more than 300 million people suffer from depression, the leading cause of disability, with many of these people also suffering from symptoms of anxiety. More than 260 million are living with anxiety disorders. Many of these people live with both.

A recent World Health Organisation (WHO)-led study estimates that depression and anxiety disorders cost the global economy US$ 1 trillion each year in lost productivity. Unemployment is a well-recognized risk factor for mental health problems, while returning to, or getting work is protective. A negative working environment may lead to physical and mental health problems, harmful use of substances or alcohol, absenteeism and lost productivity. Workplaces that promote mental health and support people with mental disorders are more likely to reduce absenteeism, increase productivity and benefit from associated economic gains.

To a consultant psychiatrist and Executive Director of the foremost private psychiatric hospital in Nigeria and West Africa, The Retreat, located in Ikorodu, Lagos State, Dr. Olawale Olagunjoye, it is not really hard to see why employees might feel stressed, burnt out or exhausted especially in a city like Lagos - leaving home at 4 am, enduring hellish traffic and then having to deal with work pressure and the prevalent job insecurity not to add individual family problems and responsibilities.

"It is no surprise that in general, many more people seems to be suffering from anxiety and depression. The recent increase in reports of suicide in the media is a source of great concern. To my mind, this is a challenge to us all to do more to support each other and to help the most mentally vulnerable people in our society. Everyone deserves a chance to make a reasonable living, to work and contribute positively to the society to the best of their ability," he said.

The psychiatrist told journalists ahead of the WMHD, that in Nigeria, there are no data on financial losses to businesses resulting from poor mental health of employees.

Olagunjoye said estimates from the United Kingdom (U.K.) indicate that up to £70 billion pounds is lost annually due to mental ill health and reduced productivity of employees with up to 20 percent of the workforce taking on average, one day off annually because of stress and other mental health related issues. He said it is obvious that poor mental health of individual employees has significant repercussions for businesses including poor motivation, increased staff turnover, sickness absences due to stress, burnout and exhaustion.

According to the WHO, there are many risk factors for mental health that may be present in the working environment. Most risks relate to interactions between type of work, the organizational and managerial environment, the skills and competencies of employees, and the support available for employees to carry out their work. For example, a person may have the skills to complete tasks, but they may have too few resources to do what is required, or there may be unsupportive managerial or organizational practices.

According to the WHO, risks to mental health include: inadequate health and safety policies; poor communication and management practices; limited participation in decision-making or low control over one's area of work; low levels of support for employees; inflexible working hours; and unclear tasks or organizational objectives.

Risks may also be related to job content, such as unsuitable tasks for the person's competencies or a high and unrelenting workload. Some jobs may carry a higher personal risk than others (example first responders and humanitarian workers), which can have an impact on mental health and be a cause of symptoms of mental disorders, or lead to harmful use of alcohol or psychoactive drugs. Risk may be increased in situations where there is a lack of team cohesion or social support.

Bullying and psychological harassment (also known as "mobbing") are commonly reported causes of work-related stress by workers and present risks to the health of workers. They are associated with both psychological and physical problems. These health consequences can have costs for employers in terms of reduced productivity and increased staff turnover. They can also have a negative impact on family and social interactions.

Solutions

So, what should employers of labours and organisations be doing to provide an enabling working environment for their employees and help employees dealing with mental health issues?

Olagunjoye said: "The starting point is awareness of these issues and for employers to recognize that they have responsibilities to their employees some of which are statutory.

"The workplace must be an environment that challenge, support and help develop a sense of purpose of the employees. A mentally healthy workplace is built on good basic line management relationships, clear Human Relation (HR) policies and engagement of staffs in decision-making. A workplace that discourages culture of bullying and encourages openness, communication and easy access to management helps foster a 'happy' working environment."

The psychiatrist said prevention is key - organizations need to enable employees to flourish and for those in distress to access help quickly. He said there should be access to confidential telephone lines to help deal with stressful work-related issues that people do not feel comfortable talking about face to face with their managers.

Olagunjoye said there should be a clear grievance process and ways of seeking redress when things go wrong. "When employees have a mental disorder and it is disclosed, employers must keep the information confidential and the employee should be supported to return to work after recovery with reasonable adjustments made to their job if necessary and/or be allowed to return in a graded fashion or be placed in less demanding and more appropriate roles within the organization. There should be access to stress management courses, occupational health services and to mental health specialists, preferably outsourced," he said.

What about the employees? The psychiatrist said the employees are under no obligation to disclose a mental disorder to an employer except for some positions, for example, if the job involves having contacts with vulnerable people. However, he said, it would be impossible for the employer to provide support if nothing is disclosed.

Olagunjoye further explained: "This is obviously a very sensitive issue in our society with potential adverse outcomes including loss of job and inappropriate use of the disclosed information. This is further compounded by the general culture of silence in our society when it comes to talking about mental health issues or how it impacts us."

The psychiatrist said stigma surrounding the topic does not make it an easy conversation to have, with many employees not used to disclosing their mental health or even seeking help for fear of being stigmatized, discriminated or even ostracized.

According to the WHO, an important element of achieving a healthy workplace is the development of governmental legislation, strategies and polices as highlighted by recent European Union Compass work in this area. A healthy workplace can be described as one where workers and managers actively contribute to the working environment by promoting and protecting the health, safety and well-being of all employees.

A recent guide from the World Economic Forum suggests that interventions should take a three-pronged approach:

*Protect mental health by reducing work-related risk factors.

*Promote mental health by developing the positive aspects of work and the strengths of employees.

*Address mental health problems regardless of cause.

The guide highlights steps organizations can take to create a healthy workplace, including:

*Awareness of the workplace environment and how it can be adapted to promote better mental health for different employees.

*Learning from the motivations of organizational leaders and employees who have taken action.

*Not reinventing wheels by being aware of what other companies who have taken action have done.

*Understanding the opportunities and needs of individual employees, in helping to develop better policies for workplace mental health.

*Awareness of sources of support and where people can find help.

According to the WHO, interventions and good practices that protect and promote mental health in the workplace include: implementation and enforcement of health and safety policies and practices, including identification of distress, harmful use of psychoactive substances and illness and providing resources to manage them; informing staff that support is available; involving employees in decision-making, conveying a feeling of control and participation; organizational practices that support a healthy work-life balance; programmes for career development of employees; and recognizing and rewarding the contribution of employees.

The WHO recommends that mental health interventions should be delivered as part of an integrated health and well-being strategy that covers prevention, early identification, support and rehabilitation. Occupational health services or professionals may support organizations in implementing these interventions where they are available, but even when they are not, a number of changes can be made that may protect and promote mental health. Key to success is involving stakeholders and staff at all levels when providing protection, promotion and support interventions and when monitoring their effectiveness.

Available cost-benefit research on strategies to address mental health points towards net benefits. For example, a recent WHO-led study estimated that for every USD $1 put into scaled up treatment for common mental disorders, there is a return of USD $4 in improved health and productivity.

Researches have shown that organizations have a responsibility to support individuals with mental disorders in either continuing or returning to work. Research shows that unemployment, particularly long term unemployment, can have a detrimental impact on mental health. Many of the initiatives outlined above may help individuals with mental disorders. In particular, flexible hours, job-redesign, addressing negative workplace dynamics, and supportive and confidential communication with management can help people with mental disorders continue to or return to work. Access to evidence-based treatments has been shown to be beneficial for depression and other mental disorders. Because of the stigma associated with mental disorders, employers need to ensure that individuals feel supported and able to ask for support in continuing with or returning to work and are provided with the necessary resources to do their job.

Article 27 of The UN Convention on the Rights of Persons with Disabilities (CRPD) provides a legally-binding global framework for promoting the rights of people with disabilities (including psychosocial disabilities). It recognizes that every person with a disability has the right to work, should be treated equally and not be discriminated against, and should be provided with support in the workplace.

At a global policy level, WHO's Global Plan of Action on Worker's Health (2008-2017) and Mental Health Action Plan (2013-2020) outline relevant principles, objectives and implementation strategies to promote good mental health in the workplace. These include: addressing social determinants of mental health, such as living standards and working conditions; activities for prevention and promotion of health and mental health, including activities to reduce stigmatization and discrimination; and increasing access to evidence-based care through health service development, including access to occupational health services.

To assist organizations and workers, WHO has produced the "Protecting Workers' Health" series which provides guidance on common issues such as harassment and stress that can affect the health of workers. As part of the Mental health Gap Action Programme (mhGAP), which provides tools for evidence-based health care, WHO's technical instruments for early identification and management of alcohol and drug use disorders and for suicide prevention can also be useful for improving mental health in the workplace. WHO is developing and testing IT-supported self-help tools to address common mental disorders, harmful use of alcohol and psychological distress in low-and middle-income countries.

The Lancet study proposed a global investment case for a scaled-up response to the public health and economic burden of depression and anxiety disorders.

The researchers noted: "The net present value of investment needed over the period 2016-30 to substantially scale up effective treatment coverage for depression and anxiety disorders is estimated to be US$147 billion. The expected returns to this investment are also substantial. In terms of health impact, scaled-up treatment leads to 43 million extra years of healthy life over the scale-up period.

"Placing an economic value on these healthy life-years produces a net present value of $310 billion. As well as these intrinsic benefits associated with improved health, scaled-up treatment of common mental disorders also leads to large economic productivity gains (a net present value of $230 billion for scaled-up depression treatment and $169 billion for anxiety disorders)... "

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