A Comprehensive Strategy

To address the impact of mental health on today’s workplace and workforce, a progressive and comprehensive strategy is required:

• Leadership commitment to determine the scope of the impact on the organization and demonstrate resolve to address identified areas of concern;
• Assessment of the scope of the problem – review legal requirements; carry out a baseline study on the fiscal, organizational, and personal impact of mental health related concerns in the workplace;
• Implementation of a defined response to the observed impacts using a format that encourages ongoing measurement, review, and improvement.

Establishing the Baseline

Results of the needs analysis will enable the organization to understand where they are positioned with respect to a mental health continuum that runs from a workplace with serious employee mental illness concerns (the “toxic workplace”) to one that is a mentally healthy and sustainable workplace.

• The “toxic work-place” with serious mental illnesses = An unsustainable workplace – poor worker mental health, H and S, and tumbling productivity
• The mentally healthy workplace = A sustainable  workplace; mentally and physically healthy, safe, and productive

Most data needed to establish costs related to mental health impacts on the employees and the workplace already exist.

Data Sources

Aggregated data results can come from sources such as:

• Health risk assessments;
• Specialized questionnaires such as:
  • PHQ (Patient Health Questionnaire 9);
  • SSOS (Stress and Satisfaction Offset Score);
• EAP programs;
• Insurance records: drugs, benefits;
• Company medical reports and health records;
• Human resources absenteeism data
• Employee surveys.

Parameters to ascertain annual COSTS include:

• Extended/Group Health Care Costs:
  • Drug claims costs by major drug category per covered active employee;
  • Mental illness-related drug claim costs as a percentage of total drug claim costs per covered active employee
  • Number of mental illness-related drug claims + those where a second drug is also being claimed for another ailment (co-morbidity);

• Employee Assistance Costs:
  • Number and percent (as a percentage of total program users) of employees using the program for mental illness-related disorders;
  • Apportioned annual cost of the EAP services.

• Replacement Worker Costs:
  • Total cost of replacement workers as a percentage of total active payroll costs

• Short and Long Term Disability Costs:
  • Total costs for short term disability claims related to MH disorders based on number of claims, average length of time off work per MH claim and cost per day for short term disability;
  • Total costs for long term disability claims related to MH disorders based on number of claims, average length of time off work per MH claim and cost per day for long term disability;
  • Calculate total annual costs for short and long term disability related to mental health (MH) claims.

• Absenteeism Costs:
  • Number and percent of total lost workdays (paid and unpaid) per year for mental illness-related disorders;
  • Absenteeism costs per year by type of mental health ailment/disorder;

• Short and Long Term Disability Costs per year
  • % of employees with short term disability claims related to mental health disorders;
  • % of employees with long term disability claims related to mental health disorders;
  • Number of replacement workers (fulltime equivalent) used per reporting period;
  • Employee turnover rates relating to mental health disorders;
  • Lost workdays (paid and unpaid) for mental illness-related disorders as a percentage of total lost workdays.

Parameters to ascertain annual IMPACTS include:

• Employee Assistance Impact
  • Percent of overall employees using the program for mental illness-related disorders;
  • Utilization as a percentage of total program users;
  • Number of cases referred to community-based treatment programs;
  • Number of high risk mental illness cases.

• Short and Long Term Disability Impact:
  • % of employees with short term disability claims related to mental health disorders;
  • % of employees with long term disability claims related to mental health disorders;

Review resources on changing legal requirements with respect to mental health in the workplace;

• Legal Framework in Canada – Links to current and evolving legislation for accommodating employees with mental illness
• Review customer and investor requirements with respect to employee health/mental health related expectations.

To be successful in today’s workplaces, a work-place framework for mental health must be:

• Consistent with other internationally recognized systems such as ISO 9000, ISO 14000, or OHSAS 18000;
• Involve input from all stake-holders in the development, implementation, & review;
• Used as a workplace tool to drive continual improvement;
• Accommodate external forces such as regulations and social policy.

Set Direction and Policy

Several options exist for how a workplace Policy on Mental Health can evolve.

The Policy on Mental Health may be:

• A stand alone policy with its own framework;
• A key component of the organizations health (or health and safety or environment, health, and safety) policy;
• A key component of the human resources policy.

Whichever approach is chosen, the framework accompanying the Policy must ensure that all necessary attributes are included and that continual improvement is part of the overall process.

Key functional aspects for managing the Mental Health Policy:

• The policy may be a stand alone policy or part of another key policy area such as Occupational Health or Human Resources;
• As part of showing leadership commitment, the policy must be signed by the organizational leader(s), dated, and communicated to all employees on a timely basis;
• There should be evidence of application of the mental health policy in company documentation such as: management labour agreements, personnel orientation literature, public information statements, etc.;
• The policy must indicate the organization’s commitment to respect laws and regulations, recognized mental health practices, and organizational protocols.
• The policy should state that it encompasses all relevant stakeholders – e.g. contractors, employees. visitors, etc..
• The policy should reflect a commitment to continual improvement of the mental health policies, management systems, and related programs.

The overall Policy under which an organization can develop its approach to mental health might read as follows:

“The ABC company considers the psychological safety of its employees to be as important as all other aspects of health and safety. ABC is committed to the prevention and resolution of mental health issues in its workplaces through the fair and equitable use of appropriate programs to assist employees towards the overall improvement of all aspects related to mental health in the workplace.”

Planning

Planning is the first phase of policy implementation and may also be used to provide an initial benchmark survey of current status.

The role of the planning phase is to carry out a needs analysis relative to the direction intended by the organization’s policies.

The needs analysis points the way to specific actions required to address the defined problems and/or opportunities for improvement.

The needs analysis also provides point in time data against which improvements and cost benefit analyses can be measured;

Regulatory requirements and benchmarking with other industries may provide useful information;

For mental health, the planning phase may include an assessment of:

• Workplace attributes that contribute to a positive mental health climate;
• Workforce status with respect to mental health;
• System requirements to manage mental health in the workplace;

Measure the attributes that encourage positive mental health in the workplace, the use of a tool such as GuardingMinds@Work may be of value:

• Developed by B.C. and Ontario experts on mental health in the workplace;
• Project sponsored by Great West Life;
• Includes an employee psychosocial risk survey;
• Questions based on a systematic review of the relevant scientific literature to identify and describe key workplace psychosocial factors that increase worker mental health risk and compromise psychological safety.

Attributes of a Healthy Workplace

(courtesy: Guarding minds @ Work)

Psychological Support – A work environment where coworkers and supervisors are supportive  of employees’ psychological and mental health concerns, and respond appropriately as needed;

Organizational Culture – A work environment characterized by trust, honesty and fairness;

Clear Leadership & Expectations – A work environment where there is effective leadership and support that helps employees know what they need to do, how their work contributes to the organization, and whether there are impending changes;

Civility & Respect – A work environment where employees are respectful and considerate in their interactions with one another, as well as with customers, clients and the public;

Psychological Job Fit – A work environment where there is good fit between employees’ interpersonal and emotional competencies, their job skills, and the position they hold;

Growth & Development – A work environment where employees receive encouragement and support in the development of their interpersonal, emotional and job skills;

Recognition & Reward – A work environment where there is appropriate acknowledgement and appreciation of employees’ efforts in a fair and timely manner;

Involvement & Influence – A work environment where employees are included in discussions about how their work is done and how important decisions are made;

Workload Management – A work environment where tasks and responsibilities can be accomplished successfully within the time available;

Engagement – A work environment where employees enjoy and feel connected to their work, and where they feel motivated to do their job well;

Balance – A work environment where there is a recognition of the need for balance between the demands of work, family and personal life;

Psychological Protection – A work environment where employees’ psychological safety is ensured.

Implementation

General Considerations

To appropriately address the workplace and workforce mental health needs, various policies and programs may be required;

Existing policies and programs may also require the addition of new aspects to ensure that the workplace will be able to meet the structural and employee based requirements for a mental health friendly work environment;

Selection of the most appropriate policies/ programs should be based on the outcome of the needs assessment/planning process.

Administrative Aspects

The organization should assess regulatory requirements;

Any regulatory citations or instructions related to mental health aspects must be disclosed and implemented according to regulatory requirements and all actions documented.

Health related records, including those related to mental health, must be under the care and custody of health professionals and comply with regulatory requirements and company policies on record retention and confidentiality.

Release of information forms that meet generally accepted standards must be used whenever there is a request for confidential health information.

Employee Assistance program (EAP) Programs and Policies

An EAP (EFAP) program should be open to all employees with information on the program made  available to employees and their families;

A toll-free phone 24 hour/365 days a year with a  live person call answer should be provided for easy access to the EAP program;

Access to direct person to person counseling should be possible within a reasonable period of time (24 – 72 hours);

The EAP program must always ensure client confidentiality.

Aggregated usage reports and advice on key areas of concern should be given to the organization on a quarterly basis and include:

• Number and % of employees using service;
• Demographics of users;
• Type of enrollee (e.g., employee/dependent);
• Referral source;
• Depression screening;
• Problems presented;
• Actual problems identified;
• Average number of sessions per person;
• Number of new and repeat (same/new problem) cases;
• Functional outcomes.

A mechanism to ensure referral to appropriate resources following the initial period of counseling is an essential part of the EAP program;

EAP program provider must have appropriately credentialed employees and a mechanism for ongoing training of their employees;

EAP programs need to be aligned with Human Resources and other relevant areas of the organization including:

• Disability Management
• Health Care Benefits
• Occupational Health & Safety
• Diversity Policies
• Organizational Development
• Security
• Training and Development

Measurement

Checking and Corrective Action

The purpose of “checking and corrective action” is to assess organizational effectiveness in implementing policies, carrying out planning, and delivering programs that meet the identified mental health needs of the workplace and the workforce;

Regular audits of system effectiveness are best used to drive continual improvement and further enhance workplace and workforce mental health;

Audits, using generally accepted audit principles, should be done every 2 – 3 years provided that no major issues arise that suggests the need for an increased frequency of auditing.

The  mental health management system audit may be done singly or as part of the system audit for other areas having interests in common such as occupational health or human resources;

Professional development activities of mental health professionals must also be documented and subject to regular review.

A system must also exist to review complaints concerning mental health issues at the site. An annual summary of these complaints should be made and all complaints documented and follow up action indicated. Confidentiality must be preserved.

Review

An annual review report must be prepared for site management and should be discussed with all other interested parties;

The review should provide summary details and an assessment of:

• The current policy;
• Changes in the past year and future plans;
• Administrative issues;
• Personnel;
• Key areas of concern and actions taken;
• Wellness programs;
• Statistical summaries.