Annals of Work Exposures and Health, 2018, Vol. 62, No. S1, S93–S100

Authors: Anthony D. LaMontagne, Clare Shann, Angela Martin

Institutions: Deakin University, Shann Advisory, University of Tasmania, Pracademia

Link to original paper: https://esf.com.au/wp-content/uploads/2020/05/Integrated-approach-LaMontagne_2018_Annls-Work.pdf

Abstract

An integrated approach to workplace mental health includes three main activities:

  1. Protection: Reduce work-related and other risk factors for mental health problems.
  2. Promotion: Enhance positive aspects of work and worker strengths.
  3. Inspector: Address mental health problems at work regardless of their cause.

This approach simplifies a complex issue, making it accessible for workplaces to build comprehensive mental health programs. The article, based on a presentation at the 2017 Understanding Small Enterprises conference, is in two parts: a summary of the integrated approach and a hypothetical conversation with a small business owner considering mental health programs.

Introduction

The article originates from a presentation at the Understanding Small Enterprises 2017 international conference. It summarizes an integrated approach to workplace mental health, previously detailed in other publications, and includes a conversation aimed at convincing a small business owner to take action.

Part I: Overview of the Integrated Approach

Prevalence and Impact

  • Mental health issues like depression and anxiety are significant concerns in the workplace.
  • Interventions have evolved from various disciplines, each with strengths and limitations.

Three Key Areas of Activity

  1. Protect Mental Health: Reduce risk factors informed by public health, occupational health, and organizational psychology.
  2. Promote Mental Health: Develop positive aspects of work and worker capacities, drawing from organizational development and positive psychology.
  3. Address Mental Health Problems: Manage mental health issues at work, influenced by psychiatry and clinical psychology.

Mutual Reinforcement and Efficiency

These three areas are interconnected and can create efficiencies and synergies, similar to integrated approaches in cancer prevention:

  1. Protection: Focus on identifying and addressing factors adversely affecting mental health, encouraging a safe work environment.
  2. Promotion: Complement risk reduction by enhancing positive aspects of work and promoting autonomy.
  3. Inspector: Manage mental health issues through mental health literacy (MHL), which includes recognizing, treating, and supporting affected workers.

Part II: Conversation with a Small Business Owner

Scenario

A hypothetical dialogue with a small business owner who has not yet implemented workplace mental health programs but is considering it.

Small Business (SB) Owner/Operator: I’m hearing more and more about workplace mental health, and I know some businesses are doing things in this area. But I don’t know a lot about it and I don’t have a lot of time or resources to direct this way. What do you think I should do?

Inspector: You need to look at three things: (i) preventing harm, (ii) promoting the positive, and (iii) responding to mental health issues as they manifest at work.

Small Business (SB) Owner/Operator: Sounds ok, but that could be a lot? Is all that really necessary?

Inspector: Yes, we believe taking action in each of these three areas is the best way to go. Why? First, by way of background, were you aware that mental health problems are very common in the working population? At any point in time, roughly one in five workers are experiencing a mental health problem. Most of those problems are mild to moderate—such as temporarily feeling distressed or having mild anxiety, but about one in twenty employed people are working with a serious mental illness, such as schizophrenia or major depression. So, in short, you are likely to work with people who have mental health problems, most likely mild or temporary ones, at some point—if you have not already.

Small Business (SB) Owner/Operator: But we don’t have the time or resources for all this…

Inspector: You don’t have to take it all on at once. You can start small with awareness-raising to foster an environment where mental health can be discussed. For example, you could do this by marking World Mental Health Day, or having a suicide prevention awareness day (e.g., an ‘RUOK Day’). If you are part of a small business network, Chamber of Commerce, or other network, you could consider getting specific advice there, or even sharing program or support services to make it more manageable and affordable. How about listening to some short perspectives on this from other small business owner/operators? Try our Business in Mind website, which includes some brief testimonials from SB owner/operators.

Small Business (SB) Owner/Operator: That’s all well and good, but… I don’t think the stuff that’s out there is really in line with the needs of small business… they don’t really understand the particulars and constraints of running a small business.

Inspector: It’s certainly true that the early resources on workplace mental health were more based on the experience of medium to large businesses, and also more oriented to their needs. But that’s changing—there’s a growing range of workplace mental health programs, materials, and more for small businesses of various kinds. For example, there’s our Business in Mind workplace mental health program designed specifically for small to medium enterprises. Then there’s a whole new set of specific resources for small businesses on beyondblue’s Heads Up website. These resources were launched in 2017 and were developed by the Australian government-funded mental health promotion foundation called beyondblue. We can vouch for these materials being based on good information and principles; indeed, our research has informed some of the materials.

Small Business (SB) Owner/Operator: Ok, so suppose I give this a try. Where do I start?

Inspector: Start small. Picture planting a little tree with three branches corresponding to Protecting from Harm, Promoting the Positive, and Responding to Mental Health Issues as they arise… and growing it over time. Start with one thing on each branch and add on as you go.

Preventing Harm

Inspector: I suspect you might already be doing some things in this area. First, let’s talk about Protecting from Harm: Do you informally check in with staff on a regular basis? Things like having a quick word: ‘How’d that job go yesterday?’ ‘Have everything you need for that client?’ Do you adjust things as needed, such as reallocating tasks or staff in response to acute demands, or taking on extra help in peak periods?

Small Business (SB) Owner/Operator: Yea, I do that sort of thing sometimes, especially when we’re busy.

Inspector: Well, in addition to sound management, that’s Preventing Harm by monitoring and managing workload. In a small business, the owner can often do this effectively by informal means, just by virtue of size and being engaged in the work at the ground level with employees.

Small Business (SB) Owner/Operator: Yea, that’s right. I’m right in there with them when things get busy.

Inspector: Great. The parallels between good business management and workplace mental health are worth exploring further—there’s a lot of overlap. To run your business, you work out the service or product you’re to provide or produce. Then you work out what it will take to do that—including the sort of personnel, skills, experience, infrastructure, equipment, materials, etc., that will be required. And of course, you want to do this in the most efficient and effective way possible so that your business will be viable (efficiency) and you’ll be providing a product or service of choice (effectiveness). As owner/operator, you’ve always got an eye on that balance between inputs and outputs.

Small Business (SB) Owner/Operator: So you’re saying that managing people’s mental health is like managing the business.

Inspector: Yes, the same basic principles apply. Good people management is consistent with job stress prevention. And whatever you might invest in becoming a better people manager is likely to benefit workplace mental health as much as your business.

Small Business (SB) Owner/Operator: Yes, but the skills are different. Understanding how people are doing isn’t the same as monitoring a profit and loss balance.

Inspector: True. It’s the people skills that are emphasized and developed in the ‘integrated approach.’ Those ‘resources’ for getting a job done include how you lead and supervise your workers. For example—how you can best support them while at the same time fulfilling other demands of being their boss. What is reasonable in this regard? How do you give feedback that’s constructive and motivating and avoid being harshly critical and demotivating? How do you best manage conflict among employees? How do you set a tone or culture where people are engaged in their work yet feel free to talk to you about how they’re going?

Small Business (SB) Owner/Operator: Ok. This is a lot, but I can see how all of this would be helpful to me in running my business.

Promoting the Positive

Inspector: Great, enough on Preventing Harm for now. Let’s see what you might be doing on Promoting the Positive. How well do you know your staff, their different strengths, and limitations?

Small Business (SB) Owner/Operator: Well, yes, generally. I’d say so. It’s not so hard because we’re a small group.

Inspector: True, this is one of the virtues of being small. Do you know what your individual staff like most about their work? Is it possible to give them more of the type of work they like?

Small Business (SB) Owner/Operator: Maybe…

Inspector: Great—here’s an example. Let’s take a fictional character, Sally. She’s a skilled accounts manager, but she doesn’t seem engaged lately. You check in with her to see how it’s going, and it turns out she’d be keen to get her head out of the books more often and have more personal interaction with clients. So, you progressively share more client relations responsibilities with Sally, she gets more engaged, and you’re freed up to do something else. This is an example of Promoting the Positive—in this case with both workplace mental health and business benefits.

Most people like a bit of challenge in their work. It’s one of the things that brings us pride, that makes us feel like valuable contributors to the community and society. And working toward realistic and achievable challenges promotes mental health. So another example of promoting the positive while simultaneously improving business effectiveness would be to talk to your workers about setting some individual or group work goals of their choosing (e.g., new skill development, rearranging the way a service is provided based on their day-to-day experience), then supporting them towards achieving those goals.

Responding to Mental Health Issues

Inspector: Now on to Responding to Mental Health Issues as they manifest at work. As mentioned earlier, if you haven’t encountered an employee mental health issue yet—including your own mental health—it’s likely to occur sometime.

Small Business (SB) Owner/Operator: Are you telling me I’m now responsible for my staff’s mental health!?

Inspector: No! But you are responsible for providing work that is psychologically safe to the extent feasible, especially if you are legally an employer. The key knowledge and skills you need here are: how to recognize signs of possible mental health problems, how to appropriately express your observations or concerns, how to offer support, and how to direct or refer people to further help when needed. It’s key to remember that as a manager, you’re doing what you can to support the person in their work role, not trying to solve their mental health problem.

If you have encountered a mental health issue with someone you were managing, think about how you responded. Did you find yourself wanting to know more about how to respond, or worried about saying the wrong thing? Part of this is also understanding worker entitlements to confidentiality—e.g., you need to know a person’s work abilities and limitations to determine what accommodations you as an employer can offer, but you don’t need to inquire about or know their diagnosis. This requires particular sensitivity in small workplaces, where people tend to know each other better than in larger workplaces.

These sorts of discussions can also be about finding reasonable accommodations for someone returning to work from a mental or other illness. Again, some countries have disability accommodation laws that would be relevant here.

Getting Started

Small Business (SB) Owner/Operator: Ok, so what next? Where should I start?

Inspector: Here are some ideas:

  1. Consider Your Own Mental Health: Check out this site on the new beyondblue Small Business pages—it includes a self-check on your work-life balance.

  2. Raise Awareness: Do some web-based awareness training for staff—start with an overview of resources for employees in small businesses. Follow up with discussions to see what further training or programs they might like.

  3. Use Available Resources: Utilize resources developed to support efforts in Preventing Harm, Promoting the Positive, and Responding to Mental Health Issues. This should be plenty to get started.

Discussion Points

  1. Importance of Mental Health:

    • Mental health issues are common among workers, with around one in five experiencing problems at any time.
    • Employers have legal and ethical obligations to provide a psychologically safe workplace.

  2. Starting Small:

    • Begin with raising awareness and creating an environment where mental health can be discussed, such as marking World Mental Health Day or using resources from business networks.

  3. Practical Steps:

    • Utilize available resources and start small with programs like awareness training.
    • Gradually build a more comprehensive mental health strategy.

  4. Tailored Approaches:

    • Adapt strategies to fit the specific context of small to medium-sized enterprises (SMEs).

Key Actions

  1. Preventing Harm:

    • Regularly check in with staff, manage workloads, and adjust tasks to prevent stressors.

  2. Promoting the Positive:

    • Identify and enhance workers’ strengths and interests, provide opportunities for engagement and development.

  3. Responding to Issues:

    • Recognize signs of mental health problems, offer support, and know how to refer to further help while respecting confidentiality.

Conclusion

Improving workplace mental health benefits both employees and businesses. Starting with manageable steps can lead to the development of comprehensive and effective mental health programs over time.

Acknowledgements

This article is based on a keynote presentation at the 2017 Understanding Small Enterprise conference. The development of the integrated approach to workplace mental health has been supported by various funders and projects, including the Australian National Health and Medical Research Council and beyondblue. The authors declare no conflict of interest.

References

Selected Key References:

  • Jorm et al. (1997): Mental health literacy survey.
  • LaMontagne et al. (2014): Integrated intervention approach.
  • Martin and LaMontagne (2018): Application in SMEs.

For more detailed information and supporting evidence, refer to the full list of references in the original paper.