Mental Health Promotion

Mental Health Promotion

Health & wellbeing & resilience in the workplace: Evidence and Practice Mike McHugh 15/5/15 The full cost of poor health for employers These apply only in the US 30% Medical care and pharmaceutical costs

70% Health-related Productivity Costs All these apply to the UK also Absenteeism Overtime Turnover Temporary Staffing Administrative Costs Replacement Training Off-Site Travel for Care Customer Dissatisfaction

Variable Product Quality (adapted from R. Loeppke, US National Business Group for Health, Philadelphia 2009) Workplace Health and Wellbeingwhat is our overall goal? Healthy, engaged workforces Well-managed organisations A high-performing, resilient workforce

Enhanced productivity Contributing to: A well-functioning society Better economic performance Population trends and working life For a flourishing society we need the maximum number of productive years from as many of the population as possible. We need the ratio of earners and wealth-generators to dependants (children, pensioners, unemployed) to be as high as possible. Childhood

Working life Retirement On current predictions, the future population will be composed of longer survivors, with more long term conditions. Do not wait for leaders; do it alone, person to person. -Mother Teresa of Calcutta Good work according to Marmot

Precariousness stable, risk of loss, safe Individual control part of decision making Work demands quality and quantity

Fair employment earnings and security from employer Opportunities training, promotion, health, growth Prevents social isolation, discrimination & violence Share information, participate in decision making collective bargaining,

justice if conflicts Work/life balance Reintegrates sick or disabled wherever possible Promotes HWB psychological needs self efficacy, self esteem, belonging

and meaningfulness Both physical and psychosocial environments critical Workplace wellbeing programmes: ?cost-effective A multi-component health promotion programme accessed by employees through their workplace showed savings of around 9.70 for every 1 invested. The programme included personalised information provision and

health appraisal, access to an online resource and workshops and seminars. It led to reduced stress levels and sickness absence, as well as improved productivity. Included in the economic analysis were costs saved by the NHS due to mental illnesses avoided. Few workplace interventions have been subject to controlled trials because companies do not usually require this level of evidence before implementation. Companies who have implemented a range of interventions have maintained them because they are perceived to be cost saving.

NICE Guidance, 2012 What can local authorities achieve by tackling health at work? Life is a journey through the desert What is mental health? ..a state of well-being in which every individual realizes his/her own potential, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her/ his community WHO 2001

Absence of mental illness Positive mental health Mental well-being Dimensions of mental health If I am not for myself, who will be for me? And if I am only for myself, what am I? If not now, when? Emotional resources e.g. coping style, mood, emotional

intelligence Mental health (capital) Social skills e.g. listening, relating, communicating, co operating, accepting Promoting mental health in Wales

[email protected] [email protected] Cognitive resources e.g. learning style, knowledge, language, flexibility, innovation, Meaning and creativity

purpose e.g. vision, spiritual growth, connectedness Mental health builds wellbeing What do we mean by Wellbeing? "The subjective state of being healthy, happy, contented, comfortable and satisfied with one's quality of life. It includes physical, material, social, emotional ('happiness'), and development and activity dimensions. DOH, Commissioning Framework for

health and wellbeing, 2007 p 99 Separate view of health Historically, mental and physical health have been seen as separate and non- interacting domains, resulting in separate treatment approaches and policies Mental Health Physical Health

An integrated view of health In reality, there is considerable overlap and interaction between physical and mental health Poor mental health is probably a larger contributor to health risk behaviours and poor physical health than the other way round Mental Health Physical Health The mental health

spectrum From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Flourishing Moderate mental health Languishing Number of symptoms or risk factors

Mental disorder The effect of shifting the mean of the mental health spectrum Flourishing Moderate mental health Languishing

Number of symptoms or risk factors From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Mental disorder Benefits of flourishing Wider Social Benefits Improved educational attainment Reduced anti-social behaviour, crime and violence Fewest missed days off work

Health Healthiest psychosocial functioning, i.e. low helplessness, clear goals, high resilience Lowest cardiovascular disease Lowest number of physical diseases with age Fewest health limitations of activities of daily living Lower health care utilisation oose to go to the ch e W ...

n! oo M e th to We choose to go , not because gs in th r he

ot e th do d an Moon in this decade rd.. JFK, Rice ha e ar ey th

e us ca be t bu , they are easy ber, 1962 University , Texas, Septem Relationship between levels of prevention, intensity of intervention, mental illness, recovery and well-being

Recovery Mental illness treatment & tertiary intervention Early signs of illness early intervention & secondary prevention

High risk groups including history of mental illness secondary prevention General population Increasing levels of well-being Primary prevention Resilience: Bouncebackability

Oxford English Dictionary: (Especially in sport) the capacity to recover quickly from a setback: promotion-chasing sides need to show the requisite bouncebackability after defeat Create flourishing, connected communities A Public Mental Health Framework for Developing Well-Being

Meaning from adversity: Post traumatic growth Psychological therapies Positive reflection Reduce social exclusion: Address discrimination and stigma Target high risk groups

Reduce risk factors Cultivate purposefulness & fulfilment: In life, work, education and volunteering By creativity, coherence and flow With inclusive beliefs and values Develop sustainable, connected communities

Reduce: Smoking Alcohol Drugs Obesity Reduce Inequalities: Unemployment Fuel Poverty Homelessness Violence and Abuse Impact of Climate Change

Nurse J 2008 Promote meaning & purpose Prevent and reduce impact of Adverse Childhood Experiences: Child abuse Parental mental illness Parental substance misuse Parental Domestic Abuse

Household offender Childhood bereavement Integrate physical & mental health & well-being Build resilience & a safe, secure base Ensure a positive start in life

Enhance: Community engagement Ecological intelligence and connectedness Improve: Physical activity Healthy Food Sexual Health Health Checks Promote:

Employment Benefits Checks Safe Green Spaces Insulated & Warm Homes Partnership Working Improve: Parenting & Parental Health Social and Emotional Literacy in Healthy Schools Early interventions for conduct & emotional disorders Promote

protective factors Capacidad (feminine) de recuperacin Capacit di riprendersi dalle avversit (resilienza) Policy Context The Foresight Report (2008) Marmot Review - Fair society, Healthy Lives Marmot Review (2011)

Healthy Lives, Healthy People (2011) No Health Without Mental Health (2011) Foresight Report Mental Capital and Wellbeing: Making the Most of Ourselves in the 21st Century highlighted the importance of mental capital and wellbeing: An individuals mental capital and mental wellbeing crucially affect their path through life and are vitally important for the healthy functioning of families, communities and society

Five ways to well-being The quality of mercy is not strained It droppeth as the gentle rain from heaven Upon the place beneath It is twice blest; It blesseth him that gives and him that takes: T is mightiest in the mightiest; it becomes The throned monarch better than his crown: The Merchant of Venice, William Shakespeare, 1564 - 1616

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom -Viktor Frankel, 1905 1997 h_in_search_of_meaning Bertrand Russell, 1872-1970 Three passions, simple but overwhelmingly strong, have governed my life: -the longing for love -the search for knowledge

-and unbearable pity for the suffering of mankind Thank you ? Questions Workplace Health A Healthy Workplace What are the features of a poor workplace? What makes a workplace good?

PERCENT OF POPULATION REPORTING HEALTH INTERFERING WITH WORK OR OTHER REGULAR DAILY ACTIVITY (SF-36) % Postal survey of 9332 adults (16-64 yrs) Oxford Region Stewart-Brown S, Layte R. J Epid Comm Health 1997 Workplace health: (1) absences 113m days lost in England each year to sick leave (1m with sick leave 4 weeks plus) 70m related to mental illness

Cost in ESA/IB was 2x musculoskeletal Off for more than 6 months only 20% chance of returning in 5 years (2) Presenteeism Unrecognised and untreated mental health issues reduce productivity possibly by as much as absences Many people fail to take necessary sick leave When these workers do take sick leave, they take longer to recover

Co-morbidity is common (3) Causes of causes! (psychological) Self-rated health and social construction of poor health at work Early life risk factors : parenting, child temperament, cognitive ability and speech, educational experience and attainment Poor working circumstances:

- job strain (high demand, low (4) More causes of causes! (sociological/political economy) Restructuring of global economy and redesign of work Part-time, unsocial hours and zero-hours Hollowing-out of lower and middle class occupations and professions Work surveillance and control Impact of austerity and shrinking public sector Status and class (Marmot and Savage)

Example: people maintained in productive work Discuss the costs and benefits of maintaining people in productive work Example: people maintained in productive work

benefits savings to firms/organisations from costs of vacancies, agency cover, lost productivity reduced costs to Department of Work and Pensions increased tax revenues, multiplier effect and social contributions

reduced costs to primary care, mental health and social care services reduced detrimental impacts on other services, families and communities but opportunity cost of other (lost) investments marginal elasticity and scale factors reduced productivity and substitution negative macro-economic effects Making work better Psychologically healthy organisations Positive psychology in the workplace (Oswald)

Group and individual resilience Well-designed work Training for managers Focus on functioning Prioritization for secondary services Making organisations and society better!

Utopian or Scientific? Living wage Early support for children and parents Appropriate, personalised discretion Meaningful work and recognition of value Ethical leadership and removal of fear Work/life balance, family support Handling change and crisis management

References (1) Acas 2011. The Equality Act what`s new for employees? Black C. 2008.Working for a healthier tomorrow. Stationary Office. Harvey S, Joyce S, Tan, L, et al. Developing the mentally healthy

workplace: A review of the literature. Sydney 2014. Henderson M and Madan I. Mental Health and Work. 2014. CMO, Ch 10. Improving Health and Changing Lives 2008. Govt. Publications Karasek R and Theorell T 1990. Healthy Work: stress, productivity and the reconstruction of working life. Basic Books. Keegan S 2015. The Psychology of Fear in Organizations. Kogan Page. Kivimaki M, Elovaino M, Vahetra J .Organisational Justice a new psychosocial predictor of health. Am J Public Health 2002;92(1): 105-8. References (2)

Marmot M 2015. The Health Gap. Bloomsbury. OECD. Mental Health and Work United Kingdom,2014. Oswald A (forthcoming) Journal of Lbour Economics Race M-C and Furnham A 2015. Mental Illness at Work. Palgrave Macmillan

Savage M 2015 Social Class in the C21st.Pelican. Schrecker T and Bambra C 2014 How Polititics Makes Us Sick Schultz AB, Edington DW. Employee health and presenteeism: a systematic review. Journal of Occupational Rehabilitation 2007; 17(3):54-79 Siegrist J. Adverse health effects of high effort/low reward conditions. J Occup Health Psychol 1996;1(1): 27-41

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