Mental health in the workplace koamed occupational medicine

In the last two blogposts, we described why psychosocial health plays such a big role in occupational health right now and which demographics are most at risk. We were able to illustrate that demographic vulnerability is often related to the following factors: (Female) gender, age and origin.

In this blog post, I would now like to share with you some of the theoretical background on mental health. In addition, it is important for me to explain how we classify mental health in occupational medicine. This is how you can deal with the ie of mental stress in your company and what to do if you suspect hazards. In other words, this post will give you an introduction to the theoretical basis of mental health in occupational health practice. Hopefully, this will make this complex topic tangible to you.

What is mental health?

The World Health Organization (WHO) defines health in its constitution thus:

"a state of complete physical, mental, and social well-being and not merely freedom from disease or infirmity."

So this definition also includes mental and social health, as well as the concept of well-being. Thus, it can be said that a person's well-being is an essential component of their health: spiritual, psychological, and physical well-being.

"a state of well-being in which a person can realize his or her capabilities, cope with the normal stresses of life, work productively, and contribute to his or her community."

In this definition, we can find three important elements of mental health: Agency, Resilience, and Productivity. In addition, according to the definition, good mental health enables social participation and performance. In principle, this is the state of a good employee – a person who is capable of action, resilient and productive, who is able to participate socially and contribute something. Someone who can tackle. Someone who feels good and can therefore draw from the full.

Work is important for mental health

According to the WHO and other experts, for example the Action Alliance for Mental Health, work is in principle very important for our mental health. Work creates structure, meaning, a sense of being needed. This is where social contacts are made and maintained. Whoever works has a task in society. Work is thus fundamentally beneficial to health – if we also design it in a way that promotes health.

Especially for vulnerable people, as we described in our last blog post, the workplace can quickly become a health trap. Therefore, it is essential that employers commit to health promotion and engage in regular training to protect vulnerable employees from mental stress at work through effective prevention.

Psychological stress at work

In recent years, we have observed an increase in mental illnesses in our society. In relation to the workplace, this often involves talk of burnout, depression and anxiety disorders. In Germany, more than 50% of employees feel limited in their ability to work due to mental stress, and in the last 15 years the proportion of depression and anxiety disorders has risen by 80% – frightening statistics!

In general, it is important to emphasize that mental stress is always a component of work. Basically, they can also have a positive effect, for example by leading to training effects or increased motivation. High responsibility, for example, is of course a certain burden, but can also make the person feel particularly valued and significant for the company. However, psychological stress can also have negative effects and, in the worst case, lead to illnesses. We also observe in psychologically overstressed people a tendency to risky behavior and substance abuse, for example increased alcohol consumption.

Psychosocial stress can have a variety of causes, which are sometimes very difficult to grasp. Examples are mobbing or other forms of persistent personal conflicts, shift work, constant prere to perform, overwork, presenteeism despite illness and the fear of losing one's job. All these are elements of so-called precarious working conditions: Problematic factors that arise in the relationship between employer and employee and pose a risk to employee health – including, in particular, psychosocial health. (On the topic of precarious work, I am currently writing my master's thesis in medicine under the supervision of Prof. Dr. Ute Bultmann from the University of Groningen.)

Mental health in occupational health and safety

In occupational medicine, we use the so-called stress-strain model in order to be able to correctly assess work-related mental stresses. This model relates the influences from work to the employee's private environment. Here, among other things, a distinction is also made between work-related psychological stresses. Distinguish work-related mental stress. Work-related stresses are emotional, cognitive or behavioral challenges arising from work content, work environment and work organization. Work-related mental stress refers to the totality of emotional, cognitive, behavioral and centrally nervous reactions to work – in other words, the employee's reaction to the stress. In this context, misuse refers to reactions that significantly impair health in the short or long term. As already mentioned, stresses can also be experienced positively. Stress can ultimately only be measured by observing and consulting with employees regarding their experience, behavior and physical condition.

In occupational health and safety, we are focused on preventing the negative effects of mental stress before they occur or eliminating them early enough so that they do not affect employee health as much as possible. To do this, we look not only at individual employees but also at the structures within the company. Examples of this are the specified working hours, employee management and corporate culture. The most important keyword here is prevention through health management and workplace health promotion measures involving employees and their representatives in the company.

Legal basis for occupational medicine& mental health

Mental health is also legally anchored in all important legal foundations of occupational medicine. Social Code VII already contains an extended prevention mandate for the accident insurance institutions, which also includes them training and advising companies. The occupational physicians of the statutory accident insurance should also support entrepreneurs in their work. Advising insured persons on work-related risks to mental health.

The Occupational Health and Safety Act (ArbSchG), one of the most central laws for occupational health and safety, also includes mental health. According to § 3 para. 1 and § 4 ArbSchG, employers are obliged to provide occupational health and safety in a holistic manner. More precisely, they are required to take occupational health and safety measures, taking into account circumstances that have an influence on the safety and health of their employees at work. Furthermore, employers are obliged to properly link existing technology, work organization, social structures and environmental influences when planning measures. This therefore results in an obligation also to protect the psychosocial health of employees.

Of particular interest to occupational medicine is the Occupational Health and Safety Act §3: This stipulates that company physicians must advise the employer on occupational psychological ies. In addition, it is the task of occupational physicians to analyze working conditions and from this to assess the cause of work-related illnesses. Based on the results of the examination, the company physicians then recommend measures within the company to prevent these illnesses in the future. In addition, company physicians are to instruct all employees about potential health hazards. Employees also learn what measures and facilities are in place to prevent these hazards.

The legal mandate for occupational physicians can also be found in the Ordinance on Preventive Occupational Medicine (ArbMedVV), as well as in the Ordinance on VDU Workplaces. You are obligated to assess mental stress and to assist in its prevention.

We are therefore required by all parties to support you in this challenge – a responsibility that we are very happy to fulfill!

Occupational medical processing of psychological stress

In occupational medicine, it is our task to detect so-called critical constellations at the workplace. This is often done in connection with desired preventive care, in the course of which employees seek contact with us. Another opportunity is the identification of causes for special events. This can be, for example, increased accidents in a department, frequent illness of an employee, or regular conflicts in a work group. On the basis of the events and taking into account the stress-strain model, we determine whether the problem is an individual problem relating to a person or whether there is a structural cause in the company. We analyze the stresses and strains of the individual as well as those of the work area and the company, if necessary. This may require employee interviews, discussions with managers, as well as more detailed analyses. This gives us a good picture of the situation in the company.

This is usually not done exclusively in the context of a "mental risk assessment", for various reasons. The ie of mental health is far too complex for that. It interacts with too many other factors as well as other hazards in the company. The risk assessment can thus be seen more as an orientation prior to a more in-depth analysis. There are other written procedures for this, for example the instrument for stress-related work analysis or the Trier Inventory for Chronic Stress. A site visit and direct questioning of employees can also be very helpful. There is no one-size-fits-all solution: mental stress has a large subjective and individual component. Therefore, it is very important for us to develop the right roadmap together with you. We involve you in all steps to develop the right approach for your company.

Based on the analysis, we advise you on the appropriate measures to take. These can be short-term or long-term, depending on the hazard and the needs of your employees. Short-term measures could be, for example, supportive work equipment, further training or lowering the noise level. Further, company-centered measures are then oriented to the company as a whole. Here, a more detailed survey should take place in order to derive specific solution approaches.