World Suicide Prevention Day (WSPD) on 10 September 2022, is organised by the International Association for Suicide Prevention (IASP) to advocate and communicate a singular message that suicide can be prevented. The MENTUPP Consortium, an international consortium of experts in mental health, suicide prevention, depression, stigma, implementation science, and health economics, proudly supports WSPD and World Suicide Prevention Week by developing, implementing, and evaluating the MENTUPP intervention aimed at preventing suicidal behaviour in the workplace.
Introduction
This briefing highlights the existing gaps in mental health policy with regards to the workplace. It articulates the need to develop workplace mental health strategies to promote the mental health of all employees and employers and to ensure the early identification and treatment of mental health conditions across the EU and in Australia.
Mental health difficulties represent an important public health matter, affecting one in six people in Europe in 2016 (1), and the work environment has the potential to exacerbate poor mental health or to positively contribute as a source of wellbeing (2). Mental health in the workplace has long been underestimated in most societies and by policymakers due to the existence of widespread stigma and preconceptions about mental illness (1). This neglect matters for two important reasons. First, mental ill-health in the workplace, particularly stress, burnout, depression, and anxiety, is common, affecting one in five European workers. Second, the social and economic costs of mental illness in the workplace are high for affected individuals, managers, and the EU economy (3.5-4% GDP) as a whole (1).
Small and medium-sized enterprises (SMEs) are the backbone of the EU economy and represent more than 90% of all businesses in the EU and Australia (3). SMEs, therefore, have huge potential for influencing population health on a larger scale. SMEs generally do not have comparable employee welfare and mental health resources to those of larger organizations, which warrants the development of accessible online mental health promotion tools that are 1 easy to deliver and implement. Since most of adult life is spent in the workplace, SMEs represent an ideal setting for health-informed initiatives that promote mental wellbeing and design healthy environments.
For enterprises, mental health initiatives can save substantial resources by increasing productivity, encouraging retention, and reducing absenteeism, presenteeism and healthcare costs (4). Together with targeted initiatives such as MENTUPP, integrated policy approaches are needed to support better mental health promotion in the workplace, which entails providing key players, including employers, with clear guidelines on their responsibilities, tools, and training opportunities for identifying and addressing mental illness in a timely manner, as well as access to professional resources available for help and support.
Problem
A negative working environment can lead to physical and mental illnesses, harmful use of substances or alcohol, absenteeism, presenteeism, and lost productivity (4). Stigma and social exclusion of people with mental disorders are key factors in the under-recognition and low treatment rate of mental disorders, in particular in workplace settings (5). Yet, not all EU Member States started from the same digital and technological point, thus strongly affecting patients and individuals that sought professional help and/or support in the past year (6).
Solution
“Mental Health Promotion and Intervention in Occupational Settings”, MENTUPP, is a four-year EU-funded project involving 17 partners and focusing on developing a multilevel intervention that can be successfully implemented by SMEs in the construction, healthcare, and Information and Communication Technology (ICT) sectors. The intervention addresses the following three components:
• Stress, burnout, wellbeing, and depressive symptoms (non-clinical),
• Depressive disorders and co-morbid anxiety according to ICD-11 (clinical), and
• Destigmatisation of mental (ill-)health.
The MENTUPP intervention:
• Provides information and tools that can help SMEs to better promote wellbeing at work, creates a supportive environment, and prevents and manages the mental health of staff;
• Provides guidance for SMEs on how to identify employees with mental health problems, allowing SMEs to become active at an earlier stage and before more severe conditions develop; and
• Supports SMEs in creating mentally healthy workplaces, which have been found to be associated with less absenteeism and higher work performance.
The MENTUPP intervention is built on a solid foundation of evidence, which leverages extensive experience from partner European Alliance Against Depression’s, four-level community-based intervention to improve mental health and reduce suicide risk in Europe, and partner Mates in Construction (MIC)’s successful workplace intervention to reduce suicide amongst construction workers in Australia (7). The MENTUPP intervention is currently being tested in a Cluster Randomised Controlled Trial (cRCT) in SMEs across eight countries in Europe and Australia, looking at mental health outcomes, cost-effectiveness (including absenteeism, higher work performance) and implementation factors to establish a robust evidence base.
Policy and Legislation
The MENTUPP consortium designed and disseminated a survey to a panel of experts in the field of mental health in the participating countries to assess challenges and barriers of mental health in the workplace, existing preconceptions and stigma in the workplace, and the potential rate of success of the MENTUPP multilevel intervention in the workplace. The results of the expert survey confirmed what the previously conducted literature review had highlighted; lack of commitment from managers and supervisors to promote mental health in the workplace, existing stigma, time-management issues, and the lack of policy addressing mental health interventions in the workplace are key barriers that could affect the success of the MENTUPP multilevel intervention (8). From the expert survey, key differences between the construction, health, and ICT sectors also emerged.
Governments play an essential role in designing policy and regulatory frameworks that foster mentally healthy workplaces and facilitates the access to effective treatments for all employees in need. Many improvements in the management of mental health issues in the workplace have resulted from the adoption of top-down approaches, where legislative changes have occurred followed by targeted policy initiatives (9).
A mental health policy and regulatory framework for the workplace is a fundamental component in creating a healthy work environment and improving employees’ mental health. Establishing this as a model for action is key. Without a top-down approach, the lack of coordination and the possibility of fragmentation would reduce the impact of any mental health intervention in the work environment.
Policy Recommendations
Based on the key findings of the expert survey (8) and the MENTUPP Pilot Study (10), the MENTUPP consortium recommends to:
• Initiate consultation with a range of government and non-government stakeholders;
• Foster mental wellbeing of all employees and employers by reducing stigma related to and raising awareness of mental health conditions;
• Encourage activities/initiatives in the workplace that promote mental health and enable employees to safely seek help when mental illness occurs;
• Promote and enforce psychosocial risk assessment and risk prevention in the workplace in line with appropriate privacy and non-discriminatory legislation, with the adequate support of occupational health services in order to ensure that all enterprises have complied with their legal responsibilities;
• Address stigma, discrimination, and misconceptions through the introduction of compulsory training for managers and employees in enterprises for better identification of mental ill-health and active promotion of workplace psychological health and safety; and
• Raise greater awareness of the labour productivity losses due to mental health conditions by designing guidelines for managers and human resource professionals to encourage a better response to workers’ mental health conditions and to offer advice on when and how to seek professional support, with due regard to personal privacy.
For more information about the MENTUPP Project, check our website at https:// www.mentuppproject.eu/.
References
1.OECD. Integrated Mental Health, Skills and Work Policy. OECD. [Internet]. 2018. [cited 2022 Aug 17]. Available from: https://www.oecd.org/els/emp/Flyer_MHW%20Council%20Recommendation.pdf
2. Cottini, E. and Lucifora, C., 2013. Mental Health and Working Conditions in Europe. ILR Review, 66(4), pp.958-988.
3. European Commission, Directorate-General for Internal Market, Industry, Entrepreneurship and SMEs. User guide to the SME Definition [Internet]. Available from: https://ec.europa.eu/regional_policy/sources/conferences/state-aid/ sme/smedefinitionguide_en.pdf
4. Cohen, A. Addressing comorbidity between mental disorders and major noncommunicable diseases [Internet]. Who.int. [cited 2022 Sep 14]. Available from: https://apps.who.int/iris/bitstream/handle/ 10665/344119/9789289052535-eng.pdf?sequence=1&isAllowed=y
5. Eiroa-Orosa FJ, Lomascolo M, Tosas-Fernández A. Efficacy of an intervention to reduce stigma beliefs and attitudes among primary care and mental health professionals: Two cluster randomised-controlled trials. Int J Environ Res Public Health [Internet]. 2021;18(3):1214. Available from: http://dx.doi.org/10.3390/ijerph18031214
6. Nicolás ES. Revealed: Hit to EU mental health services during Covid-19 [Internet]. EUobserver. [cited 2022 Sep 14]. Available from: https://euobserver.com/health-and-society/150262
7. Gullestrup, J.; Lequertier, B.; Martin, G. MATES in Construction: Impact of a Multimodal, Community-Based Program for Suicide Prevention in the Construction Industry. Int. J. Environ. Res. Public Health 2011, 8, 4180-4196. https:// doi.org/10.3390/ijerph8114180
8. Hogg B, Moreno-Alcázar A, Tóth MD, Serbanescu I, Aust B, Leduc C, et al. Supporting employees with mental illness and reducing mental illness-related stigma in the workplace: an expert survey. Eur Arch Psychiatry Clin Neurosci [Internet]. 2022; Available from: http://dx.doi.org/10.1007/s00406-022-01443-3
9. World Health Organization. Mental health policies and programmes in the workplace. [Internet]. 2005. Available from: https://www.who.int/mental_health/policy/services/13_policies%20programs%20in%20workplace_WEB_07.pdf
10. Arensman E, O’Connor C, Leduc C, Griffin E, Cully G, Ní Dhálaigh D, et al. Mental health promotion and intervention in occupational settings: Protocol for a pilot study of the MENTUPP intervention. Int J Environ Res Public Health [Internet]. 2022;19(2):947. Available from: http://dx.doi.org/10.3390/ijerph19020947
