Mental Health is your business: Workplace Interventions that do good, and those that do harm

Key points

  • To promote mental health, give employees more control over the scheduling of their own work and introduce programs to facilitate a healthy lifestyle, for example enabling employees to engage in physical activity
  • Screen employees when appropriate; recommend and support Cognitive-Behavioral Therapy and other effective interventions for those diagnosed with a mental health disorder
  • Recognize interventions which do not work and might even have adverse effects. Thinking again about prior decisions might save money and time.


What does work have to do with mental health? When I told a friend the topic of the article I was writing, he dismissed it by saying: “but people who work don’t have mental health problems, otherwise how could they work?”.  He was right and wrong at the same time. It’s true that the most common mental health disorders, namely anxiety and depression, are the leading cause of sickness absence and long-term work disability in developed countries. But it’s wrong to assume that work and mental health are two separate affairs: work-related factors such as high demands and low control cause stress and increase the risk of being diagnosed with anxiety or depression. Such disorders are often treatable and sometimes preventable, therefore it is logical to look at what organizations can do to prevent these conditions and to support employees who suffer from them. Aside from better well-being for your employees, taking action might also improve organizational and economic outcomes of your company. But how do you choose an intervention with the best chances of actually working?


Not all interventions are created equal

A very recent systematic review conducted by Joyce et al. (2016) takes a thorough look at what managers can do in the workplace to combat common mental health disorders. They analyzed existing research and summarized what we know about what could work, and what might not.

The best way to conclude whether a particular intervention is useful or not is to try it out with a group of randomly selected people, while another, very similar to the first one, acts as a control group and continues to work as normal. After a period of time, improvements in the group who received the treatment indicate that the intervention might be effective. This conclusion becomes stronger every time independent teams of researchers repeat this trial and get the same results. Unfortunately, research involving this type of trials is not always available, and therefore it is also useful to look at less-solid research which might still indicate whether an intervention works or not.

The review presented here gathers both high-quality and lower-quality research about promoting mental health in the workplace. It indicates a few specific well-established interventions which should improve both your employees’ mental health and broader outcomes in your organization. At the same time, some popular interventions not only fail to bring the desired results, but they might even make things worse for your employees.


Here’s what works

Firstly, for workers diagnosed with anxiety or depression, Cognitive-Behavioral Therapy (CBT) helps reduce their symptoms and psychological distress, but also the time it takes for them to return to work after sick leave. For those who keep working throughout the treatment, CBT also improves job performance and productivity. CBT assumes that our emotions and behaviors are determined by our thoughts/thinking, so therapy aims to change a person’s specific misconceptions and harmful assumptions. Within the various CBT programs, one particular intervention stands out as the most effective: problem-solving therapy, which focuses on building practical problem-solving skills.



For employees suffering from anxiety disorders or Post-Traumatic Stress Disorder (PTSD), following an incident at work, exposure therapy is likely to reduce their symptoms, accelerate their return to work, and improve their productivity.

Both CBT and PTSD exposure therapy address people already suffering from a diagnosed mental health disorder. Unfortunately, the evidence is less clear for proactive interventions aiming to prevent  anxiety or depression. For a start, promoting physical activity is likely to reduce employees’ anxiety and could also reduce absenteeism in the organization. It can be particularly effective against mental health disorders when it is part of a more extensive workplace health promotion program, aiming to change employees’ lifestyles in multiple ways.

Other interventions increase the control which employees have over their work, and they are also likely to help prevent mental health disorders. For example, such interventions consist of setting up committees for problem-solving or stress reduction, allowing employees to schedule their shifts themselves, and facilitating gradual or partial retirement.


What doesn’t work and might even cause harm

Unfortunately, certain interventions cause more harm than good for the people they pledge to protect. Performing mental health screenings too regularly and on all employees can increase distress, heighten stigma and make people feel less well because they then focus more on their symptoms. Workplace screening can slightly improve mental health, but only if you limit it to appropriate situations and follow up with concrete actions or support.

Another intervention which will potentially harm employees is involving them in psychological debriefing following a potentially traumatic event in the workplace. This particular intervention does not relieve stress, as it claims to, and can actually produce adverse effects.


Takeaways for your practice

Firstly, take action for the employees who already suffer from a mental health problem: help them get effective therapies such as CBT or PTSD exposure therapy.

  • As a manager, make yourself aware of certified psychotherapists to deliver these therapies, and suggest institutions or psychotherapists which your employees can reach out to.
  • You can also make it easier for employees to access these therapies by fully or partially supporting the costs or by allowing a flexible work schedule.

By supporting such interventions for those who need them, you can expect improvements not only in their well-being, but also within your organization.

Secondly, think proactively about preventing mental health problems in your company:

  • Increase the control employees have by giving them flexibility in how they schedule their shifts and by implementing a gradual retirement program.
  • You could also design and implement a wider health-promotion program which includes physical activity in the workplace. Find  a space in the building and turn it into a gym, or offer membership to a gym close to the office. You could also check if the workload of your employees leaves them with enough time to actually take advantage of this program: there are indications that these factors might play a role (Mazzola, Moore and Alexander, 2016). In particular, promote aerobic exercise or a combination of exercise and relaxation, which is most likely to reduce your employees’ anxiety.


Trustworthiness score

We critically evaluated the trustworthiness of the research we used to inform this Evidence Summary. The original study reviews 481 single research studies of varying quality. Depending on the kind of studies available for each intervention, the trustworthiness of the conclusions differs:



Learn how we critically appraise studies to assign them a Trustworthiness Score.

We aim to provide you only the best available scientific evidence to inform your decisions.

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References

Joyce, S., Modini, M., Christensen, H., Mykletun, A., Bryant, R., Mitchell, P. B. & Harvey, S. B. (2016). Workplace interventions for common mental health disorders: A systematic meta-review. Psychological Medicine, 46, 4, 683–697.

Mazzola, J. J., Moore, J. T., and Alexander, K. (2016). Is work keeping us from acting healthy? How workplace barriers and facilitators impact nutrition and exercise behaviors. Stress and Health.

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2 comments

  1. It’s really good to see Science For Work championing more attention to mental health at work. It would be justified on economic grounds alone considering the cost to employers and the economy of mental ill health, but it is even more important from a wider human perspective bearing in mind the amount of human suffering that it causes.

    But it is a pity that this article almost exclusively discusses conventional (face to face) CBT. Cognitive behaviour therapy has been the default workhorse for many conditions for a long time (certainly in the , but it is by no means the only approach. For example, it was disappointing to see no reference at all to third wave behavioural and cognitive therapies like Acceptance and Commitment Therapy (ACT), or to the possibilities of online therapy offer to lower barriers and make providing help for employees much more cost-effective than 1:1 therapy or counselling.

    Raising awareness about mental health at work is very important, but this should also give employers a broader view of the options that exist to support their employees.

    • Hi Koenfucius, thank you for your remarks. Indeed, as you point out, our article is not exhaustive regarding which interventions might work. We based this piece of writing on one article which looked in detail at especially high-quality published research, and although the article is from 2016, it might have missed newer therapies that have simply not been investigated as much yet, especially regarding their relation with the workplace.
      Regarding the specific forms of psychotherapy you mention, computerized CBT indeed seems to be a viable and cheaper alternative to face-to-face CBT. However, as the NICE guidelines very transparently explain (https://www.nice.org.uk/guidance/ta97/chapter/4-Evidence-and-interpretation), there is quite some variance in the CCBT programs available, which makes it difficult to make general recommendations about it as a whole.
      As far as ACT goes, the research we’ve looked at indicates contradictory findings (some meta-analyses find ACT works better than CBT, while others conclude it doesn’t). For sure new psychotherapies are something we will look into in the future, in order to, as you say, offer employers a broader view of ways to support employees’ mental health.