Key facts
Work is good for mental health but a negative working environment can lead to physical and mental health problems.
Depression and anxiety have a significant economic impact; the estimated cost to the global economy is US$ 1 trillion per year in lost productivity.
Harassment and bullying at work are commonly reported problems, and can have a substantial adverse impact on mental health.
There are many effective actions that organizations can take to promote mental health in the workplace; such actions may also benefit productivity.

Unemployment is a well-recognized risk factor for mental health problems, while returning to, or getting work is protective. A negative working environment may lead to physical and mental health problems, harmful use of substances or alcohol, absenteeism and lost productivity. Workplaces that promote mental health and support people with mental disorders are more likely to reduce absenteeism, increase productivity and benefit from associated economic gains.
Work-related risk factors for health
There are many risk factors for mental health that may be present in the working environment. Most risks relate to interactions between type of work, the organizational and managerial environment, the skills and competencies of employees, and the support available for employees to carry out their work. For example, a person may have the skills to complete tasks, but they may have too few resources to do what is required (inadequate PPE during covid-19 pandemic), or there may be unsupportive managerial or organizational practices.

Risks to mental health include:
inadequate health and safety policies;
poor communication and management practices;
limited participation in decision-making or low control over one’s area of work;
low levels of support for employees;
inflexible working hours; and
unclear tasks or organizational objectives.

Bullying and psychological harassment are commonly reported causes of work-related stress by workers particularly health care workers (doctors and nurse) to be sources of risks to their health. Both are associated with both psychological and physical problems. These health consequences can have costs for employers in terms of reduced productivity and increased staff turnover. They can also have a negative impact on family and social interactions.
Some jobs may carry a higher personal risk than others (e.g. first responders, health care workers and humanitarian workers), which can have an impact on mental health and be a cause of symptoms of mental disorders, or lead to harmful use of alcohol or psychoactive drugs.
It is of note that health-care workers (HCW) involved in the response to the COVID-19 pandemic are often required to work in highly challenging conditions and may therefore be at increased risk of experiencing mental health problems.
Throughout the COVID-19 pandemic, many health-care workers (HCWs) have worked extremely long hours in high-pressure environments. Additionally, they may have been exposed to trauma and/or faced moral dilemmas relating to challenges in the delivery of high-quality care, possibly due to a lack of experience and equipment, or because availability of few staff. These unprecedented circumstances are likely to increase the risk of mental health disorders such as post-traumatic stress disorder (PTSD) or depression, other anxiety disorders, substance misuse and suicide. HCWs caring for patients with COVID-19 are also at increased risk of infection, and by extension, have to contend with the risk of infecting their families.
The risk of psychological harm is not restricted to frontline HCWs; in fact, most HCWs, regardless of their specialty, are likely to have experienced notable challenges since the pandemic began, including changes to the way they work and, at times, being unable to deliver the quality of care they would normally do. Whilst some HCWs will undoubtedly thrive in such stressful circumstances, it is imperative that employers of HCWs take measures to protect the mental health of staff as well as identify those who do experience psychological injuries, to ensure they are provided with appropriate evidence-based support or care.
Two risk factors most strongly predictive of long-term mental health status are lack of post-trauma social support and exposure to stressors during recovery from trauma. These stressors might be directly attributable to the trauma, for example, the death of a family member or co-worker, or secondary to the crisis, such as relationship difficulties. The powerful effect that supportive employers CAN have on the mental health of their staff is globally. Taken as a whole, available evidence suggests that protecting the mental health of HCWs requires consideration of four key elements.
First, HCWs should be thanked.
Appropriate acknowledgement of the challenging work undertaken can foster resilience. This acknowledgement should also include recognition of potential psychological difficulties and provide information about support options available.
Second, given that avoidance is a key symptom of traumatic stress and this behaviour may manifest through distressed staff staying away from work, it is imperative that staff who do not turn up to work are contacted in case their non-attendance is indicative of poor mental health.
Third, as the COVID-19 pandemic begins to recede all HCWs should receive ‘return to normal work’ interviews. These should happen as staff begin the transition from crisis response roles back to the new normal and supervisors who, by virtue of experience or training, can confidently speak about mental health should conduct it. They provide an opportunity for a supervisor to better understand a staff member’s experiences and can help foster an ‘it’s okay not to be okay’ approach to mental health.
Fourth, anyone who have been exposed to a potentially traumatic event should be actively monitored, particularly those considered at higher risk of developing mental health problems. Although this type of monitoring forms part of good management, available evidence suggests that proactively, asking such individuals about their mental health can increase the take-up of mental health care. This monitoring could be achieved with an anonymous, online self-check tool comprising a range of mental health measures giving tailored advice, such as self-help information or ways to access professional care. Such an anonymous approach is likely to increase the chance that HCWs will use the self-check tool.
Lastly, given the likelihood that HCWs have been exposed to morally distressing circumstances during the COVID-19 pandemic, most probably repeatedly in different scenes, employers should help them to make sense of their experiences. Being able to develop meaningful narrative that does not blame themselves or others for what happened during the crisis or any other difficult situations is likely to reduce the risk of them suffering psychological harm.
Supporting the mental health of HCWs is not just morally justified — done well it should lower the risk of mental illness and maximize the opportunity for staff to experience psychological growth from overcoming the challenges faced during the pandemic or any other challenging situations.
The unwritten psychological contract between HCWs, their employers and the public has been that staff members will give their all to save lives and in return the nation does all it can to protect their mental health through the provision of proper support.
Finally, health-care employers have a substantial role to play in protecting the mental health of their staff as well as in helping those that need additional care and support to access it.

Dr. Olufunmilayo Akinola (MBBS,FMCPsych) is the Chief Consultant Psychiatrist in Charge of the Federal Neuropsychiatric Hospital Annex, Oshodi Lagos. She is a fellow and examiner of the National Postgraduate Medical College of Nigeria, a Consultant to the Nigeria Navy Reference Hospital, Ojo and a NEBOSH internationally certified Occupational Health and Safety Specialist.
A trained mentor, Dr Akinola’s interests also include Rehabilitation, Advocacy, Hospital Management and Enlightening people about their Behavioural Health through print and electronic media.
An avid reader and traveller, Dr Akinola is a certified Jesus lover and she is happily married to Rev. Idowu Akinola. The union is blessed with lovely children.

She is also involved with a lot of mental advocacy activities with community based societies.

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Milligan-Saville, J. S. et al. Workplace mental health training for managers and its effect on sick leave in employees: a cluster randomised controlled trial. Lancet Psychiatry 4, 850–858 (2017).

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