Framework for Mentally Healthy Workplaces

This article, titled “A mentally healthy framework to guide employers and policy makers” by Deady, Sanatkar, Tan, et al. (2024), provides an updated comprehensive framework for creating mentally healthy workplaces. This framework is designed to guide employers and managers in applying strategies and inform future research avenues.

The authors highlight that mental health problems among the working population are a growing concern with significant impacts on individuals, organizations, and social welfare systems. While workplaces present both psychosocial risks and unique opportunities for intervention, clear, evidence-based guidance has been limited despite a rapid expansion of interventions. Previous models often did not adequately consider the full evidence base or where best-practice principles alone informed action.

The update to the Framework for Mentally Healthy Workplaces was necessitated by three major developments:

• The World Health Organization (WHO) released its first-ever evaluation and guidance for mental health at work in 2022.
• An updated meta-review of the evidence base for workplace psychosocial risks and interventions became available.
• National and international regulatory and legislative changes have shifted employer responsibilities regarding mental health at work.

The updated framework incorporates concepts from existing alternate models to present a comprehensive overview of strategies aimed at enhancing wellbeing, minimizing harm, and facilitating recovery. It draws on both primary, secondary, and tertiary level evidence from specific programs, and evidence-informed principles underpinning mental health and wellbeing strategies within organizations.

A key innovation of this updated framework is its three-pillar classification for strategies: Protect, Promote, and Respond. These pillars aim to deliver benefit across an individual worker’s mental health spectrum:

• Protect strategies are primary or universal prevention interventions designed to mitigate hazards and minimize harm or psychosocial injury.
• Promote strategies go beyond harm minimization to enhance wellbeing and foster thriving.
• Respond strategies are delivered when a worker is experiencing distress or illness, including tertiary interventions for those unwell or returning from sick-leave. Promote strategies benefit all workers regardless of their mental health status, with a primary emphasis on early stages of the mental health spectrum.

Furthermore, the framework delineates four workplace strategy levels to guide where interventions can be directed within an organization, aligning with categories of workplace risk factors:

• Systems and Policy level: Focuses on organizational policies and procedural arrangements.
• Operations and Team level: Encompasses initiatives optimizing interpersonal, team, and general work environments.
• Job level: Refers to initiatives altering the design, delivery, or content of work tasks.
• Individual level: Includes programs delivered to employees to modify perceptions and responses to conditions/experiences, rather than changing the workplace itself.

Key Changes from the Original Framework:

• Incorporation of the “Promotional” pillar.
• Finer delineation of the four strategy levels of intervention.
• Richer consideration of evidence-informed principles underpinning strategies.
• Update based on new evidence.

Here are more details on strategies under each pillar and level:

I. Protect against harm This pillar focuses on identifying and managing work-related hazards to prevent and minimize harm. Employers have legal obligations to manage psychosocial hazards.

• Systems and Policy Level:
  • Develop systems to identify and mitigate harm, including collective psychosocial risk assessment and management. This involves hazard analysis, risk evaluation, and implementation/monitoring of mitigation strategies.
  • Policies should reflect the organization’s cultural values regarding psychological health and provide means for implementing practices at other levels, such as flexible working policies and procedural fairness standards.
• Operational and Team Level:
  • Maintain a safe and healthy physical and social environment.
  • Preventative manager training has shown to improve managers’ knowledge, attitudes, and self-reported behavior in supporting employees.
  • Mitigating hazardous physical conditions (e.g., noise, temperature, lighting, ergonomics) is recommended, though rigorous evaluation of these interventions for mental health is limited.
  • Anti-bullying interventions exist, but evidence for their effectiveness is currently limited.
• Job Level:
  • Design and re-design jobs to minimize psychological harm.
  • Strategies include improving job control (e.g., decision latitude, flexibility, autonomy), mitigating high-risk work, increasing job security, and limiting long hours. The SMART work design model aims to prevent harm by increasing job resources and reducing adverse demands.
• Individual Level:
  • Provide universal and selective prevention programs.
  • Universal prevention programs are offered to all employees to prevent mental illness symptom development. Widely evaluated interventions are based on cognitive behavior therapy (CBT), stress management, or mindfulness principles. These programs, often digital, can reduce stress, depression, and anxiety symptoms.
  • Selective prevention programs target employees at specific risk, particularly in high-stress occupations. They often utilize CBT or mindfulness techniques and show small to moderate effects on depression, anxiety, and stress outcomes. Post-incident interventions show strongest support for trauma-focused CBT. Psychological First Aid (PFA) is suggested as a safe alternative to traditional debriefing following traumatic events.

II. Promote good health This pillar acknowledges the shift toward a more holistic view of wellbeing, focusing on initiatives that enhance positive aspects of work and worker strengths.

• Systems and Policy Level:
  • Consider policy to amplify positive aspects of work and engender wellbeing.
  • Comprehensive programs like Total Worker Health (TWH), which integrate organizational and individual approaches, have shown positive impact.
  • Developing psychologically safe environments—where employees feel confident to raise ideas and concerns without fear—is critical for wellbeing.
• Operational and Team Level:
  • Foster growth and wellbeing through physical and social environment.
  • Initiatives to target relational enhancements include team cohesion programs and communal spaces to increase social connection.
  • Spatial considerations like natural light, outdoor spaces, and indoor plant installations have been linked with enhanced socialization, stress reduction, and improved wellbeing.
• Job Level:
  • Design and re-design work to build positive emotional states.
  • Strategies often overlap with “Protect” (e.g., SMART work design, increased autonomy/job control, flexible working).
  • Job crafting, an employee-initiated approach to modify tasks and roles to suit optimal working, is linked to increased health, job satisfaction, and engagement.
• Individual Level:
  • Offer programs to improve personal wellbeing.
  • Most interventions utilize physical activity, mindfulness/meditation, positive psychology, or resilience training principles.
  • Mindfulness-based programs are widely implemented and have been shown to increase positive affect, overall wellbeing, and resilience.
  • Positive psychology interventions (e.g., gratitude- or mindfulness-focused) are associated with improved wellbeing, job satisfaction, and reduced negative symptoms.
  • Resilience interventions (often combining CBT/mindfulness) also show positive effects on wellbeing.

III. Respond to ill health This pillar focuses on the important role workplaces play in responding to employee psychological distress and mental illness by building systems, facilitating care, and offering appropriate adjustments.

• Systems and Policy Level:
  • Incorporate systems to respond to ill health.
  • This includes equity, diversity, and inclusion practices to address unique mental health needs related to diversity and destigmatization.
  • Early identification via mental health screening tools is used, but current international guidelines do not recommend universal screening unless linked to enhanced access to treatment.
  • Return-to-Work (RTW) planning is central to recovery and reintegration, considering role clarity, employer-worker expectations, and supervisor/colleague literacy. Workplace adjustments (e.g., to work schedules, roles) are crucial, though evidence for specific adjustments can be limited.
• Operational and Team Level:
  • Facilitate help-seeking and provide a supportive recovery environment.
  • Skill-based training for managers is highly effective in increasing manager confidence and skills in mental health conversations, potentially reducing sick leave.
  • Mental health awareness and anti-stigma programs can improve knowledge and attitudes.
  • Mental Health First Aid (MHFA) training aims to teach recognition and response to mental health problems, showing improvements in knowledge and confidence.
  • Peer support programs are an emerging intervention, especially in high-risk occupations, promoting early help-seeking and reducing perceived barriers to care.
• Job Level:
  • Adjust work to support recovery.
  • Critical aspects include RTW policy, active management, and collaborative consultation.
  • Employers may be required to provide reasonable adjustments to ensure employees with disabilities are not discriminated against, such as working hour adjustments, staggered returns, or review of tasks.
• Individual Level:
  • Provision of programs to reduce symptoms and illness.
  • Indicated prevention for depression supports CBT approaches, with some evidence for physical exercise, mindfulness, and resilience training for at-risk employees.
  • Workplace counseling, often through Employee Assistance Programs (EAPs), can be effective in improving anxiety, stress, and depressive symptoms, though study quality can vary.

Challenges and Gaps in Evidence: The authors emphasize a significant knowledge gap regarding effective evidence-based workplace interventions, especially at the job, team, or system levels, where evaluation studies are more complex to conduct. There is a tendency for workplaces to favor individual-level changes, which risks overlooking mental health-adverse operational or systemic factors and places the onus on employees.

The framework acknowledges that external factors (e.g., regulatory frameworks, health services, socioeconomic conditions) profoundly influence employee mental health and can present barriers to intervention. Furthermore, there is a lack of information on comparative (cost-)effectiveness, uptake, and acceptability of interventions, particularly for smaller, non-sedentary, or resource-poor workforces, as the evidence base is often derived from large, white-collar organizations in high-income countries.

In conclusion, the updated framework provides a systematic, coordinated, and multi-level approach to integrating mental health considerations, strategies, and interventions in the workplace. It aims to equip employers with the knowledge to make appropriate changes for their specific business and workforce, fostering workplaces where employees are healthy and can thrive by promoting positive wellbeing, mitigating risk, and addressing symptoms of poor mental health at all stages.

APA Reference: Deady, M., Sanatkar, S., Tan, L., Glozier, N., Gayed, A., Petrie, K., Dalgaard, V. L., Stratton, E., LaMontagne, A. D., & Harvey, S. B. (2024). A mentally healthy framework to guide employers and policy makers. Frontiers in Public Health, 12, 1430540. https://doi.org/10.3389/fpubh.2024.1430540