The world is no longer ignoring mental health. It can’t. According to the World Health Organisation (WHO), around 450 million people are currently living with some form of mental health condition, and 25 percent of people will experience a mental or neurological disorder at some point in their lifetime. This makes it one of the leading causes of ill health across the globe.
Alongside the personal, unquantifiable impact of this mental health crisis, the economic costs are stark: the Lancet Commission on Global Mental Health and Sustainable Development estimates that mental disorders will cost the global economy $16trn by 2030. That’s before taking into account lost tax revenues, benefits payouts and increased pressure on public health services. It’s before even considering the impact of COVID-19, which the WHO predicts will see mental health issues across the globe soar in the coming months and years.
The pressure to attend work despite health problems is not conducive to employee wellbeing or good business
It’s not just governments feeling the impact of the global mental health crisis. Businesses – and their bottom lines – are bearing the brunt too. In January, Deloitte published a study titled Mental Health and Employers: Refreshing the Case for Investment, which found that mental-health-related issues cost UK firms as much as £45bn ($56.72bn) a year, up 16 percent from 2017. In the US, the figure sits closer to $100bn, Forbes reports.
Hitting the bottom line
The costs of poor mental health come from a variety of factors. Laurie Mitchell, Assistant Vice President for Global Wellbeing and Health Management at Unum Group, explained: “Lost productivity, lower morale or ‘presenteeism’, when employees continue to work, yet function at a lower level than when they are healthy, mean costs can add up for employers. When you consider that nearly half of employees say they’ve struggled with their mental health in the previous year, it’s easy to see the impact.”
According to Deloitte’s report, presenteeism alone costs UK employers between £27bn ($34bn) and £29bn ($36.6bn) a year, pointing to a facetime culture so ingrained in our psyches that many don’t even question it. In its 2018/19 Workplace Wellbeing Index, mental health charity Mind found that 81 percent of employees said they always or usually came into the office when they were struggling with their mental health and would benefit from time off. According to Unum’s 2019 Strong Minds at Work report, 22 percent of respondents with a mental health issue said that work stress triggered their conditions to flare up or worsen (see Fig 1).
The pressure to attend work despite health problems is not conducive to employee well-being or good business, but neither is absenteeism. Forbes reports that in the US, depression accounts for 400 million lost working days every year. Meanwhile, in the UK, a staggering 54 percent of all sick days taken in 2018-19 were a result of work-related stress, anxiety or depression, according to a report by the government’s Health and Safety Executive.
Businesses have started to wake up to the importance of looking after their employees’ mental health. According to HR consultancy Buck’s global 2018 Working Well report, 40 percent of the organisations surveyed had some form of wellbeing strategy in place, up from 33 percent in 2016. “Wellbeing programmes have really risen up the business agenda over the last five years,” said Paul Barrett, Head of Wellbeing at the Bank Workers Charity. “In 2019, for the first time, health and wellbeing became the biggest HR priority in the UK – something that would have been inconceivable five years earlier.”
Last year, more than 40 CEOs from across the US, led by executives from Johnson & Johnson and Bank of America, attended the American Heart Association CEO Roundtable, where they set out strategies for employers to help workers manage depression, anxiety and other mental health conditions. Meanwhile, in the UK, 30 organisations signed up to the government’s Mental Health at Work Commitment, which outlines core principles that employers should follow to improve the mental health of their staff.
For some organisations, caring for the wellbeing of their workforce is nothing new; Johnson & Johnson established its Live for Life programme as early as 1979, with the ultimate aim of improving productivity and limiting healthcare spending. But for the vast majority of companies, this is a relatively recent change – one that was spurred on by the 2008 crisis and spearheaded by the finance sector. “Banks were among the first to actually develop wellbeing strategies,” Cary Cooper, President of the Chartered Institute of Personnel and Development, told World Finance. “They were the ones to think of wellbeing as a strategic issue rather than ping pong tables, or sushi at your desk, which isn’t proper wellbeing.
It is important to question whether companies are adopting programmes for the sake of ticking boxes and looking good
“That’s because they wanted to retain top talent. They were hit the worst during the recession – there were fewer people doing more work, feeling more job insecure, working longer hours and getting ill from stress-related illnesses, so they weren’t retaining people.”
Among those leading the wellbeing trend in the sector was UK bank Barclays. The company launched its This is Me campaign in 2013 with the aim of combatting stigma surrounding mental health by sharing videos of employees speaking about their experiences. It sparked a London-wide This is Me in the City campaign, which saw other banks follow suit.
Santander also made mental health a priority by establishing its employee-led wellbeing network and launching its Thrive app, which is dedicated to improving users’ mental health. Lloyds has taken a similar approach by launching a personal resilience portal to help colleagues better understand the measures that can be taken to prevent illness, both in terms of mental and physical health. The bank plans to train 2,500 of its employees to become mental health advocates by 2021.
Lloyds says its initiatives have helped to open up the conversation around mental health and improve employee engagement. “Over the past three years, we have seen an increase in the number of colleagues who feel comfortable telling us they have a mental health issue,” said Fiona Cannon, Director for Responsible Business, Sustainability and Inclusion at Lloyds. “The engagement level of colleagues with a mental health condition has also increased by 22 percentage points.”
Businesses outside the banking sector have started to take action too, and with positive results. Accenture reported an eight percent rise in employee engagement, a three percent increase in productivity and a 9,000-hour drop in absenteeism after implementing its wellbeing strategy. Meanwhile, e-commerce company Next Jump said its annual sales growth quadrupled after it invested in health and wellbeing, climbing from 30 percent to 120 percent.
Barriers to progress
While such progress is promising, there is more to be done. Those businesses already taking action are the exception rather than the rule, with 60 percent of organisations across the world still operating without a wellbeing strategy in place, according to Buck’s survey. In the UK, the same survey found that only 26 percent of businesses had implemented a strategy. Concerningly, even among those that have introduced initiatives, many aren’t evaluating their success. “Unfortunately, a lot of companies will do mental health first aid training, or they’ll do mindfulness at lunch, and they don’t know whether it works or not,” Cooper said. “They just do it because it’s low-hanging fruit, it’s easy to do, and it doesn’t cost much.”
Cooper explained that the success of mental health first aid training in particular was still up for debate: “Companies use it because it’s easy – they send their employees on a training programme, but there’s no clear evidence it works yet. There are lots of questions about it: should employers select people instead of asking for volunteers? Is the training adequate? Is it actually effective for employees, or does it benefit the mental health first aiders themselves more than their colleagues?”
Employee assistance programmes (EAPs) are another topic that’s up for debate. They have a great deal of potential, providing free assessments, short-term counselling, referrals and follow-up services for employees, yet their effectiveness is unclear. A report by the Employee Assistance Professionals Association found that only nine percent of surveyed HR managers had attempted to evaluate the return on investment via sickness absence, productivity, performance or engagement. “The EAP [is] considered to be simply the ‘right thing’ to offer,” the report read. “There is a fundamental perception of EAPs as a ‘cost-effective’ or ‘far less expensive’ option than other wellbeing improvement schemes.”
It is important to question whether companies are adopting programmes for the sake of ticking boxes and looking good, rather than implementing strategies that actually work. In reality, the uptake of EAPs is limited. Research by Towergate Health and Protection found that while 76 percent of UK firms offered access to an EAP, only five percent said they were being used. That’s not to say they can’t be effective, though – a large part of the problem is the lack of communication, according to Mitchell. “We find there’s an education gap between what resources companies offer and what employees are aware of,” she said.
While the conversation around mental health has changed substantially in recent years, for many it’s still a difficult subject
According to Unum’s report, 93 percent of employers said that their company provided an EAP, but just 38 percent of employees knew this resource was available to them. The same knowledge gap existed in relation to other mental health resources (see Fig 2). This is due, in part, to inadequate training. According to Unum’s report, only a quarter of managers in the US have been trained on how to refer colleagues to mental health resources, and more than half of employees were unsure of how they would help someone who came to them with a mental health issue.
The stigma surrounding mental health is another barrier to the uptake of support schemes. While the conversation around mental health has changed substantially in recent years – in a survey by Accenture, 82 percent of respondents said they were more willing to talk about issues now than they were only a few years ago – for many it’s still a difficult subject. In the Unum report, 81 percent of employees said the stigma around mental health issues has prevented them from seeking help. Nearly half feared they would be given fewer opportunities for advancement, and 37 percent worried they would be shunned by colleagues.
“Many of those struggling with mental illness keep their issues secret, often fearing discrimination, reputational problems, or even the loss of their job,” Mitchell said. “But mental health issues are prevalent and treatable and/or manageable. Someone with a mental health issue such as depression or anxiety should not be treated any differently than an employee with heart disease or asthma.”
Wellbeing programmes – even those with a decent uptake and proven return on investment – can only go so far. Prevention is the real key to easing the mental health crisis. Deloitte’s report showed that organisation-wide cultural change, education and other early interventions produced a higher return on investment than later-stage, in-depth support tools. Such culture changes involve a fundamental review of our working lifestyles and a thorough analysis of what is causing work-related mental health issues.
For Unum medical consultant David Goldsmith, our growing reliance on technology and the move away from physical interaction is the problem. “Five years ago, I would sit in a room with my peers and talk face to face,” he said at a Disability Management Employer Coalition webinar on mental health. “As technology moves along, I spend more time looking at a computer screen and talking on a headset… We’re driven by metrics. Everything is monitored and the employee feels threatened… The bond between the employer and the employee doesn’t feel like family anymore.”
A culture of always being contactable is also taking its toll on employees’ wellbeing. According to a survey by the Chartered Institute of Personnel and Development, 40 percent of people check their work emails at least five times a day outside of working hours and nearly a third feel that remote access to work means they can never completely switch off. Some firms have taken action to help combat the problem: in 2012, Volkswagen stopped its Blackberry servers from sending messages to employees when they weren’t working, while France has implemented a ‘right to disconnect’ law that gives staff the legal right to avoid emails and calls outside of work hours. For the vast majority of workers, however, being available at the touch of a button has become part of the job description.
Culture changes involve a fundamental review of our working lifestyles and a thorough analysis of what is causing work-related mental health issues
The long hours resulting from the show-your-face culture that characterises working life is just as problematic. “We need to get rid of the long hours culture – it’s a big problem,” Cooper told content platform Work in Mind. “Bad managers are appalling at seeing when people aren’t coping, or when they’re working long hours. They reinforce that behaviour, which burns people out. It’s important to remember that long [hours] means illness, not efficiency.”
It’s up to business leaders to ensure their company is doing enough. According to Cooper, they should question each aspect of their operations: “Do they have good people skills? Do we have a long-hours culture? Do we have an excessive email culture? Do we train people to be more resilient? Do we get social support systems? Do we allow them to work flexibly? That flexibility means trusting people to work when and where they want, whether from home or from a central office. As long as they finish and complete it and do a good job, who cares?”
The COVID effect
With the COVID-19 crisis forcing many businesses to allow their staff to work from home, greater flexibility may well become the norm in the future. That should at least push businesses to rethink the traditional nine-to-five day and find new ways of working that are more conducive to good mental health and productivity.
But while the novel coronavirus could encourage businesses to be more flexible with their staff, it brings significant mental health challenges. The UN has warned that we could see “a major mental health crisis… if action is not taken”, and that mental health must be “front and centre of every country’s response to and recovery from the COVID-19 pandemic”. A survey by NRC Health found that more than half of respondents, across all generations, were experiencing worse mental health due to coronavirus (see Fig 3).
Adding to people’s anxiety about COVID-19 is the effect of the resulting economic downturn, which the IMF has predicted will be the “worst recession since the Great Depression”. For Cooper, this could be the biggest issue of all. “A lot of people are going to lose their jobs, meaning [the] people that remain will be overloaded and feeling job insecure,” he said. “They will feel unable to cope with their workload, and they’ll come into work ill. In other words, they’ll suffer from presenteeism at higher rates, delivering no added value, but they’ll be at work because they’ll be frightened of not being at work. But they’ll also be the good workers that employers can’t afford to lose. So it’s the scenario we saw in 2008 writ large.”
It’s a challenging time for employers and employees. If businesses are to succeed, they will have to take action to retain top talent. They will have to think hard about how to reduce stigma so employees feel confident talking about their mental health, and establish effective, tried-and-tested strategies to support those who are struggling. More importantly, they will need to go beyond investing in the easy, image-friendly wellbeing products, and instead hold a mirror up to the principles that have for decades governed working life.
If they do it right, businesses might emerge from the crisis stronger than before. If they don’t, they will likely find themselves left behind and it will be up to governments and the wider economy to support those who have been failed by their employers.