GENEVA (ILO News) - An ILO study ^* of mental health policies and programmes affecting the workforces of Finland, Germany, Poland, United Kingdom and United States shows that the incidence of mental health problems is increasing, with as many as one in ten workers suffering from depression, anxiety, stress or burnout, which lead, in some cases, to unemployment and hospitalization.

The report estimates that anywhere from 3-4% of GNP is spent on mental health problems in the European Union. In the US, the national spending associated with treatment of depression ranges between US$30 to US$44 billion. In many countries, early retirement due to mental health difficulties is increasing to the point where they are becoming the most common reason for allocating disability pensions.

Ms. Phyllis Gabriel, a vocational rehabilitation specialist and the chief author of the report, expressed alarm at the widespread costs of these disturbing trends:

"Employees suffer from low morale, burnout, anxiety, stress, lost income and even unemployment associated in some cases with the inevitable stigma attached to mental illness. For employers, the costs are felt in terms of low productivity, reduced profits, high rates of staff turnover and increased costs of recruiting and training replacement staff. For governments, the costs include health care costs and insurance payments as well the loss of income at the national level."

Among the major findings of the report, which warns that the costs of mental health disability are rising, is a pattern of increasing personal and psychiatric problems suffered by the working age populations of all the countries studied. For example:

• In the US, clinical depression has become one of the most common illnesses, affecting one in ten working age adults each year resulting in a loss of approximately 200 million working days each year;
• In Finland, over 50% of the workforce experiences some kind of stress-related symptoms, such as anxiety, depressive feelings, physical pain, social exclusion and sleep disorders; 7% of Finnish workers suffer from severe burnout, leading to exhaustion, cynicism and sharply reduced professional capacity and mental health disorders are the leading cause of disability pensions in Finland;
• In Germany, depressive disorders account for almost 7% of premature retirements and depression-related work incapacity lasts about two and half times longer than incapacity due to other illnesses; the annual volume of production lost because of absenteeism related to mental health disorders is estimated at over 5 billion DM annually;
• In the UK, each year nearly three out of every ten employees experience mental health problems and numerous studies indicate that work-related stress and the illnesses it causes are common; depression, in particular, is such a common problem that at any given time one in every 20 working-aged Britons is experiencing major depression;
• Public health statistics in Poland indicate growing numbers of people, especially individuals suffering from depressive disorders, receiving mental health care, a trend that can be related to the country's socio-economic transformation and resulting increases in unemployment, job insecurity and declining living standards.

The countries were chosen for study, the ILO insists, not because they have inordinately high incidences of mental illness, but because they are emblematic of different approaches to workplace organization and welfare systems, embodying different types of legislation, health care and approaches to mental health issues.

The series of detailed country studies address such issues as workplace productivity, loss of income, health care and social security costs, access to mental health services and employment policies for the mentally ill.

The ILO undertook the study because, as Ms. Gabriel emphasized, "the workplace is an appropriate environment for educating individuals and raising their awareness of mental health difficulties in order to target mental health problems and prevent them from developing".

The ILO report notes that while the origins of mental instability are complex and the workplace practices and income and employment patterns differ widely among the countries studied, a number of common threads appear to link the high prevalence of stress, burnout and depression to changes taking place in the labour market, due partly to the effects of economic globalization.

For example, the report notes that the recession of the early 1990s "brought many changes to Finnish society and the Finnish labour market, such as high unemployment, job insecurity, short-term contracts and time pressure" innovations which coincided with a marked deterioration in the reported mental well being of the workforce.

It notes that German workers have seen similar changes in the recent decades "due mainly to rationalization and the rapid introduction of technology" along with rising unemployment. Many of these changes had positive results in terms of reducing monotony and increasing autonomy and responsibility for decision-making amongst workers. Nonetheless, they also led to stress due to increased time pressure of tighter deadlines and demands in terms of quality and quantity of production.

Workers in the US and UK suffered relatively less from the threat of unemployment in recent years, but have had to confront much the same circumstances, including an array of new technologies and methods of work organization stemming from inexorably rising productivity requirements.

The impact of the information technology revolution, which is unfolding rapidly in the US, UK and elsewhere, has accelerated competition and, the report finds that "it is therefore not surprising that more and more cases of disability are related to developing chronic conditions such as depression and work-induced stress".

In Poland, major political changes brought welcome political and economic change but the costs of what amounts to a major socio-economic transformation "had serious ramifications for the labour market and for the mental well being of people in the workplace".

A great deal of the mental health work in Poland since then has focused on developing a framework for meeting the needs of people suffering from mental illnesses. Poland's Mental Health Act, which was adopted in 1994 and amended in 1997 and 1999 introduced major improvements in shifting mental health care away from large, isolated institutions to community-based facilities and programmes.

The ILO report sees progress in coming to terms with mental health issues in the workplace in all the countries studied. It notes, for example, that "in the US, employers of all sizes are beginning to recognize that depressive disorders often constitute their highest mental health (medical) and disability cost. A large number of employers understand the relationship between health and productivity and are improving their management strategies by developing and implementing programs supportive of work/family/life issues".

Finland, the report notes, has actively started to address mental health issues, both at the national and international levels, adding that "the culture of mental health promotion is evolving in the workplace: the Finnish concept of work ability is not just about promoting employees physical health but also about mental health in healthy work organizations".

In Germany, which already enjoys strong institutional and government support for mental health services, corporate health promotion is becoming a higher priority and successful stress reduction programmes have been underway for many years. These programmes include "relaxation procedures, role playing and behavioural training to increase self confidence and improve interpersonal skills".

In the UK, employees' and employers' organizations play an active role in mental health issues and the Government and institutional response to the issue is generally proactive. Some companies have already developed mental health policies for the workplace. Analysis of existing policies has defined certain key elements of good practice, the report notes, adding that "the most fundamental step for organizations is to recognize and accept that mental health is an important issue and show commitment to mental health promotion".

Mental Health in the Workplace

At the close of the Congress, to mark World Mental Health Day on Tuesday, 10 October, the ILO is jointly organizing a Symposium on Mental Health and Work, in cooperation with the World Health Organization and the World Federation for Mental Health. The ILO Director-General Juan Somavia will be among the speakers at the Symposium.

* Mental health in the workplace: Introduction. Prepared by Ms. Phyllis Gabriel and Ms. Marjo-Riitta Liimatainen. International Labour Office, Geneva, October 2000. ISBN 92-2-112223-9.