Indian J Med Res 146, October 2017, pp 441-444 Quick Response Code:
DOI: 10.4103/ijmr.IJMR_1298_17
Editorial
Workplace stress: A neglected aspect of mental health wellbeing
Workplace stress is defined by the World Health about two-third of employees who had suffered from
Organization as ‘the response people may have when depression either faced discrimination at work or
presented with work demands and pressures that are faced discrimination while applying for new jobs. This
not matched to their knowledge and abilities and which study also found that both anticipated and perceived
challenge their ability to cope’, and elaborated that it discrimination was more in high-income countries
can be caused ‘by poor work organization (the way we compared to lower-income countries. Both perceived
design jobs and work systems, and the way we manage and anticipated discrimination are major causes for
them), by poor work design (e.g., lack of control over people suffering silently at the workplace and not seeking
work processes), poor management, unsatisfactory proper care. This by itself can be a major issue when
working conditions and lack of support from colleagues seeking care for mental disorders as it adds to stigma
and supervisors’1. While workplace stress, stigma and related to help-seeking and increases treatment gap - the
attitudes towards employees suffering from stress or gap in the proportion of people who suffer from mental
mental illness have been researched and interventions disorders and the proportion of them who actually
developed to address them better, globally2,3, it still receive adequate mental health care. If organizations
remains an oft-neglected aspect across different are made aware of this, and they encourage staff to seek
industries and countries, including India, and only a appropriate mental health care as per need, then it will
few of the learnings are actually implemented. not only lead to improved care for persons with mental
International laws have been in force for many disorders, but also to a situation where employees are
decades to protect human rights of employees at comfortable discussing their mental health issues with
workplace, and the key ones being Article 23 of the appropriate staff and take actions early on, so that more
Universal Declaration of Human Rights4, Articles severe mental disorders do not manifest.
6 and 7 of the International Covenant on Economic, Another risk factor is that besides depression
Social and Cultural Rights5 and Article 27 of United or anxiety being an outcome of stress, physical
Nations Convention on the Rights of Persons with disorders such as hypertension and diabetes can also
Disabilities6. However, the execution of policies is be caused due to stress. While research has established
variable and often suboptimal. Moreover, low- and the two-way link between stress and these physical
middle-income countries where one has the largest disorders9,10, organizations need to realize this and
population in working age groups, continue to encourage staff to maintain a good work-life balance.
lag behind in conducting or identifying suitable This by itself can be a difficult task to implement
interventions, and often do not have adequate policies given deadlines, having a competitive edge, sustaining
in place to prevent discrimination against employees growth and one’s personal need to earn more by doing
with mental disorders7. overtime. Thus, organizations need to have guidelines
Workplace-related stress – a reality that needs to about working hours based on good industrial practices
be addressed through evidence-based interventions and take measures to enforce these routinely.
Brouwers et al8 conducted a cross-sectional study Sexual harassment and bullying at workplace is
across 35 countries including India and reported that another workplace-related stress that can happen at any
This editorial is published on the occasion of World Mental Health Day - October 10, 2017.
441
442 INDIAN J MED RES, OCTOBER 2017
organization. Both genders could be affected by these, to be effective, but could lead to a potential increase
but often women and those lower in the hierarchy are in anxiety levels in those who are screened as false
at increased risk. Organizations should be cognizant positives, so routine screening at workplace is not
of this and take active measures to ensure that recommended3.
workplace is a safe and secure place for every worker.
Guidelines to improve workplace culture and
In India, there are specific legal provisions to ensure
reduce stress
safety at workplace (http://labour.gov.in/policies/
safety-health-and-environment-work-place), and there The World Health Organization has outlined key
are specific laws to prevent sexual harassment of factors related to stress at workplace and advocated
women (http://indiacode.nic.in/acts-in-pdf/142013. guidelines to redeem them11. Some factors that cause
pdf). Strict guidelines and processes are advocated, and increased stress at workplace include ‘workload
every organization should have identified committees (both excessive and insufficient work), lack of
to handle any such issue. participation and control in the workplace, monotonous
or unpleasant tasks, role ambiguity or conflict, lack
While extant research has tended to focus on
of recognition at work, inequity, poor interpersonal
alleviation of symptoms and risk factors associated
relationships, poor working conditions, poor leadership
with workplace-related mental disorders, less emphasis
and communication and conflicting home and work
has been placed on gathering evidence on how mental
demands’11. This document also outlined guidelines to
disorders affect performance and absenteeism and how
improve the situation and enumerated four key steps
interventions have resulted in improvement of work
which are not only relevant to individual organizations,
performance and absenteeism3. Thus, more research
but to other stakeholders also, such as trade unions,
is needed to gather evidence on the cost-effectiveness
employees, government and employees11.
of interventions and the cost of mental disorder-related
loss of productivity on the larger community. This Step 1: Analyzing the mental health issues - As a
is relevant to all countries and becomes specifically first step, it is essential to have a clear understanding
significant when each employment sector tries to of not only the prevalence/incidence and risk
become more competitive and wants to increase factors associated with workplace stress, but also a
productivity while at the same time tries to keep better knowledge about the cost implications to an
their cost to a minimum. In low- and middle-income organization in terms of lost productivity. This is an
countries, there are additional needs to (i) conduct basic exercise that can be done at individual organizations,
epidemiological studies to understand the prevalence at specific employment sector level in specific regions
of workplace-related mental disorders and specific or across regions. This may need gathering new data
risk factors associated with different employment through surveys or collating data available with the
sectors, (ii) understand what kind of systems are being human resources or anonymized health records.
put in place by different sectors to manage them, and
Step 2: Developing the policy - A policy can be
(iii) to what degree are existing laws being followed and
developed once the initial knowledge gained through
implemented, and what organizational restructuring
the first step is available. The primary objective of
is needed to improve the situation. Current evidence
such a policy should be to address concerns of all
suggests that no single intervention can work in
stakeholders and adhere to the organizations vision
isolation and it is recommended to have a package
and mission. This should involve multiple meetings
of interventions at organization level which could be
with different stakeholders to identify key components
accessed by those in need3. Some interventions that
that need to be addressed. This engagement should be
were specifically found to be useful were enhancing
a continuous process throughout the development and
employee control, promoting physical activity,
execution of the policy.
cognitive behaviour therapy for stress management and
problem-focused return to work programmes. On the Step 3: Developing strategies to implement the
contrary, counselling and debriefing following trauma policy - While implementing the policies, care should
were not effective3 and any exposure to trauma should be taken to identify the key strategies that need to be
be followed by provision of psychological first aid and implemented, the processes that need to be in place
formal psychological support by trained professionals. to implement such strategies, targets to be achieved
Workplace screening for mental disorders followed by and timelines that need to be adhered to while
access to basic mental health services has been found implementing the strategies. Finally, any additional
MAULIK: WORKPLACE STRESS 443
budgetary allocations or training required to implement are aware of the issues fully and nor are well informed
the policies, need to be made available. about its ramifications. Although laws are present in
most countries to ensure that the rights of persons
Step 4: Implementing and evaluating the
suffering from mental disorders related to workplace
policy - The implementation of any strategy will need
stress are safeguarded, often such are not executed
collaboration and clear buy-in from all stakeholders.
or regulated effectively, leading to a situation where
For some strategies, one might need to have a small
persons with mental disorders are not able to verbalize
demonstration project to start off, and based on
their problems and suffer silently - a situation that
the results tweak the strategies and then scale it up
to a larger forum. Before implementing a policy, ultimately leads to increasing mental health-related
information should be disseminated widely either disability that affects productivity. In this year, when
through a formal launch meeting or individual workplace stress is being identified globally as a cause
organizations’ dissemination network. For example, for concern, all stakeholders should take additional
major government level policies that impact large notice of its importance and see what needs to be
number of employees or employers could have a done to improve the situation on the ground and make
launch meeting, whereas policies affecting only one workplace a safer and healthier place for all.
organization with limited staff could be disseminated Acknowledgment
through office emails. This would enable everyone The author is an intermediate fellow of the Wellcome
to be aware of the policies. One major drawback of Trust/DBT India Alliance.
many policies is that they lack a formal evaluation.
This should be built into the system and appropriately Pallab K. Maulik
funded from the outset. Specific guidelines about how Deputy Director and Head of Research,
to monitor and evaluate the policies should be in place The George Institute for Global Health,
at the time of the launch of the policies and conducted New Delhi 110 025, India
as per agreed timelines. pmaulik@georgeinstitute.org.in
Role of government Received August 10, 2017
The government should play a key role in ensuring References
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