Mental health: an occupational health and safety challenge

When most people think of workers' compensation, they think of physical injuries like slips, trips, falls, and repetitive strain injuries. This meant that, historically, occupational health and safety committees have focused on the physical workspace when considering accident and injury prevention.  

In fact, post-traumatic stress disorder (PTSD) from witnessing or suffering a life-threatening or traumatic workplace event was one of the sole compensable psychological disorders covered by the various workers’ compensation boards across Canada. This situation changed when several boards amended their policies to include other forms of workplace psychological injury, including cumulative exposure to harassment and bullying. This was a great start in addressing the psychological safety of workers through workplace practices and policies.  

Read more: Actions speak louder than words in psychologically safe workplaces

Whether work-related or not, mental-health disorders can significantly affect a company's bottom line and be a key contributor to physical workplace injuries. According to a study by OHS Canada in May 2021, work-related psychological injuries resulted in wage replacement and healthcare expenses that were 12 times higher than physical injuries. In the study, nearly half of the workers with musculoskeletal conditions had a sustained return to work two to five months post-injury, compared to only 28 per cent of workers with work-related mental illness.  

Employers struggle 

Many employers struggle with accommodating employees returning from a bout of mental illness, which often results in longer claim durations and a negative experience for the employee.  

When workers are off with a physical injury suffered at work, they are at risk of developing a mental illness. The stress of being away from work, filling out forms, and going through treatment can become overwhelming for a worker, especially if their recovery is prolonged.  

In addition, the longer someone is away from work, the more likely they are to feel anxious as the return-to-work date approaches. Canadian HR Reporter published study results from Occupational and Environment Medicine in June 2020 that found 29 percent of participants with a physical work-related injury also had a serious mental illness. However, only 41 percent of those workers accessed mental health services during recovery. Employees who return to work without having received treatment for their mental illness may have trouble with concentration, leading to the risk of further workplace accidents.  

In 2021, there were 277,217 claims across Canada for workplace injury/illness lost time (Association of Workers' Compensation Boards of Canada). Mental disorders or syndromes only accounted for 7,495 (2.7 percent) of the claims. But how many of the estimated 103,798 claims resulting from falls, burns, cuts, or crush injuries could have been due to workers struggling with concentration or fatigue due to untreated mental illness? Mental Health Research Canada found that in 2021, 35 percent of workers surveyed felt burned out. According to Telus's latest mental health index, 75 percent of those surveyed were at moderate-to-high mental-health risk. Poor mental health has an impact on concentration, sleep, productivity, emotional regulation, and judgement. 

It can also lead to an increased risk for chronic disease, including diabetes, obesity, cardiovascular disease, musculoskeletal disorders, and cancer.  

In October 2021, the Centre for Addiction and Mental Health (CAMH) reported the results of a study connecting mental illness with poor sleep quality ‒ the most extensive study of its kind. Data was collected from over 89,205 participants with a previous diagnosis of mental illness. Up to 80 percent of people with mental health disorders have problems falling asleep, staying asleep, or waking up early.  

The reverse is also true. Those struggling with sleep disorders have a higher risk of developing mental illness. It's well known that shift workers are more susceptible to poor sleep. Shift work is associated with considerable impacts on sleep, depressed mood and anxiety, substance use, impairments in cognition, lower quality of life, and even suicidal ideation, says one study.1 The Manufacturing Safety Alliance of BC found that workplace fatigue contributed to 13 percent of workplace accidents.  

The bottom line is that mental illness is a complex condition affected by internal and external factors. When workers struggle with untreated mental illness, their risk of workplace injury is heightened.  

So what can employers do to ensure workers are physically and psychologically supported?  

Mental health strategy 

Creating a mental health strategy for the workplace is critical in ensuring workers' psychological and physical health and safety. In 2013, the National standard for psychological health and safety was released.2 This guide was created to help employers identify psychosocial factors in the workplace. It offers prevention and health promotion strategies to help protect and improve employees' health. In addition to the standard, employers can support employee mental health in various ways. Some options include: 

• managers' mental health training for leaders and supervisors 
• education and awareness campaigns to help reduce the stigma associated with mental illness 
• identifying the impacts on employee mental health whenever changes are made to workplace practices and policies 
• making mental health a corporate commitment, included in the company mission, vision, and value statements 
• including employees in decisions that affect their jobs 

• reviewing employee benefit programs and considering a separate paramedical maximum for psychological health 
• providing access to mental health supports, including employee and family assistance programs, pharmacogenetic testing, and substance use management 
• offering fatigue management programs  

Mental health is one part of an overall holistic workplace well-being strategy. Given the connection between psychological and physical health, employers need to create a culture of health and well-being to truly support workers.  

Building a culture of well-being starts at the top. The C-suite must prioritize employee health, allocate resources and budget, and weave wellness into the company's DNA. Business practices, policies, corporate communications, benefit programs, and physical workspaces and environments should continually be reviewed through a lens of employee health.  

To get started, make employee health a metric on your corporate scorecard. Results from employee engagement surveys each quarter can gauge employee workplace satisfaction and sense of belonging. Utilization and trend data from workers' compensation claims, employee and family assistance programs (EFAP), group benefits programs (drug, paramedical, disability), and employee engagement surveys can provide insights into employees' health, including incidences of chronic conditions like mental illness, diabetes, and cardiovascular disease. You can also measure results from customer satisfaction surveys. 

Empathetic leaders can help employees feel connected. The 2021 McKinsey and Company review of their Great attrition survey found that 51 percent of respondents left their jobs because of a lack of connection with their workplace and manager.3 Additionally, a new study by the Workforce Institute at UKG found that 69 percent of people said their managers had a greater impact on their mental health than their doctor (51 percent) or therapist (41 percent), and were on par with their partners.4 To retain talent and improve employee engagement, leaders should try to connect with employees on a deeper level, demonstrating empathy and vulnerability. Being present and taking the time to walk around the office and connect with employees can help build those connections.  

Ask employees what they need. Understanding what employees want and need concerning their well-being starts by asking them directly. Too many companies launch programs without surveying employees to determine what they truly want or need. 

Offer choice and flexibility. Consider providing some choice and autonomy regarding scheduling, which projects or lines employees work on, and whom they work with.  

Communicate health and well-being information appropriately. Create a unique name and brand for your well-being program and include it in all communication. You can also conduct an inventory, summarizing existing offerings that employees may not remember are available. This could consist of paramedical benefits that cover mental health and nutritional coaching, or treatments that assist employees struggling with obesity or fertility.  

Make it easy for employees to find support by using a central hub to house information. This could be the company intranet or a digital well-being app. When communicating well-being initiatives and programming, ensure you use multiple communication channels beyond email, including employee town halls, one-on-one meetings, team meetings, and posters. 

Recognize employees with recognition and rewards promptly instead of monthly or quarterly. You can also have a program encouraging people to recognize their co-workers, such as a postcard program or social program like Sprout or Virgin Pulse. 

Workplace safety is about more than the physical environment and the mechanics of the job. To protect workers, employers must encompass all aspects of employee health ‒ physical, psychological, financial, social, and occupational ‒ within their health and safety programs. Protecting the mind will help protect the body, improve productivity, and reduce absence and worksite injuries.  

Lianne Clarke (B.Sc., B.Ed) is a principal and vice-president, wellness and disability innovation and growth at Cowan Insurance Group Ltd. 

_{1. Brown JP, Martin D, Nagaria Z, Verceles AC, Jobe SL, Wickwire EM. Mental Health Consequences of Shift Work: An Updated Review. Curr Psychiatry Rep. 2020 Jan 18;22(2):7. doi: 10.1007/s11920-020-1131-z. PMID: 31955278} 

_{2. https://www.csagroup.org/store/product/CAN-CSA-Z1003-13-BNQ%209700-803-2013/} 

_{3. De Smet, A., Dowling, B., Mugayar-Baldocch, M., Schaninger, B.} 

_{4. Tilo, D4.}