Psychological Health at Work – Some Frequently Asked Questions
France St-Hilaire, Ph. D., CRHA
Associate professor, Human Resource Management, Université de Sherbrooke
Director of Équipe sur les organisations en santé (ÉOS)
Scientific director, Global-Watch
Marie-Claude PELLETIER, MBA, ASC
President and founder, Global-Watch
Lecturer, Graduate Microprogram in Organizational Health, Université de Sherbrooke
1. What are the best ways of assessing mental health in our company while ensuring that we have all the data available to us?
Existing or “in-house” questionnaire: Certainly the best solution is for the organization to use a reliable measurement tool. However, it’s important to take the necessary precautions to measure the right mental and psychological health indicators; the questionnaire has to be reliable and of good quality (in-house or external expertise). It is also important to measure not only indicators of mental health impact (e.g. depression, burnout), but also early indicators (e.g. psychological distress). You can also refer to organizations such as the Institut national de santé publique du Québec (INSPQ) to get support for making a diagnosis (e.g. as part of the Entreprises en santé standard). In addition, it is essential to measure mental health risk factors in order to get a picture of the organizational factors that can contribute to workers’ distress because these are factors that the organization’s interventions can target, rather than directly targeting psychological health.
Remember that consulting employees will raise expectations. Therefore, it is essential for the diagnostic phase to be part of an intervention program where action will be taken once results are communicated. Otherwise, there’s a risk of creating resistance to change and cynicism about future interventions.
Also try to take the time to meet with your managers before rolling out the questionnaire so that you can properly explain the reasons for the employee consultation process. Otherwise, employees may feel threatened, as you will surely be asking questions (through the questionnaire) about management practices and, therefore, their relationship with their supervisor.
Mental health is also an issue involving shared responsibility among employers, managers and employees. It would be desirable to use this questionnaire to measure how employees are equipped to deal with these issues and what their habits are in this regard.
A joint employer-employee initiative will have better chances of success through action.
2. Not all companies can afford a diagnosis, so what can they do to take action?
Qualitative tools: The INSPQ also provides a validated qualitative tool, the Tool for Identifying Psychosocial Risk Factors in the Workplace, which can be used to make a diagnosis when resources are limited. Focus groups and interviews can also be used.
Existing data: Organizational indicators such as absenteeism, turnover rate and disability costs are also indicators of the state of workers’ health..
University students: Students can perform organizational diagnoses free of charge or for a nominal fee as part of their training program. Many organizations do business with graduate-level students who provide quality work, supervised by specialists.
The INSPQ’s Tool for Identifying Psychosocial Risk Factors in the Workplace is indeed an excellent tool for making a good diagnosis at a low cost. The INSPQ also offers inexpensive, well-designed training on how to use the tool. The training is online and includes readings, exercises and tests.
No existing data: If you don’t have in-house indicators, this is the right time to take care of this and establish measurement tools that will allow you to put together a dashboard to monitor regularly. Don’t hesitate to ask your insurer, broker and benefits advisor for help.
In the meantime, you can use the aggregate data available for Canada, Quebec or your industry.
3. What are your recommendations for starting a survey to measure psychological health?
- Before doing anything, make sure that there will be a follow-up to the survey. If there are no plans for intervention, the survey will simply raise expectations and provide fertile ground for resistance to change during future initiatives.
- Choose the right survey (questionnaire) that will allow you to compare your results over time. It’s crucial to take the time to create a survey that meets your needs.
- See the answer to question Q2.
Start with your managers to be sure that they have a good understanding of what it’s all about. This will help them become ambassadors of the process afterwards, having experienced it themselves. Even better is a questionnaire that includes personalized, confidential feedback for the individual based on their responses, as this facilitates their taking action in the form of a personalized initiative.
4. How long does it take before seeing the impacts of this type of health management program?
Set qualitative as well as quantitative goals: Goal-setting should be the first step; it’s a matter of clearly stating what we mean by, and aim for, as impacts. Qualitative changes can be seen more quickly (e.g. improvements in the work environment), while quantitative indicators, such as the absenteeism rate or costs related to disability and productivity, may take a few years (up to five years for large organizations) to appear.
Factors influencing impacts: We know that several factors influence a program’s impacts. The following questions, although not exhaustive, can serve to guide you:
- Were the right actions implemented for the problems in question or the identified areas requiring improvement?
- Can other factors explain the improvement or deterioration of workers’ psychological health (e.g. new CEO, merger/acquisition, layoffs, other organizational change)?
- What is the organization’s capacity for change?
- What size is the organization?
- Is it a priority for the organization and its management team?
As a rule, qualitative impacts are more discernible in the first year. As for the much-talked-about return on investment, it takes three to five years before it can be measured. In the meantime, the organizational indicators mentioned in question 2 may change.
As for success factors that ensure significant, positive impacts, I believe that the most important thing is to follow a structured process in phases. The Entreprises en santé standard provides a suitable one:
- Convince and mobilize management
- Put together a steering committee that will formulate a strategy and coordinate implementation
- Make a diagnosis based on organizational and individual data through questionnaires and/or focus groups
- Establish an action plan with interventions prioritized based on the organization’s challenges AND the issues and needs expressed by employees
- Measure (participation, satisfaction, changes in indicators, impacts on health, possibly return on investment, if necessary)
5. A steering committee involving employees as well?
Yes, especially employees. As in the area of health and safety or for any organizational change, a joint initiative is unquestionably a success factor.
In fact, the makeup of the steering committee should represent what I call the organization’s DNA: employees from administration, from the plant, from locations outside the large urban centres, and individuals with key roles in implementation: HR representatives, a member of the management team, a union representative, someone from communications.
6. Could workplace psychological health committees be made mandatory (especially for larger companies)?
Legislation is one measure that encourages organizational responsibility in this area. The European experience has shown us that legislation has its pros and cons. Although the benefits outweigh the drawbacks, if the company doesn’t believe in the initiative, it will simply fulfill its obligation and will not achieve any real results. This means that we can’t impose legislative measures alone without convincing organizations of the importance of an initiative to bring about impacts (human, financial and economic). Workplace psychological health has to become a corporate value.
Just as with organizational transformation and cultural change with respect to workplace health and well-being, you first have to be convinced of the importance of the initiative.
7. How far can or should we be involved as employers when it comes to workplace psychological health? When should we step away?
This is a broad question that could be discussed at length. Beyond their legal obligations (e.g. psychological harassment regulations), it is in an employer’s best interest to provide a healthy, stimulating work environment if for no other reason than that they will be the first to benefit from it. Some organizations may have substantial financial resources and may be able to offer their staff a range of services (a gym, for example); however, what matters most is caring about and preventing psychological health problems. It should be emphasized that the job and the employer are not the only causes of, or factors responsible for, psychological health issues. However, we know that organizations and work play significant roles in fostering employee health. The more proactive an organization is in terms of promotion and prevention, the more benefits it will reap in all areas, including attracting and retaining the best talent. Taking care of psychological health should be integral to a company’s business strategy.
It is in the employer’s interest to establish management practices that, rather than ruining health, protect and even promote it. The employer also needs to make tools and services available that can be used by employees when they need them, whether in the event of illness or, more importantly, to prevent absenteeism and presenteeism. The employer and managers do not have to act as therapists, but should refer employees to the available resources.
8. Could you provide examples of individual or workplace protective factors?
There are many, but I’ll mention the main ones.
Organizational protective factors: Without a doubt, the most powerful protective factor is social support, especially the type provided by a supervisor. Recognition at work is also a protective factor that reduces the negative effects of the risk factors that we have to deal with (e.g. an imposed organizational change). For more information, refer to the following free publications:
- Guide for a Strategic Approach to Preventing Psychological Health Problems in the Workplace (in French only)
- Assessing Mental Health in the Workplace: An Analysis of Human Resources Management Practices (in French only)
- Mental Health – Psychosocial Risk Factors in the Workplace
Individual protective factors: Strategies for coping with stress are an example. See the following publication for more details: Instant Stress Management Stage
On top of what France mentioned, I would say that, since workload or a lack of time to complete work is one of the most frequently mentioned problems, the following factors can be implemented: rebalancing priorities, giving employees a certain degree of flexibility to manage their time and their days, asking employees for their opinion and allowing them to suggest changes and solutions, and offering training and good tools so that they can work more effectively.
9. What approach should we adopt in workplaces in remote areas (job scarcity) and/or in multicultural settings, where workers consider themselves lucky to be employed despite difficult conditions?
This is a challenge we face in the area of occupational health and safety in general, as well as in organizations in large urban settings where there is increasing diversity in the labour force. It’s not an issue where I can claim to have expert knowledge to the extent that I could provide a fair and appropriate answer. However, I recommend that you have a look at the work of Professor Sylvie Gravel (UQAM), as well as the following article that was published in the magazine Prévention au travail: Sensibiliser les travailleurs immigrants à la SST (available in French only).
I think that the same tools, i.e. awareness-raising, questionnaires and management practices, can be implemented to:
- avoid presenteeism to prevent the spread of illness (employees come to work despite the possibility of contaminating others) and
- encourage attracting and retaining qualified employees in areas outside the main urban centres.
10. « Pourrait-on avoir le lien internet ou la référence complète pour l'étude sur le ROI (Renaud, 2008) ? »
RÉPONSE DE MARIE-CLAUDE :
Vous pouvez retrouver un article publié dans le Canadian Journal of Public Health. Cet article documente les impacts observés. La mesure de retour sur investissement a été calculée par des actuaires pour le compte du Mouvement Desjardins.
Implementation and Outcomes of a Comprehensive Worksite Health Promotion Program, Canadian Journal of Public Health, Jan-Feb 2008
10. What measurement tools do you recommend to raise individuals’ awareness of their responsibility?
I’m not sure I’d discuss this need in terms of measurement tools, but I believe the key lies in employee involvement and participation. When they participate in making decisions and determining what actions to take, they inevitably develop a feeling of responsibility and accountability. This way, the more they are involved and considered in the decision-making process, the more aware they’ll be of their power and responsibility.
- Giving a person a questionnaire to complete raises their awareness of their situation.
- If, in addition, the questionnaire that you use allows the employee to receive confidential, personalized feedback based on their responses, with suggestions of actions to take and resources available to help them change their behaviour, you will maximize their involvement and the chances of making an impact.
- An executive report aggregating all employee responses anonymously will provide you with quality indicators that will help your steering committee prioritize what interventions to implement.
- Lastly, the way you communicate the entire survey operation will have an impact on how employees perceive the initiative for themselves and the benefits they’ll get from it. In Canada, when it is presented properly, this initiative can be seen as a “gift”. The confidentiality of the process and the data is essential in terms of both PERCEPTION and FACTS.
11. As the workspace is the place where a company’s values and strategies are put into practice, what are your thoughts on the role of the workspace?
The workspace plays a crucial role in the application of strategies because it is the platform that allows people to make connections and contribute to well-being. The workspace can indeed serve to implement part of the strategy. Some examples are spaces for informal gatherings (games, coffee/beverage space), ergonomic desks, adjustable-height conference tables, rooms and furniture for napping, equipment facilitating sports activities (secure bike racks, rooms for dance or yoga sessions, showers, etc.), convivial dining rooms with healthy eating options, etc. There are many possibilities that don’t have to be expensive, and your employees will surely have some good ideas.
13. « Quelles sont les exigences légales minimales en matière de santé psychologique au travail ? »
RÉPONSE DE FRANCE :
La protection de la santé et de la sécurité du travail, dont la santé psychologique est traduite dans La Charte des droits et libertés, le Code civil ainsi que dans la Loi sur la santé et la sécurité du travail (LSST). Je vous réfère à ce texte merveilleusement bien vulgarisé : Droit du travail Prévention des risques psychosociaux avec une spécialiste du domaine, la Professeure Anne-Marie Laflamme. Voici les principales obligations avec des références gratuites complémentaires :
- Loi sur le harcèlement psychologique au travail.
- L’obligation d’accommodement dans un contexte de santé mentale
- LSST – garantir la « qualité des conditions matérielles d’exécutions du travail »
12. As a firm providing services to businesses, how can we encourage a health-promotion service to a company that has no existing employee services?
You need to develop a “pitch” that focuses on the benefits for the employer. The main argument would deal with the cost of doing nothing. Some elements of the answer have been covered in the previous questions, but you can also refer to the following web page: Workplace Health and Well-being – Comprehensive Workplace Health and Safety Program. It discusses this issue and many other points.
- Are you familiar with the company’s challenges? Did you determine how taking their staff’s health and well-being into consideration can be key to their business plan? Are the challenges financial in nature? Are they related to how absenteeism impacts their operations? The cost of insurance? Work climate? Attracting and retaining talent? Social responsibility or sustainable development goals? Motivations differ from one company to the next.
- Do you know which decision-makers need to be convinced? Who plays what role, and what their convictions, lifestyles and personal motivations about this subject are? These factors will also be important in your “persuasion strategy”.
15. « Y a-t-il des études sont en cours qui permettront de renouveler les références. Il appert non évident de convaincre avec des références de 2006 »; « Comment expliquer le fait que les références de recherches se situent au début ou au milieu des années 2000 et que tout cela est encore très contemporain ? »
RÉPONSE DE FRANCE :
Les références qui datent des années 2001 à 2010 concernent les modifications des conditions de travail des cadres. Ces changements se sont amorcés au tournant des années 2000 et sont toujours bien révélateurs de la situation en 2016. Ainsi, il est encore d’actualité et connu qu’il y a davantage d’insécurité d’emploi (Lindholm, 2006), une intensification du travail pour tous les niveaux de gestion (Green, 2001) ainsi que des coupures d’emplois et des réorganisations ayant eu pour effets d’augmenter le nombre d’heures travaillées par les cadres (Mc Cann et al., 2004; Mintzberg et al., 2003).
Les références scientifiques ne sont pas exhaustives, ce n’était pas l’objectif d’une telle présentation. Les références ont été choisies pour appuyer ces conditions de travail. L’objectif était de décrire ces modifications et de les appuyer par des références de qualité et justes. Des références plus récentes existent (ainsi que d’autres études en cours), mais qui ne traduisant pas toutes cette idée de mutations du travail des cadres amorcée au début des années 2000. Ces nuances théoriques n’étaient pas adaptées au format de ce Webinaire grand public. De plus, la qualité des études citées est également à prendre en compte dans le choix des références.
Enfin, il me fera plaisir d’offrir une bibliographie plus exhaustive et récente à ceux et celles qui s’intéressent à un aspect bien particulier de la santé des cadres puisque je poursuis des études sur le sujet.
RÉPONSE DE MARIE-CLAUDE :
En sus de ce que France mentionne, je vous encourage à recourir à des chercheurs universitaires quand vous voulez analyser ou tester des approches, c’est en collaborant de façon proactive avec le milieu universitaire que nous réussirons à avoir davantage de recherches et d’études solides. C’est aussi pour cette raison que nous avons coanimé France et moi ce webinaire : la recherche et
13. What is the best way to take care of managers’ psychological health?
- By using the same steps as for employees: a strategic plan consisting of diagnosis, intervention, follow-up and outcome analysis.
- The approach to take will be different, though. Psychological health may be taboo for people in general, but it is even more so for managers. Moreover, stress management and emotional control are qualities that are recognized and looked for in candidates for management positions. Recognizing that they, too, are vulnerable can represent failure in their eyes. That’s why it’s important to be more cautious and take extra time to make them aware that no one is immune to psychological health issues and that preventing them can only serve to support them in their management career, not hinder them. Some managers are afraid that revealing their problems or distress could hold them back in their careers or even result in losing their position.
- Preventing or reducing organizational psychological health risk factors has to be done in another way. It’s a tricky matter for executives and can have a political dimension. An example is role conflict (a head nurse who has to enforce instructions from management that are in conflict with her nursing values: reducing time spent with patients), a risk factor that managers are more frequently exposed to and sensitive about. To successfully tackle real issues, managers need to be provided with a space for supportive discussion, and senior management’s commitment has to be unwavering.
- Create safe discussion spaces, ideally among managers themselves, or if this isn’t possible, outside the company (e.g. an external co-development group, if necessary);
- Be sure that management is prepared to rethink their ways of doing things.
- Lastly, the key to success is, without a doubt, senior management’s behavioural example-setting: “walking the talk”. If you want managers to take care of their health and the health of other employees, management has to make it their priority, and that means starting with the managers themselves.
I consider France a specialist in this area…
And making management’s strategy the starting point for your strategy is key. Why? So that they themselves can experience it as part of a strategy geared to their reality, so that they can be the best ambassadors when it comes time to implement it among employees, so that they are better equipped to intervene appropriately, especially when it comes to psychological health.
14. In a small organization consisting of four employees, the workload is huge. Doesn’t it seem like a sign of weakness to open up to your boss? What’s the best way to bring up the subject?
Two great questions. For the first,
Psychological health in the workplace is still a taboo subject; experiencing problems or talking about them may be viewed as signs of weakness. However, recognizing our condition is the first step to finding the best strategies. We’re a lot less inhibited when it comes to discussing our physical injuries or illnesses than our psychological state of mind. However, psychological health is a dimension of our overall health and no one is immune to experiencing struggles or illnesses in this realm. In short, we first have to examine our own self-judgment before claiming that we will be judged by others. This increased self-awareness will make it easier for someone else to be receptive and responsive to our situation.
For the second question,
Generally speaking, occupational health and safety management is a challenge for resource-poor SMEs. However, small organizations have a significant advantage: fewer levels of hierarchy to convince.
For a worker whose fear of being judged (by themselves or others) is holding them back, it might be a good idea to seek the support of a professional (a psychologist, for example) so that they can find the right way to express their needs. Being prepared for a meeting will boost your self-confidence and allow you to set clear objectives for the meeting and refer constructively to the issues.
If your organization would like to take action, the Groupe Entreprises en santé has developed PME en santé (“Healthy SMEs”) to meet this urgent need. This program can provide a starting point to address the issue or serve as a framework, a shared language to draw on and adapt to your reality.
Mental health destigmatization is the first step in being able to talk freely about this subject. Mental health must be discussed as openly as more physical problems. An initiative such as PME en Santé will provide tools and resources that suit the reality of SMEs and foster awareness-raising and action. .
15. The initial diagnosis already represents change for employees and makes them fearful about their future. Do you consider acting on internal communications to be the most appropriate leveraging mechanism?
It’s an essential leveraging mechanism. However, focusing only on internal communication about the diagnosis could divert you from the basic goal: taking action and intervening with respect to psychological health risk and protective factors. As with any organizational change, about 30% of the members of an organization will be convinced from the very beginning that the project should go ahead. Therefore, it’s important to make continued efforts while remaining attuned to employees’ needs. When those who resist see that the changes are for the better, they will gradually come around. Communication is important, but it has to go hand-in-hand with action. Communication should accompany every step of a change process and successes should be shared.
I also think that clear, authentic and transparent communication early on in the process, having previously received the mobilization of the management team and the different internal stakeholders, will facilitate employees’ appropriation of the process and can reassure them; however, intentions must be real and felt through action to be credible. Lastly, the mere fact that the company is taking the time to make a proper diagnosis, which involves listening to employees’ needs and concerns, should be seen as reassuring for them because their concerns are being heard.
16. Our organization has introduced Entreprises en santé standard, but most managers see it as an additional task added to their workload. It’s as if HR wants to make a good impression by introducing this program while managers are at the end of their rope. What are your thoughts?
RÉPONSE DE FRANCE :
It’s hard to make a statement about a specific situation without knowing the full context. But your situation does allow us to mention certain key factors required for the successful establishment of a psychological health intervention program in the workplace:• The importance of assessing the feasibility of the intervention and the right time to implement the change (sometimes waiting a few weeks in a period of peak workload can make a difference);
- Try to improve existing practices rather than only adding new initiatives (sometimes just continuing positive actions is sufficient because managers and employees are unable to take on more);
- First take care of managers’ health so that the health intervention can truly be effective;
- Make workplace psychological health integral to the company’s strategic plan so that it can influence decision-making;
- Health also needs to be a value to try to ensure the engagement of all stakeholders in the initiative.
If managers don’t see the initiative as providing added value, they’ll view it as an additional task that they need to take care of. On the other hand, if they have a good understanding of how it benefits THEM, they will more readily get involved. For example,
- If the manager of a department with 50 employees knows their absenteeism numbers and has to deal regularly with unplanned workplace absences causing operational delays, they will understand that it is in their interest to reduce these absences and introduce preventive measures.
- If they have trouble recruiting suitable employees, it may be appropriate for them to “sell” this initiative to potential employees who are seeking it in their next position.
17. What power does an employee really have in a work environment where management doesn’t understand the importance of focusing on physical and psychological health in the workplace?
Management’s engagement is an essential leveraging mechanism. However, some organizations have seen transformation occur through employee-initiated change. Some employees have created walking and running clubs, while others have suggested new ways of holding meetings to encourage everyone’s involvement and participation or better procedures to reduce workload and time devoted to a task. These are only a few examples of employee power. Even though it’s not always possible to make major organizational changes as an employee, we still have power over certain organizational sources of irritation. This can be accomplished through bottom-up change, which is one way of raising employers’ awareness and convincing them. For some organizations, this type of change even served as a catalyst for the establishment of an organizational program.
This also reminds us that, regardless of the environment where the employee works, they must first prioritize their health and develop tools and resources to protect it. They will be the first to benefit from this type of approach.