Including mental health in a quality strategy

The ways in which healthcare professionals and businesses approach mental health has evolved over the last few years. We no longer think of it as a straight choice between firing on all cylinders and being unable to work, but more a continuum, as mental health is just one factor that can affect performance (others may include physical health, temporary stressors and life events). It therefore makes sense to talk more in terms of wellbeing to make a positive drive towards optimal mental health outcomes, rather than merely tackling problems as they arise – by which time, it may be too late to address the root causes. 

Ideas around promoting optimal mental health are not new and they are highly pertinent to the world of quality as they have an onward impact on organisational performance. The Boorman Review (Department of Health, 2009) found that NHS Trusts with high scores on the health and wellbeing index show better performance in metrics, including patient satisfaction and fewer acute infections. Similarly, an in-situ study by Marsden and Moricone at the London School of Economics found that an investment of £45m in wellbeing at Royal Mail in 2012 had generated a £225m return on investment over the following three years by reducing absenteeism and increasing productivity.

The lesson is clear: if your business employs people to do the work, then wellbeing should be a crucial component in quality.

Challenges to wellbeing

Unfortunately, it is too easy to put the important business of wellbeing on a back burner when emergencies present themselves. According to the World Health Organization (WHO), countries have dealt with Covid-19 by redirecting mental health resources into tackling the pandemic. Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO, said: “We are already seeing the consequences of the Covid-19 - pandemic on people’s mental well-being, and this is just the beginning. Unless we make serious commitments to scale up investment in mental health right now, the health, social and economic consequences will be far-reaching.”

If it is a lesson that governments are slow to learn, the business community is presented with a clear opportunity to act with more purpose.

What specific factors shift the needle from ‘optimal’ wellbeing to ‘under-performing’? We know that unexpected change can be stressful even when it is positive. We also know that agency (the amount of control an individual has over their circumstances) comes into play.

Consider the sudden shift to remote working that has rolled out across many businesses. In 2019, being allowed to work from home was considered one of the major perks that employees could negotiate to improve their work-life balance. Workers considered remote working to be a bonus when it was voluntary. But now, with remote working being forced upon employees, workers’ circumstances have changed; there are no longer the informal support mechanisms that we expect from casual face-to-face meetings with colleagues and different regions dipping in and out of restrictions on movement, agency is also in short supply.

The impact on mental health under such circumstances can be sudden. As early as April 2020, The Lancet had credible research to show that “mental health in the UK had deteriorated compared with pre-Covid-19 trends.”

As vaccines are now being administered, there is optimism for a return to more ‘normal’ ways of working in 2021. As ever in quality, however, the challenge is not simply to go back, but to create a better future. As businesses regain control over their operations, there are clear opportunities for mental health and wellbeing to take a central role in the workplace. 

Promoting wellbeing

There may be little a business can do about sudden changes and agency, but as business-led membership organisation Business in the Community notes, “pressure and workload are the biggest drivers of work-related poor mental health” – and these factors sit squarely within the control of business management.

Business in the Community further defines wellbeing as “the mutually supportive relationship between an individual’s mental, physical, social and financial health and their personal wellbeing”. How can businesses support this in their people?

Mental Health at Work is an initiative curated by the Mind mental health charity. This resource has six recommendations that are based on up-to-date research from both employers and mental health experts, which include increasing organisational confidence, capability as well as increasing transparency and accountability through internal and external reporting.

Businesses that do not yet have a policy in place to deal with the issue of wellbeing in the workplace should lean on resources such as these to ensure that they are able to look after the health of their employees at a time when everyone is feeling the pressure.

Work-life balance

The point of a work-life balance is that ‘balance’ is the optimal word. In the Lancet article cited earlier, the authors note: “Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness.” This highlights one of the most important things management can do when it comes to promoting wellbeing – listen with empathy.

In 2020, we saw that structures for care of others and ourselves have been put under stress and pulled apart. Many of us have also had to recalibrate relationships in the face of illness and bereavement. Given the upheaval of professional and personal relationships last year, employers should avoid setting up situations that create deliberate conflict within workers, such as missing the school play to attend a client meeting.

Again, we return to the issue of agency. There is a happy middle ground between no choice at all and the confusion of infinite possibilities, as this Deloitte Centre for Healthcare Solutions whitepaper says, “Employees who can take proactive measures to manage their mental health and wellbeing, can give their best at work”. At a minimum, therefore, to ensure better wellbeing outcomes, employers must give their teams the resources and backing to make the decisions that are right for them.

For more information on Covid-19, go to: quality.org/content/coronavirus