Why is the workplace an important vehicle for health?
Workplace interventions have potential to create a slightly different impact than public health campaigns. For example, workplaces can hold mandatory trainings whereas public campaigns require voluntary participation.  They can also provide resources that you may not have known about otherwise, may not have had access to, or may not have felt comfortable seeking yourself.
For example, one study listed these as barriers to use of mental health services, several of which can be addressed in a workplace setting: 
Lack of time
Lack of finances
Lack of accessibility
No healthcare provider follow-up
Recognizing a need for help
Preferred to manage on own
Did not think there was effective help
Did not feel comfortable asking for help
In addition, because you (likely) spend a large portion of your week working, organizational sources of stress can make up a significant proportion of overall psychosocial stress and interventions at an organizational-level could help ameliorate these.
An interesting study out of Germany suggests that workplace interventions are also unique in who they are able to help. This study investigated if offering psychotherapeutic consultations in the workplace would improve access to treatment compared to standard outpatient care. Although you might think stigma would prevent this from being successful, this is not what they found.
The researchers discovered that more people “at risk” for depression rather than those with “severe” depression made use of the psychotherapeutic consultations in the workplace. Not only that, but adding this access within the workplace meant a greater number of males received psychotherapeutic consultations, whereas their participation in outpatient care is low (at least in the area studied). This points to a promising setting for early intervention in common mental disorders. 
In this article, we’ll take a look at mental health in the workplace from four perspectives:
How can you receive better support from your colleagues?
How can you, as an employee, better support your peers?
How can you, as an employer, better support employees with mental illness?
How can you, as an employer, better promote mental wellness?
How can you receive better support from your colleagues?
When you have a mental illness you sometimes face obstacles to getting the help you need. Some of these, like the impact of stigma on seeking help, are obstacles that the workplace can help reduce or remove.
Here are just a few types of concerns that have been brought up: [1,4]
What will my peers think of me?
Will using mental health services negatively affect my career?
Will my manager think less of me if they know I use mental health services?
I feel like I am not pulling my weight.
Are my peers gossiping about me?
If you’ve had these same thoughts, you’re clearly not alone.
Research supports that the general public has an inaccurate view of mental illness, and that these attitudes can transform from stigma from others to stigma of self.  The key word here is “inaccurate”.
This gives us two insights. First, there is room to improve people’s understanding of mental illness. Second, be aware that other people’s stigma can lead you to have these same negative thoughts about yourself. These views of the general public are often inaccurate and you shouldn’t be tough on yourself because of them.
Your workplace can play an important role in changing these attitudes and helping your colleagues get a better sense of what mental health is all about. But you can have an impact on this too.
The options available to you will depend on where you work. Here is an example from a study of kindergarten teachers. These teachers were asked about how they included colleagues with back pain and mental health conditions. They said that it was easier to include these colleagues when their health concerns were specific, and when they clearly stated their needs for accommodation.  Sometimes people worry they will hurt you by a clumsy attempt at helping. Or sometimes they simply don’t understand why you are able to perform a task one day but not another. In other words, they can’t “see” your illness. If you are in a workplace where you can state your needs, it gives your colleagues a specific way to help.
Also in this study, one of the things that made it more difficult to include their peers was when they had health concerns themselves.  When you feel like someone isn’t supportive of you, it may not be because they don’t want to help you but rather that they don’t feel able to right now as a result of their own situation. Nothing personal.
However, the decision to disclose a mental health condition must be balanced with caution. In an ideal world, yes you would have a supportive workplace and you could all work together to complement each other’s strengths and weaknesses on the job.
Unfortunately, this is not always what happens. It is still possible to face discrimination.  Weigh up the harms of potential discrimination against the potential for receiving understanding and support. Harms could include job loss and other forms of discrimination.  On the other hand, understanding and support could make your workday a whole lot less stressful (which can itself exacerbate an illness).
If you really love your job and your workplace is not very open to mental health discussions, the timing may not be right to disclose a mental health condition. Seeking professional help outside of work can still be beneficial. If the love of your job is overshadowed by the stress of an illness and your workplace is open to mental health discussions it is possible that asking for support could change your workday dramatically.
It really depends, and it is a decision that is unique to you and your workplace. If unsure, talk it through some of these points with your doctor: 
How has your work contributed to your symptoms?
Is work going to help or make your symptoms worse?
What are workplace relationships like?
Do you have access to an occupational physician or other professional?
Could safety for you, your colleagues or the public be compromised?
Depending on your situation, you may want to consider whether your workplace is a good fit for you or if it’s time to move on. Psychosocial stressors can add to existing illness-related stress. While a little challenge encourages us to grow, a lot of challenge in the form of a poor-quality job, an unsupportive workplace or an employer you don’t see eye-to-eye with may be more stress than necessary. At the end of the day, remember that you are not defined by a mental health condition, many people with mental health conditions go on to have successful careers, and you are not alone – there are many people in the workforce that have mental health conditions.
Finally, check out this next section on how you can support your peers too. Why? Because your willingness to help them and the understanding you show them increases the chance they will be understanding of and willing to help you in return. Plus, you are part of your workplace and how you act affects the culture there too.
How can you, as an employee, better support your peers?
Sometimes it is hard to know how to help someone you don’t know well. And sometimes it is even hard to know how to help someone you are really close to. For example, perhaps you don’t reach out to your peers because you are worried you will say the wrong thing.
People can find it easier to help someone who has physical health limitations because they understand how to be helpful. With mental illness, sometimes everything looks fine from the outside and there are no obvious clues on how you can help. It can be very frustrating to want to help but not know how.
This could be a good opportunity to speak up and ask for mental health programs in your workplace. Those with mental illness may be held back from asking for help due to concerns of being discriminated against. If you are not subject to the same stigma, “asking for a friend” could spark implementation of new programs or a more supportive workplace culture that can help both you and your friend to improve or maintain your mental wellbeing.
If your workplace is not open to this, you can participate in programs such as Mental Health First Aid that are open to the public to improve your own mental health literacy and confidence in speaking up when you are worried about someone.
If you sense that a colleague or friend needs help, ask them if everything is okay. If everything is okay, now they know that somebody cares about them enough to reach out. If everything is not okay, now they know that somebody cares about them enough to reach out and that somebody is keeping an eye out for them.
Why is this so important? Because it is important to show each other we care. Because we cannot be so scared of asking or reaching out that people are left alone in illness, thinking nobody cared. And because when we lose people it is heart-wrenching to think “If only I had asked. If only I had reached out sooner. I noticed something wasn’t right the other day but I wasn’t sure… I meant to…”
Start a dialogue, listen, listen and listen some more. Don’t judge or give advice (unless you are a trained professional). You can help them identify their supports and direct them to professional help. Be a part of the change you wish to see in your workplace.
One last note, don’t judge your colleagues (or yourself!) for using vacation days. I cannot emphasize enough the importance of work-life balance. Take time for your family, your friends, your hobbies, or simply a break to stop and catch your breath. Just like you need to take time to exercise or eat well, you also need to make time for your mental health regardless of whether or not you have been given a mental health related diagnosis. Help normalize a workplace culture where nourishing your mental health is okay.
How can you, as an employer, better support employees with mental illness?
Addressing stigma is like opening the door to all other interventions. As you can see from the concerns listed earlier in this article, it is stigma that so often holds people back from seeking help. An example of a workplace stigma is that people with a mental illness are lazy or incompetent. These are assumptions, and a workplace culture that holds these stigmas intact is harmful. Being ill is not the same as being lazy and people with mental health conditions can go on to have successful careers and make meaningful contributions.
You may not realize how many people in your workforce have a mental health condition. But they are there. Very few employees feel comfortable disclosing a mental health condition to a colleague, manager or supervisor.  Because the effects of discrimination can be so harmful, it can be hard for doctors to know whether to advise patients to speak up and ask for workplace accommodations. 
Interventions like Mental Health First Aid, Beyond Silence (for healthcare organizations) or role playing help people to have a better understanding of mental illness, reduce stigma and increase helping behaviours, creating a supportive environment. [1,6,7] Addressing stigma may be especially relevant if your workplace already has some supports in place but is finding that few people use them. Workplace culture can mean the difference between someone getting the help they need or remaining silent. As an employer, you have power to set the tone.
Future research will hopefully provide insights into how you can better protect the personal information of employees disclosing mental health conditions.
Helping Employees Return to Work
Employees take sick days. Sometimes, employees need to take “sick” days (some companies have “mental health” days) for mental health reasons. After being away, it can be hard for employees to return because they may not feel like they belong anymore.
Based on focus group feedback  and other considerations , here are some ways to make it easier for employees to return from a long absence due to mental illness:
Promote workplace understanding of mental health. Employees may receive sympathy from colleagues when they first leave, but after they have been gone for a while, their peers may be less understanding.
Make them feel welcome. Reassure a sense of belonging, and update them on any changes that have occurred in their absence and discuss how these will affect them.
Ease them back into routine with a modified workload, regular breaks, shortened workday or other accommodations as necessary. If the workday cannot be shortened, would it be helpful to do part of a day in-office and part of a day working remotely? Have a discussion to set reasonable conditions and expectations.
Create a supportive atmosphere. When other employees and supervisors are supportive, it makes a return to work easier.
Allow time for medical appointments
Give additional training if needed to improve confidence in performing job-related tasks
Given a healthful work environment, employees stand to benefit from returning to work in that they have activity, income, social interaction and higher self-esteem. 
Incorporating Mental Health Interventions in the Workplace
Just because an employee doesn’t take a sick day does not mean they are “okay”. In fact physical health symptoms are more closely tied to absence, while mental health conditions have more of an effect on performance. [as in 8] Then again, mental health symptoms and physical health symptoms can overlap or mask each other. This is one reason why efforts to improve workplace culture surrounding mental health are needed. It’s not simply about making accommodations for specific people but about helping all your employees to function optimally, and to perform their best on the job.
In a 2016 article by Pransky et al., three types of workplace-level (as opposed to employee-level) interventions are noted: 
Change conditions: reduce physical and chemical exposures
Change work schedules: adjust hours, shifts, intensity, pace, deadlines, breaks
Change work organization: reduce psychological stress, reduce problematic social factors, acknowledge efforts, change responsibilities, adjust procedures, change team structure/organization
Ideally, both workplace-level and individual-level concerns are taken into consideration to create a healthy company culture. These concerns include breaks, access to healthy foods, time for physical activity, work-family balance, rest and healthy social interactions. 
Is there research supporting specific interventions in all of these categories? Yes, there is for some. There are still lots of questions left unanswered. However, a number of organizations have put out recommendations on how to implement workplace interventions to reduce sick days due to mental illness. For example, you can check out the World Health Organization’s policy here.
Although there is significant variation in the types of workplaces and interventions studied, the interventions with the best workplace outcomes appear to be those that improve mental and physical health or that use multiple mental health interventions (for example individual interventions as well as workplace-level supports).  This is not surprising, given the ties between physical and mental health. Consider the fact that depression (and other mental illnesses) and musculoskeletal pain commonly co-occur and both are major causes of work disability. [5,11]
A good example of an intervention with effects on physical and mental health is “active rest” and we will cover this in the next section on promoting mental health. Other facets of health that have been brought up are financial health and social health and these could also be part of a comprehensive wellness program.
Can online programs be useful interventions for your workforce? It depends. Some studies do not find a significant effect, although one review found that there was a small effect on psychological health for digital interventions that largely used CBT-based (cognitive behavioural therapy) approaches.  A few reasons for these small effects may include quality of the program, the fit of the program for the specific workplace and a failure to incorporate aspects of both physical and mental health.
Reducing Workplace Bullying
In order to preserve the mental health of your workforce, attention must also be paid to workplace bullying. Bullying is not just a childhood playground matter, and is a real threat to reducing mental health.
Bullying at work is associated with lower mental health and lower mental health is associated with bullying. It can be a vicious cycle if it doesn’t get called out. However, bullying predicts poor mental health more strongly than low mental health predicts being a target of bullying. 
As a bit of a tangential illustration to this concept, consider the effect of workplace violence on nurses’ mental and physical health. The fact that there is an association between workplace violence and their health is not surprising. But what may be more shocking is that it is the internal workplace violence (such as psychological and verbal violence from colleagues) rather than the external violence (such as from patients and their families) that is more highly associated with poor health, even though in this study external violence was more common. 
Aside from being a target of workplace bullying, being a witness to workplace bullying can also be stressful and is associated with lower wellbeing in certain contexts (even after controlling for their own experiences of being bullied). 
Occupational safety processes should take workplace bullying into account. Workplace bullying can be reduced by increasing co-worker and supervisor support, improving communication, giving attention to psychosocial safety, performing regular surveys of workplace violence and having a way for employees to report workplace violence in addition to a protection protocol for these employees. [14,15]
How can you, as an employer, promote mental wellness?
Rather than focusing solely on supporting those with mental health conditions, mental wellness itself should also be supported, and for all employees. Addressing mental health is important not just for taking care of your employees, but also for productivity and engagement.
Preventing illness, though it may seem similar on the surface, is not quite the same thing as promoting wellness. For example, the absence of illness does not automatically indicate wellness. Wellness approaches have the advantage of being acceptable for all to participate, whereas intervention approaches targeting specific groups may run into the low participation due to stigma problem. Both prevention/intervention and wellness promotion should be addressed.
There are many ways this can be done. Some that have been suggested in recent years are:
Modifying organizational stress
Improving social support
Adding dogs to the workforce
Incorporating active rest
Modifying Organizational Stress
How does work contribute to your stress? While stress stimulates us to grow, too much is too much. Consider what would make your workday less stressful and then put yourself in the shoes of your employees – what would also make their workday less stressful?
Modifying work schedules or workload, increasing employee control and promoting physical activity all have potential to reduce work-related stress.  Resilience training, cognitive behavioural therapy and mindfulness strategies have also demonstrated potential to improve mental health. [5,16]
A review focusing on men’s mental health found that certain resilience programs (one online and one a combination of in-person, app games and phone calls) also helped reduce stress, increase work performance and increase happiness/quality of life amongst employees. Interestingly, the authors of the review noted that when studies included both men and women, the interventions were more effective for women (possibly because this gave a sense of support).  It is quite possible that the ideal intervention for your workplace will vary by its gender makeup and its other unique characteristics.
Changes at an organizational level send a message that you are actively trying to create a healthier work environment and that you support a culture of health. It also creates the space and opportunity for employees to engage in employee-level interventions. Finally, encourage people to use their vacation days and to find work-life balance. Provide leadership that demonstrates this balance and removes stigma around taking breaks.
Social Support at Work
Our social connections are a key component of health and this includes your social interactions in the workplace. In one study, those with poor social capital (or social support) in the workplace had a two times higher prevalence of psychological distress, after controlling for individual characteristics, compared to those with high social capital.  This does not imply that one caused the other, and indeed the relationship is likely more nuanced and cyclical.  However, we do know enough about the role of social support to know that it is important in health.
If you step outside the research, you can find many innovative approaches to mental health in the workplace. One that tackles stigma and makes use of peer counseling is the novel I Got Your Back program (you can read more about it in this news article). Mulvaney, who designed the program, incorporates workplace peer counselling by giving employees trained in counseling a pin to wear that identifies them as someone other employees can talk to. He also provides online resources and a “mood box”. When the mood box is set out at the beginning of the day, employees can anonymously put in a coloured card depicting their current mood. Then in a pre-work meeting he takes the cards out and shows which colours are at work that day. It has been helpful for his restaurant, and the program is about to be tested out in several others.
Dogs in the Workplace
Pets can be a wonderful addition to the family, and are increasingly showing up in the workplace. The most obvious ways they show up in a work context are service dogs, therapy animals and emotional support animals meant to help a specific person. However, visitation dogs and other animals can be brought in to a workplace by their owners for short social visits and resident dogs may keep the same working hours as their owners.
Could pet-friendly workplaces such as those at Google and Amazon improve employee mental health? In general, research suggests that pets can have positive effects on stress and provide a form of social support.  In one study on dogs in the workplace, employees that brought their dog to work had reduced perceived stress levels compared to days when the dog was left at home. They also had reduced stress levels compared to employees without a dog. However, this was a fairly short study, and was carried out over a one week period. 
Animals have been used to help humans in such a wide variety of contexts that, while we don’t have a lot of data on the benefits of pets in the workplace specifically, it would be very interesting to see more research on the impact this has on mental and physical health as well as job performance. Potential benefits based on research outside of the workplace include: lower perceived stress, improvements in task performance, increased social interactions with other people, and improved mood. 
Considerations prior to implementing pet-friendly workplace policies include the specific needs of the workplace (equipment, hygiene, etc depending on industry), the well-being of the animals, the safety of animals and employees, allergies, cultural differences in acceptance of pets, and animal-specific fears or phobias, amongst other topics. 
Incorporating Active Rest
The concept of active rest arose from the idea that being active re-invigorates more than lying down. Many people do work while sitting and their workday is punctuated by breaks where they are still…seated. Active rest interventions mix this up by getting people to move around on their breaks.
In one studied example, participants completed active rest exercises three times per week over their lunch break. The exercises were performed as a group, lasted 10 minutes and included stretches, cognitive functional training, aerobic exercise, and body weight resistance training. After ten weeks, participants (compared to controls) had improved mood states and decreased job-related stress. Improvements were also seen in physical activity and personal relationships. 
Something similar is provided by humanOS, a brilliant online platform that I use myself to incorporate movement in my day. This program provides well-researched courses on a variety of health topics and short, equipment-free workouts that you can complete throughout your day. It also tracks your activity so you can see if you are meeting standards for health on an ongoing basis.
The workplace is uniquely positioned to reduce risks and contributors to mental illness, educate on and reduce stigma of mental illness, improve access to mental health care, target people who are at-risk before they develop a more severe mental illness and promote mental health.
The best ways in which to do this may vary across industries but a few commonalities include cultivating a supportive workplace culture, providing education and resources and including both physical and mental health in health programs.
How does your workplace promote workplace wellness?
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