It is perhaps not surprising that mental health problems are considered by many to be the predominant health issue facing working-age populations. Given that employees can spend around 60 percent of their waking hours at work, the workplace provides an important context for improving people’s psychological health and quality of life. Drs. Paul Flaxman and Frank Bond, authors of “The Mindful and Effective Employee: An Acceptance and Commitment Therapy Training Manual for Improving Well-Being and Performance,” suggest that organizations move beyond the traditionally more reactive approach to mental ill health and toward prevention and mental health promotion.
Staff turnover, elevated sickness absence rates, and reduced output found among psychologically distressed workers yield substantial business costs. Data from the Annual Survey of Occupational Injuries and Illnesses, which collects information from private industry in the United States on reported reasons for and duration of absences from work, indicate that anxiety, stress, and neurotic disorders account for a much higher percentage of long-term sickness absences than do other types of injuries or health problems. Specifically, in data collected in 2001, 42.1 percent of absence cases attributed to mental ill health involved 31 or more days away from work. As a result, the number of workdays lost among workers in the United States with these common mental health problems was on average four times greater than the number of workdays lost for all other nonfatal injuries and illnesses (National Institute for Occupational Safety and Health, 2004).
Reduced on-the-job productivity due to mental health problems far exceeds the costs associated with sickness absence. This reflects the phenomenon of “presenteeism,” which is attracting considerable interest from occupational health researchers and policy makers. Presenteeism occurs when employees appear at work but are unable to function at their full or usual capacity due to symptoms of ill health. Depending on the country of origin, estimates of the costs to industry range from 1.5 to several times larger than the costs associated with sickness absence. Moreover, there is some evidence to suggest that presenteeism is more common among white-collar and professional (hence more highly paid) occupational groups (Sainsbury Centre for Mental Health, 2007).
The costs associated with psychological distress among working populations such as those stemming from increased health-care and welfare spending required to support large numbers of working-age adults with mental health problems, and the aggregated output losses resulting from reduced productivity of distressed workers, inevitably impact the wider society and economy. In our book, we provide the following data to support this claim:
A large-scale study of U.S. workers indicated that health-care expenditures for employees with high levels of stress were 46 percent higher than those for employees with low stress levels (Goetzel et al., 1998).
Among the member states of the European Union, mental health problems are estimated to cost an average of 3 to 4 percent of gross national product (GNP), including treatment costs and output losses associated with employee absence and low productivity (Seymour & Grove, 2005).
Every year in the United Kingdom, an average of 200,000 working-age adults become dependent on welfare (incapacity benefit) payments because of a mental health problem (Black, 2008).
The Centre for Mental Health (2010) recently estimated the increase in the economic and social costs of mental health problems for England between 2002/2003 and 2009/2010. The overall societal cost in 2009/’10 was estimated at £105.2 billion ($164 billion), representing a 36 percent increase since 2002/’03 (the largest increase was in the costs of health and social care, which rose by 70 percent).
Intervention Approaches
Various types of workplace intervention have been applied to improve employees’ psychological health and work/life functioning. Traditionally, many of these interventions have been labeled as stress management interventions (SMIs). There are two types of SMIs:
- Organization-focused SMIs seek to modify aspects of the design and management of work to prevent or reduce psychological ill health among working populations. The most common organization-focused programs adopt a highly participative approach, in which employees are closely involved in the identification of problems and solutions, and in the implementation of any problem-solving initiatives.
- Individual-focused SMIs generally seek to modify the way individuals appraise stressful events and aim to improve workers’ coping resources. By far the most common (and empirically evaluated) approach takes the form of stress management training (SMT) programs. These programs are delivered to small groups of employees in the workplace and usually comprise a combination of traditional cognitive behavioral therapy (CBT) techniques (such as cognitive restructuring, muscular relaxation training, and time management training).
Expanding upon the CBT-based approaches to stress management interventions, Mindfulness-Based Stress Reduction (MBSR) programs increasingly are being delivered to employees in the workplace, and researchers have shown that abbreviated versions of traditional mindfulness programs can elicit impressive improvements in employees’ psychological health (Klatt, Buckworth, & Malarkey, 2009). Mindfulness intervention primarily would be considered an individual-focused approach as it seeks to improve employees’ personal levels of psychological flexibility.
Acceptance and Commitment Therapy, another approach to stress management that incorporates mindfulness, also meets objectives beyond improvements to employees’ psychological health, including applications of the ACT model and intervention technology for leadership, career, or organizational development. ACT has the potential to advance the theory and practice of worksite mental health promotion. Unlike more traditional SMT programs, ACT is underpinned by a unified theoretical model that offers clear guidance to researchers interested in identifying, measuring, and testing intervention processes of change. Moreover, ACT’s focus on promoting psychological flexibility rather than symptom reduction is congruent with current trends in occupational health policy and practice.
In the years to come, workplace programs that can be shown to enhance employees’ psychological well-being and behavioral functioning will come to be viewed less as an indulgence and more as an investment with considerable cost-saving potential. Data from Australia suggest that employers that invest in mental health initiatives, such as screening and facilitating help-seeking behavior, can expect a fivefold return on that investment (Hilton, 2005). To paraphrase the author of a major workplace well-being review conducted in the United Kingdom: Good mental health is good business (Black, 2008).
Adapted and used with permission by New Harbinger Publications, Inc., from “The Mindful and Effective Employee: An Acceptance and Commitment Therapy Training Manual for Improving Well-Being and Performance,” by Paul E. Flaxman, Ph.D., Frank W. Bond, Ph.D., and Fredrik Livheim, MS. For more information, visit http://www.newharbinger.com/mindful-and-effective-employee
Paul E. Flaxman, Ph.D., is senior lecturer in psychology at City University London. He specializes in adapting acceptance and commitment therapy (ACT) to help improve employees’ mental health and performance. Dr. Flaxman recently directed two major projects focused on delivering ACT and other mindfulness-based interventions to public sector workers across the United Kingdom.
Frank W. Bond, Ph.D., is professor of psychology and director of the Institute of Management Studies at Goldsmiths, University of London. His research and consulting work focus on the psychological and organizational processes that underpin peak performance and well-being in the workplace.
