Mental ill health: a very brief history

Evidence spanning centuries tells us that ancient Egyptians, Greeks, Chinese and Indians experienced challenges to their mental fitness. The causes were typically referred to as "supernatural agents, sorcery or witchcraft" and those affected were labelled as having hysteria and melancholy; those deemed as "mad" were hidden away, denied an existence and regarded as bringing shame on the family. Trephining (drilling into the skull), bloodletting and exorcisms, restraints, torture, straitjackets, dousing in boiling or freezing water and starvation were treatments of the day. In the first half of the 1900's asylums became testing grounds for treatments such as ECT and lobotomy. In 1886 Freud set up his clinic in psychoanalysis in Vienna and had no shortage of patients. Acts of Parliament spanning from the 1808 County Asylums Act to the 1890 Lunacy Act, 1913 Mental Deficiency Act and the 1959 Mental Health Act would indicate that mental ill health is no modern-day phenomenon. Thankfully attitudes to mental health have changed in recent decades, however it was as recent as 1961 in the UK (1993 in Ireland) that suicide was no longer a criminal act. In 1959, out of almost 5,400 suicide attempts, 33 were imprisoned, whilst others were fined or put on probation.

Present day

Despite a more positive attitude towards mental ill-health in recent years, stigma around the topic remains. Approximately half of people say they would not feel comfortable talking to their employer about mental health problems (Mind, 2022). As a cause of sickness absence, mental ill-health has been the leading cause of long-term absence for several years (CIPD, 2023). Mental ill-health is described by the NHS as the largest single cause of disability in the UK, and the World Health Organisation state that “mental disorders remained among the top ten leading causes of burden worldwide, with no evidence of global reduction in the burden since 1990” (WHO, 2022).

Sadly, suicide rates have increased and in 2022 there were 5,284 deaths by suicide, 65 more than in 2021.

Mental health and the workplace

According to the latest CIPD Health and Wellbeing at Work Survey 76% of organisations reported some stress related absence (rising to 92% of organisations with more than 250 employees), with heavy workloads and management style being the most common cause. The survey also notes that “non-work factors, such as health issues and relationships/family, are also among the most common causes of stress-related absence”.

Legal provisions, guidelines and regulations are made clear for protecting workers from harm or injury via the Health and Safety at Work Act 1974, the HSE Management Standards for Stress and the Management of Health and Safety at Work Regulations 1999, with the latter requiring employers to conduct risk assessments to identify hazards in the workplace, including those related to stress, and to take appropriate measures to control those risks. Unfortunately, few organisations do this, either because they are unaware of the requirement, do not know how to or are confident that they can get away without being reported. It’s worth noting that the HSE has been including asking for evidence of organisation-wide stress risk assessments within their spot-checks since 2021.

The future

Mental health awareness weeks are all well and good (and seemingly still much needed), but could it be advantageous to rebrand it to Mental Health Action Week? There is now an abundance of recommendations and evidence via white papers, surveys and research informing us of what interventions can support performance, productivity, retention and low attrition rates (not forgetting worker-wellbeing). Surely, it’s time that mental and physical health are regarded with parity of esteem as per the Health and Social Care Act, 2012, not only via health and social care providers but within organisations too. Hugh Robertson, a previous HSE board member and senior policy officer at the TUC stated in his speech at the HSE Stress Summit in 2020 that in their survey of safety reps, stress has been identified as the risk that caused most concern. He went on to say “there has been very little enforcement-action around the issue of stress … stress is being treated differently from other risks. We are enforcing around chemicals or around musculoskeletal issues and so on… but there is a requirement for employers to remove a hazard caused by stress as far as is reasonably practicable …”.

Actions have to include primary interventions that start with the culture of an organisation where leadership threads mental health through their wider strategy. The six domains of the HSE Management Standards for Stress are clearly laid out and invite companies to assess how workers are affected by demands, control, change, relationships, support and their role prior to making a regularly reviewed action plan that addresses areas where a risk is identified. This is likely to lead to improved line manager skills and confidence (identified in the CIPD survey as a top challenge), a more manageable workload, autonomy of control, communication around change, and reduced stigma that enables authentic and adult behaviours.

Piecemeal offerings such as healthy food options, onsite mindfulness or one-off wellbeing events have a minor role. Linking policies on mental health to the wider business strategy, securing a visible commitment from senior leaders, engaging the wider workforce to bring to life a culture shift and using the expertise of Occupational Health and specialist trainers are just some of the major actions to explore during this mental health awareness week.

This article was written by Libby Morley-Hassanali, Vice Chair, On behalf of iOH, The Association of OH and WB Professionals. iOH is dedicated to providing support to the professional community that is evidence-based, relevant and improves the health of the working-age population.

References

Health and wellbeing at work | CIPD
mind-index-insights-report-2021-22.pdf
SN06988.pdf (parliament.uk)
Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 - The Lancet Psychiatry

About the iOH

Established 30 years ago, iOH is an inclusive professional development and networking group for all Occupational Health workers, professionals and students.  Membership offers support, OH Today Journal with a research round-up and the opportunity to network regionally, nationally, in person and online with colleagues who actively invest in their development.