COVID-19: An opportunity to combat the burden of poor mental health in Australian workplaces

The COVID-19 pandemic has shone a light on the mental health crisis in our workplaces, exacerbating stresses and strains experienced by workers worldwide, including in Australia. Job-stress related mental health impacts on frontline workers such as emergency responders, healthcare, retail, warehouse distribution and social support workers have emerged as particular concerns. However, mental illness related to workplace conditions was a substantial preventable problem long before COVID-19.1Harvey SB Modini M Joyce S et al.Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems.Occup Environ Med. 2017; 74: 301-310Crossref PubMed Scopus (308) Google Scholar Changes over the last few decades including digitisation, automation, casualisation and the gig economy have been accompanied by a rise in non-standard employment arrangements. This has been associated with increases in job instability, perceptions of job insecurity and low job control, and elevated levels of job-related stress.2Arena A Petrie K Deady M Glozier N Morris R Harvey S. Has the Mental Health of Working Australians Changed Over the Last 20 Years?. Black Dog Institute, Sydney2021Google Scholar Job strain and job insecurity are common stressors in the working population, translating to substantial preventable burdens of mental and physical illness.3LaMontagne AD Too LS Punnett L Milner AJ. Changes in job security and mental health: an analysis of 14 annual waves of an Australian working-population panel survey.Am J Epidemiol. 2021; 190: 207-215Crossref PubMed Scopus (21) Google Scholar,4Niedhammer I Sultan-Taieb H Parent-Thirion A Chastang JF. Update of the fractions of cardiovascular diseases and mental disorders attributable to psychosocial work factors in Europe.Int Arch Occup Environ Health. 2022; 95: 233-247Crossref PubMed Scopus (12) Google Scholar In 2017, nearly one in every five Australian workers reported poor mental health.5Yu S Glozier N. Mentally Healthy Workplaces in NSW: a Return-on-Investment Study. Safe Work Australia, Canberra2017Google Scholar While poor mental health is associated with numerous individual and contextual characteristics,6Cohen A Gilman SE Houck PR Szanto K Reynolds 3rd., CF Socioeconomic status and anxiety as predictors of antidepressant treatment response and suicidal ideation in older adults.Soc Psychiatry Psychiatr Epidemiol. 2009; 44: 272-277Crossref PubMed Scopus (57) Google Scholar approximately 15% of depression in the Australian working population is attributable to job strain (low control and high demand jobs).7LaMontagne AD Keegel T Vallance D Ostry A Wolfe R. Job strain - attributable depression in a sample of working Australians: assessing the contribution to health inequalities.BMC Public Health. 2008; 8: 181Crossref PubMed Scopus (99) Google Scholar It is estimated that 17-35% of depression in the European working population is attributable to five psychosocial stressors commonly experienced in the workplace (job strain, effort-reward imbalance, job insecurity, long working hours and bullying).4Niedhammer I Sultan-Taieb H Parent-Thirion A Chastang JF. Update of the fractions of cardiovascular diseases and mental disorders attributable to psychosocial work factors in Europe.Int Arch Occup Environ Health. 2022; 95: 233-247Crossref PubMed Scopus (12) Google Scholar Complementing these more formal epidemiologic assessments, a recent report found Australian workers perceived that almost half of mental health problems were attributable to adverse workplace conditions.8Carter L Stanford J. Investing in Better Mental Health in Australian Workplaces. The Australia Institute Centre for Future Work, Canberra2021Google Scholar Emerging research suggests that non-work stressors, e.g., time constraints due to domestic unpaid work, combine with work stressors as determinants of mental health.9Doan T LaBond C Banwell C Timmins P Butterworth P Strazdins L. Unencumbered and still unequal? Work hour - health tipping points and gender inequality among older, employed Australian couples.SSM Popul Health. 2022; 18101121PubMed Google Scholar This unfolding crisis of workplace mental ill-health imposes enormous costs on workers, their families, and society at large. Prior to COVID-19, the Australian Productivity Commission's Mental Health Inquiry estimated that poor mental health cost Australia $200-220 billion per year, with at least $16-$17 billion arising directly from work stressors, injuries, and conditions.8Carter L Stanford J. Investing in Better Mental Health in Australian Workplaces. The Australia Institute Centre for Future Work, Canberra2021Google Scholar,10Productivity CommissionMental Health.2020Google Scholar Australia can do better. Reducing work stressors that adversely affect mental health would improve lives, reduce government and other healthcare expenditure and contribute to Australia's GDP by several billion dollars per year.10Productivity CommissionMental Health.2020Google Scholar If, prior to COVID-19, we had been charting a course toward poorer workplace mental health, the conditions wrought by COVID-19 have exacerbated this. Younger workers, females, and the casually employed were hardest hit by job losses and loss of hours related to COVID-19. Prior to COVID-19, these populations were known to be at greater risk of poor mental health; their differential exposure to these COVID-19 induced stressors may compound this situation as well as instigate additional mental health problems.11LaMontagne AD King T Taouk Y. Submission to the Australian Senate Select Committee on job security on the impact of insecure or precarious employment on the economy, wages, social cohesion, and workplace rights and conditions.New Solut. 2022; 31: 469-474Crossref PubMed Scopus (3) Google Scholar Many of the adverse changes in the nature of work induced by the COVID-19 pandemic may persist, and concerted efforts should be made to monitor and rectify this. An integrated approach with proactive strategies that reduce work stressors, and support mentally healthy work environments, and encourage early help-seeking will be critical for organisations. Mental health has long been considered by many to be an individual responsibility, and employer, government or collective responsibilities have been minimised or ignored. But individual-level mental health strategies alone will not solve problems related to working conditions. To date, workplace mental health policy has focussed heavily on workers and illness, and not enough on working conditions. This cannot continue. Responsibility for mental health must shift from a central focus on the individual, to systems and structures and the working conditions they produce. To create mentally healthy workplaces, a balanced and integrated approach is needed at the individual, organisational and government levels.12LaMontagne AD Martin A Page KM et al.Workplace mental health: developing an integrated intervention approach.BMC Psychiatry. 2014; 14: 131Crossref PubMed Scopus (176) Google Scholar Despite long-standing recommendations for the reduction of exposure to work stressors, most Australian workplaces have yet to implement work-directed actions to reduce job stressors. Until very recently existing laws were inadequate to address work-related mental health problems.8Carter L Stanford J. Investing in Better Mental Health in Australian Workplaces. The Australia Institute Centre for Future Work, Canberra2021Google Scholar However, the federal government agreed in 2021 to amend the model workplace health and safety laws to ensure psychological health and safety in the workplace is given similar consideration to physical health. The National Mental Health Commission is also developing national guidance on workplace mental health (https://www.mentalhealthcommission.gov.au/mental-health-reform/national-workplace-initiative). These are promising steps, but further action is needed. The law is now clear; employers have a legal duty of care for the psychological safety of their employees which involves addressing the preventable mental health burden attributable to modifiable working conditions. However, it is incumbent on all stakeholders to develop solutions. A collective holistic approach including government (health and economic policies/strategies), organisations, and workers (including family and community) is required if we are to successfully address the burden of poor mental health in the workplace. With the urgency and attention induced by the COVID-19 pandemic, we must seize the opportunity to further drive change. YT: conceptualisation, project supervision, writing - original draft, and writing – review & editing; AL, TK, JR: writing – review & editing. AL is a board member of MATES in Construction, a voluntary/unpaid position, and is reimbursed for travel related to his work on the board. AL and his university employer received consulting fees by Pracademia for workplace health consulting, unrelated to this work. The rest of the authors have no conflicts of interest to declare. No specific grant from any funding agency in the public, commercial, or not-for-profit sectors was received for this study.

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