Health & wellbeing & resilience in the workplace: Evidence and Practice

1. Health & wellbeing & resilience in the workplace:Evidence and Practice Mike McHugh 15/5/15

3. The full cost of poor healthfor employers These apply only in the US 30% Medical care and pharmaceutical costs 70% Health-related Productivity Costs Absenteeism Overtime Turnover Temporary Staffing Administrative Costs Replacement Training Off-Site Travel for Care Customer Dissatisfaction Variable Product Quality All these apply to the UK also (adapted from R. Loeppke, US National Business Group for Health, Philadelphia 2009)

4. Workplace Health and Wellbeing-what is our overall goal? Healthy, engaged workforces Well-managed organisations • A high-performing, resilient workforce • Enhanced productivity Contributing to: • A well-functioning society • Better economic performance

5. Population trends and working life For a flourishing society we need the maximum number of productive years from as many of the population as possible. We need the ratio of earners and wealth-generators to dependants (children, pensioners, unemployed) to be as high as possible. Childhood Working life Retirement On current predictions, the future population will be composed of longer survivors, with more long term conditions.

6. ‘Do not wait for leaders; do it alone, person to person.” -Mother Teresa of Calcutta

7. ‘Good work’ according to Marmot • Precariousness – stable, risk of loss, safe • Individual control – part of decision making • Work demands – quality and quantity • Fair employment – earnings and security from employer • Opportunities – training, promotion, health, “growth” • Prevents social isolation, discrimination & violence • Share information, participate in decision making collective bargaining, justice if conflicts • Work/life balance • Reintegrates sick or disabled wherever possible • Promotes HWB – psychological needs self efficacy, self esteem, belonging and meaningfulness • Both physical and psychosocial environments critical

8. Workplace wellbeing programmes:?cost-effective • A multi-component health promotion programme accessed by employees through their workplace showed savings of around £9.70 for every £1 invested. The programme included personalised information provision and health appraisal, access to an online resource and workshops and seminars. It led to reduced stress levels and sickness absence, as well as improved productivity. Included in the economic analysis were costs saved by the NHS due to mental illnesses avoided. • Few workplace interventions have been subject to controlled trials because companies do not usually require this level of evidence before implementation. Companies who have implemented a range of interventions have maintained them because they are perceived to be cost saving.

9. NICE Guidance, 2012 • What can local authorities achieve by tackling health at work?

10. ‘Life is a journey through the desert’

11. What is mental health? ‘..a state of well-being in which every individual realizes his/her own potential, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her/ his community……’ WHO 2001 • Absence of mental illness • Positive mental health • Mental well-being

12. Dimensions of mental health If I am not for myself, who will be for me? And if I am only for myself, what am I? If not now, when? Emotional resources e.g. coping style, mood, emotional intelligence Cognitive resources e.g. learning style, knowledge, language, flexibility, innovation, creativity Mental health (capital) Meaning and purpose e.g. vision, spiritual growth, connectedness Social skills e.g. listening, relating, communicating, co operating, accepting Lynne.friedli@btopenworld.com Michael.parsonage@scmh.org.uk

13. Mental health builds ‘wellbeing’…What do we mean by Wellbeing? "The subjective state of being healthy, happy, contented, comfortable and satisfied with one's quality of life. It includes physical, material, social, emotional ('happiness'), and development and activity dimensions.” DOH, Commissioning Framework for health and wellbeing, 2007 p 99

14. Separate view of health Historically, mental and physical health have been seen as separate and non- interacting domains, resulting in separate treatment approaches and policies Mental Health Physical Health

15. An integrated view of health In reality, there is considerable overlap and interaction between physical and mental health Poor mental health is probably a larger contributor to health risk behaviours and poor physical health than the other way round Physical Health Mental Health

16. The mental health spectrum From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Moderate mental health Mental disorder Flourishing Languishing Number of symptoms or risk factors

17. The effect of shifting the mean of the mental health spectrum From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Flourishing Moderate mental health Mental disorder Languishing Number of symptoms or risk factors

18. Benefits of flourishing Wider Social Benefits • Improved educational attainment • Reduced anti-social behaviour, crime and violence • Fewest missed days off work Health • Healthiest psychosocial functioning,i.e. low helplessness, clear goals, high resilience • Lowest cardiovascular disease • Lowest number of physical diseases with age • Fewest health limitations of activities of daily living • Lower health care utilisation

19. ‘We choose to go to the Moon! ...We choose to go to the Moon in this decade and do the other things, not because they are easy, but because they are hard….. ‘ JFK, Rice University , Texas, September, 1962

20. Relationship between levels of prevention, intensity of intervention, mental illness, recovery and well-being Mental illness Recovery treatment & tertiary intervention Early signs of illness early intervention & secondary prevention High risk groups including history of mental illness secondary prevention General population Primary prevention Increasing levels of well-being

21. Resilience:‘Bouncebackability’ Oxford English Dictionary: “(Especially in sport) the capacity to recover quickly from a setback: promotion-chasing sides need to show the requisite bouncebackability after defeat”

22. Create flourishing, connected communities A Public Mental Health Framework for Developing Well-Being Meaning from adversity: • Post traumatic growth • Psychological therapies • Positive reflection Promote meaning & purpose Cultivate purposefulness & fulfilment: • In life, work, education and volunteering • By creativity, coherence and flow • With inclusive beliefs and values Enhance: • Community engagement • Ecological intelligence and connectedness Reduce social exclusion: • Address discrimination and stigma • Target high risk groups Develop sustainable, connected communities Integrate physical & mental health & well-being Improve: • Physical activity • Healthy Food • Sexual Health • Health Checks Reduce: • Smoking • Alcohol • Drugs • Obesity Reduce risk factors Promote protective factors Reduce Inequalities: • Unemployment • Fuel Poverty • Homelessness • Violence and Abuse • Impact of Climate Change Promote: • Employment • Benefits Checks • Safe Green Spaces • Insulated & Warm Homes • Partnership Working Build resilience & a safe, secure base Prevent and reduce impact of Adverse Childhood Experiences: • Child abuse • Parental mental illness • Parental substance misuse • Parental Domestic Abuse • Household offender • Childhood bereavement Improve: Parenting & Parental Health • Social and Emotional Literacy in Healthy Schools • Early interventions for conduct & emotional disorders Ensure a positive start in life Nurse J 2008

23. “Capacidad (feminine) de recuperación”

24. “Capacità di riprendersi dalle avversità (resilienza)”

26. Policy Context • The Foresight Report (2008) • Marmot Review - Fair society, Healthy Lives Marmot Review (2011) • Healthy Lives, Healthy People (2011) • No Health Without Mental Health (2011)

27. Foresight Report “Mental Capital and Wellbeing: Making the Most of Ourselves in the 21st Century” • highlighted the importance of mental capital and wellbeing: “An individual’s mental capital and mental wellbeing crucially affect their path through life and are vitally important for the healthy functioning of families, communities and society”

28. Five ways to well-being

29. “The quality of mercy is not strained” It droppeth as the gentle rain from heaven Upon the place beneath It is twice blest; It blesseth him that gives and him that takes: T’ is mightiest in the mightiest; it becomes The throned monarch better than his crown: The Merchant of Venice, William Shakespeare, 1564 - 1616

34. ‘Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom’ -Viktor Frankel, 1905 – 1997 • https://www.ted.com/talks/viktor_frankl_youth_in_search_of_meaning

38. Bertrand Russell, 1872-1970 “Three passions, simple but overwhelmingly strong, have governed my life: -the longing for love -the search for knowledge -and unbearable pity for the suffering of mankind”

40. Thank you? Questions

42. Workplace Health

43. A Healthy Workplace • What are the features of a poor workplace? • What makes a workplace good?

44. percent of population reporting health interfering with work or other regular daily activity (SF-36) % Postal survey of 9332 adults (16-64 yrs) Oxford Region Stewart-Brown S, Layte R. J Epid Comm Health 1997

45. Workplace health: (1) absences • 113m days lost in England each year to sick leave (1m with sick leave 4 weeks plus) • 70m related to mental illness • Cost in ESA/IB was 2x musculoskeletal • Off for more than 6 months – only 20% chance of returning in 5 years • Sick related benefits cost £13bn pa • Employers pay £9bn pa

46. (2) “Presenteeism” • Unrecognised and untreated mental health issues reduce productivity – possibly by as much as absences • Many people fail to take necessary sick leave • When these workers do take sick leave, they take longer to recover • Co-morbidity is common

47. (3) Causes… of causes! (psychological) • Self-rated health and social construction of poor health at work • Early life risk factors : parenting, child temperament, cognitive ability and speech, educational experience and attainment • Poor working circumstances: • job strain (high demand, low control –Karasek 1990) • effort-reward imbalance (Siegrist 1996) (pay, sense of satisfaction and achievement) • organisational justice: “procedural” and “relational” components (Kivami et al 2003)

48. (4) More causes of causes! (sociological/political economy) • Restructuring of global economy and redesign of work • Part-time, unsocial hours and zero-hours • Hollowing-out of lower and middle class occupations and professions • Work surveillance and control • Impact of austerity and shrinking public sector • Status and class (Marmot and Savage)

49. Example: people maintained in productive work Discuss the costs and benefits of maintaining people in productive work

50. Example: people maintained in productive work benefits • savings to firms/organisations from costs of vacancies, agency cover, lost productivity • reduced costs to Department of Work and Pensions • increased tax revenues, multiplier effect and social contributions • reduced costs to primary care, mental health and social care services • reduced detrimental impacts on other services, families and communities but • opportunity cost of other (lost) investments • marginal elasticity and scale factors • reduced productivity and substitution • negative macro-economic effects