Making work healthier

Ella Rhodes reports.

While psychologists have a long history of supporting national policy to improve safety at work, their contribution to workplace health has perhaps been less prominent. Two psychologists who work on a Health and Safety Executive (HSE) committee spoke to Ella Rhodes about how this is changing, and psychology’s place in ensuring work does not adversely affect people’s physical and mental health.

Psychologists Dr Joanna Wilde and Dr Emma Donaldson-Feilder have both been involved with the HSE’s Workplace Health Expert Committee (WHEC) for a number of years, given their familiarity with research evidence in the field and experience of working within organisations. The role of the committee, which also includes experts in occupational medicine, human factors and occupational health practice and provision, reviews evidence on emerging workplace health risks to support the HSE science division.

Recently Wilde and Donaldson-Feilder have contributed to a rapid review of the evidence on Covid-19 testing in the workplace, examined the evidence on evaluations of interventions in the workplace which aim to reduce ill-health – both physical and mental, and helped with a review of the occupational factors in suicide risk. Donaldson-Feilder first provided input to the HSE in 2003 when she was involved in consultations on their management standards for preventing stress.

‘There’s more recognition now that mental health isn’t just an individual issue – that we need to look at psychosocial environment and recognise that there’s a systemic element to it.’  

When asked about psychology’s role in supporting the understanding of health in the workplace, Donaldson-Feilder said a lot of focus in the past had been on the importance of stress, mental health, and human factors. ‘Part of our role initially was to make sure the focus wasn’t all about lung disease, diesel fumes and repetitive strain injury, and that there was a consideration of mental health and the psychosocial environment. It also involved saying that it’s all well and good to put in place an exposure limit on a particular chemical, for example, but what about the behavioural aspect of whether people will actually comply with that?

‘More recently, we have increasingly sought to raise awareness of how a failure to engage with the behavioural and contextual issues around an intervention can impact intervention success and potentially lead to unintended harm; for example, the potential negative impact on trust was a significant issue raised in the review of the use of Covid testing in the workplace.’

Since joining the committee, Wilde has been keen to emphasise the complexity of the workplace environment when introducing interventions aimed at supporting or improving employee health, as well as the evidence base underpinning intervention design and implementation. Three main concerns were of particular interest to Wilde when speaking with the committee on workplace interventions, incorporated into the recently published WHEC evidence review on the topic.

She said that a focus on mental health alone has meant that organisations can ignore, and even worsen, the occupational factors which affect employees’ physical health. She said this was because focusing on mental health tended to frame the problem as located in ‘the individual’ rather than a consequence of  known psychosocial hazards in the workplace environment.

‘One of the key hazardous psychosocial exposures in the workplace is the combination of high demand and low support and these exposures, evidenced in longitudinal studies of work-related psychosocial exposures and biomarkers of inflammation, are implicated not only in psychological health outcomes but also in long-term physical health problems.’

Many workplace initiatives to improve employee mental health can, paradoxically, end up increasing psychosocial hazards in the workplace and use additional resources within the organisation which may be better used elsewhere, she said. ‘One of the key conversations that we wanted to broker in WHEC is that we need to have a much more sophisticated understanding of what causes unintentional harm, and therefore how we can intervene in these psychosocial exposures.’

Another concern for Wilde was that much of the research examining the relationship between work and health tended to focus on the ways work can be good for health, but she said this could create a framing effect that ignores how work can harm health, and also how unsophisticated interventions aimed at mental health in the workplace can contribute to this harm. ‘I really wanted us to look at the emerging literature in psychology about the way in which psychological ideas have been implemented in a way, which, paradoxically, increases harm.’

Wilde gave two examples – designing and implementing interventions that focus on individual behaviour without acknowledging the role of context – which she said have been demonstrated to worsen the outcomes an intervention aims to improve. ‘The other issue manifests, for example in the implementation of Mental Health First Aid, which has been rolled out in many places, but has been understood and deployed in a manner that had not been anticipated in its design. This adds demand, a known psychosocial hazard, to Mental Health First Aiders, exacerbated by a lack of support as there is no clear regulatory framework equivalent to that for workplace physical first aiders.’  

Another area for attention, Wilde said, was the contribution of work as a social determinant of health and health inequality. ‘We need to conceptualise and think about bad work and its impact on health. This is particularly important in workplaces that have been described as ‘two tier workplaces’: one tier is those on precarious, zero-hours contracts earning low wages, managed remotely often via a technology platform, with the other tier being the professional staff running the platform organisation. However, the psychological trauma experienced from bullying and discrimination are also relevant considerations when addressing the issue of bad work and its impact of work-related health outcomes.’

Looking to the future of WHEC’s work, Donaldson-Feilder said some of the committee’s members have been asked to act as a small governance group on the National Core Study research programme on environmental and transmission risk factors for Covid, which includes exploring transmission mechanisms and controls in workplace settings. The committee is also hoping to share the evidence reviews it produces more widely.

‘When the committee was set up it was very much couched in terms of giving advice to HSE but I think there’s a realisation that the papers that we are producing are actually of value to a much wider audience, and we have been thinking about how we can get our existing work out to audiences much more broadly.’

The HSE has also posed a question to WHEC on fatigue and mental health in the construction sector. Donaldson-Feilder said that understanding the factors that increase risk to mental health and intervening to reduce risk is not a simple matter; it involves engaging with the full complexity of the psychosocial environment in which workers – in this case construction workers - operate.

‘I think this could build on the interventions paper that Joanna spearheaded, exploring the complex systemic nature of psychosocial hazards, multi-level and multi-factorial causation, and how we might intervene to create an environment that is more conducive to workplace health – be that workplace physical health or workplace mental health. My aspiration is that, in the long run, we get to a point where we are helping employers create cultures of genuine care, where we are building compassion and care into the system, into attitudes, into the way organisations are run and managed and led.’

More information on WHEC

More information on the National Core Study

Read WHEC’s rapid review of workplace Covid testing

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