Canadian employers are becoming increasingly aware of the impact of mental health disorders on productivity, absenteeism and presenteeism. Many are also recognizing that, as the research literature suggests, poor psychosocial work environments can lead to the development or worsening of mental health problems.
In the Thunder Bay region, an area north of Lake Superior in northwestern Ontario that is home to about 146,000 people, public health officials had been noticing a growing interest among area employers in resources to help workers cope with stress. In 2015, the Thunder Bay District Health Unit (TBDHU), which includes workplace health promotion in its chronic disease prevention program, responded by partnering with about a dozen organizations to launch a multi-faceted program aimed at raising awareness in the community about mental health at work.
The program, called Superior Mental Wellness @ Work, also set out to increase familiarity among employers with the National Standard for Psychological Health and Safety in the Workplace. Created by the Mental Health Commission of Canada, the standard is a comprehensive framework for helping organizations build psychologically safe environments. It describes 13 workplace factors that can impact worker psychological health and safety.
“When we heard that employers wanted to learn more about how to support employees in dealing with work stress, we did a literature search and realized that employee mental health is much bigger than just work stress,” says TBDHU Health Promotion Planner Lynda Fraser. “So we wanted to encourage workplaces to look at the bigger picture and consider the standard.”
With a grant from Ontario’s Ministry of Labour, a research team worked together to evaluate the effectiveness of the two-year program. This evaluation was led by epidemiologist Dr. Vicki Kristman, associate professor in the Department of Health Sciences at Lakehead University and associate scientist at the Institute for Work & Health (IWH).
According to an open-access article published in May 2019 in BMC Public Health (doi: 10.1186/s12889-019-6976-x), the team found that employer participation in the Superior Mental Wellness @ Work program was associated with improved knowledge on a range of mental health topics. These included increased familiarity with the workplace mental health standard, as well as greater knowledge about mental health challenges, the impact of stigma, mental health promotion strategies, community resources available to workplaces and how to build a business case.
However, when it came to changes in practice and policy, the picture was mixed. According to the team’s evaluation, organizations that took part in the project were more likely to have an action plan to implement the standard, were better prepared to champion mental health in the workplace, and reported better employee mental health and lower stigma levels in their workplaces. However, they were not significantly different from non-participating organizations when it came to the priority given to mental health or the existence of a mental health policy in the workplace.
Kristman says the findings are positive overall, because they show the project achieved a key objective of raising awareness among employers about mental health. “The intervention really helped increase employers’ knowledge about mental health in the workplace and their understanding of the standard, even if it didn’t really change their actions,” says Kristman, now an IWH adjunct scientist.
“That makes sense to us because it takes time to make change, and you really need a champion to do this. People were just getting interested and becoming or developing champions. There wasn’t enough time for us to see workplace change.”
A multi-faceted program
The Superior Mental Wellness @ Work program consisted of several components. The main one was a training program for employers on how to implement the national psychological health and safety standard in their workplaces. The training included six monthly modules, each lasting three hours. The training was delivered to 65 people from 32 worksites over a two-year period.
The second component of the program included a speaker series, Mental Health First Aid courses offered by the Mental Health Commission of Canada and Mental Health Works sessions offered by the Canadian Mental Health Association. These aimed to build mental health awareness, strengthen the ability of workplaces to respond to challenging situations, and foster healthier, safer workplace environments.
The third part of the intervention was a social marketing campaign that included a travelling exhibit of photos and testimonials designed to fight the stigma of mental illness. The exhibit was made available for workplaces to sign out for a week at a time. “It was immensely popular,” says Sue Armstrong, TBDHU’s public nurse. “It was booked solid by workplaces in the region for about a year. We’re still getting calls about it now.”
Two sets of comparisons
To evaluate the program, Kristman’s team conducted two surveys, one before the program was offered and one after. For each survey, about 350 randomly selected employers from the Thunder Bay area were contacted, and one representative (in a human resources, occupational health or safety management role) from each employer was invited to take part. The pre-program survey was completed by 89 employers; the post-program survey, by 61. Among these 61, 37 reported taking part in some part of the program: 81 per cent of the 37 in the training, 70 per cent in the speaker series or workshops, 40 per cent in the exhibit, 38 per cent in two of the three components, and 27 per cent in all three.
Kristman and her team evaluated the Superior Mental Wellness @ Work program on two fronts: its impact on employers in the region overall and its impact on employers who participated in the program. With respect to its impact on employers in the region overall, Kristman compared the responses of all employers who answered the pre-program survey with the responses of all employers who answered the post-program survey.
She found that, after the program was implemented, employers overall reported 55 per cent more familiarity with the standard. They also reported increased knowledge of mental health challenges in the workplace (16 per cent more), of mental health strategies (33 per cent more) and of existing community resources to support mental health at work (20 per cent more). However, no difference was found between the two samples when they were asked whether they had developed an action plan to implement the standard, had a mental health policy in place, or were ready to champion mental health at work.
With respect to evaluating the impact of the program on participating employers, the team compared the post-program survey responses of employers that took part in the program with those that did not. Here, the team found more noticeable differences.
Employers that took part in some or all offerings of Superior Mental Wellness @ Work scored significantly higher than non-participants on a range of issues related to mental health. For example, their knowledge about mental health in general was higher (21 per cent higher), as was their knowledge of more specific issues such as stigma and its impact, legal perspectives, mental health promotion strategies and ways to build a business case to gain management support (ranging from 25 to 88 per cent higher). Participating employers scored even higher compared to non-participating employers in terms of being familiar with the standard, having an action plan to implement the standard, and being ready to champion mental health in the workplace (ranging from 75 to over 300 per cent higher).
“There’s still more to be done, but overall, the intervention has opened employers’ eyes about how important mental health is and what options they have to address it,” says Fraser.
Kristman notes that a key shortcoming of the program was that it was not taken up by hard-to-reach workplaces. “Some sectors were missing from our samples—particularly from the post-program sample—such as resource industries and manufacturing. The companies that attended our events or training tended to be those that were already proactive around mental health,” she says.
“But what we were missing were small companies that were unable to afford the time to participate in the program, and those that might have felt that workplace mental health just isn’t a problem. And that continues to be a challenge for all of us in mental health promotion.”