New World Health Organisation (WHO) guidelines on mental health at work make it clear: workplaces amplify the issues that people have, from finances to relationships and a sense of inequality, and so employers have a responsibility to take action.
But what action? While the WHO’s lead has to be welcomed as a massively positive development in terms of keeping mental health high on policy agendas, we also have to bear in mind this is a universal document, adopting pan-global terms and language – some of which could be misinterpreted. It’s such a major reference point for government policy makers, campaigning bodies and employers internationally, so we have to be clear from the beginning about any practical implications. In other words, how the recommendations translate for UK businesses, and what they actually mean for how we do things.
Catch-all terms like ‘psychosocial’, heavily used in the WHO guidelines, can be useful for a shared, international understanding, but could also be unintentionally exclusive. As a result, the value of workplace counselling, as one example, isn’t mentioned. Neither is the central role and importance of EAPs.
Just talking in terms of psychosocial and ‘evidence based’ leads to a narrowing of thinking and could be assumed to mean channelling employees only through the most recognised evidence-based treatments, such as cognitive behavioural therapy (CBT), and little else. In practice, CBT wouldn’t be an appropriate response to many of the issues faced by employees and employers; for example, cases of bereavement and grief, relationships breaking down or the spiralling implications of debt. With this in mind, it must be assumed that psychosocial includes EAP and counselling, but that needs to be made clear.
We know that EAPs and counselling work. They work because they take an open-minded approach to the different origins of problems, the different levels and stages of their effects on people, and the very different kinds of support and advice that will help individuals. There is no leap to a diagnosis of ‘illness’; there is no hard labelling of issues; no medicalisation of language; no single route to ‘treatment’.
When someone is feeling anxious about rising mortgage payments, it’s important they get practical advice on their legal position and how they can remodel their finances, and not be drawn inexorably into questions about mental illness. EAPs, and the support of counsellors when it’s needed, provide a more realistic and adaptable set of ways forward for employees. It’s also a joined-up approach, involving training and support for managers. Increasingly, we are building up a bank of evidence of the impact. The most recent analysis from 2021 data suggests employers see a return of £8 for every £1 spent on their EAP – in terms of absence, management time and productivity – particularly as a result of access to professional counselling.
As a sector, we’ve always wanted mental health to be taken as seriously as physical health. But that doesn’t mean it can be treated the same way. We need to be careful when it comes to seeing mental health as a kind of binary problem – you’re healthy or you’re unhealthy – rather than what it is: a flux of human challenges that can be talked through and addressed, especially when there are early conversations and awareness of specific problems. And, similarly, not thinking about mental health as the source of costs for society, another kind of illness that needs treatments based on the evidence for the cures – a medicalised condition. In this way we are still talking as if mental health interventions were something ‘done’ to employees, the passive patients, when the real solutions come from individual responsibility and actively working through challenges together, through partnerships of employees and supporting services.
The WHO guidelines are an important milestone for awareness of the problem. But we also have to be clear on what’s needed and what works in practice, and get on with the job of delivering the most practical interventions.
Eugene Farrell is chair of the Employee Assistance Professionals Association UK, and Kris Ambler is workforce lead at the British Association for Counselling and Psychotherapy