The cost of mental ill-health is high for individuals, employers, and governments. Common mental disorders, such as depression and anxiety, are estimated to cost the global economy $1 trillion USD, or 3.5 percent of GDP annually.
With more employees working from home than ever before, increased reports of mental ill-health amid the COVID-19 pandemic linked to long hours, increased isolation, and inability to separate work and home life have placed the issue of occupational health in relation to psychosocial factors under even more scrutiny.
During this time, more than 97 percent of occupational therapists experienced at least “some” restrictions in regard to their usual service population accessing services, and in 93 percent of countries worldwide, critical mental health services were disrupted or halted. Around three-quarters reported at least partial disruptions to school and workplace mental health services. Not only are people reporting higher rates of mental illness, but they have less access to potential sources of treatment. Yet prior to the pandemic, countries were spending less than 2 percent of their national health budgets on mental health.
The case for employers to create mentally healthy workplaces is strong. The Organisation for Economic Co-operation and Development (OECD) outlines a number of “costs” associated with mental illness, including increased unemployment gaps, reduced workplace productivity, and heightened strain on benefit systems. People with severe or moderate mental health issues are more likely to be at risk of poverty or working in jobs that are of “poorer quality.”
In economic terms, it is estimated that for every $1 USD put into scaled-up treatment for common mental disorders, there is a return of $4 USD in improved health and productivity.
Despite this, according to the International Labour Organization, only 45 percent of countries specifically include psychosocial hazards as part of occupational health legislation and guidance.
Country Profiles
Norway
- Direct spend on mental health (health systems and social benefits): 26% of GDP
- Life satisfaction score (on a scale of 0 to 10): 6 (highest)
- Percentage of day spent on personal care: 65%
- Share of population with any mental health or substance use disorder (2017): 12%
- Include psychosocial hazards as part of occupational health legislation: Yes
Norway is among the wealthiest nations in the world, with low levels of income inequality. Life expectancy is generally long, and there is good availability of effective and high-quality medical care. This comes at a high cost, as the Norwegian health system is among the most expensive in Europe, with most financing coming from public funds. In recent years, there has been increased policy focus on provisions of mental health care with a shift towards a more holistic approach to ensure that mental health is incorporated as an integral part of public health.
Mental welfare of workers is protected in the Norwegian Working Environment Act (Arbeidsmiljøloven), which regulates most employment contracts. Occupational laws ensure workers have access to flexible hours for health, social, or welfare reasons; limit maximum working hours; and prevent discrimination. Moreover, employers must preserve employees’ integrity and dignity against harassment or other improper conduct.
Japan
- Direct spend on mental health (health systems and social benefits): 5% of GDP
- Life satisfaction score (on a scale of 0 to 10): 9 (lowest)
- Percentage of day spent on personal care: 59% (lowest)
- Share of population with any mental health or substance use disorder (2017): 36%
- Include psychosocial hazards as part of occupational health legislation: Yes
The Industrial Safety and Health Act was first introduced in Japan in 1972 following a high number of occupational accidents and deaths in the 1960s. Japan’s work culture is thought to be so intense, people in the 1970s developed the concept “Karoshi” which translates to “death by overwork.” In 2004, employers were made liable for “Karoshi” and since 2018, labor laws require a mandatory interview by a physician for employees working excessive hours. Due to further concerns around high levels of workplace stress, in 2015, the government made it mandatory for all businesses with more than 50 employees to offer an annual stress check to their workers.
Employer attitudes and measures taken to ensure the wellness of employees are becoming more widely considered to be competitive resources and are closely monitored by investors and prospective candidates. For example, Japanese workplace practices have been criticized for creating barriers for parents in achieving balance between family and work-life due to the disparity in men taking paternity leave and poor opportunities for women returning to employment after having children. Despite efforts to increase workforce participation of women, birth rates and the proportion of female workers remain low. The government has now established a certification system for employers that encourages work-life balance. While stigmatization of mental illness is still prevalent, attitudes are changing, and some employers are introducing measures, such as EAPs, to support employees.
United States
- Direct spend on mental health (health systems and social benefits): $225 billion USD(1.05% of GDP)
- Life satisfaction score (on a scale of 0 to 10): 9
- Percentage of day spent on personal care: 60%
- Share of population with any mental health of substance use disorder (2017): 34%
- Include psychosocial hazards as part of occupational health legislation: No data available
According to the Center for Disease Control, mental health disorders are among the most burdensome health concerns in the United States. While the government provides much advice and guidance for employers regarding the creation of mental health-friendly work cultures, and more than 180 worker protection laws do exist covering maximum working hours before overtime must be paid, family leave, and discrimination, these are less stringent than regulations in other “developed” countries. For example, the Fair Labor Standards Act (FLSA) does not require payment for time not worked, such as vacations, sick leave, federal, or other holidays; this is left to employer-employee agreement. In the U.S., there are no national mandating rules for the assessment of psychosocial risks or violence against workers, and the training courses offered by the Occupational Safety and Health Administration (OSHA) do not include these topics either.
Brazil
- Direct spend on mental health (health systems and social benefits): 0.14% of GDP
- Life satisfaction score (on a scale of 0 to 10): 4
- Percentage of day spent on personal care: 61%
- Share of population with any mental health or substance use disorder (2017): 74%
- Include psychosocial hazards as part of occupational health legislation: Not reported
Brazil shows the highest rates of disability caused by depression (9.3 percent) and anxiety (7.5 percent) in the Americas. The Ministry of Labour and Employment, and specifically the Department of Health and Safety at Work, are responsible for workplace health and safety in Brazil. Laws relating to working conditions include a maximum working week and entitlements to paid time off, some of which can be converted to additional salary, and employees can use their sick leave to deal with mental health issues. However, employers don’t necessarily recognize the need of employees to take time off to prioritize self-care.
The 2017 labor law reforms in Brazil have been referred to as a “regression,” partly leading to improvements in health and safety policies but also contributing to the emergence of new psychosocial risk due to increased work overload, fast-paced environment pressure, competitiveness between peers, and inability to enforce their rights.
Traditional Brazilian work culture glorifies hard work and encourages people to become “workaholics.” Physical health is still prioritized over mental health, thus mental issues are often underestimated or ignored. Brazil’s mental health care services are still evolving and shifting from institutions to community services that now offer psychosocial care centers, which help those with persistent and severe mental health challenges through therapeutic workshops, sports, and family assistance.
United Kingdom
- Direct spend on mental health (health systems and social benefits): 27% of GDP
- Life satisfaction score (on a scale of 0 to 10): 8
- Percentage of day spent on personal care: 62%
- Share of population with any mental health or substance use disorder (2017): 65%
- Include psychosocial hazards as part of occupational health legislation: Sometimes—risks not covered by specific provision
Worker safety has been addressed through national laws, including the Health and Safety Act and the Management of Health and Safety at Work Regulations, which require employers to provide a safe environment and to assess and control risks to worker safety. A Working Time Directive prohibits employees from working more than 48 hours per week. From the first day of employment, workers are entitled to minimum statutory paid holidays, as well as UK public holidays.
Whether work is causing the health issue or aggravating it, employers have a legal responsibility to help their employees. Work-related mental health issues must be assessed to measure the levels of risk to staff. Where a risk is identified, steps must be taken to remove it or reduce it as far as reasonably practicable.
Most people in the UK are conscious of the need to guard their own mental state and are aware of the factors that affect mental wellbeing and how this can be improved. Attitudes towards persons with mental health issues have improved over time, but stigma attached to mental illness still exists. Those with mental health problems say they experience discrimination in all aspects, including employment. Government and non-government organizations, as well as employers, continue to educate people and offer support for stress and mental health issues. However, the National Health Service is reportedly “in crisis” with more people than ever before contacting mental health services following COVID-19.
France
Recognizing the value of work-life balance, employee working hours in France are highly regulated, and any time worked over 35 hours per week is payable as overtime. Employees are entitled to a minimum of five weeks’ paid holiday, plus 10 public holidays per year.
Physical and mental health are protected by French labor laws. Health and Safety Committees within organizations contribute to the protection of physical and mental health of workers, including protection against moral harassment, especially if it results in damage to an employee’s physical or mental health or career.
Studies conducted in 2018 indicated that one in five French people suffers from mental disorders. Despite familiarity with mental illness, it was reported that one in three French people would be embarrassed to share a meal or work next to a person suffering from psychiatric disorders, and 75 percent regard psychiatric patients as a risk to themselves or others.
China
- Direct spend on mental health (health systems and social benefits): 0.18% of China GDP
- Life satisfaction score (on a scale of 0 to 10): Not reported
- Percentage of day spent on personal care: Not reported
- Share of population with any mental health or substance use disorder (2017): 40% (lowest)
- Include psychosocial hazards as part of occupational health legislation: Yes
In China, the number suffering from mental illness heavily outweighs the number of mental health facilities and therapists, and it was only in 2012 that the country passed its first mental health law.
The National People’s Congress mandates the working hours in China, with any work exceeding eight hours paid as overtime. The law limits overtime work to a maximum of three hours per day and 36 hours per month. Employees who have worked at a company for one continuous year are entitled to five days annual leave, which increases with tenure or cumulative work experience.
Employers are mandated by Chinese law to create a safe environment beneficial to the physical and mental health of their employees. To ensure employees can comfortably perform their work duties, employers must assign work within the capacity of the employee, ensure equal treatment for them, and provide necessary training, including mental health education.
However, mental health is heavily stigmatized which is believed to prevent many from seeking treatment or support from employers. Some traditional beliefs associate mental illness with possession by demons, improper childbearing behaviors, or wrongdoing by one’s ancestors. Consequently, people with severe mental health issues can be socially excluded to prevent embarrassment.
Singapore
- Direct spend on mental health (health systems and social benefits): 0.09% of Singapore GDP
- Life satisfaction score (on a scale of 0 to 10): Not reported
- Percentage of day spent on personal care: Not reported
- Share of population with any mental health or substance use disorder (2017): 44%
- Include psychosocial hazards as part of occupational health legislation: Yes
Singapore’s Ministry of Manpower has in place an Employment Act, which mandates a maximum number of work hours per week and a minimum of seven days paid annual leave per year, plus one extra day for every additional year of service.
In 2020, a government advisory on mental wellbeing at workplaces was issued recommending the appointment of wellness champions within organizations, the provision of access to counselling services, and extension of the scope of medical benefits to include mental wellbeing programs, consultations, and treatments. Organizations are also advised to review the state of employees’ mental wellbeing regularly, implement flexible work arrangements, and establish return-to-work policies to support employees who are recovering from mental health conditions. These, however, are not statutory requirements and are dependent on an organization’s available resources and willingness.
Mental illness stigma is still prevalent in Singapore, with many reporting fear of persons with mental illness and dismissing such conditions as “not real,” which is believed to be influenced heavily by local cultural values.
New Zealand
- Direct spend on mental health (health systems and social benefits): 0.18% of GDP
- Life satisfaction score (on a scale of 0 to 10): 3
- Percentage of day spent on personal care: 62%
- Share of population with any mental health or substance use disorder: 71% (highest)
- Include psychosocial hazards as part of occupational health legislation: No—General duty provisions in principle address psychosocial risks; but there are no provisions explicitly addressing psychosocial risks
Workplace stress, fatigue, discrimination, and psychological harm are covered by health and safety laws and employers must ensure that these are identified and managed accordingly. Sick leave may be provided for an employee who is suffering from work-related stress. Laws protecting workers include maximum working hours, meal breaks, and paid rest breaks. New Zealand workers are entitled to a minimum annual leave of four weeks, plus 11 public holidays, and employees may opt to exchange one week’s leave for cash.
A recent survey by Ipsos revealed that 73 percent of New Zealanders agree that mental illness is an illness like any other, and 76 percent agree that their society needs to adopt a far more tolerant attitude towards people with mental illness. The New Zealand government estimates that nearly half of New Zealanders will meet the criteria for a diagnosis of mental illness at some point in their lives, and with this, recognizes the important role businesses play in supporting the workers’ mental wellbeing. The government recently pledged a record figure of NZ$1.9 billion to mental health over a five-year period in its first wellbeing budget.
South Africa
- Direct spend on mental health (health systems and social benefits): 0.18% of GDP
- Life satisfaction score (on a scale of 0 to 10): 7 (lowest)
- Percentage of day spent on personal care: 62%
- Share of population with any mental health or substance use disorder (2017): 78%
- Include psychosocial hazards as part of occupational health legislation: Yes
For employees in South Africa, working time and overtime is limited per day, and there is a right to 21 consecutive days of paid annual leave. In relation to sickness absence, leave entitlement can be used for dealing with mental health issues, as long as the period of rest is endorsed by a medical professional. The Constitution protects employee rights to equality, dignity and fair labor practice and the Employment Equity Act (EEA) and Labour Relations Act protects employees from unfair discrimination and dismissal because they are disabled or ill.
Psychological issues are heavily stigmatized in some communities with many holding the traditional belief that mental illness results from a demonic possession, which can prevent individuals from seeking help. Reportedly only one in six South Africans would disclose their mental health issues to their manager, although many employers are now recognizing the cost of mental ill-health in terms of presenteeism and productivity, and efforts are being made to address this.
Despite the clear imbalance between the availability of mental health services across the globe, the growing needs of citizens, and the “business case” for improved mental health and its potential impact on the economy, labor reforms are slow, and many countries still lack concrete guidance over mental health at work. Measures relating to the reporting of mental health pervasiveness must also be viewed with caution; stigma and cultural values in certain locations may be skewing results relating to progress. The World Health Organization (WHO) states that businesses have a “responsibility” to support individuals with mental disorders in either continuing or returning to work by offering flexible hours, job redesign, positive workplace dynamics, and supportive and confidential communication with management. With increasing numbers reporting heightened stress, anxiety, and depression in the workplace, pressure is on employers to ensure the mental safety of their workers, as well as physical.
