Mental health, presenteeism and the limits of the risk assessment

Whilst Mental Health is considered a modern-day illness, recognition of mental ill health is very different. One of the traditional definitions, related to the absence of disease. Mental Health disease, often related to the more severe mental health conditions such as Bipolar, Schizophrenia, Major Depressive Disorder & Complex Personality Disorders. Conditions such as stress, anxiety and depression were not recognised as they are today. Therefore, to what degree these did exist is difficult to ascertain

Stress was introduced in 1936 by endocrinologist Hans Selye who defined stress biologically as the "nonspecific response to the body of any demand" and established the General Adaption Syndrome (GAS), proving that psychological or environmental pressures could cause physical illness. Earlier, Walter Cannon (1914) had referred to the "fight or flight response" to a perceived harmful event. This was known as the first stage of the GAS. Coping mechanisms and resilience strategies have been built over time yet stress is not classified as a medical condition or mental illness on its own which has often led to this state being ignored.

Anxiety was formally recognised in 1952 in the DSM, although forms of anxiety had been around certainly in the late 19th and 20th centuries. It was further updated in 1980 (DSM-III) which classified in more detail the various forms of anxiety, including Generalised Anxiety Disorder (GAD), panic disorder and Post Traumatic Stress Disorder.

Depression was formally separated from anxiety in 1980 (DSM-III) when it became known as Major Depressive Disorder.

Hence, from medical perspective, the categorisation of the disorders which cause the most problems in the workplace are relatively recent. The medical model, as we understand it today, dates to the 1800s when man was really trying to understand in more detail health, disease and how to treat the latter

This followed the first industrial revolution in 1760 and then just some forty years later the evolution of the UK Health and Safety with the Health and Safety Factories Act in 1802 (the Health and Morals of Apprentices Act). This then led to the first Factory Act of 1833. Around 1870 to 1914 we witnessed the second industrial revolution, and this changed our world with advancements in rail, communications, gas, water, sewage and electrical power. This finished with World War I. whilst technology continued to be developed and arguably our first form of AI was developed by Alan Turing work during World War II.

As part of this evolution in the UK, we had the Factories Act of 1937, 1948, 1961 and then the Health and Safety at Work Act 1974 (amongst a plethora of other acts and modifications over the years).

The recognised issues of this period in Health and Safety were physical risks. Whilst psychological risks are mentioned in the 1974 Act the HSE did not develop the concept of the psychological risk assessment until 2004 BUT this was based on the physical risk assessment and it is evident neither the HSE or the organisations they expected to use the suggestions of the Management Standards understood how to assess and address psychosocial risks.

Occupational versus Personal Risks

In the UK, the HSE firmly focus on the identifiable occupational risks within the role or the tasks within that role. Most countries follow a similar pathway to assessing occupational risks. However, some countries have moved towards a broader psychosocial risk assessment which will improve significantly the hazard identification and the potential to reduce harm to the individual.

Those involved in some of the countries, for example Australia, do also recognise that this needs to move more towards a Biopsychosocial approach, which aims to assess the risks that are impacting the person or have the potential to impact the person physically and psychologically when performing their role. The intent of the countries that have moved forward in this area is to protect the employee not to discriminate. However, they will be clear to the potential employee if they feel that the person cannot perform the role safely, will offer modifications it all reasonably practicable but may not offer the person the role if they feel there is a risk to that individual or to other employees. As an example in Australia, the law is clearer than in the UK and the requirement to undertake a psychosocial risk assessment will be enforced.

Psychological Occupational Risk Assessment

Should include:

• Step 1: Identification of the Occupational Hazards, physical, psychological, social and environmental by age, gender, ethnicity.
• Step 2: Deciding who can be harmed and how. This can only be assessed robustly if the employer can identify the "visible" psychological risks of the individual and possibly the "invisible". For example, we know from research and data younger people (under 30) are more vulnerable to psychological stressors what we may not be able to ascertain is "how" they can be harmed. To understand this without impacting the individual's privacy may require a referral or involvement of OH, the EAP or similar.
• Step 3: Precautions or Controls may have to be adapted to the different potential impacts a risk could have. We should not expect one size to fit all.
• Step 4 & 5: An employer should record their findings, implement their strategies and then review on a regular basis. This review should be adapted to the needs of the various employees, including age and gender, length of tenure, exposure to any traumatic risks e.g. difficult customers and any other review features that may evolve from OH, HR etc.

Personal Health Risks

Many Health and Safety professionals feel uncomfortable in assessing psychosocial risks and feel it should not be conducted by them. In which case, a solution needs to be found either internal or external rather than avoid managing the risk appropriately for the benefit of the employee, their colleagues and members of the public.

Protecting the employee from harm, and potentially their colleagues, and possibly in some cases members of the public and customers, ultimately involves assessing the visible and non-visible personal risks.

A psychological risk assessment can help identify the work risks and this can easily be combined with a personal health risk assessment that remain confidential. A simple approach is to organise the completion of a Health Questionnaire that can be a digital tool which can be evaluated by that provider or by an Occupational Health professional who understands the work.

These risks cannot be ignored if we are to protect individuals from harm at work or whilst performing work for the organisation. Neither can we continue to blame work for the harm if we have not assessed the risks.