This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future.
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Well before the pandemic hit in early 2020, we were profoundly aware of the seriousness of this dimension to our health with one in two people in OECD countries experiencing a mental health condition in their lifetime. In April 2021, we devoted a first session of the OECD Forum to mental health in COVID context. Addressing the Hidden Pandemic: The Impact of COVID-19 on Mental Health dwelt on the very sharp increase in rates of anxiety and depression across OECD countries due to uncertainty about the future, job and financial worries and social isolation brought on by the COVID-19 pandemic.
Against this backdrop we decided to return to the issue again in November with the OECD Forum event Working it Out: Mental Health and Employment, coinciding with the release of a new OECD report, Fitter Minds, Fitter Jobs: From Awareness to Change in Integrated Mental Health, Skills and Work Policies, presented by OECD Deputy Secretary General Ulrik Knudsen at the outset, to explore how to ensure people can get help as early as possible from mental health services, but also in school and at work.
Rewatch the OECD Forum virtual event Working it Out: Mental Health and Employment
The economic cost of poor mental health is estimated to be over 4% of GDP: across OECD countries, this translates to more than USD 2.5 trillion, while in the United States alone it represents close to USD 1 trillion. The pandemic has accelerated and amplified the fact that young people, women and the unemployed are among the groups that have been shown to be most susceptible to mental health challenges. Those who suffer must bear a burden that entails a greater risk of exclusion from jobs and careers. The resulting scarring effects could lead to life-long impact that weighs on those affected and on society more generally.
So getting policy and support right is as much a matter of moral imperative as it is of economic efficiency. There has been progress: greater openness and acceptance have reduced some of the stigma associated with mental health challenges, which allows sufferers greater freedom to voice their concerns about what they are going through, in turn allowing others to provide the necessary support. In framing the discussion I recalled that “health, social, youth, employment and education policies are too often delivered in isolation, in silos, when they should be approached together and reinforce each other to be effective”. Consequently, we needed to work towards ways to improve the policy mix—to ensure health and social services, employers and schools work better together to realise the desired goal of an effective, integrated support infrastructure.
Anita Everett, Director at the US Center for Mental Health Services, Substance Abuse & Mental Health Services Administration (SAMHSA) revealed “the Centers for Disease Control and Prevention (CDC) have identified that 40% to 50% of the US population has experienced increased anxiety and depression in the last year”. Mobility restrictions, financial uncertainty and health fears have taken their toll on mental health for many during the COVID-19 pandemic. According to SAMHSA’s national survey in the United States in the past year, in a workplace of 100 staff, on average 20 individuals report a form of mental illness, of which four to five are serious and may be associated with a form of disability. Everett has built SAMHSA’s approach to addressing mental health within the broader framework of well-being, around four key areas of focus: Health, Home, Sense of Community & Purpose.
Poor mental health is a subject that has often been shrouded in stigma—but what exactly is poor mental health? Put simply, common conditions in the form of depression or anxiety may lead to difficulty managing how to think, feel and react in response to everyday situations, diminishing the capacity to feel or be effective at home, and at work. Recognition of this, both for those affected and the people and organisations around them, is the vital first step.
For many organisations, people are their core asset. When people are not well, they do not perform well. It is therefore essential that organisations invest in the well-being of their workers.
– Alison Unsted, CEO, City Mental Health Care Alliance (United Kingdom)
A role for companies
Alison Unsted, Chief Executive of the City Mental Health Alliance in the United Kingdom, explained the prevalence of cultural stigma across communities from different social and national backgrounds, means some people feel “far more comfortable getting support through their employer than through their families or communities”, stressing the critical role companies play in tackling mental health problems. “Employers have an opportunity and a responsibility to play their part in helping to challenge stigma, raise awareness, and make support more accessible”, she reminded us, pointing to the aspects of work that play a core role in an individual’s well-being—notably social connections and recognition of one’s efforts and contributions.
A poll of the audience during the session demonstrated that 61% would not feel comfortable raising mental health issues with their employer.
Audience members who had the courage to raise mental health issues at work felt they received most support from their direct colleagues (70%), rather than their direct manager (35%) or the HR department (15%).
Craig Kramer, Mental Health Ambassador at Johnson & Johnson, emphasised the need for business leaders with the humility, empathy, and determination to ensure that people feel safe to speak about mental health issues at work, and get access to the help they need. Talking openly to co-workers at his company about his daughter’s struggles with an eating disorder, Craig’s openness led many other colleagues to reveal they, too, had or were facing similar difficult experiences they had kept quiet about. Those discussions led to a “flood” of colleagues wanting to find ways to help employees and their families address mental health concerns. In response, Craig was entrusted with creating and leading an employee resource group for mental health. His company’s human resource and managerial-level staff are also being trained how to spot potential signals and provide help.
“This approach has led our employees to see the company as a place of safety, growth and innovation”, explained Kramer. Through its support for better health and wellness, it is also better positioned to attract and retain diverse talent. “The new generation coming into the workforce will demand change. If employers do not understand what that looks like, they will lose talent”.
A wider acknowledgement of the problem has opened the way for more effective policy action. Most OECD countries have put in place strategies to support the mental health of children and young people, now frequently accepted as a policy priority, in stark contrast to the situation 20 years ago. As the OECD’s Ulrik Knudsen reminded us, “Addressing mental health issues at an early age is the best way to strengthen the future education and labour market outcomes of young people”.
Advances in thinking about the role workplaces can play in promoting good mental health means more countries have developed guidelines for employers, helping countries go beyond reactive approaches centred on mere access to public mental health services. Canada blazed a trail when it introduced the National Standard of Psychological Health and Safety in the Workplace in 2013. Created to address the mounting legal, social and economic costs of mental health challenges, it put in place a set of voluntary guidelines, tools and resources for organisations that set the benchmark for others. The result? Better outcomes for employee well-being, fewer days taken off work, greater productivity and output and, above all, a better chance of connectedness and inclusion for those most affected.
The sudden shift in working practices since the onset of the pandemic—specifically the move to remote working and hybrid working patterns—also means policies must adapt to prevent the burnout and anxiety linked to longer working hours encroaching more into our private lives. Belgium, France, Italy, Portugal and Spain are among the first European countries to introduce “right to disconnect” laws, giving workers the right to digitally switch off.
An investment rather than a cost
While there has been progress, there remain many obstacles. The general lack of robust policy frameworks that support employees while they are sick and, crucially, help them return to work means that the risk of labour market exit remains significant.
The United States has witnessed a mass exodus from the labour market during the course of the COVID-19 pandemic. “In April 2020, the US resignation rate was 1.6% of the population; a year later it doubled—some four million people left their jobs during this time”, explained Anita Everett, referring to what has been coined “The Great Resignation”. There is little consensus on why this has happened or whether this will be an enduring phenomenon. Nonetheless, a sense of burnout, a lack of support, the loss of community at work, a change in priorities and limited advancement opportunities are all plausible reasons for a shift in attitudes to work, according to Everett, who believes greater attention will have to be paid to retention in the workplace.
Some 40 to 50% of the US population has experienced increased anxiety and depression in the last year.
– Anita Everett, Director at the US Center for Mental Health Services, Substance Abuse & Mental Health Services Administration
“For many organisations, people are their core asset”, said Alison Unsted. “When people are not well, they do not perform well. It is therefore essential that organisations invest in the well-being of their workers”. Are social purpose and profit therefore mutually reinforcing? Unsted believes moral principle can bolster economic self-interest, which entails putting in place a framework consisting of three key pillars. The first is organisational culture—the extent to which firms commit to and implement supportive programmes. The second is the workplace—how a commitment to providing support translates into long-term action. And the third is support provision—helping employees prioritise health and well-being, providing access to support and education, and empowering people to have confident conversations with each other and their leaders.
The COVID-19 pandemic has been a great epoch-making event in many spheres, not least in the arena of mental health. Gaps in coverage remain big. The goal of creating an integrated mental health support infrastructure requires targeted investment—in the health sector, in education, in welfare services, and in employment services.
The OECD’s Deputy Director of Employment, Labour and Social Affairs Mark Pearson pointed to the fact that mental health service provision is limited to a small number of people: those who qualify for disability benefits. “Of all the people with mental health issues, only about one-third are able to gain access to disability benefits. Access to mental health support should not be tied to disability benefits”, he argued, pointing to how those with mental health challenges are 50% more likely to miss work. The chances of re-entering the labour market diminish rapidly after three months—while the long-term scarring effects of exclusion from employment are significant. “Interventions must therefore be targeted at those who struggle with work before they lose their job”, said Pearson, bringing us back to the nexus of social purpose and economic self-interest at a governmental level.
Profile: Meg Hoffmann Nakagawa
Meg Hoffmann Nakagawa, Founder of Blossom the Project, shared her remarkable story about her own struggles with anxiety and depression at the age of 17, while attending high school in Japan.
“Japanese society does not encourage talking about mental health due to stigmatisation of mental illness”, explained Nakagawa. “When I eventually went to see a psychiatrist and was diagnosed with depression, the first thing that I felt was huge relief. There was finally a name for what I was experiencing!” It was only then that she realised that what she was feeling was what many people experience—and that there was no shame in it.
Later on, while studying in New York, she was forced to abandon her dormitories in April 2020 due to COVID-19, whereupon she moved to California. As study and work all went online with people cut off from their everyday lives, she began to wonder, “How are people coping?”
This provided the motivation for Nakagawa to start Blossom the Project, an online platform whose aim is to provide a network of support for people in Japan and the United States—a place to talk about mental health, and social and political challenges. Through Instagram, it has since garnered online followers from all over the world.
“We are breaking ground by normalising mental health issues”, said Nakagawa. “The next step is making sure that young people can get the support they need—and this should come from government entities, medical facilities and educational institutes”. She believes the process should start much earlier, with schools being the starting point for mental health support. A classroom education, with the opportunity to talk about mental health, could in itself make a huge difference and this could continue through working life.
“Through Blossom, I have hosted workshops with companies based in Japan and the US”, she said. “It is nice to see companies taking steps to talk about the mental health of their employees and providing employees with the necessary resources”.
Nakagawa also encouraged employers to see and seek five key qualities of those colleagues suffering from mental health issues: humility, empathy, innovation, creativity and “stickability” or resilience, and to harness them in leadership positions.
In drawing preliminary strands together from an extremely rich exchange, I recalled how those workers in healthcare have been among the most affected by the impact of COVID-19 on their mental health: around half of all frontline workers have met the clinical criteria for anxiety and depression, according to Rachel Clarke, a palliative care doctor and author of Breathtaking, who had joined our April session. One in five meet the criteria for post-traumatic stress disorder (PTSD). My colleague Mark Pearson confirmed that the level of stress experienced by people working in health, social care, as well as in education has been so high in the past year that the OECD is starting to see that people are exiting these sectors, which are so essential for all of us.
This is one of the biggest challenges that we will be facing in the coming years, and that the OECD will be addressing. Given the scale of the challenge, an integrated approach to mental health policy that takes into account the education, employment and welfare dimensions of mental health is more urgent than ever, with a focus on groups hardest hit by the COVID-19 crisis.
When addressing mental health, the propensity to dwell on a half-empty glass and difficulty to see the other part of that glass often comes to mind. Such insights, contributions and exchanges as those from this session may have served to make the glass that is mental health smaller and somewhat more manageable, but much remains to be done.
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