Mental disorders as a challenge for the world of work

Mental disorders tend to occur more frequently at ages when most people are in employment. They are often associated with deteriorating performance, restricted workability, absences from work on sick leave, early retirement, and unemployment.

Many mental health problems and disorders are detected too late. It often takes months or years before they are treated adequately and appropriate therapy can be put in place. This increases the risk of chronification, which frequently results in long-term incapacity for work.

Information and advice in the workplace

The reasons for delays in seeking help with mental problems include fear of stigmatisation, lack of information, and insufficient access to initial advice and psychotherapy.

It therefore seems obvious to supply information for employees directly in the workplace and make counselling services available to them there. This is the starting point for several kinds of provision in which psychological and psychotherapeutic experts work together with companies. Employees benefit from brief therapeutic interventions, are supported in the resolution of their problems, and, if necessary, have access to the medical/therapeutic system facilitated for them.

What do psychotherapeutic and psychosomatic consultations at work involve

These therapeutic services concentrate on tackling the mental health crisis at an early stage. They involve an initial diagnostic assessment and a brief therapeutic intervention delivered by psychotherapists. The emphasis is placed on work-related issues.

The services are aimed at identifying and encouraging reflection on mental health crises and teaching strategies that allow mental pressures to be dealt with more effectively, including stress, conflicts at work, and family strains. Ideally, they help to prevent mental disorders. In some instances, though, it may become apparent that longer-term treatment (therapy and/or inpatient admission) is required.

The framework for psychosomatic and psychotherapeutic consultations

The provision is usually organised as follows:

• Access is arranged for employees either directly and anonymously (for example, using information provided internally within the organisation) or via a contact in the workplace, such as the company physician.
• The consultations usually take place close to the workplace.
• It is easy to book an appointment and this is done swiftly.
• The experts providing the treatment have backgrounds in psychosomatics or psychotherapy.

The number of appointments is limited to between three and fifteen. Good internal coordination and transparency within the organisation are conducive to the acceptance and utilisation of the consultations, as are assurances that medical confidentiality will be strictly observed.

Further recommendations for organisations on early intervention in mental health crises:

• Workplace cultures characterised by acceptance and trust lay the foundations for the open approaches to mental health crises and problems.
• Services that can be used promptly and without major barriers encourage individuals to tackle mental problems at an early stage.
• Cooperation between the different professionals involved in the workplace and medical/therapeutic systems supports the development and implementation of interventions.

Risk and resilience factors should be looked at during the consultations. These include organisational structures, overload and underload, relationships with superiors and colleagues, the social support available at work and in employees’ private lives, and leisure activities. You can learn more about the possible options and experience of previous projects from the BAuA fact sheet Psychosomatische Sprechstunde im Betrieb (PSIB): Ein flexibles Angebot für Beschäftigte (in German).

Early Intervention in the Workplace (friaa)

The Early Intervention in the Workplace (friaa) study is a consortium project being run by universities and hospitals in Ulm, Düsseldorf, Hildesheim, Erlangen, Heidelberg, and Günzburg, the Rehabilitation Centre Seehof (Reha-Zentrum Seehof) at Teltow, and the Federal Institute for Occupational Safety and Health in Berlin. Employees with mental health issues are able to obtain timely, low-threshold support and treatment. The services are being monitored in order to examine their effectiveness. This is being done with a multicentre randomised controlled study and a formative qualitative evaluation that BAuA is conducting as part of the project. This study is funded by the Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF).

Evaluation of workplace psychosomatic consultations in Lower Saxony

BAuA supervised and evaluated the introduction of psychosomatic consultations and preventive health coaching in workplaces in Lower Saxony. Attention centred on how the provision was perceived by employees and organisations.