Bringing it all together; what has stood out and what is next? (MHST Assignment #3)
Over the past 12 weeks I have explored with curiosity a critical view on defining health, its contributing factors and diving deeper into specific health issues within my area of my professional interest; workplace health promotion. The weekly learning activities of MHST 601 have kept me accountable to explore resources and converse with my peers on various health topics including many that I had not previously dedicated time to such as Indigenous health and health surveillance tools. I’ve had the opportunity to practice expressing and articulating my thoughts through what is Not just another health blog within my new ePortfolio. In this blog post I am bringing all the pieces together to reflect once more on workplace health promotion. Join me as I explore the role of the workplace as a determinant of mental health, where I anticipate the direction of workplace health promotion going, and the missing piece of unemployment.
The Workplace as a Determinant of (Mental) Health
We explored early in the course the Determinants of Health and it was from that exercise that I was reminded of the importance of the complex and multi-faceted nature of health for both individuals and populations. From that topic, I wanted to better understand what determines mental health specifically. That week within my blog I created the mind map below to better conceptualize the many Social Determinants of Mental Health (Figure 1.). It was after creating this map that I was inspired to pull out a few of the factors and explore them in more depth in the following weeks. This included Applying an Ecological Model to Employee Mental Health, Food Insecurity and Mental Health through an Ecological Model, Heart Disease at a National, Local and Workplace Level, The Workplace and Health of Indigenous Peoples and The Impact of Poverty on Individual Health.
Figure 1. I created this mind map using Canva to better conceptualize my resource findings on the Social Determinants of Mental Health. Check the blog post where I originally posted for more information.
The workplace can be both a determinant of mental health, such as the example from Figure 1 of "hostile interaction with employer" which can be harmful to psychological health, as well as the workplace can be an environment for intervention to promote and protect mental health. The Canadian Public Health Association released a position statement on their recommended approach to population mental wellness which, among many policy and programs, includes fostering workplace mental health programs and interventions, as they boast a return on investment of up to 9.69 (2021).
I won’t spend too much of my word count on workplace mental health interventions as I already investigated that when I blogged about Applying an Ecological Model to Employee Mental Health. To summarize, the most effective health promotion interventions include more than one ecological level and preferably include strategies further upstream such as from the policy or leader/work group level, as opposed to interventions which only target individual employee health behaviors (Golden & Earp, 2012). Table 1 below shows an example of one study by Guisino and colleagues that reviewed using a multi-level approach the mental health of health care workers during the first wave of the pandemic. This exemplifies how the workplace can be an environment ideal for health promotion interventions at different levels and of various scope.
Table 1. This table is from the qualitative study by Giusino et al. (2022) which summarizes the various demands (barriers/risks) and resources (supports or protective factors) for employee mental health at each of the four levels within the organization.
Future Directions of Workplace Health Promotion
Though my professional background and education is as a Registered Dietitian, my career over the last number of years has transitioned to working in the area of workplace health promotion. The COVID-19 pandemic has impacted workplaces across Canada (and the world), including our health care institutions. I see no slowing down in the value, importance and need for evidence-based interventions that employers and workplaces can action to support the health and mental well-being of staff. Among my own interest to improve the health of my community, the benefits of comprehensive workplace health programs are also beneficial for organizations as it may improve employee engagement, retention, morale, productivity, as well as reduce absenteeism, turnover, health costs such as medical or disability leave and presenteeism (Canadian Centre for Occupational Health and Safety, 2022)
In Canada, we have the National Standard for Psychological Health and Safety in the Workplace. Released in 2013 by the Canadian Standards Association, Bureau de normalisation du Québec and Mental Health Commission of Canada, this guiding framework with tools and resources is intended to support organizations of all sizes and industries to promote the psychological health of employees and prevent psychological harm in the workplace (Mental Health Commission of Canada, 2017). A qualitative study by Memish and colleagues (2017) found that of 20 workplace mental health guidelines from nations around the world, Canada’s National Standard for Psychological Health and Safety in the Workplace ranked the highest all around in areas of promotion, prevention and management of mental health challenges in the workplace. However, this is currently voluntary for employers to follow.
Just like Medicare in Canada being coined as “Universal Healthcare” it does not mean it is perfect. Similarly, just as Canada has developed a well-recognized guideline for optimizing workplace mental health, the role and impact of the workplace on employee mental health needs improvement. To make the list short, there are two areas that I perceive as needed to be a priority to improve the health of our society, coverage for mental health services and the supports to health care workers specifically.
Adequate Coverage for Psychological Services - Important services of mental health care are not covered publicly, such as pharmaceuticals and counseling services, which are mostly accessed through out-of-pocket expenses or private insurance plans such as an employers extended health benefits. The services and coverage offered by employers is an important resource to support the mental health of workers and their immediate family (Mental health Commission of Canada & Canadian Psychological Association, 2022). The Mental Health Commission of Canada & Canadian Psychological Association released a report in 2022 on a survey they’d conducted with employers and employees on extended health benefits. Of the employees surveyed, 80% reported that coverage was inadequate. Furthermore, the report highlights that a common barrier to accessing mental health resources is when individuals have to pay out of pocket.
Health care workers – If I were to pick an industry that needs special attention for worker health promotion I choose healthcare because of the unique challenges health care workers face in their work environment and how the overall work they do is critical for the greater health of our society. To recognize these unique needs the Standard for Psychological Health and Safety in the Workplace has incorporated two additional psychosocial factors specific for health care environments;
1. Support for psychological self-care
2. Protection from moral distress (Grady et al., 2022).
Grady and colleagues looked to identify the facilitators and barriers to these two factors at various levels through an adapted version of the social ecological model of health, as shown in Figure 2 below.
Figure 2. This figure was retrieved from a 2022 report which looked at the facilitators and barriers to psychological self-care and protection from moral distress of Canadian health care workers from various health fields (Grady et al.)
These are import and valuable to not only the healthcare workers and their individual well-being, but also the ripple effect that healthy (or unwell) healthcare workers can have on our overall health system, including patient outcomes. Figure 3 below displays that higher experiences of moral distress are associated with higher likelihood to quit (turnover) increased burnout and decreased perceived quality of care by the worker (Grady et al., 2022) (2022).
Figure 3. Retrieved from the report by Grady et al. (2022) this graph displays the results of their survey to healthcare workers that the greater the experience of moral distress, the higher the turnover and burnout, and decreased quality of care.
What about those without employment?
Employment itself, along with income, are argued to be the most foundational social determinants of health (Brydsten, 2018). Because I work in the area of workplace health promotion, my obvious target audience is the workplace environment and employees within it. However, over the past 12 weeks I’ve been inspired to diversify my perspective; to use my skills and influence to explore how to better engage vulnerable groups to employment opportunities that would remove the health barrier of lacking employment. In one blog I investigated The Impact of Poverty on Individual Health and it humbled me to realize the extent of how poverty is associated with poor health behaviors such as smoking, physical inactivity, inadequate diet, chronic illness, and infrequent health screenings (Health Quality Ontario, 2016). A peer from the course, Amanda Dahl, RDH and I, co-authored a blog post to compare Vulnerable Populations: British Columbia and Alberta. Though we only reviewed the rates of each group, a closer look at employment and various vulnerable populations could be viewed through an ecological model of health. I anticipate that much can be done to improve access and opportunity to employment to various vulnerable groups such Indigenous Peoples. As discussed in the blog The Workplace and Health of Indigenous Peoples, employers can and should do more to support the health needs of Indigenous Peoples, both through inclusive hiring practices and supports once they’re employed.
Putting the pieces together
In my first blog post, Identity, Values and Professionalism, I made an intention to pursue this professional online identity in a way that aligns with my values of respect, integrity, curiosity, humility and balance. I feel that I’ve begun this online journey with that alignment, but now I am adding the value of diversity to my list of professional values. One of my key takeaways has been to not just look at the population which I serve, but also to look beyond, to the bigger picture of health in our system. The input and perspective from my peers in MHST 601 has been invaluable to my learning. In many ways it has highlighted that across Canada the challenges to our healthcare systems are similar. As I wrap up this course, I seem to have more questions than answers. But it is with curiosity and humility that I take forward as my greatest skills as a health professional striving to make a difference.
To my peers and instructor of MHST 601, thank you for sharing you time and energy over these past 12 weeks.
- Kylie
References
Brydsten, A., Hammarström, A., & San Sebastian, M. (2018). Health inequalities between employed and unemployed in northern Sweden: a decomposition analysis of social determinants for mental health. International Journal for Equity in Health, 17(1), 59. https://doi.org/10.1186/s12939-018-0773-5
Canadian Centre for Occupational Health and Safety. (2022). Workplace Health and Well-being – Comprehensive Workplace Health and Safety Program. https://www.ccohs.ca/oshanswers/psychosocial/mentalhealth_work.html
Canadian Public Health Association. (2021). A Public Health Approach to Population Mental Wellness. https://www.cpha.ca/public-health-approach-population-mental-wellness
Golden, S. D., & Earp, J. A. L. (2012). Social Ecological Approaches to Individuals and Their C
ontexts: Twenty Years of Health Education & Behavior Health Promotion Interventions. Health Education & Behavior, 39(3), 364–372. https://doi.org/10.1177/1090198111418634
Government of Canada. (2022, June 14). [Government]. Social Determinants of Health and Health Inequalities. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Grady, C., Chênevert, D., & Coderre-Ball, A. (2022). Exploring Two Psychosocial Factors for Health-Care Workers: Support for psychological self-care and protection from moral distress in the workplace: Facilitators and barriers. Mental Health Commission of Canada. https://mentalhealthcommission.ca/resource/exploring-two-psychosocial-factors-for-health-care-workers/
Giusino, D., De Angelis, M., Mazzetti, G., Christensen, M., Innstrand, S. T., Faiulo, I. R., & Chiesa, R. (2022). “We All Held Our Own”: Job Demands and Resources at Individual, Leader, Group, and Organizational Levels During COVID-19 Outbreak in Health Care. A Multi-Source Qualitative Study. Workplace Health & Safety, 70(1), 6–16. https://doi.org/10.1177/21650799211038499
Mental Health Commission of Canada. (2017). Case Study Research Project Findings. https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/2017-03/case_study_research_project_findings_2017_eng.pdf?_ga=2.121368331.2003241518.1669776624-1727373321.1660064167
Memish, K., Martin, A., Bartlett, L., Dawkins, S., & Sanderson, K. (2017). Workplace mental health: An international review of guidelines. Preventive Medicine, 101, 213–222. https://doi.org/10.1016/j.ypmed.2017.03.017
Mental health Commission of Canada, & Canadian Psychological Association. (2022). Extended mental health benefits in Canadian workplaces: Employee and employer perspectives. https://mentalhealthcommission.ca/resource/extended-mental-health-benefits-in-canadian-workplaces-employee-and-employer-perspectives/
Moroz, N., Moroz, I., D’Angelo, M. S. (2020). Mental health services in Canada: Barriers and cost-effective solutions to increase access. Healthcare Management Forum. 33(6):282-287. doi:10.1177/0840470420933911
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