Mental health in the workplace: Insights for Boards

Summary of discussion

As we begin to emerge from COVID-19 and move towards recovery, challenges are arising for organisations in how they respond to mental health and what Directors should be looking out for not only in their workforces and executive teams, but within their respective boards as well. 

This discussion was led by Stuart Babbage, Damien Angus and Sharon Ponniah, from PwC’s Health & Wellbeing team. For more information go to Mental health in the age of COVID-19 or Mental Wealth.

Key points for Directors

  • Workplaces have been changing, even before COVID-19. Organisations have increasingly been dealing with stress and burnout, loneliness, sexual harassment, Workplace manslaughter laws and other impacts of COVID-19

  • Boards and leaders need to start thinking about mental health strategically. The approach should aim to mitigate illness, prevent harm and promote thriving 

  • Practical steps businesses can take include encouraging rest and recovery, making small changes, monitoring attrition, managing return to work, clear communications and understanding what works and what doesn’t?

Overview

Mental health in the age of COVID-19 has become more serious. This week we saw a summit of leading health practitioners write to the Victorian Premier warning that the city’s lockdown was causing a devastating wave of mental “anguish, despair and suicidal” thoughts among young people. And the rate at which they're seeing that, is a serious and emerging challenge for society. The question is, what should be done about it? 

PwC is engaging with a range of government and business entities on what they’re doing to nurture and maintain mental health in their organisations and communities. This session will address how workplaces have been changing, why mental health should be front of mind for boards and management teams and some practical tips to support your employees, executives and colleagues.  

How have workplaces been changing?

Even before COVID-19, the way we work had changed. It had become a fast paced, 24/7 culture where we are connected all the time and using less sick and annual leave. COVID-19 has simply emphasised a blurring between work and home life, heightened by the fact that many of us are now only working from home. We have been seeing some key themes impacting our workplaces in recent months.

Stress and burnout 

The impacts of stress and burnout are very real. Last year the World Health Organisation incorporated stress and burnout as a classification of the disease classification system (ICD10) conceptualising it as a chronic syndrome, resulting from chronic stress that has not been successfully managed. The definition becomes really important for the controls and risks we put in place across workplaces to effectively manage burnout over time. The signs and symptoms include energy depletion, exhaustion, increased mental distance, feelings of negativity towards others and a reduction in professional productivity. 

Loneliness

With people feeling more disconnected from their families, friends, neighbors, and community, loneliness has also become an increasing problem. We’re seeing declining trust across society, particularly in the  groups that we used to trust such as churches, community groups, police, and frontline services. In the UK, the former Prime Minister appointed a Minister for Loneliness demonstrating what an important societal issue this is. Research published earlier this year showed the symptoms of a human brain or the way it looks when it's hungry and starved of food is exactly the same as it looks when it is lonely, starved of human interaction and deprived of touch. 

Sexual harassment 

Sexual harassment and bullying is another pervasive feature of workplaces. Earlier this year, The Sex Discrimination Commissioner, Kate Jenkins, released the Respect@Work report into sexual harassment in Australian workplaces. The report showed that one third of workers have experienced sexual harassment in the workplace in the last five years, with 50% experiencing sexual harassment in the workplace, for a duration of 12 months or more, and in their own workstations. There are a number of groups more at risk, in particular LGBTQI, people of culturally and linguistically diverse backgrounds, young people and those with insecure job prospects or in positions where there's a real power division. We've seen the reputational damage this can have on a business, as played out recently with  AMP and QBE.  We need to be thinking not only about how this behaviour impacts on workplace mental health and well being, but also the psychological and psychosocial safety of our people. 

Workplace manslaughter laws

Workplace manslaughter laws are now in place in some states and are being introduced in others. These laws put company directors at risk and place a responsibility on having a duty of care for your employees. There are serious repercussions for workplace manslaughter if you fail to make the necessary adjustments to create a mentally healthy workplace. 

Other impacts of COVID-19

COVID-19 has placed an extra layer of complexity. People are increasingly feeling more socially disconnected, isolated and lonely. We're becoming increasingly sedentary due to increased time in front of the screen. People are finding it difficult to disconnect at the end of the day and lack of sleep is becoming an issue that we're observing across different industries. And generally, people are using and interacting with the healthcare system less than they should. Those at risk of chronic disease or who should be screening for cancer aren't doing that. Elective surgeries are being deferred. There's a broader risk of public health issues that goes beyond mental health for your employees and those in our communities.  

What should be front of mind for boards?

Mental health is an interesting topic because it's foundational to everything that a business does already. It’s often instructive to look at what the government is doing because that illustrates what’s clearly on its mind societally wide. It also raises interesting questions about what executive teams inside businesses and ultimately, boards should be thinking about. 

The 2019-2020 bushfires brought about the government’s 2020 response to mental health. This included special announcements around counselling and a ramp up of services beyond what was generally available for those affected. There was a real recognition that those on the front line would potentially need much more help, specialised services to deal with trauma and extended separation from family.

Today, PwC has people on the front line, working with our healthcare clients on the COVID-19 response. Those individuals are likely to be much more affected by COVID than perhaps some other teams. So how do we as an organisation, think about how we support and help those people? It's a broad theme for many businesses. The government has ramped up the effort on mental health and suicide prevention, and how they connect services and take things to the next level to deal with COVID-19. 

How do we encourage businesses to think about mental health strategically? While it's great to focus on mental health, wellness is a holistic thing. Whenever we engage with a business they are often focused only on a particular area, whether it’s mental, physical, financial, social or workplace health. We encourage them to couch it in the broader suite of wellness. Any mental health initiative should be integrated and connected with the broader activities of the organisation rather than a stand alone activity. We encourage that to be the focus, because at some point in time you have to ask yourself the question: was this worth it? And if you don't understand how it fits in the context of everything else you’re doing to support your people, it becomes very hard to evaluate. 

The other lens that we apply is looking at the three major dimensions of what it is you are trying to tackle. The first is usually around mitigating illness. When people are returning from workplace stress or other acute circumstances there are a set of mitigation actions that need to be undertaken such as looking at how their supervisors interact with them, addressing any areas of bullying that may have existed, that is the acute end of the spectrum. The other two dimensions are how do you prevent harm and promote thriving to help provide a holistic view of workplace and employee wellness.  

As with many things in our healthcare system, often we don’t know for sure if mental health initiatives are going to work and have their intended outcomes. To address this, we have a discussion around what are the lead indicators and what evidence can we measure to demonstrate that it's having the intended impact. For example you might look to measure how often people access a particular program and connect that to related factors over time such as absenteeism, presenteeism or injuries. Thinking through what are we seeing in the short term that tells us whether we're having a long term impact is a critical part of the thinking. 

Ultimately, we think that all three dimensions of mitigating illness, preventing harm or promoting thriving need to be thought about together. In the current environment, it's true to say that people will be dealing with all three of them. Not everything that people deal with in mental health, anxiety or stress is a clinical condition. They’re all part of being a normal human being. What we ultimately are looking to do is help people to help themselves and recognise what is normal. 

What are the practical steps can businesses take?

Practical steps organisations can take to promote mental health should focus on prevention, early intervention, promoting thriving and tapping into the knowledge base of your people. That will create competitive advantage for your organisation by ensuring your employees are in the best frame of mind to be able to contribute fully.

Rest and recovery

COVID-19 has been a long haul particularly in Victoria, and we were dealing with the bushfires before that. It’s important to ask how much time people have taken off just for reflection and processing.  When you watch a football match, you see people performing at the height of their physical and mental capacity at the weekend. But during the week, you see them at the pool, the gym, taking it easy in order to recover and improve. Do we approach that the same way from a workplace perspective? We have things weekends, and holidays built in but how does the culture of the organisation support periods of recovery following intense periods of high performance. 

The culture of recovery says a lot about workplace culture. I have the privilege to work in and advise a number of organisations and it is interesting to see the way the different cultures approach things like late night emails, working on weekends, the zero inbox and response times. If people are always ‘on’, what's the longer term implications of that? While each individual needs to reflect on that for themselves, it’s the leadership team that sets the culture of the organisation. How do your executives and leaders approach leave and well being? Is it visible and participatory? 

Small changes

We know that the experience of many in the workplace is based on their interaction and relationship with their immediate manager or supervisor.  How is that playing out in the new environment? We are all appreciating a new work rhythm, adjusting to a different way of working, whether at home or returning to the workplace. People are also adjusting to changes outside of work such as different childcare arrangements and homeschooling. Just reflecting and appreciating that, and allowing small changes to allow people to manage those gaps and priorities, is important to help people perform at the right level. What does the response look like when someone asks for help or needs time off to do something? How is that response changing? If someone needs even just a small thing, the response can be an important indicator of culture. 

Attrition

Obviously, attrition is probably down at the moment, with less people moving jobs, but trying to understand why people are leaving can be really insightful. Other measures such as sick leave or other recurrent workplace issues are also important to stay on top of.

Return to work

Returning to work after a mental health issue can be a tricky time. If someone breaks an arm tripping on a staircase, you can easily isolate that risk by putting up an extra bannister for example. With mental health it's a lot harder to identify what needs to be done. How do you get people back up to full speed in an individualised and stepwise manner? 

What works and what doesn’t?

Most organisations will have an Employee Assistance Program (EAP) and/or mental health advocates. Sometimes we don't really know what works and what doesn't in mental health. There’s a whole range of solutions including prescription medication, cognitive behavioral therapy and other forms of psychology support,  as well as more informal / lived experience mechanisms as well. There is also the need for culturally and linguistically diverse and indigenous led recovery programs. There is no textbook solution for what's going to work with every single person every time. It’s about the appropriate, specific combination for the individual - and sometimes it is a case of test and learn.  Choice and options are important, because a person may need to try a few things to work out what works for them.. 

Communications

Clear communications around the level of support available is critical. It was RUOK day last month, and that campaign took a step further this year in addressing what happens next.  What can your organisation do to promote these activities and normalise them as a part of life as it is for many people. What can you do to bring this to the front of your organisations and help your people to work at the best of their potential? 

Discussion

One of the things that PwC is taking an interest in is how we make sure that people are disconnecting. We're still working from home, or as many people refer to it, sleeping in the office, and it's blurring the boundaries between work and home. People seem to be feeling that they're on all the time so how do they disconnect? How do we ensure people are taking some annual leave and disconnecting from the office to get that moment to recharge?

How is digital technology helping organisations to manage mental health and what is the role of boards in overseeing this?

One of the hardest things we’ve found when working with executive teams on mental health in the workplace is working through the plethora of solutions that are available. Even the National Mental Health Commission recognises it is so hard for business, particularly smaller business, to understand what offerings exist. They're looking to establish a marketplace to better enable businesses to make decisions around the effectiveness and credibility of various solutions. 

We're doing some work with the Department of Health including how technology supports the mental health ecosystem, not just for those dealing with crises but those just seeking information, which can be even harder because there is so much out there. We know that a lot of organisations have an EAP and have had for years. But the reality is, people don’t use it. You would think through COVID-19, there would be a spike in demand and utilisation, but other than small pockets, we're not seeing it taken up across any industries or workplaces. That suggests a potential for other modes of delivery and support to be accessed and used by workplaces. Some of the work that we’re doing indicates that coaching is being used to better understand stress triggers and anxiety levels. That involves discussions around how employees deal with stress, how to recognise the early signals and developing a plan to know what they need to do. There is absolutely a role for psychologists, but not across the board necessarily. We’re seeing coaching as particularly effective in early intervention and other non-professional parts of the system. It’s thinking through some of those elements and what is right for your workplace as well.

How do you encourage people to take self-accountability for wellness?

The most important thing is your leadership team. One of the things that people are not necessarily good at is self reflection.  What creates stress in them and what motivates them to do things they recognise are not leading to good health, and then doing something about it? Everyone has different stress triggers but it's important to recognise what are the things that  make your tummy tighten up? What makes you do the work when you really don't want to be doing the work? What are the things that drain you and potentially increase your stress. These things over time add up to more of a clinical issue than just a physiological issue so it is a really important reflection for executives to focus on.

Another approach is using data and nudges. For example if people haven't taken annual leave for 8 months, just encouraging them to take some time off can help. Having a culture that celebrates success and big milestones and allowing people to have that recovery time rather than just going again can help build that culture of recovery. 

We have this amazing technology now that goes everywhere with you. In the past if you wanted to work from home you had to use dial up technology and it just stopped people. But that created more natural spaces between work and rest which have now really evaporated.

Are there other key indicators that the board should be thinking about around the output we're getting from employees or if there’s an overload of effort being drawn?

The metrics are interesting because it’s very hard to work out if you are getting 100% or a thriving effort or if people are just turning up and going through the motions. It’s very hard to measure that extra bit of effort if it's occurring. You can often tell when a team’s running hot versus when it's just running too hot. As a leader you should get some sense of that and know when it’s time to pull back. That’s not something you can see on a spreadsheet but you can sense it in a team when they've been going too hard at it. So for boards, when you’re sitting at the apex of the organisation, it's about having the conversation with your leadership teams to ensure that they're thinking about how they are observing that. 

You need to be conscious of the personal styles or capabilities of the management teams you're dealing with. Some senior management have probably not the degree of empathy you need in these circumstances. And you know from dealing with some of the staff directly that they're not as well as senior management think they are. So you need to be conscious of that.

There is no one solution to these types of issues. Understanding how different people tick, what pulls their trigger and what ultimately can contribute to moving from a status of anxiety or stress to something that is much more serious, is critical.   It’s not necessarily a cause or direct link in every instance, you have to help people help themselves and find different solutions in different circumstances.

This is not business as usual. But I also think that with all the things we have in place we should be equipped to help people in the circumstances they’re in. Some of it needs a refresh and it's not just COVID-19  that's driving that. If COVID-19 is what it takes to rethink how we help people to be great in the workplace, then that’s positive. The time is now to take the opportunity to reflect on what's being spent across the wellness programs inside your business. We talked about EAP and its underuse and some other old ways of thinking that are still embedded. We need to deal with our OH&S issues, but now there are some real developments and really good thinking that can take you to the next level. 

Contact us

Peter van Dongen

Peter van Dongen

Chairman, PwC Australia

Tel: +61 (2) 8266 3378

Stuart Babbage

Stuart Babbage

Partner, PwC Australia

Tel: +61 2 6271 3021

Sharon Ponniah

Sharon Ponniah

Director, PwC Australia

Tel: +61 2 8266 1906

Damien Angus

Damien Angus

Partner, PwC Australia

Tel: +61 (3) 8603 0294

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