When it comes to mental well-being, sobering statistics abound. The National Institute of Mental Health (NIMH) estimated that in 2020, one in five—52.9 million—U.S. adults lived with a mental illness. It is safe to assume that number has only risen due in part to the stressors of COVID-19. The World Economic Forum estimates that by 2030, the global costs of mental disorders will reach $6 trillion. About two-thirds of this amount represents lost productivity.
Workplace wellness programs have typically promoted fitness and nutrition. Recognizing the importance of mental health has been a lesser discussion, if at all. Psychosocial reasons (the interrelation of thought and behavior influenced by social factors) are now the leading cause of safety accidents.
The International Organization for Standardization (ISO) 45003-2021 hopes to offer guidance on addressing mental health in the workplace. Approved in June 2021, the standard’s name says it all: “Psychological Health and Safety at Work—Guidelines for Managing Psychosocial Risks.” It is a big step in increasing awareness of the link between mental health, occupational health and safety management.
In 2018, the Journal of Occupational and Environmental Medicine published findings and information from “Mental Health in the Workplace: A Call-to-Action Proceedings from the Mental Health in the Workplace—Public Health Summit.” The 2016 symposium, held at the Johns Hopkins Bloomberg School of Public Health, brought together medical professionals, academics and business organizations. This alarming statistic was shared at that gathering: mental disorders are the most “burdensome and costly” illnesses in the United States (over $200 billion a year) and well exceed the costs of heart disease, strokes, cancer and obesity. The authors also wrote, “Approximately one-third of the mental health cost burden is related to productivity losses, including unemployment, disability and lower work performance.”
In 2018, the ISO began developing a framework standard for mental health, referenced in ISO 45001, Occupational Health and Management Systems. While the resulting ISO 45003 is not a mandatory standard, its use in tandem with 45001 is clear. The new standard’s scope includes the promotion of well-being at work. Well-being is defined as the fulfillment of the physical, mental and cognitive needs and expectations of a worker related to their work.
Ken Clayman is a senior lead technical specialist at Booz Allen Hamilton, a global U.S. management and information technology consulting firm based in McLean, Va. He serves as a member of the U.S. Technical Advisory Group to the technical committee ISO/TC 283, which is responsible for the ongoing development and enhancement of ISO 45001. A member of the American Society of Safety Professionals (ASSP), he facilitated the standard’s introduction to that organization and the American National Standards Institute.
“Workers dealing with psychosocial issues are often not as focused on their work,” Clayman said. “They are distracted and suffer a lack of concentration. When you are not paying attention, it can lead to physical injury. Illness can develop from a weakened immunity. Stress can lead to a stroke or heart attack. Aggression can arise, lashing out and abuse of the environment, be it toward co-workers, property or a lack of following safety practices.”
“Every organization has occupational health and safety responsibilities, and the current pandemic has brought into sharp focus the key role that psychological health in the workplace plays.”
—Norma McCormick, Corporate Health Works Inc.
The new standard recognizes mental health stressors can come from the home and work environments.
“External sources could be anything that has a negative impact for a worker,” Clayman said. “If not resolved, they can impact work performance.” He cited stressors ranging from interpersonal (marital, family and other relationships), to financial, health and more.
“Meanwhile, stressors at work could be pressure to meet production goals, meet other performance metrics, dealing with an abusive manager and divisive behavior targeting gender, race or religion,” he said.
A carefully thought-out standard
Norma McCormick is president of Corporate Health Works Inc., Winnipeg, Manitoba. She served as project leader of the ISO technical committee that developed ISO 43005 and has headed Canada’s delegation for ISO 45001.
“Every organization has occupational health and safety responsibilities, and the current pandemic has brought into sharp focus the key role that psychological health in the workplace plays,” she said. “While many have felt powerless about the impact of recent events, there are many things that can be done to build the resilience of staff and promote a strong organizational culture. This standard brings together international best practice in this area and is relevant to companies of all types and sizes.”
In the justification study that led to approval for developing 45003, McCormick said the ISO found that mental health and stress management commonly rank first on the list of emerging health and safety concerns. Analysis prior to the COVID-19 pandemic found that one in three workplace disability claims relate to mental illness and represent 70% of short- and long-term disability costs, which is a considerable cost to people and an organization.
“ISO 45001 is the standard where one can be certified,” she said. “One requirement is addressing risk in the workplace and putting in control measures. ISO 45003 provides specific guidance and direction on mental health and well-being.”
McCormick said the standard aims to help organizations gain awareness, spot psychosocial problems and behaviors, then figure out a plan of action. If harm does occur, that plan should have support mechanisms in place and an ongoing support plan.
“While this standard emphasizes the importance of control measures when you find the problem (psychosocial) it doesn’t specify them,” she said. “The employer will make that discovery. The importance of prevention is emphasized.”
ISO’s Working Group 2 helped develop ISO 45003.
“The expertise of this group’s members helped us determine what to look at in terms of mental health and the workplace,” Clayman said. “Members included psychologists, occupational health and safety professionals and other persons with degrees in psychology and occupational psychology.”
McCormick added that around 40 countries were represented. Some countries, such as Canada, Great Britain, Australia and Japan have their own national standard to address mental health that helped inform the development of ISO 45003. McCormick serves on the Canadian Standards Association Board of Directors.
McCormick and Clayman related how the COVID-19 pandemic has affected the workplace, including the challenges workplace cultures faced when incorporating work-from-home policies and coronavirus prevention or mitigation strategies such as masking, testing or vaccine requirements in the office, on the manufacturing floor or at the construction site. This added stress and anxiety built on the risk of COVID-19 infection and the possible long-term health challenges if infection occurred.
For workers managing children during the pandemic and interacting with schools, grappling with COVID-19 mitigation also piled new stressors onto daily life at home and work.
Three areas for well-being
McCormick said the new ISO standard defines three areas for workplace psychosocial risk and need for well-being: work organization, social factors at work and work environment, including equipment and hazardous tasks. Furthermore, remediation includes three levels. Primary is organization-level controls or actions when mental health issues arise, and secondary is building awareness of mental health that might include training and other education on stressors from inside and outside the workplace. The third level—known as tertiary or supportive—includes rehabilitation actions used to build and preserve good mental health in the workplace.
Like other safety programs, mental health would require performance monitoring and measurement to confirm that the programs ably identify risk assessment and confirm the controls in place are working.
The cost of inaction
Safety is at risk when psychosocial stressors are ignored.
“Also at risk is an organization’s financial success,” McCormick said. “At stake is employee performance, productivity and your reputation as an employer. Anxiety, depression and uncertainty about job security impact the individual worker and the families as well.”
A study in the Journal of Occupational and Environmental Medicine also found that more workers are absent from work due to stress and anxiety than from physical illness or injury. Further, more days of work loss and impairment are caused by mental illness than other chronic conditions such as diabetes, asthma and arthritis. Employees with depression report their productivity at 70% of their peak performance, which results in an estimated 32 work days lost to presenteeism (working while sick). NIMH found depression was the leading cause of disability among U.S. adults ages 15–44. Approximately 80% of people with depression reported some level of functional impairment, and 27% reported serious difficulties in their work and home life.
“Workers dealing with psychosocial issues are often not as focused on their work. They are distracted and suffer a lack of concentration. When you are not paying attention, it can lead to physical injury.”
—Ken Clayman, Booz Allen Hamilton
McCormick said that a big supporter of the Canadian national standard was Great West Life Assurance Co. (now Canada Life), a life insurance company that provides coverage to companies designated as having a percentage of workers facing prolonged or long-term mental health disability. Great West in part helped bring mental health issues to the forefront.
“Insurance companies will note a rise in mental health disability and may raise its rates for a company or deny coverage altogether,” she said. “It will also cost the employer if mental health is ignored, resulting in a high quit rate and a revolving door of employees. Currently, mental health overtakes other safety issues in the workplace. A worker comes into work harboring stressors from home, resulting in anxiety or leading to depression, or they may face work-related stresses that create anxieties they bring back home. Mental conditions exasperated through either environment means the individual and the organization pay a price.”
Clayman added that ASSP is seeing strong interest in ISO 45003. “A Guide to ISO 45003,” a short and informative overview, is available at https://www.assp.org.