Mental Health And Work. The concept of Employee Asssistance Programme.

(text of public lecture delivered at the Federal Neuro-Psychiatric Hospital, Yaba on 10.10.17 to mark World Mental Health Day 2017)

By
Dr Olufemi Olugbile FRCPsych FNIM

The Place of WORK in our lives

• It is generally said that modern man spends his life virtually parcelled out as follows:

u First one third of life-span preparing for a career

u Next half of life-span living a work-life u The remainder of the life-span in reIrement

The Nature of Work

• •  Any acIvity, or set of acIviIes, engaged in the aLainment of a set of objecIves, usually including some remuneraIon.
• •  One of the most important areas of life.
• •  OOen plays a major role in determining quality of

  life.

• •  The lack of work, temporarily or permanently, is one of the most important precipitaIng and sustaining factors for emoIonal illness in human beings.

The Purpose of Work

• •  OnemayseektoanswerthequesIon:‘WhydoweWork?’
• •  ThePsychologyofMan,asitpertainstoWork,isbest described by a Hierarchy of Needs first described by Abraham Maslow. It goes from the most basic need which is to get three square meals a day for self and family, to the need for Shelter. Then comes a need for a Sense of Belonging and involvement in the Work-acIvity, and a sense of being Valued in the Work place.
• •  AttheapexofthehierarchyisthenoIonof‘Self ActualisaIon’ where the individual begins to aspire towards a sense of fulfilment and contentment at having done his bit n Society and got appropriate value out of life through Work.

How important is Work, and Why do people do it?

• •  Alo (Alo, O. 1984) carried out a survey among Nigerian workers. He found that for 67.1% Work was their ‘Central Life Interest’ (i.e. the most important thing in their lives).
• •  Frederick Taylor, proponent of Time and Mo3on Studies, believed that Work was not about making workers ‘happy’ or ‘fulfilled’, but devising systems to make them do the maximum amount of work in the most efficient way possible (thereby maximising the profit of the employer/organisaIon).
• •  Human Rela*ons Movement: Believe that the feelings of workers and the relaIonships they form at work are important in creaIng MoIvaIon and opImising producIvity. The work place should be designed to encourage posiIve interacIon and make people feel good about the office/factory. Workers should be allowed to make inputs and feel they have a stake in the Workplace.

The Influence of Culture

• •  ThereisapercepIonthatfiguresofmythandliterature

  tend to reflect some fundamental Values in every society.

• •  OkonkwointheChinuaAchebenovel‘ThingsFallApart’ has a work-ethic which many would consider to be reflecIve of his tribe.
• •  AresearchernamedMcClelland(McClelland,J.1968) believed one could predict which society was going to be producIve by analysing children’s stories, which would reflect whether the society’s predominant interest was with Achievement, Affilia3on, or Power. He studied Nigeria’s three major ethnic groups. His conclusion – controversial!- was that the Yoruba in parIcular showed ‘a high need for Achievement’.

Why Do Nigerians Work?

• •  Professor Olatunde Oloko, one of the pioneers of Sociology in Nigeria, surveyed 500 workers at Ewekoro Cement Factory (now owned by Lafarge), asking them to rank a set of 14 ‘Mo3va3ng Items’ in terms of their importance to them.
• •  They rated some of the factors in this order: q Opportunity for making progress on the job

q Job Security
q Good Salary/Wages

q Good Medical Services
q Working on the job they prefer q Good Pension Plans
q Credit/RecogniIon for the job
q Having good people to work with q Having a good Supervisor/Boss

What Factors Could Affect the Wellness of the individual at Work?

• •  The Worker is doing a job he does not like or find interesIng.
• •  He is working in an uncomfortable or hosIle environment
• •  He has a negaIve amtude to Work generally
• •  He brings his problems from non-Work life

  (Marital issues etc) into the Work-place

• •  Drug/Alcohol Abuse
• •  Unhealthy Life Style, with inadequate Sleep, lack of Exercise etc

The History of Work

• •  Have human beings always Worked?
• •  The answer, to a large extent, is ‘YES’.
• •  Other Animals work too, but most of their exerIons are insInctual and funcIonal, aimed at ‘drive-reducIon’. The lion is ‘working’ when he stalks and kills his prey, but it is not the same organised, complicated work that is done by the workers at the Coca Cola factory at Agidingbi.

Mental Health and Work

What exactly, if any, is the rela*onship between a person’s Mental Health and his Work?

• •  Dynamic, reciprocal relaIonship.
• •  Without a doubt, a person’s Mental Health influences the manner and effecIveness of his Work.
• •  On the other hand, a person’s Work influences his Mental Health. Difficulty at work is a commonly reported factor associated with the onset of mental health problems.
• •  Stress is the usual pathway for the expression of the influence of Work on a worker’s mental health.
• •  The lack of Work – unemployment, or the lack of suitable work, is a commonly reported factor associated with mental health problems.
• •  Work is important to everyone’s Mental Wellness for

v Economy
v Linkage to Society

v Human Rights (ArIcle 23 of UN DeclaraIon of Human Rights ‘every individual has a right to work, to free choice of employment, to just and favourable condIons of work, and protecIon against unemployment’.)

Mental Illness and Work

• •  In society at large, the ‘lifeIme prevalence’ for diagnosable Mental lllness is generally quoted as being of the order of 10-20%
• •  The commonest of these illnesses are Depression and Anxiety.
• •  In the United Kingdom, up to one in six persons of working age (20-60 years) would at some Ime experience symptoms sufficiently severe to meet the diagnosIc criteria for Mental Illness (Office for NaIonal StaIsIcs 2001)
• •  During such episodes, there is significant absenteeism from work, and work performance is negaIvely impacted.
• •  Another one in six experience symptoms that are transient, or that do not otherwise meet the criteria for ‘case-ness’. Despite this, they may have a negaIve impact on the person’s work performance.

The Issue of Stigma

• •  SIgma describes the expression and implicaIons of the widely prevalent negaIve amtudes held by people in society towards Mental Illness and the people who suffer from it.
• •  It has a strong cultural basis, and is expressed in a lot of local wimcisms (e.g. ‘Were dun wo, ko se bi l’omo’)
• •  Strong underpinning of ignorance e.g. all mental illness is regarded by many as one and the same, with a uniformly negaIve prognosis; mental illness is associated with metaphysical causaIon and oOen a sense that a person is being deservedly

  ‘punished’ (Olugbile, O., Zachariah, MP et al 2009)

Stigma in the Workplace

• •  A person with a history of Mental Illness, even aOer treatment and full recovery, is less likely than others of equal qualificaIon to be employed.
• •  A truthful declaraIon of past illness (or well controlled illness) leads to HR people making addiIonal inquiries and examinaIons about the individual that may lead to his disqualificaIon from employment.
• •  As a result people oOen constrained to make false declaraIons about their past history in employment documents.
• •  Unfortunately this may mean that even if they get employed, they get no support from their employers in paying the cost of follow-up treatment or relapse.
• •  Tendency to ascribe all incidents surrounding a person with a history of Mental illness to ‘illness’
• •  Tendency to exclude
• •  Glass ceiling on career advancement
• •  DimuniIon in assignment of Responsibility aOer relapse and recovery. ‘Sidelining’
• •  First casualty in every ‘downsizing’ exercise

Economic Costs Of Mental Illness

Financial Costs to employers exist in the following areas:

2 Absenteeism

2 Presenteeism (the most costly!)

2 Cost of Rapid Turnover (i.e. competent replacement)

2 (locally) Cost of Treatment (in some cases)

2 Total cost to Private sector and Public sector would run into several billions of naira annually.

The Nigerian Workers’ Situation

• •  High rate of unemployment
• •  Workers jealously guard their jobs, fearful of losing them.
• •  May endure difficult situaIons at work without complaint. May result in a situaIon of ‘learned helplessness’ that may amount to great Stress and precipitate illness in the predisposed.
• •  Hide records of past (and even current) illness from employers, a situaIon that is bad for employer and employee

The Nigerian Worker’s Situation contd

• •  Some employers, especially internaIonal firms such as the ‘Oil Majors’ have good Staff Health Services manned (or led) by OccupaIonal Health Physicians.
• •  Other ‘Blue Chip’ companies such as the ‘new wave’ Banks have Social Health Insurance schemes that cover their workers. The HMOs and Healthcare Providers under these schemes may procure specialised Mental Health services for idenIfied individuals, but usually only when they fall ill.
• •  These arrangements have the following downsides:

o Coverage is poor or nonexistent for long-termconditons e.g.

Schizophrenia.

o EmployeeshavelegiImateworriesthattheirdiagnosesmaybemade available to HR, with deleterious effects on their careers.

o Asaconsequencetheymaydenysymptoms,avoidtreatment,andcreate a burden of ‘presenteeism’.

o ThefocusisontreaIngILLNESS,ratherthanmaintainingWELLNESS

The Nigerian Worker’s Situation contd

• •  TheFederalCivilServiceworkforcearecoveredbyNHIS.
• •  Mental Health care is ‘Fee For Service’ based on referral from Primary Healthcare provider.
• •  Focus is on established(orsuspected)illness, rather than on Wellness.
• •  Although professional confidentiality protections are supposed to be operational, there is fear on the part of the employee that his medical record will count against him.
• •  Many non-Civil Service workers who suffer from the most common mental health conditions (Depression, Anxiety) do not or cannot get access to diagnosis and treatment for their condiIons.

New Thinking – The WELLNESS Concept

• •  There is a concept beginning to creep into the mainstream of Medical PracIce, especially in the area defined as ‘Public Health’.
• •  Focusses on a shift of emphasis from ‘ILLNESS’ to ‘WELLNESS’ in the organisaIon of services.
• •  This means that citizens will be encouraged, through advocacy, to interface with health personnel and faciliIes on the basis of seeking and affirming Wellness, rather than treaIng already established illness.
• •  Public advocacy will focus on lifestyle issues such as Obesity, and the dietary and other prevenIons for Diabetes Mellitus, Hypertension and common Cancers.
• •  Routne age-based comprehensive Medical Screening (annually recommended for people 50 years and above), as well as encouragement of Exercise and appropriate diet should become widely available to the general public, especially with the insItuIon of compulsory Health Insurance.

WELLNESS AND THE WORKER – THE

PHYSICAL AND PSYCHOLOGICAL

DIMENSIONS
• Over the past few years, the best employers of labour

in Europe and America have insItuted many elements of ‘WELLNESS’ as described above into the Health package made available to their workers.

• •  Many have built gymns where workers can work out in the premises, made health screening available

  (compulsory in some cases), taken other measures to make the worker’s life less sendentary, and introduced Stress Management and other training programmes for their employees.

• •  This is not philanthropy, but expenditure that is proven to result in huge savings on tradiIonal medical costs

AIMING FOR THE TOTAL WORKER –

THE EMPLOYEE ASSISTANCE

PROGRAMME (EAP)
• The concept of ‘Employee Assistance’ represents a

paradigm shiO in Employer-Employee relaIonship.

• Unlike the postulaIon of Frederick Taylor and his ‘Time and MoIon Studies’, which says the feelings and family problems of an employee are not the business of the employer, who should only be interested in the efficiency of his work processes, the best modern-day thinking recognises that the criIcal indicators of the dysfuncIonal workplace – a high rate of ‘SICK OFF’ and a low rate of EFFICIENCY can only be improved when workers are not only physically well, but PSYCHOLOGICALLY AND SOCIALLY WELL.

THE EMPLOYEE ASSISTANCE

PROGRAMME – contd

Deriving from the above logic, the Employee Assistance Programme is focussed on helping the worker achieve and maintain wellness within himself and his social space, for the purpose of guaranteeing his performance at work.

It provides such things as Counselling for emoIonal worries, specialist referral for more major psychological problems, advice and assistance on issues to deal with family members and even such maLers as accommodaIon and legal advice. The central planks arethe encouragement of self-referral, total confidenIality, which means the employer does not get to know the details of the interacIon, and 24-hour access to telephone or face-to-face interacIon or any maLer causing worry to the worker.

CONCLUSION – TOWARDS THE

MENTALLY HEALTHY NIGERIAN

WORKER
• Even where Nigerian employers may consider the considerable cost burden of a full-blown

Employee Assistance Programme too onerous to bear in the current situaton, it is important to imbibe the logic by showing a holisIc interest in the Nigerian worker.

• •  A worker who is beaten up every day by his wife cannot be expected to give his best service at work, even with the ever-present threat of peremptory sack.
• •  In the same way, a worker who suffers from untreated Depression or Anxiety is unable to give efficient service, despite his best efforts.
• •  There is currently not just a high burden of Absenteeism, but even more of Presenteeism in the Nigerian workplace.
• •  Any effort made to develop services using this expanded holisIc view of Wellness is not philanthropy but expenditure guaranteed to bring a return on investment. The achievement is a win-win ulImately for Worker and Employer.
• •  Nigerian Psychiatrists should begin to step outside their tradiIonal comfort zone of diagnosing and treaIng Mental illness to developing and advancing services to preserve the Mental Wellness of society, especially its workers.
• •  We need to develop rapport with Employers of Labour and other professions and bodies such as InsItute of Directors, the Nigerian InsItute of Management, the naIonal body of Personnel Management in order to arIculate our views and use our professional knowledge to influence their thinking and pracIce. This includes gemng them to take ownership of the war against SIgma in the workplace, the treatment and effecIve reintegraIon of persons with mental illness in the workplace, and the pursuit of a holisIc agenda for the psychological, physical and social wellness of the Nigerian worker.

References

• •  Alo,O.(1984)UnderstandingWorkAmtudesand Behaviour – A Study of Work and Non-Work Spheres of Life (PhD Thesis Obafemi Awolowo University Ile Ife)
• •  Maslow.A(1968)TowardsaPsychologyofBeing.Brooklyn
• •  McClelland.J(1968)TheAchievingNaEon.London
• •  OfficeforNaIonalStaIsIcs(2007)LabourForceSurvey
• •  Oloko,O.(1965)TheMuddywaterStudies.Labourand Development in Nigeria. Lagos
• •  Olugbile,O.,Zachariah,MP.,Kuyinu,A.,Coker,A.,Ojo,O., Isichei, B. Yoruba World View and the nature of psychoEc illness African Journal of Psychiatry (Johannesburg),2009 12(2), pp 149-56