Permanent Uptake of COVID-era Flexi-Work Models Could Improve Mental Health: WHO
Man showing signs of workplace stress
Can flexible working arrangements help to reduce workplace stress?

Practices implemented during the COVID-19 pandemic, such as flexible working arrangements and teleworking, could help to reduce work-related mental health challenges, according to a first-ever set of Guidelines on Mental Health at Work released Wednesday by the World Health Organization (WHO).

The COVID-19 pandemic triggered a 25% increase in what was already a high percentage of people suffering from anxiety and depression worldwide, WHO has previously noted. At the same time, the pandemic accelerated the pace of transformations in the world of work, especially in remote work, e-commerce and automation – and now emerging evidence shows that more access to flexi-time and remote work arrangements have mental health benefits.

Conversely, shift work and excessively long working hours adding up to 55 hours or more a week are associated with depression, increased alcohol risk and even suicidal behaviours, the WHO Guidelines review found.

More broadly,  job insecurity as well as a lack of  “job control” also are related to higher risk of depressive symptoms and risk of suicidal behaviours, while having more authority to make decisions about your job role and performance is “protective for depressive symptoms and higher job control is associated with reduced emotional exhaustion burnout.”  A lack of “organizational justice also is associated with “subthreshhold mental health symptoms”, the WHO review found.

Work and mental health closely intertwined

Pandemic lockdowns also imposed a mental health penalty when they confined to their homes for work and socializing – but now the benefits of more flexible work schedules are being recognized in the new WHO guidelines.

Release of the detailed 135-page guidelines was accompanied by a joint WHO and International Labour Organization appeal for concrete actions to address mental health concerns amongst the working population and provided evidence-based global public health guidance on how to do so in a policy brief.

“Work and mental health are closely intertwined,” WHO and ILO wrote in their joint policy brief. “A safe and healthy working environment supports mental health, and good mental health enables people to work productively. An unsafe or unhealthy working environment can undermine mental health, and poor mental health can interfere with a person’s ability to work if left unsupported.”

“As people spend a large proportion of their lives in work – a safe and healthy working environment is critical. We need to invest to build a culture of prevention around mental health at work, reshape the work environment to stop stigma and social exclusion, and ensure employees with mental health conditions feel protected and supported,” ILO Director-General Guy Ryder said of the new advice.

The World Health Organization's guidelines on mental health at work

The WHO Guidelines, the product of a lengthy and exhaustive global review of evidence, provide guidance in the following areas: organisational interventions, manager and worker training, individual interventions for promoting positive mental health, and prevention of mental health conditions. The guidelines also include a section offering recommendations on returning to work following an absence associated with mental health conditions and how to aid people with mental health conditions to gain employment.

The guidelines meet the standards for evidence-based guidelines, although in most cases there is low or even very-low certainty of evidence given that the recommendations are based on research into highly complex psycho-social risks, as compared to randomized-controlled drug trials.

Leap in depression and anxiety

Even before COVID-19, the world of work was experiencing changes, from technological development, climate change, globalisation, and demographic shifts. The pandemic accelerated these changes and forced companies and organisations to restructure both for financial reasons and to keep workers safe.

For many employees, WHO and ILO noted, these changes created new psychosocial risks or worsened existing ones.

Before the pandemic, in 2019, around 15% of working-age adults lived with a mental disorder, WHO found in its World Mental Health Report, released in June. This included 301 million people who were living with anxiety and 280 million individuals suffering from depression.

COVID led to a 25% increase in anxiety and depression, making the situation more acute. According to the reports, 12 billion working days are lost annually due to depression and anxiety at a total loss to the global economy of $1 trillion, predominantly from lost productivity.

“It’s time to focus on the detrimental effect work can have on our mental health,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The well-being of the individual is reason enough to act, but poor mental health can also have a debilitating impact on a person’s performance and productivity. These new guidelines can help prevent negative work situations and cultures and offer much-needed mental health protection and support for working people.”

Organisational interventions – flexible work among the many examples

Flexi-work and telework are just a few among the many examples of organisational interventions that employers can take to address psychosocial risks at work, WHO found.  Others involve  involving workers more in decisions about their jobs, and changing workloads and work schedules to enable better work-life balance.

More “participatory” organisational strategies that allow workers to have a say in their own job design, workload changes, or break schedules also have positive mental health benefits – as does better feedback on worker performance.

Additionally, improvements to the physical work environment can have a positive impact, addressing issues such as “inadequate equipment availability… lack of space, poor lighting, excessive noise.”

In all cases, there was evidence of in favour of these practices, WHO found, even if the review also classified that evidence as weak in classical terms – where randomized controlled trials of the kind used for new drugs are typically seen as the gold standard.

“The GDG [Guidelines Development Group] concluded that, despite very low certainty of the available evidence, the likely benefits of organizational interventions on reducing emotional distress and improving work-related outcomes outweighed the possible harms of implementing these interventions,” the recommendations state. “This was supported by evidence for risk factors at work which negatively affect mental health outcomes, indicating that interventions to reduce, remove or mitigate risk factors could improve these outcomes.”

Addressing mental health of people with existing conditions

On a cold winter morning these women from Raipur, India are crowded into the back of a truck on their way to work.

The WHO guidelines also include recommended measures for addressing the mental health of humanitarian and emergency workers, as well as for integrating new or returning workers with mental health conditions into the workforce.

Finally, the guidelines map out recommendations for training both employers and workers in mental health literacy – including  strengthening managers’ skills to recognise and act on mental health conditions at work, and empowering workers to seek support.

In their joint brief, WHO and ILO call for the creation of an environment with “cross-cutting actions to improve mental health at work” through seven factors they said are “critical for progress:” leadership, investment, rights, integration, participation, evidence, and compliance:

  • Leadership involves the development of a mental health plan and assigning roles based on that plan. Investment centers on allocating the financial and human resources towards implementing such plans, as well as including mental health services in any work benefits package.
  • A “‘rights” based approach calls for employers to develop and implement non-discrimination policies around mental health and take the necessary steps, such as training programs, to stop stigmas around mental health in the workplace.
  • Integration means the embedding of mental health into existing occupational safety and health strategies and participation engage workers – especially those who have lived with mental health challenges – in the decision-making process.

Walking the talk at WHO

WHO’s new headquarters in Geneva – touted architecturally for its modern design but with many staff doubling up on desks in the new atrium open-space.

Ironically, prior to the pandemic, WHO itself was the agency with some of the UN’s most restrictive policies on teleworking and flextime – until COVID which forced most of its 8,000+ workforce to abruptly begin working remotely in March 2020 – the resulting efficiencies triggered a re-evaluation of internal policies.

Until today, most the WHO workforce in its Geneva headquarters is still working off-site much or most of the time – as a massive building renovation project coinciding with the pandemic reduced office space and forced workers to double up on desks – unless they are high-level directors.

More recently, a new WHO policy calling for workers to return to the office for at least one day a week may have been met with relief among some staff happy to reconvene with colleagues again, but resistance among others who say that office work policies need to be fine-tuned in light of workers’ individual status and needs.

In particular, WHO’s new building design, chosen after painstaking review, has received complaints among from critics who say that the modern, open-plan offices reduced privacy and net desk space, leaving almost no room for consultants.  Even some of the regular staff have to double up on desks in a windowless “atrium” area, taking everything home at night.  More private office spaces, featuring windows, run along the sides of the new building, but these are largely taken up by higher-level officials.

WHO’s “atrium offices” in the new building headquarters – windowless cubicles crowded together.

Observed one senior WHO staff member who asked not to be named: “I think that days in the office should be decided upon based on the benefit that can be derived from going to the office relative to the risks/disadvantages.

“For instance, effects on work-life balance would be negative for me, since I would have to waste between 1 hour and around 2 hours of my day on commuting.

“Additionally, some 95% of my work is with people outside Geneva, not to mention that I have a great teleworking set up at home – whereas in the office I have a small desk area with ‘blinders on three sides’ in a hallway (which they euphemistically call ‘atrium’) that I would have to clear every evening since it will be used by somebody else on another day. This is not what I consider a productivity environment.”

Asked for comment, Aiysha Malik, WHO’s lead coordinator of the new guidelines from the Department of Mental Health and Substance Use said: “These first ever guidelines from WHO …mean that employers, and the people responsible for the health and wellbeing of workers, can now be assured in what works for mental health. Like all organizations, WHO will review the recommendations and ensure that this guidance forms part of its way of working.”

Elaine Ruth Fletcher contributed to this report.

Image Credits: Ciphr Connect, Neil Moralee/flickr , World Health Organization, Prem Kumar Marni/Flickr, Geneve Internationale/WHO and BBK Architekten, Health Policy Watch .

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