Mental Health in the Workplace
What are mental health problems?
There are different ways of defining the term mental health. Some definitions emphasise positive psychological well-being whereas others see it as the absence of mental health problems.
Topics for Return-to-work cooordinators
For example, the World Health Organisation has defined mental health as: “… a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”
Mental health can be seen as a continuum, ranging from having good mental health to having mental illness. A person will vary in their position along this continuum at different points in their life. A person with good mental health will feel in control of their emotions, have good cognitive functioning and positive interactions with people around them. This state allows a person to perform well at work, in their studies and in family and other social relationships.
What are mental health problems?
A variety of terms are used to describe mental health problems: mental illness, serious emotional disorder, extreme emotional distress, psychiatric illness, mental illness, nervous exhaustion, mental breakdown, nervous breakdown, and burnout. Slang terms include crazy, psycho, mad, loony, nuts, cracked up and wacko. These terms promote stigmatising attitudes and should not be used.
These terms do not give much information about what the person is really experiencing. A mental disorder or mental illness is a diagnosable illness that affects a person’s thinking, emotional state and behaviour, and disrupts the person’s ability to work or carry out other daily activities and engage in satisfying personal relationships.
There are different types of mental illnesses, some of which are common, such as depression and anxiety disorders, and some which are not common, such as schizophrenia and bipolar disorder. However, mental illnesses, as with any health problem, cause disability, which is sometimes severe. This is not always well understood by people who have never experienced a mental illness.
A mental health problem is a broader term including both mental illnesses and symptoms of mental illnesses that may not be severe enough to warrant the diagnosis of a mental illness.
The word depression is used in many different ways. People feel sad or blue when bad things happen. However, everyday ‘blues’ or sadness is not depression. People with the ‘blues’ may have a short-term depressed mood, but they can manage to cope and soon recover without treatment. However, ‘major depressive disorder’ lasts for at least two weeks and affects a person’s ability to carry out their work or to have satisfying personal relationships.
Signs and symptoms of major depressive disorder
If a person is clinically depressed they would have five or more of these symptoms (including at least one of the first two) nearly every day for at least two weeks:
- an unusually sad mood that does not go away
- a loss of enjoyment and interest in activities that used to be enjoyable
- a lack of energy and tiredness
- feeling worthless or feeling guilty when they are not really at fault
- thinking about death a lot or wishing to be dead
- difficulty concentrating or making decisions
- moving more slowly or, sometimes, becoming agitated and unable to settle
- having sleeping difficulties or, sometimes, sleeping too much
- loss of interest in food or, sometimes, eating too much – changes in eating habits may lead to either loss of weight or putting on weight
Not every person who is depressed has all these symptoms. People differ in the number of symptoms they have and also how severe the symptoms are. Even if a person does not have enough symptoms to be diagnosed with a depressive disorder, the impact on their life can still be significant.
Symptoms of depression affect emotions, thinking, behaviour and physical wellbeing. Some examples are listed below.
Sadness, anxiety, guilt, anger, mood swings, lack of emotional responsiveness, helplessness, hopelessness.
Frequent self-criticism, self-blame, worry, pessimism, impaired memory and concentration, indecisiveness and confusion, tendency to believe others see you in a negative light, thoughts of death and suicide.
Crying spells, withdrawal from others, neglect of responsibilities, loss of interest in personal appearance, loss of motivation.
Chronic fatigue, lack of energy, sleeping too much or too little, overeating or loss of appetite, constipation, weight loss or gain, irregular menstrual cycle, loss of sexual desire, unexplained aches and pains.
Find out more about early warning signs of depression in the workplace.
Everybody experiences anxiety at some time . When people describe their anxiety, they may use terms such as: anxious, stressed, uptight, nervous, frazzled, worried, tense or hassled. Although anxiety is an unpleasant state, it can be quite useful in helping a person to avoid dangerous situations and motivate the solving of everyday problems. Anxiety can vary in severity from mild uneasiness through to a terrifying panic attack. Anxiety can also vary in how long it lasts, from a few minutes to many years.
Signs and symptoms of anxiety
Anxiety can show in a variety of ways:
Unrealistic or excessive fear, irritability, impatience, anger, confusion, feeling on edge, nervousness.
Lots of worry about past or future events, mind racing or going blank, poorer concentration and memory, trouble making decisions, vivid dreams.
Avoiding situations or people, obsessive or compulsive behaviour, distress in social situations, increased use of alcohol or other drugs.
Pounding heart, chest pain, rapid heartbeat, blushing, rapid shortness of breath, dizziness, headache, sweating, tingling and numbness, choking, dry mouth, stomach pains, nausea, vomiting and diarrhoea, muscle aches and pains, restlessness, tremors and shaking, having difficulty sleeping.
An anxiety disorder differs from normal anxiety in the following ways:
- it is more severe
- it is long lasting
- it interferes with the person’s work or relationships.
There are many different types of anxiety disorders. The main ones are generalised anxiety disorder, panic disorder, phobic disorders, post-traumatic stress disorder and obsessive-compulsive disorder.
Find out more about early warning signs of anxiety disorders in the workplace.
Substance use disorders include any of the following:
- dependence on alcohol or a drug
- use of alcohol or a drug which leads to problems at work, school or home, or to legal problems
- use of alcohol or a drug at a level which is causing damage to health. The damage may be physical (such as hepatitis from self-administration of injected drugs) or mental (such as depression secondary to heavy consumption of alcohol).
The symptoms of substance dependence are:
- tolerance for the substance (person needs increased amounts over time or gets less effect with repeated use)
- problems in withdrawal (person experiences withdrawal symptoms or uses the substance to relieve withdrawal symptoms)
- use of larger amounts or over longer periods than intended
- problems in cutting down or controlling use
- a lot of time is spent getting the substance, using it, or recovering from its effects
- the person gives up or reduces important social, occupational or recreational activities because of substance use
- the person continues using the substance despite experiencing its ill effects.
Psychosis is a general term to describe a mental health problem in which a person has lost some contact with reality. There are severe disturbances in thinking, emotion and behaviour. Psychosis severely disrupts a person’s life. Relationships, work and self-care are difficult to initiate and/or maintain. The main psychotic illnesses are: schizophrenia, bipolar disorder (manic depressive disorder), psychotic depression, schizoaffective disorder and drug-induced psychosis.
Adjustment disorder is a term used to describe a mental health problem in which there is a psychological response to an identifiable stressor or life event that causes significant emotional or behavioral symptoms. The condition is different from an anxiety disorder which lacks the presence of a stressor, or post-traumatic stress disorder and acute stress disorder which are usually associated with a more intense stressor. There are several types of adjustment disorders and while symptoms vary, they begin within three months of a stressful event. Symptoms include emotional symptoms such as sadness, anxiety difficulty sleeping, feeling overwhelmed, as well as behavioural symptoms such as fighting, avoiding family or friends and poor work performance. An adjustment disorder may be acute or chronic, depending on whether it lasts more or less than six months.
How common are mental illnesses?
Mental illnesses are common in the Australian community. The 2007 National Survey of Mental Health and Wellbeing, a community survey of 8,841 people aged 16-85 years of age, living in private dwellings across Australia, found that one in five (20%) had a common mental illness (depressive, anxiety and/or substance use disorder) at some time during the 12 months before the survey (see table below). This means that one in five Australians aged 16-85 suffer from some form of common mental illness in any year. This is equal to 3.2 million people.
Percentage of Australians aged 16-85 with common mental illnesses in any one year
Type of Mental Illness
Substance use disorders
Any common mental illness
These results reflect the whole population of Australia aged 16-85 years. Research on specific sub-groups within the population may show higher or lower rates of common mental illnesses. For example, Aboriginal people are at a higher risk of anxiety and depression.
These three types of mental illnesses often occur in combination. For example, it is not unusual for a person with an anxiety disorder to also develop depression, or for a person who is depressed to misuse alcohol or other drugs, perhaps in an effort to self-medicate. Terms used to describe having more than one mental illness are dual diagnosis, comorbidity and co-occurrence. Of the 20% of Australians with any mental illness in any one year, 11.5% have one disorder and 8.5% have two or more disorders.
The 2007 National Survey of Mental Health and Wellbeing did not cover the less common but more serious mental illnesses. Other research has found that 0.4-0.7% of Australian adults have a psychotic disorder, such as schizophrenia, in any one year.
Many people with common mental illnesses do not seek any professional help. The National Survey found that professional help is received by only 35% of people who have a common mental illness in the past year (59% of people with depressive disorders, 38% with anxiety disorders and 24% with substance use disorders). People with less common mental illnesses, such as schizophrenia and bipolar disorder, will generally get professional help eventually. However, it can sometimes take years before they are correctly diagnosed and receive effective treatment.
Treatments for mental health problems
A range of treatments are available for mental health problems. They include medical, psychological, complementary and self-help treatments. For more information on what works for depression and anxiety, see the following resources: A Guide to What Works for Depression and A Guide to What Works for Anxiety Disorders.
Text reproduced with permission from: Kitchener BA, Jorm AF, Kelly CM. Mental Health First Aid Manual. 2nd ed. Melbourne: Mental Health First Aid Australia; 2010