Some 50 years after the introduction of the Health and Safety at Work etc. Act in the UK, it finally feels as though the mental health and wellbeing of workers is being valued as equally by employers as their physical health and safety.

That it has taken so long, and something as cataclysmic as a global pandemic to get to this stage, says David Sharp, CEO of International Workplace, should not be a surprise. This briefing explores the history, and where we are now.

A brief history

The world of work in the early 1970s was very different, as were the type and scale of industrial accidents the legislation was seeking to prevent. As former Chair of the National Coal Board, Lord Robens was the ideal candidate at the time to lead the government’s review into health and safety. Largely unchanged since its introduction in 1974, the Health and Safety at Work etc. Act’s (HSWA) principal focus on controlling physical risks really has stood the test of time: maintenance of plant and systems of work; use, storage and transport of articles and substances; maintenance of the workplace, and so on. It’s strident on safety, however less so on health. The requirement to provide a safe working environment goes only so far as to say it must be ‘adequate’ as regards facilities and arrangements for workers’ welfare.

As the service sector has grown (from 56% of the UK economy in 1970 to 80% in 2016) the link between work and where that work takes place has been decoupled. The nature of work, and the risk to workers’ health has changed with it. In many ways the HSWA has done its job. Its impact on reducing the number of workers killed at work has been significant – down from nearly 500 deaths in 1981 to an annual average of 137 in recent years.

But in the early 2000s we started to see a growing appreciation among legislators and some employers of the importance of workers’ wider health, not just their physical safety.

Judgments from the courts, such as the landmark ruling in the case of Walker v. Northumberland County Council (1995) showed that an employer’s duty of care to its employees can extend to their psychiatric health, with a spate of similar cases (Hatton v. Sutherland in 2002 and Barber v. Somerset Council in 2004) embedding the principle further.

In 2004 the HSE introduced a set of management standards to help organisations comply with the law and tackle work-related stress. In 2007 the new Health Act introduced a ban on smoking in the workplace, to be enforced by employers to protect the health of its employees. Both signalled an acceptance that employers had an overt – if not necessarily new – duty to intervene even where there was no immediate physical danger to health.

At around the same time, a lady in Australia called Betty Kitchener, together with her husband Professor Anthony Jorm, came up with a stunningly simple concept: Mental Health First Aid (MHFA). Intended to work in the same way as physical first aid, the training programme they founded spread first to Scotland in 2003, then in the following years to England and Wales.

MHFA training really took off when the HSE changed its official guidance on first aid in 2018, for the first time advising employers how to support employees experiencing a mental health issue. The initiative has been a huge success. Globally, more than four million people have completed the Mental Health First Aid training programme in 24 countries, over half a million of them in the UK.

The prize is certainly one worth fighting for. Approximately one in four people in the UK will experience mental illness each year. It’s the biggest cause of sickness absence, costing UK businesses £33-42bn every year, with a cost to the UK economy of £74-99bn. In 2016, 15.8m working days were lost as a result of mental illness. And with suicide rates high in some sectors (with men working in construction and decorating significantly above average), the true impact on workers’ friends and families is impossible to calculate.

Prevention better than cure

The MHFA programme has had a tremendous impact on raising awareness and reducing the stigma around mental health at work. All of which should be lauded. But it does also have its critics. Legislation to make mental health first aid training a legal requirement in the UK is making its way only slowly through parliament, and a number of respected voices – such as Stephen Bevan at the Institute for Employment Studies – have raised concerns that it shouldn’t be considered a one-size-fits-all approach to managing mental health at work.

Most obviously, prevention is always better than cure. While both need investment in time and resources, many feel employers should be doing more to apply a risk management approach to mental health at work rather than relying on the ‘sticking plaster’ of mental health first aid. This is the approach advocated in the 2017 Stevenson / Farmer review of mental health and employers, which talks of people thriving at work rather than merely surviving. One goal from the report’s ten-year vision is that all organisations, whatever their size, will be “equipped with the awareness and tools to not only address but prevent mental ill health caused or worsened by work” (my italics).

It is to the issue of prevention that the focus is now turning. Two years ago, the world’s leading health and safety body IOSH developed a new course designed to help line managers proactively address psychosocial health and safety risk before the need for first aid might arise. Here at International Workplace, we’ve been developing a special version of the IOSH Managing Occupational Health and Wellbeing course for delivery in eLearning and virtual classroom formats, which launches this week. The course is aimed firmly at front-line managers, to help them understand how to deal with fluctuations in people’s health and what to consider in a health needs assessment. It’s not trying to turn anyone into a mental health expert, but it fills a very important gap that links the risk management principles used in health and safety with the people management practices used in human resources. It seeks to address a concern around MHFA training, to ensure that any support given to colleagues is part of an integrated risk management plan for the organisation as well as the individual.

The future

The publication of a new international standard earlier this month provides an additional tool to help employers manage risk. ISO 45003 Psychological health and safety at work provides guidance on the management of psychosocial risk, as part of the ISO 45001 occupational health and safety framework that will be familiar to many. While ISO 45003 is only advisory – it’s not a standard that is intended to be audited against – its Plan-Do-Check-Act approach helps to embed the management of psychosocial risk firmly at the organisational planning level, using terms that will be familiar to employers around the world.

As with mental health first aid and training such as IOSH Managing Occupational Health and Wellbeing, adopting ISO 45003 will not make a difference to workers’ mental health and wellbeing overnight. But by adopting it, organisations are agreeing what they need to do. And by committing to it, they’re telling their workers very publicly what they can expect. Iterative progress is being made.

David Sharp FCIM FIWFM TechIOSH is CEO of digital learning provider International Workplace.