Mental Health is an Increasing Global Epidemic in the Workplace

Since the beginning of the Covid-19 pandemic, research on mental health across the globe suggests high rates of anxiety, depression, post-traumatic stress disorder and general psychological distress driven by job losses, financial worries, workplace stress, disruptions to work and education, loneliness, loss of loved ones and fear of Covid-19 infection.

The WHO has identified stress as the epidemic of this century and a contributor to poor mental health. The primary source? The workplace. According to the United Nations, before the Covid-19 pandemic, anxiety, depression, and other mental health conditions accounted for about 13% of the global burden of disease and cost the global economy over US$1 trillion per year, noted as the “greatest causes of misery in our world”. The WHO estimates that anxiety disorders affect 275 million people worldwide, while depression affects 264 million people. Research indicates that in South Africa, depression affects 1 in 4 employees, and 8 in 10 employees will continue working despite depression. Absenteeism due to depression costs the economy nearly R30 billion per year, and R200 billion is lost annually due to employees with depression reporting for work whilst unwell (presenteeism)¹.

Global trends

Data from ICAS Southern Africa, a leading provider of mental health and employee wellness services, shows that stress, a perception of inadequate resources to cope with environmental demands at work or home or in life in general, anxiety disorders and depression were consistently among the top issues for employees who sought help through ICAS services during 2019 and 2020. As expected, during 2020, Covid-19 concerns were also a major issue. 

How South Africa compares to global trends

Stress is a major contributor to depression and anxiety in South Africa, even prior to the pandemic. According to the 2019 Bloomberg Business Survey, out of 74 countries, South African employees were the second most stressed in the world, behind Nigeria. The WHO and the South African Depression and Anxiety Group (SADAG) estimate that high levels of depression and anxiety in the workplace are undiagnosed because of stigma, reluctance to seek help and poor knowledge on mental health.

Data for South Africa from ICAS for the period 2018 to 2020 highlights the need for more advocacy for mental health in organisations. Stress, depression, anxiety disorders and other mental health conditions are a major cause of sickness and absence from work. Their relatively low rank among the top 20 most frequently presented issues in Figure 1 suggests that mental health beliefs and attitudes potentially discourage employees from seeking assistance. Naturally, one must enquire about the multiple contexts that have the potential to destigmatise help-seeking for mental health conditions, including the workplace, local communities and the education system. It is important for organisations to examine how the provision of mental health workplace benefits may be better supported through broader efforts that encourage disclosure and seeking help. 

Mental issues relating to Covid-19

Covid-19 has been associated with higher rates of depression, anxiety and stress. The ICAS data reveals that the outbreak of the Covid-19 pandemic saw an initial decline in the utilisation of services during the first national lockdown. However, as lockdown levels eased, utilisation of services increased. From March to December 2020, employees accessed ICAS services primarily for issues related to Covid-19 symptoms, testing and tracking.

There was a 37% decline in the number of employee referrals to ICAS by either managers, human resource, or occupational health specialists in 2020 as compared to 2019. A key factor in ICAS referrals was absenteeism, which was treated as an indicator of something being possibly amiss with employees.

Working from home led to significantly reduced physical interactions at the office that often provide opportunities for managers to observe outward symptoms of depression, anxiety and other mental health conditions among employees and refer them for support.

Workplace stress and anxiety

Granted, the workplace can be a stressful environment as organisational demands on employees such as workload and pressure to perform increase. Workplace stress and anxiety result from employee perceptions of their available resources such as autonomy, work relationships, and opportunities for growth as being inadequate to deal with increased organisational demands.

There may be a need for organisations to interrogate the parts of their culture that compromise employee mental health and overall well-being. For instance, some employees are subjected to feelings of guilt for taking their annual leave, although a legal employee entitlement. The company culture may also expect employees to be constantly available (take calls, respond to emails and WhatsApp or messaging on other digital platforms), even after working hours. These behaviours may have a negative impact on the mental health of employees. A lesson from the pandemic is the need for organisations to regularly examine their established ways of work to ensure that they do not contribute to poor mental health.

The negative impact of organisational change

Even before the Covid-19 pandemic, employees had to adapt to change as organisations adjusted or transformed their business models by adopting new technologies to remain competitive in the global marketplace. The pandemic has introduced more change for employees as organisations adopt hybrid workplaces that combine the remote/virtual office with the traditional office. During organisational change, managers often find themselves struggling to balance implementing change with supporting employees to manage the emotions associated with the change. Such emotions, if ignored, can exacerbate workplace anxiety and stress.

Utilisation of wellness programmes during the pandemic

The utilisation of ICAS services by employees for Covid-19 issues was about four times higher compared to financial issues. This highlights the urgency with which employees dealt with the perceived threats to their physical health by seeking help from professionals. This is in stark contrast to the financial health issues (over-indebtedness) that develop over a longer period and mental health issues that can burden the employee who still reports to work while the manager assumes he or she is fine. 

The data shows a drop in utilisation during the pandemic and an increase as lockdown levels eased. In general, ICAS data shows that South African employees have higher utilisation rates than their global counterparts. Levels of seeking help for major psychosocial issues such as mental and financial health are relatively low given their preponderance among employees in South Africa.

Mental health – post the pandemic

Despite the impact of mental health conditions on individuals, organisations, families and society across the globe, there is underinvestment in mental health by all spheres of society – private, civil, and government. Based on the effects of past pandemics on mental health such as the SARS global outbreak in 2003, researchers predict that the mental health impact of the Covid-19 pandemic will last much longer than the physical health impact. Therefore, employers need to invest more on the mental health of their employees through various wellness benefits.

In conclusion, one cannot help but ask what the personal and organisational barriers are that prevent more employees from seeking help for major psychosocial issues. Examining organisational culture and individual attitudes towards help-seeking can give organisations some answers to this question.

The data raises some questions. Are employees coping effectively with major psychosocial issues including those related to the Covid-19 pandemic? Do employees know? Do employers know? It may be useful for organisations, in addition to assessing the mental health and overall well-being of their employees, to ask them what support they need and expect.

Six tips for work and good mental health

1. Maintain healthy work and home boundaries
2. Maintain social connections
3. Prioritise eating well, sleep and physical fitness
4. Regularly switch off from technology
5. Ask for help
6. Manage stress

Source: SADAG

The five key things to keep you sane while working from home

1. Physically “switch off” from work. Shut down or snooze all electronic devices after hours or, alternatively, dedicate a separate number for work-related communication via WhatsApp.
2. Have a dedicated workspace. Sitting behind a desk and chair in a quiet space, as you would at the office, is likely to increase productivity.
3. Schedule regular breaks in your work diary. When working from home, schedule time to take a walk around the block or go to the gym.
4. Adopt a pet or take up a sport. A furry friend and/or a sporting activity will force you to make time to get some fresh air and socialise (while adhering to social distancing protocols).
5. Find a support group. Join an online or social media group that is focused on a leisure activity or hobby that is of interest to you.

Dr. Frank Magwegwe is a lecturer at the Gordon Institute of Business of the University of Pretoria. He is also the founder and principal scientist at Thrive Financial Wellness, a financial education and wellness solutions provider. His research interests include individual and team resilience, employee well-being and consumer financial well-being.

Farzana Sader is the director of business intelligence and consulting at ICAS World. She has over 15 years of experience in employee well-being with a particular a particular interest in the practical application of research and organisational knowledge towards the transformation of employee wellness conditions. 

¹ Evans-Lacko, S., & Knapp, M. (2016). Global patterns of workplace productivity for people with depression: absenteeism and presenteeism costs across eight diverse countries. Social psychiatry and psychiatric epidemiology, 51(11), 1525-1537.