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Quality Mental Healthcare

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Learning Objectives

• Explain the prevalence of anxiety and depressive disorders at the workplace, their economic and social costs, and their effects on productivity and functioning at work.

• Recall the wider consequences of anxiety and depression at the workplace, beyond the affected individual, and the adverse effects of not offering quality mental health care.

• Comment on employees’ access to mental health care, which should provide this care, and whether the cost of providing high-quality care is warranted by subsequent increases in productivity.


Objective: Employers provide most American mental health benefits and are increasingly cost conscious. However, commonplace anxiety and depressive disorders have enormous economic and workplace performance costs.


We performed multiple literature searches on several areas of pertinent research (and on key articles) covering the past 5 years.

Results: Substantial research exists about anxiety and depression costs, such as performance and productivity, absenteeism, presenteeism, disability, physical disability exacerbation, mental health treatment, increased medical care costs, exacerbating of physical illness, and studies of mental health care limitations and cost-offset. Research addressing the potential value of higher quality mental health care is limited.


Commonplace anxiety and depressive disorders are costly in the workplace. Employers and researchers remain largely unaware of the value of quality care and psychiatric skills. Effective solutions involve the increased use of psychiatric skills and appropriate treatment. ( J Occup Environ Med. 2005;47:1099–1109)

Table 1-1: Structure of Dissertation

Chapter 1 introduction to the research study. It discusses the background of the study and introduces the aim and objectives, then briefly discusses research methodology of the dissertation.


Chapter 2 provides a review of the literature relevant to the main aim and objectives.


Chapter 3 presents the research methodology and explains the methodological approaches that have been used in order to collect the most relevant information. It also mentions the criteria that were followed in conducting the qualitative research.


Chapter 4 classification and analysis of the main findings of the data that have been collected through secondary research will be presented in this chapter.


Chapter 5: To end the dissertation this chapter presents conclusions of the study, and it sets basis for basis for recommendations for future research


Chapter 2: Literature Review

The extended working hours not only adversely effect the productivity of an employee but also affect the emotional and social setting of the family and community. Although technical workers are in severe demand due to the increase in technology use and automation of organizations but on the other hand these workers are more in requirement of implementation of work life balance principles. Since their work involve more mental fatigue and psychological concentration. The increased working hours pose several external costs to the employees and employers both. They give rise to different health problems such as heart problems, high blood pressure, gastrointestinal disorders, psychological wellbeing and circadian disruption. The resulting increase in sick leave makes the organization bear the cost of the illness of employee. The external cost effect thus transfers to society in shape of increasing tax burden on taxpayers and on Government for the provision of more social care facilities.

 (Dawson, McCulloch and Baker, 2001).

The increase in the working hours also poses a cost to the family and community of the worker, as he cannot find time for his social life. This give rises to the conflicts in the families and community, which not only effect the health of the employee but also decrease the productivity level. Another cost which can be imposed on the company is the loss in case of accident due to increase in tension for the employee (Dawson, McCulloch and Baker, 2001).

In order to decide for the policy a firm must undertake a cost-benefit analysis it is important to obtain accurate measures of the benefits attached. But in most cases it has been found that the acquirement of accurate calculations is not possible. (Dex and Scheibl, 1999)

Mostly the advantages obtained by implementing such policies are qualitative. On the other hand the costs attached to the decision of implementing work life balance policies are measurable. Since the nature of most of the advantages are qualitative and is not identifiable most of the employee’s vision the impact of the policies negative.

Hence the implementation of work-life balance policies is not dependent upon any quantitative justification rather than the perceptions and values of the employer. In same cases the evaluation of policy is undertaken after the implementation (Evans, 2001)

Implementation costs are most important since the organization has to make necessary changes in the culture of the organization. Training cost for the flexi workers is also a direct burden on the management. (Evans 2001)

Dex and Scheibl (1999) and Evans (2001) pinpointed towards the cost of filling the position of the absent employee and get the work done by others instead of that employee. This also results in shape of temporary decrease in the productivity since the original person working on the position knows better about the work (Dex and Scheibl, 1999; Evans, 2001).

A significant number of studies displaying good quality research techniques (Strivastava, 1991. Tyler etal 1991. Tyler etal 1995. Edwards etal 2003. Rout 2000. NHS Confederation, 2005) have indicated that a high proportion of staff absence can be attributed to stress and this is true particularly of the healthcare setting. (NHS Confederation, 2005) The Chartered Society of Physiotherapist, The Royal College of Nursing, the Royal College of Physicians, The British Association of Occupational Therapists and the Royal College of Speech and Language Therapists have all acknowledged (CIPO, 2005) that there is a real issue with stress in the workplace and that steps need to be taken in order to combat it.

The Health and Safety Executive (HSE, 2001) defines stress as ‘the adverse  reaction people have to excessive pressures or other types of demand placed on them’. The stress response is natural and its effects are often short-lived and cause no lasting harm, however excessive or prolonged exposure to stress can result in ill health. Employers have a legal duty of ca, under the Management of Health and Safety at Work Regulations (1999): to assess the risk of stress-related ill health arising from work activities, and under the Health and Safety at Work Act (HSW Act), to take measures to control that risk. Work in the area of hazard control and risk management provides a framework, which seeks to enhance and improve occupational health and safety practice. The 3 principles of regulations such as the Control of – Substances Hazardous to Health Regulations (originally made in 1988, but subsequently amended and remade several times) can be effectively employed to manage psychosocial hazards and the psychological harms which may be a consequence of such hazards. The implications are that psychosocial hazards can and should be managed in much the same way as physical hazards and similar risk assessment procedures can be used in their identification and control in the workplace. Using the following structure:

-Identification of hazards.
-Assessment of associated risk.
-Implementation of appropriate control strategies.
-Monitoring of effectiveness of control strategies.
-Reassessment of risk. (HSE, 2001)

There are significant ramifications for any work environment when discussing absenteeism, but in the healthcare setting the provision of care for patients is where the most impact could be felt. (HSE,2001) Additionally the direct cost to the health service through the use of temporary staff and the potential for litigation is significant considerations. (Edwards, 2003)

As has already been identified there is a significant desire from all professional bodies to address stressful working environments. We can assume that no one wants to work in an environment that is stressful but the self-report questionnaire will be the basis of establishing that stress-related absence is the cause of the disproportionately high number of days taken as ‘sick’ by members of staff. There have been a number of very well executed studies that support the use of self-reporting as a means to investigate occupational stress. Edwards etal (2003) reviewed all of the available literature studying stress in a healthcare setting and the measure that appears to have the greatest sensitivity, reliability and validity is the Occupational Stress Indicator (OSI) Sources of Pressure Scale. It differs from other questionnaires in that it aims to measure four different areas: workplace sources of pressure, individual differences, coping strategies and stress outcomes. The HSE (2001) also identified the OSI as being sensitive, reliable and valid measure for use in most work environments.

The questionnaire is useful as it acts in two ways, one as a beginning; an investigation in to psycho-social risk analysis and secondly it acts as a method of describing circumstances that may require change in the future. Enabling this project to have a part to play in  There are some concerns that the OSI is based on literature from the 1970’s (Lyne et al, 2000) but the items identified have been updated and incorporated in to a newer version of the questionnaire. (ASE, 2006) There have always been some concerns over self-reporting, but it is generally accepted that an anonymous reporting system generates a truer reflection of opinion than interview or other techniques. (Foddy, 1994)

Research suggests (Muir,1997 Edwards, 2003 Strivastara, 1991 Tyler, 4 1991 & 1995 Rout 2000) that identifying and addressing stressors in the workplace will have a positive effect on the quantity of sick leave taken Not incurring the cost of locum staff replacing one member of permanent staff offsets easily the cost of purchase and implementation of the questionnaire In the long-term a reduction in absenteeism as a result of stress will prevent unnecessary expenditure, is likely to reduce pressure on remaining staff and produce fewer stressors in the unit (Edwards, 2003)

2 )Articulating root definitions (Checkland and Scholes, 1999)
The function of this process is to establish the grounds for where change can be introduced to improve the working environment and to give a structure which all stakeholders can relate to and work inside Bentham’s (Straker, 2001) utilitarian ideas can be employed here when we see that people choose that which provides greatest value and their choices usually include consideration of other people

3.) Debating the situation: (Checkland and Scholes, 1999)
The change manager will debate with the change agents from the stakeholder groups the results of the questionnaire. The results of the questionnaire will be unknown until this time. There should be a two-way process involved where results of the questionnaire should be discussed with the stakeholders and the first step in addressing the content will be proposed. The instigation of a dedicated counseling service for the unit should be addressed at this time as a result of the expected outcome of the questionnaire before other courses of action are discussed.
4) Taking action and sustaining the change: (Checkland and Scholes, 1999) the counseling service should be provided during working hours and, all stakeholders will be encouraged to attend once monthly. A monthly review needs to be undertaken with the counselor to evaluate numbers attending.
The success of the scheme can be viewed by the number of sick days taken and the use or otherwise of locum staff.

Chapter 3: Methodology

Solution to the problem is found out by research in a scientific approach. To find a solution to the problem by research requires identifying and analyzing the nature of the problem and experimenting with the new methods to find a solution. The first step to research is to select the basic method by which the problem can be identified and analyzed. The present study is to find out the effects of providing Quality Mental Healthcare in the Workplace.

Methods of research:

The aim of selecting any research method is to give most useful information to the key decision-makers in a most practical and cost-effective way. After adopting qualitative research method, there should be quantitative approach. The ideal researcher uses the combination of methods. At first, the qualitative approach should be followed.

Qualitative research:

 There are many methods to get the required information, the important things that should be kept in mind while gathering information are, the information should be practical, cost-effective, accurate, credible to the decision makers and the nature of the audience confirm to the methods. This is the primary phase of research.

Quantitative research:

After getting the required data qualitatively some conclusions are drawn from the data; the results are tested on a larger scale by taking statistical analysis. This is the quantitative research also termed the secondary phase of research.

Types of research methods:

 There are many ways to collect a data qualitatively; they are Questionnaires, checklists and surveys: the aim of this method is to get the information quickly; the advantage is the identity of the respondent can be protected; lots of data can be collected. However, in this method clear feed back cannot be obtained.

Interviews: the aim is to understand the individual’s experiences and impressions, the advantages are in-depth information can be obtained; a relationship with the client can be established. This process can be time consuming, costly

Documentation review:

The aim of this method is to review how the program operates, without interrupting it, it can be performed through memos, review of applications, finances etc, the advantages to this method are, and comprehensive and historical information can be obtained. The disadvantages are the process is time consuming, there is not flexibility to collect the data, and the data may be incomplete.


The aim of the program is to gather the information on how the processes of the program actually operate, the advantages are the actual processes can be viewed and the events can be adopted. The disadvantages are the difficulty to interpret the seen behaviors, can be difficult to categorize the observations, and are expensive.

Research method, which could be used instead of Case study:

Documentation review is an excellent way of evaluating the industry by taking a review of the research done in the past. Lot of useful information can be obtained through this method. For the effective implementation of the documentation major objectives of the research should be identified. Research plan should be developed very carefully keeping in view the main objectives of the research. Sequence of process should be such, that the a large amount of information can be possible to obtain in a very short time span, written notes should be taken and finally written notes on the documentation review are verified.

Agenda should have, review of the agenda, review of the goal of the agenda, review of the ground rules and wrap-up etc.

Documentation review normally comprise of the important information from documents of similar nature relating to the field of research, so documents should be selected from the set of documents having useful information regarding the research topic. They should be selected from variety of sources such as journal article, newspaper reviews, experts interviews, information available at Internet. In the review each document should be referenced properly and the key addressed points should be summarized.

In the present study, the method of case study is adopted. In this process, we focus on the case of providing Quality Mental Healthcare in the Workplace.

The reactions to the experience and suggestions are obtained which are very useful in evaluation. This is the quick and reliable way to get common impressions.

Organizing data: the data is organized in a chronological order, on the firms, which were unable to get the desired results of their psychological healthcare plans.

Developing a narrative: a readable story from firm’s perspective should be developed such that the narration includes key information on the firm’s experiences that lead to the failure in provision of Quality Mental Healthcare in the Workplace.

Cross comparison: cross comparison of the information with other similar cases was performed. That made the study to improve its strengths and overcome the weaknesses of the recommendation presented.


The establishment of a specific forum for discussion always gives a framework for communication and it is hoped that in the future this could be used as a regular open forum that would facilitate ease of communication and prevent the build up of problems such as those identified in this document. The introduction of the questionnaire and the counseling service it is hoped will bring about a reduction in stressors through identification and giving the stakeholders an outlet for discussion. This could ultimately move us toward a better understanding of each other’s roles and ultimately develop better working partnerships, where the employees provide the highest standard of performance.

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