Abstract
Essential workers, including the health workforce, were under increased stress and mental health risks in addition to infection risk during the COVID-19 pandemic.Aggravated levels of psychological distress ought to be recognised as a public health priority, and solutions are needed to address the consequences so that the potential current mental health conditions do not become disabilities. Therefore, the Expert Panel on effective ways of investing in health (EXPH) was requested by the European Commission to provide an opinion on supporting the mental health of the health workforce and of other essential workers.
The Opinion identifies the specific factors influencing the mental health of the health workforce and of other essential workers. It describes the evidence on effective and/or promising interventions, and provides evidence on cost-effectiveness, where available.Due consideration was given to providing for the needs of those with pre-existing mental health issues. The characteristics of those interventions are described, elaborating on the necessary preconditions to ensure the efficient delivery of these interventions in an effective, cost-effective, affordable and inclusive manner, across settings and jurisdictions. On the basis of this evidence, recommendations and action points were developed, emphasising the importance of involving both EU and national policy makers alike, raising awareness and engaging senior managers in sectors with a high share of essential workers, and, potentiating the role of mental health and occupational health practitioners in supporting the mental health of workers.
Mental health, defined as lack of mental illness and high levels of mental wellbeing, is influenced by a complex interplay of determinants. At work, occupation-specific determinants of mental health interact with non-occupational-specific characteristics. A conceptual framework was developed to represent the state of mental health,determinants / factors, and possible mental health trajectories over time in the face of a given stressor. The conceptual framework illustrates the potential impact of primary,secondary and tertiary prevention interventions occurring at different levels. These include: the health and social/community care sectors, workplace-level interventions(such as occupational health programmes and managerial-level changes), and economic/social policy measures. Mental health of essential workers can therefore be supported by interventions enacted within and outside of the health sector at primary,secondary, and tertiary prevention levels. Interventions in multiple settings at various levels can work synergistically to address a wide range of risk factors and potentiate awide range of protective factors. The Swiss cheese model of accident causation is a helpful heuristic to illustrate this synergy. This model demonstrates the need for multiple interventions targeting multiple risk and protective factors occurring at multiple levels to ensure that all individuals benefit from them and no one individual is left behind. It suggests the priorities of different levels of interventions, from large scale interventions supporting the largest share of essential workers, to the interventions targeting organisational and team characteristics, job characteristics and lastly targeting modifiable individual characteristics. Specifically, post-traumatic stress disorder, burnout and moral injury are associated with working in stressful conditions, and could be anticipated and prevented in the workplace, or addressed when present.
Based on available evidence and identified limitations, gaps and challenges, eight recommendations with several action points are developed: change focus to mental wellbeing; treat mental wellbeing as an inherent part of the workplace and its organisation; create a supportive environment at EU-level; create an appropriate cost-effectiveness methodology; build and share knowledge on interventions; have a common EU-wide view of mental health care; prepare organisations and their leaders to address mental wellbeing of workers; and provide timely and adequate access to care when preventive efforts are not effective.
This resource is found in our Actionable Strategies for Government: Ensuring Workers' Physical and Mental Health (Support Workers' and Learners' Mental Health & Well-Being).
