Workplace mental health interventions in the developing world

Whilst health promotion in workplace settings has received attention in the developed world, the focus on mental health promotion has been on stress in general and the identification and treatment of individuals with CMDs has not been a specific focus. Employers in developing countries may be more likely to enforce attendance of employees when unwell; hence it could be expected that higher rates of mental illness and a greater level of presenteeism may contribute to even lower productivity.

In developed countries, the welfare system provides a public "safety net", as a result of which the burden of unemployment is shared by the government. In the absence of a welfare system that may protect individuals who are unable to work as a result of their mental illness, workers in developing countries are likely to continue to work despite their disability. The impact on workplace productivity in developing countries is hence magnified, and goes beyond the direct costs as a result of impairment in the workplace. Given the evidence for the effectiveness of workplace interventions, workplace interventions in developing countries ought to be seen as an investment in social capital. It could hence be argued that the workplace provides a critical setting for health promotion, screening of individuals with CMDs as well as a focal point for the provision of interventions and identifying individuals who would benefit from referral to mental health professionals for further management. However advocacy is critical to improve working conditions in impoverished settings in order to prevent psychiatric morbidity and to improve the quality of life of workers.

The economic benefits that may arise from improving workplace conditions and reducing the burden of mental illness in the workplace are substantial, and it is highly likely that demonstration of the cost effectiveness of such programs to employers in developing countries would improve their uptake.

It is interesting to note that the focus of employers in developed countries has been on the retention of the ageing workforce, and creating incentives for individuals to remain in employment, rather than alternatives such as taking early retirement. In the absence of adequate welfare systems and the lack of opportunities for life beyond retirement age, the focus of employers in developing countries is clearly a different matter. Advocacy for improving workplace mental health must focus on fundamental changes in labour market reform and further control over informal working conditions that are so prevalent in developing countries. Such reform may in turn lead to a happier and more productive workforce.

Workplace reform interventions must be empowering and involve multidisciplinary and multisectoral cooperation. There is a need for collaboration between the primary health care sector and employers in particular. Incentive systems provided by governments to employers to improve the effort-reward imbalance may reduce the psychological stress experienced by employees. In addition, collaboration between government departments and other stakeholders responsible for health, welfare and the labour workforce is necessary to reduce inefficiencies by pooling resources to coordinate mental health promotion activities in the workforce and the promotion of work-life balance. As described by LaMontagne et al (2008), improved living conditions, improved access to primary health care and stronger communities may reduce the impact of psychosocial stress in the workplace.