Canadian Association of Occupational Therapists

Volume 6 (5), September/October • 2004

Doing work well: Preserving and promoting mental health in the workplace

by Bonnie Kirsh, Lynn Cockburn and Rebecca Gewurtz

Work-life balance is increasingly the focus of attention within workplaces and the media, as represented by the numerous newspaper and magazine articles, such as the Maclean’s Magazine article, "Redesigning Work" (March, 5, 2001, p. 34-38) and TV specials such as CTV’s Balance: Running on Empty (April 2004). A major component of achieving work-life balance is fostering harmony between workers and their work. Work is, for many, an occupation and a place where skills and talents can be applied, knowledge gained, friendships established and perspectives exchanged. For most people, work fulfils these needs; for some, work is a source of frustration, conflict or boredom. There is wide variation amongst individuals in terms of their experiences with work and the meaning it holds in the context of their lives. But, wherever we sit along this continuum, we are, as members of a working society, inextricably linked to the workplace; it is the rhythm in our lives, our identity, our contribution to society and our financial means to meet our needs and enjoy life. So much of our energy, time, focus and emotional capacity are directed at our work that it should not be surprising that our mental health and well-being are deeply connected to it. Therefore, we must ask ourselves: How can we do work in a healthy, positive, growth-promoting way? How can we avoid the ill effects of work that appear to be increasing as multiplying mental health disability claims demonstrate? What do we know about the ways we do work that help us to make meaning out of it? These questions are central to employers striving to maximize the health and productivity of workers, and to the clinical work of occupational therapists concerned with helping clients remain in, enter or return to the workforce. Indeed, these questions are important to all of our lives as we strive to do well at work.

Healthy doing at work
Occupational therapists and occupational scientists see the workplace as an important environmental context in which to study and apply knowledge about occupation and its effects. We have much to learn and much to offer regarding healthy doing at work. The study of occupational engagement in the workplace allows us to reflect on the many dimensions and potential influences of work on our mental health and well-being. This reflection is critical during this time of increased fiscal restraint. To put it simply, a focus on the mental health of workers and healthy doing at work makes good business sense. The result is a more productive workforce.

Matching demands with abilities
The “do-ability” of work is a primary factor influencing performance, satisfaction and mental health at work. Occupationally speaking, this means that there needs to be harmony within person-occupation-environment interactions. Indeed, most theories and models examining stress, mental health and work address occupation in the context of person-environment fit. When the demands placed on an individual exceed the resources to meet the demand, the result is stress. There is a large body of literature to support this relationship, including the well known Karasek model (Karasek, 1979). This model addresses two main characteristics of work that influence job strain: job demands (the requirements of the job) and job latitude (the extent to which the worker can use skills or authority to address those demands). This model postulates that jobs that have the most negative effects on health are high-strain jobs, that is, jobs which have high demands and in which the worker’s skill or authority to meet those demands is low. The model indicates that work motivation, learning and growth are most likely to occur when both job demands and worker control are high. In several studies job demands have been associated with health impairment or poor health behaviours (such as smoking), while job latitude has been associated with health-promoting behaviours (for example, exercise) and motivation (Demerouti, Bakker, de Jonge, Janssen, & Schaufeli, 2001; Hellerstedt & Jeffrey, 1997).

The benefits of a good fit between demand and ability at work are rewarding and health enhancing. Csikszentmihalyi and LeFevre (1989) posit that the quality of an occupational experience is most positive when a person perceives that there are enough opportunities for action (challenge), which are matched with the person’s own capacities (skills). They claim the state of flow is dependent on this balance and as a result, new skills and higher self-esteem develop. Further, their research demonstrates that the great majority of flow experiences are reported during work, not leisure. In his book Good Business: Leadership, Flow and the Making of Meaning, Csikszentmihalyi (2003) puts forward a set of recommendations for happier workplaces, including providing challenge to workers so that they are not bored, while being cautious not to exceed their ability to perform the task. That "just right challenge" that we strive for, that match between our needs as individuals and the characteristics of the work we do, is what makes work good for our mental health.

Sense of control
A focus on meaningful and healthful occupation at the workplace must include discussions of control and empowerment. A lack of control over the “means, manner and method of work” (Shain, 1996, p. 331) has a profound negative influence on mental health. Although at work, as in life, we cannot control all that we must do and wish to do, we all need some sense of, say, authority or decision-making power, over what we do at work. Feelings of mastery and perceived self-efficacy in our work facilitate and prolong occupational engagement and promote a sense of self-worth. In his report on healthy workplace strategies, Lowe (2004) cautions employers against managing change in a top-down, leadership-driven process; instead, he suggests balancing top-down and bottom-up approaches, which emphasize worker involvement in the process of creating and maintaining healthy workplaces. Strategies that enhance empowerment and participation are becoming more common within the workplace as a means of preventing the ill effects that commonly result from a lack of perceived influence and control. Many employers can think back to tasks that were designed and assumed by interested employees, and feel pleased about the process and outcomes of these endeavours.

Effort-reward relationship
Another relationship affecting occupational engagement and mental health at work is the effort-reward relationship. It emphasizes reward systems such as money/salary, esteem/respect, security and career opportunities as important variables. The Effort Reward Imbalance Model (Siegrist, 1996) claims that a lack of reciprocity between costs and gains (for example, a job requiring high effort but offering low reward) may cause emotional distress and poor health. Studies have shown high efforts and low rewards to be particularly stressful and even stronger predictors of poor well-being than job control (de Jonge, Bosma, Peter, & Siegrist, 2000). In a large study of workers in the British civil service (the Whitehall II study), loss of job security was found to have adverse effects on self-reported health and minor psychiatric morbidity and these effects tended to increase with chronic exposure to the stressor (Ferrie, Shipley, Stansfeld & Marmot, 2002).

From an occupational perspective, what does this mean about doing? Given that reward systems are ascribed meaning according to subjective perceptions and values, we must explore the extent to which individual workers value money, status, praise, career opportunities, amongst other factors, and strive to find or build these rewards into the work. Occupational therapists can help their clients explore and identify meaningful rewards, just as they help them explore meaningful occupation. Managers, employers, team leaders or student supervisors need to provide these incentives for doing to the extent that they are possible. Doing invites rewards and rewards invite doing.

Social support
Finally, much has been written about the importance of doing work within a supportive environment. The Whitehall II study found that support from colleagues and supervisors at work was related to lower risk of absence for psychiatric illness. The researchers concluded that high levels of social support at work was protective against psychiatric illness absence (Stansfeld, Rael, Head, Shipley & Marmot, 1997). Other studies on social support corroborate this finding. Mayo’s well-known early studies on the Hawthorne effect showed that increased output under a variety of conditions were a result of workers’ needs for acceptance and attention from their supervisors (as cited in Walsh & Tseng, 1998). He pointed out that supervisors should be trained to be more sensitive to worker needs and that doing so would increase satisfaction and effort at work. Support from coworkers and supervisors enables people to feel valued and provides a vehicle for feedback, self-assessment and growth. Doing with support is more effective than doing without it – more pleasurable, more gratifying and more productive.

Enabling work-life balance through occupational therapy
Employers and occupational therapists are in a unique position to work together to enable individuals to make sense of their doing, to promote doing work in a healthy way, and to modify doing at work so that an optimum level of occupational engagement can be achieved. Analyzing job demands and worker skills; designing workplace accommodations to promote the best possible person-occupation-environment fit; identifying meaningful work and valued rewards; and building supports into the workplace through enhanced communication and feedback mechanisms, are all strategies that can be used by occupational therapists and employers concerned with doing at work. Attention to healthy doing at work will lead to improved conditions in which workers are challenged, valued and involved, and will enable their work-life balance. Such conditions will increase productivity in our workplaces and will benefit workers, employers and, indeed, society as a whole.

References
Csikszentmihalyi, M., & LeFevre, J. (1989). Optimal experience in work and leisure. Journal of Personality and Social Psychology, 56, 815-822.

Csikszentmihalyi, M. (2003). Good business: Leadership, flow and the making of meaning. New York: Viking.

de Jonge, J., Bosma, P. H., Peter, R., & Siegrist, J. (2000). Job strain, effort-reward imbalance and employee well-being: A large scale cross sectional study. Social Science and Medicine, 50, 1317-1327.

Demerouti, E., Bakker, A. B., de Jonge, J., Janssen, P. P., & Schaufeli, W. B. (2001). Burnout and engagement at work as a function of demands and control. Scandinavian Journal of Work, Environment & Health, 27, 279-286.

Ferrie, J. E., Shipley, M. J., Stansfeld, S. A., & Marmot, M. G. (2002). Effects of chronic job insecurity and change in job security on self reported health, minor psychiatric morbidity, physiological measures, and health related behaviours in British civil servants: The Whitehall II study. Journal of Epidemiology & Community Health, 56, 450-454.

Hellerstedt, W., & Jeffrey, R. (1997). The association of job strain and health behaviours in men and women. International Journal of Epidemiology, 26, 575-583.

Karasek, R. A. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly, 24, 285-307.

Lowe, G. (2004). Healthy workplace strategies: Creating change and achieving results. (Workplace Health Strategies, Health Canada). Retrieved June 14, 2004, from http://www.grahamlowe.ca/documents/

Shain, M. (1996). Work, employment and mental health. In R. Renwick, I. Brown & M. Nagler (Eds.), Quality of life in health promotion and rehabilitation (pp. 327-341). Thousand Oaks, CA: Sage.

Siegrist, J. (1996). Adverse health effects of high effort/low reward conditions. Journal of Occupational Health Psychology, 1(1), 27-41.

Stansfeld, S. A., Rael, E. G., Head, J., Shipley, M., & Marmot, M. (1997). Social support and psychiatric sickness absence: A prospective study of British civil servants. Psychological Medicine, 27(1), 35-48.

Walsh, J. P., & Tseng, S. F. (1998). The effects of job characteristics on active effort at work. Work and Occupations, 25, 74-96.

Edited by Dr. Helene J. Polatajko, PhD, FCAOT and Jane A. Davis, MSc, OT(C) for CAOT and CSOS.
Visit CSOS at www.dal.ca/~csos/index.htm

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