Coverpage

Table of Content

Title Page Number

Introduction
- Mental health & Disability
- The Purpose of the Situation 1–4
- Methodology
Similarities & Differences Across the 5 Countries
- Size of the problem
- Work related Stress
- Costs associated with mental health problems
- Legislation
- Access to Services
- The role of the government and social partners 5 – 17
- Employers practices in the workplace
- Mental health at the National Level
- Managing mental issues in the workplace
- The economic burden of mental illness
- Prevalence of mental health disorders
- Mental health & working condition
Conclusion 18

i
 1. Introduction

Mental Health & Disability

Mental health difficulties can affect an individual’s functional and dealing capacity in numerous
ways. Depending on an individual’s age at the onset of a psychological state problem, his or her
working capacity are often significantly reduced. In the workplace, this will cause absenteeism,
require leave, and reduce productivity. Long-term psychological state difficulties are, consistent
with a WHO report, one among the three leading causes of disability, alongside disorder and
muscular-skeletal disorders, and that they are a major reason for granting disability pensions in
several countries.

The United Nations estimates that 25% of the entire population is adversely affected in one way
or another as a result of disabilities. Mental health problems do not just affect the individual, but
they impact the entire community. The cost of excluding people with psychological state
difficulties from a lively role in community life is high. Exclusion often results in diminished
productivity and losses in human potential. The cost of psychological state problems, and of
other disabilities, has three components:

• the direct cost of welfare services and treatment, including the prices of disability benefits,
travel, access to services, medication etc.,

• the indirect cost to those that aren't directly affected like caregivers,

• the chance costs of income foregone thanks to incapacity.

People with psychological state difficulties face environmental, institutional and attitudinal
barriers find mainstream employment or returning to figure and retaining jobs after treatment.
Attitudinal barriers and social exclusion are often the toughest obstacles to beat and typically are
related to feelings of shame, fear, and rejection. Stigma surrounds people with psychological
state difficulties, and therefore the recovery process is usually misunderstood. Stigmatization can
negatively affect the success of vocational efforts. For example, it's been reported that a lot of
professional workers who either resign employment or take a medical leave associated with a
mental disease episode, like depression, experience difficulty maintaining a stigma-free
relationship with their employers.

1
Those returning to the same work environment find that performance and behavioral difficulties,
which initially interrupted their work, have altered their employers’ and co-workers’ perception
of their professional abilities. It is clear that mental health problems can impose a heavy burden
in terms of social exclusion, stigmatization, and economic costs for people with mental health
difficulties and their families. Unfortunately, the longer term burden is probably going to grow
over time as a results of the ageing of the population and stresses resulting from social problems
and unrest, including violence, conflict, and natural disasters. In many countries, however, policy
makers and service providers have recognized the need to take steps to prevent problems from
arising and to respond more effectively to the growing need for mental health care services.

The workplace is an appropriate environment in which to educate individuals and raise their
awareness about mental health difficulties and target mental health problems and prevent them
from developing. Promotion of excellent psychological state practices are often a part of human
resource management policy, and occupational health care services can play a crucial role in
early recognition and identification of mental health difficulties in the workplace. This doesn’t,
however, ignore the multidimensional nature of effective psychological state services or the
multiplicity of things contributing to an individual’s psychological state. The development of
psychological state problems is complicated, and sometimes there's no single or identifiable
cause.

Nonetheless, there are risk factors which will trigger psychological state problems in certain
people, including heredity, negative life events, certain medications, diseases or illnesses, and
work-related stress. Ultimately, regardless of the causal factors, the high prevalence of
psychological state problems among employees makes them a pressing issue in their title. Some
mental health problems require clinical care and monitoring as well as special consideration for
the integration or re-integration of the individual into the labor market. It is important to
acknowledge that minimizing work-related stressors and promoting good psychological state
through workplace policies can help prevent psychological state problems from developing. In
terms of job retention and return to figure after leave, most people will get over psychological
state difficulties completely, and in due course, return to figure as before.

Depression, for instance, may be prevented in many cases, and if it strikes, may be successfully
treated in 80% of all cases. People recovering from depression, which is recognized and given

2
the appropriate medical treatment, may only require limited time or adjustment before returning
to work. Promotion of psychological state within the workplace is all the more relevant within
the context of an almost universal free enterprise during which the pace of economic activities is
fast, contractual relationships start and terminate at short notice, and international competition is
intensified. While globalization has opened new opportunities for powerful and dynamic
development and growth of the planet economy, it doesn't benefit everyone or region within the
world equally. The key elements that globalizations have brought are increasing automation,
rapid implementation of information technology, and the need for more flexible and responsive
work methods. Workers worldwide confront, as never before, an array of new organizational
structures and processes which can affect their mental health. These include downsizing, layoffs,
mergers, contingent employment, and increased work load. To guarantee the simplest leads to
international competition, it's within the interest of employers to supply their employees with
decent working conditions.

The Purpose of the Situation Analyses

The purpose of things analyses is to supply an in-depth review of the scope and impact of
psychological state difficulties within the workplace in Finland, Germany, Poland, the UK, and
the USA. The countries were selected because they represent differing types of welfare systems
and vary in terms of legislation, health care, and approaches to psychological state issues. The
UK and therefore the USA emphasize the individual’s rights, and their approach stems from
strong anti-discrimination legislation. Finland and Germany provide samples of countries with an
extended history of mainstreaming, whereas Poland is simply developing its approach to
psychological state issues. Germany and thus the United Kingdom have also been active within
the trouble, spearheaded by Finland, to affect mental state issues within the Eco Union. These
situation analyses address issues like workplace productivity, loss of income, health-care and
Social Security costs, and access to psychological state services and supply samples of employer
practices. An essential objective of the situation analyses is to provide information that
governmental agencies, unions, and employers’ organizations can use to create educational
materials and design programmers to promote mental health, prevent problems from occurring,
and develop rehabilitation services.

3
Methodology

The analyses are based on a thorough literature review, including documents from government
agencies, employees’ and employers’ organizations, and NGOs, as well as interviews with key
informants. The analyses are not intended as comprehensive assessments that address all issues
pertinent to mental health in the selected countries, but they provide an overall review of the
situation. Each situational analysis examines the subsequent areas:

• Mental health at the national level: common knowledge, individuals’ access to

information; work and unemployment; policy and legislative framework; the economic
burden of mental illness;

• The role of government and social partners: key governmental agencies and their role;
implementing law and policy; the role of workers’, employers’, and non-governmental
organizations and noted academic institutions;

• Employer practices in the workplace: examples of enterprise prevention policies and

programmers; work -family issues and their impact on productivity.

4
2. Similarities & Differences Across the 5 countries
Size of The Problem
In all five countries the incidence of psychological state problems and therefore the costs
associated with them have risen during the past decade. The increase within the incidence
of depression, especially, is alarming. However, because the Finnish and German reviews
note, the figures don't necessarily reflect an absolute increase. Changes within the
diagnostic system, more open attitudes, and improved diagnoses and recognition may
contribute to the rise in diagnosed psychological state problems. However, at any given
time, it is estimated that approximately 20% of the adult population have a mental health
problem. Less severe psychological state problems which can trigger depression also are
common. In Finland over 50% of the workforce experience some kind of stress related
symptoms, such as anxiety, depressive feelings, physical pain, social exclusion, and sleep
disorders. Poland has recently begun to review the correlation between work stress and
health status, with a view to developing preventive programs, particularly for people in
high stress jobs such as firemen, policemen, and ambulance service workers.
Both the German and Finnish studies identify job insecurity, time pressure, and lack of
opportunity for career development as potential stress indicators within the workplace.
The issues of stress, burnout, and prevention have also been under scrutiny in the UK and
the USA. In the USA, 40% of workers report their job to be very or extremely stressful.
In all five reports, the effects of job stress are ranked among the most common work-
related health problems.

Work-Related Stress
The Finnish, German, and Polish analyses note the impact of the many economic and
social changes which happened within the labor markets and society during the 1990s on
employees’ wellbeing. The possible relationship between unemployment and
psychological state problems has been a standard concern. The German report identifies
overemphasis on the outcomes, blurring boundaries between work and therefore the
private domain, overload, unpredictability of labor requirements, and neglect of safety

5
and health protection at work because the main negative side effects of recent changes
within the market.
The analyses recognize, however, that there have been also positive developments during
the 1990s, like decrease in monotony, greater autonomy at work, and increased group
work and co-operation. within the case of Poland, the transformation of the socio-
economic system has fostered positive values like pluralism, democracy, and freedom,
but it also introduced new problems like unemployment, growing rates of poverty and
crime, and a decreasing sense of security. within the UK and therefore the USA, the labor
markets are more stable with reference to unemployment, although they need been
suffering from the globalization process.

Costs Associated with Mental Health Problems

As already mentioned, the costs associated with mental health difficulties are a common
concern in all five countries. Governments, employers, employees, insurance companies,
and society as an entire bear their share of direct (sick pay, benefits, Social Security,
medical treatments) and indirect costs (loss of productivity and potential output and low
morale associated with psychological state problems). It is easier to quantify costs
associated with psychological state within the USA than within the European economies.
In Europe a greater burden remains met by welfare and health services and other
government agencies, whereas within the USA employers are directly liable for employee
costs.
However, since the methods of evaluation, concepts, and indicators for psychological
state vary from country to country, it's very difficult to supply any comparable and
reliable data concerning either the occurrence of psychological state disorders or the
prices associated with them.
In the member states of the ecu Union the value of psychological state problems is
estimated to get on average 3 to 4 you look after GNP. In the USA, the estimates for
national spending on depression range from $30 to $44 billion, with approximately 200
million days lost from work annually.
A UK governmental agency, the Health and Safety Executive, estimates that
psychological state problems are the second largest category of occupational

6
unhealthiness after muscular-skeletal disorders, leading to five to six million working
days lost annually.
In Finland and in Germany, growing Social Security costs are of great concern. In both
countries early retirement thanks to psychological state difficulties, especially depression,
has been increasing, and psychological state difficulties are the foremost common
explanation for disability pensions. The Polish situation analysis points out the high costs
related to psychological state difficulties but, thanks to lack of knowledge, it's unable to
supply exact figures.

Legislation
It should be emphasized that legislation and the implementation of policies or laws are at
the root of national differences in dealing with mental health issues. Generally, the
United Kingdom and the United States share a common approach with respect to anti-
discrimination legislation, whereas Finland and Germany emphasis the importance of a
preventative approach.

Poland is developing its approach and seems to be following the EU countries. In the UK
and the US, the introduction of employment disability anti-discrimination legislation,
such as the Americans with Disabilities Act (ADA) of 1990 and the British Disability
Discrimination Act (DDA) of 1995, has obliged employers to mainstream people with
disabilities into the labor force. Both laws make it unlawful for an employer to
discriminate against people with mental health problems and set requirements with
respect to employment of people with disabilities.
In Finland, Germany, and Poland, where this strong legal impetus is missing, the
approach to mental health issues in the workplace stems more from the perspective of
stress prevention and healthy work organization. Finland does not have over-arching anti-
discrimination legislation or a quota-system. In German legislation, people with
disabilities are covered by several Acts, including the Severely Disabled Persons Act,
which sets a 6% quota for the employment of people with disabilities by public and
private companies with minimum workforces of 16 people. German and Finnish

7
legislation puts physically, mentally, and psychologically disabled persons on an equal
basis.
However, in both countries this leads to unequal treatment, because most of the
rehabilitation measures are geared to the needs of people with physical disabilities. Polish
legislation, passed in 1994, specifically addresses mental health concerns. According to
the Mental Health Act, mental health is a fundamental human value and the protection
of rights of people with mental disorders is an obligation of the State. The Act proclaims,
among other things, “...mental health protection shall consist in the promotion of mental
health and the prevention of mental disorders.”
The Polish situation analysis, however, points out that some of the provisions of the
Mental Health Act, particularly as it concerns employment and rehabilitation, have not
been implemented. This is partly because the socio-economic changes in Poland have
affected general employment opportunities and the resources necessary to promote and
implement new legislation. In Finland, Germany, and Poland, mental health problems are
often seen as disabling only when they are so severe that they prevent a person from
obtaining or maintaining employment.
In the UK, and in particular in the USA, less severe mental health problems are more
likely to be seen as a disability if they interfere with daily living and work. This reflects
the emphasis of each country’s legislative framework.

Access to Services
The reports state that access to mental health services is often limited and not
comprehensive. There is a lack of parity in resources provided for mental health versus
physical health. This is particularly evident in rehabilitation services, which traditionally
have been more prevalent for physical disabilities. Several reports also note that often
general practitioners, not specialized services, deal with people with mental health
problems. For instance, in the UK, 80 % of the people diagnosed with depression are
treated entirely within the primary health care services, and it has been estimated that
approximately 40 % of all the visits to primary health care are due to the most common
mental health difficulties. The countries are also concerned about low detection rates,
which indicate that mental health problems are often underreported and underestimated.

8
Stigma associated with mental health issues and use of mental health care services still
exists in all five countries. Stigma may prevent the person suffering from a mental health
problem from seeking treatment, and ultimately, can lead to unnecessarily severe and
costly problems.
Finland provides an example of an extensive occupational health care service system that
reaches 90 % of the workforce. Occupational health care services are also responsible for
providing rehabilitation services for employees. Mental health issues have not
traditionally belonged to the domain of occupational health care services, but their
importance to employees’ work ability has been recognized, and more attention and
resources have been devoted to them. In the USA and the UK, where the occupational
health care services operate on a different basis, Employee Assistance Programs (EAP)
are becoming a more common and popular means to provide counselling and confidential
information. EAP services are independent of but financed by employers.

The Role of Government and The Social Partners

Governments play an important role in formulating policies that affect labor market
developments and health care and social services. All the situation analyses identify
various national agencies and bodies that contribute to the issues related to mental health
in the workplace. For instance, in the USA, the National Institute on Disability and
Rehabilitation Research and the Center for Mental Health Services have been
promoting the ADA and providing technical advice resulting in implementation. A recent
UK government White Paper recognizes mental health difficulties as a major cause of ill
health, disability, and early mortality in the UK and gives priority to development of
extensive mental health care services. A Finnish governmental agency, the National
Research and Development Centre for Welfare and Health (STAKES), has been an
active advocate for mental health issues in the European Union. In Germany, the
government is committed to equal opportunities. However, as the German review notes,
legal regulations, institutions, and services cannot always do more than provide the
framework for integration.
The reviews acknowledge the importance of collaboration between workers’ and
employers’ organizations in addressing mental health issues. The Finnish and German

9
reports illustrate employers’ and workers’ interest in tackling issues such as mobbing,
time pressure, stress, and impact of technology as they relate to employee’s work ability.
In the UK both the employers and workers are campaigning against work-related stress
and have participated in discussions concerning the development of DDA. The USA
employers and workers have shown interest in preventing violence in the workplace,
advocating for mental health benefits, and providing information concerning
accommodations, ADA, recruitment etc.
The Polish report describes a lack of interest on the part of both workers and employers
in advancing the employment of people with mental health problems. In all the five
countries non-governmental organizations (NGOs) play a vital role in raising awareness
of mental health issues, disseminating information, providing services, and reducing
stigma surrounding mental health issues. NGOs have organized successful national
campaigns and programs to create awareness of mental health issues such as depression
(USA, UK), suicide (Finland) and mental health promotion in the workplace (Poland).
It is generally acknowledged that open communication and cooperation between NGOs,
government agencies, and employees’ and employers’ organizations is important in
guaranteeing good services for people with mental health problems. Each report identifies
academic institutions that are engaged in research on mental health related issues in the
workplace. It is generally recognized, however, that the current knowledge base is not
complete despite enormous advances during the last decade in research on the
identification, causes, and treatment of mental disorders. This is particularly evident in
regards to the impact of work as a precipitating factor in the onset of depression or other
mental health problems.
The U.S. federal government plays a critical role in interpreting, translating, and
implementing the ADA. There are a number of primary government agencies and offices
actively involved in enforcement, technical assistance, research, and dissemination of
information for all mental health disorders and/or psychiatric disabilities. Through their
various activities, these agencies and offices offer support on mental health issues in the
workplace to both employers and employees. Some of their activities specific to
depression and employment are subsumed under the larger framework of psychiatric
disabilities and local community support.

10
The agencies profiled were: The US Equal Employment Opportunity Commission
(EEOC); the National Institute on Disability and Rehabilitation Research; the
Center for Mental Health Services; the National Institute of Mental Health,
President’s Committee for the Employment of People with Disabilities; and the
National Institute of Occupational Safety and Health. Numerous examples were
provided of how each agency operates with respect to mental

Employers’ Practices in The Workplace

As the reports recognizes, mental health difficulties are a significant cause of illness and
disability in the working population. Though it is difficult to quantify the impact of work
on an individual’s mental health (e.g. personal identity, self-esteem, social recognition),
the workplace is one of the key environments that affects our mental well-being and
health. Minimizing work-related mental health risks and stress in the workplace can
significantly reduce the risk of an employee developing mental health difficulties. Yet, as
the US report states, traditionally, typical worksite health promotion programs have
overlooked mental health issues. During the last ten years, however, there has been a
growing acknowledgement and awareness of the role of work in promoting or hindering
mental wellness and its corollary, mental illness, and many employers are actively
promoting mental health in the workplace.
However, mental health problems are not the exclusive responsibility of employers and
cannot be addressed in the workplace alone. In the United States, employers are
increasingly willing to invest in educating their workforces about mental health issues.
Employers have expressed their concern over the rising health care costs and lost
productivity due to mental health problems. Moreover, the increased visibility of the
disability rights’ movement and the impact of the introduction of anti-discriminatory
legislation have encouraged employers to take action. Today, approximately 40 % to 60
% of worksites with more than 50 employees offer some type of mental health programs,
including stress management programs.
A continuum of efforts to address mental health problems in the workplace includes
employee education about health promotion and disease prevention, management

11
training, and employee assistance programmers, benefit design and administration, and
information management and integration of corporate health related services. In Finland,
occupational health care is promoting work ability with the support of the government as
well as employers’ and workers’ organizations. Often the activities target issues such as
the work environment (e.g. enhancing occupational safety and ergonomics), management
and the organization of work (e.g. better job design, good communication, clear goals,
and independence at work), learning opportunities (e.g. improving occupational skills and
team work skills or promoting independent study), and health promotion (e.g. healthy life
style, substance abuse prevention, and physical activities).
These activities do not directly address mental health issues but are essential in terms of
reducing stress and creating a “healthy work organization.” In Germany, mental health
difficulties in the workplace are addressed within the framework of “corporate health
promotion” which encompasses a wide range of joint measures taken by the employers,
employees, and society to improve health and wellness in the workplace. The measures
aim to improve work organization and working conditions, promote employees’ active
participation, and reinforce their competence. The social partners actively support
corporate health promotion and see it as a way of reducing absenteeism and costs related
to absenteeism. Corporate health promotion measures addressing stress prevention in the
workplace target both the individual (health education, relaxation procedures and
training, role-playing) and work design and organizational issues. In terms of work
design and organizational issues, Germany has developed a specific, systematic
procedure called the “health circle,” which brings together all the relevant stakeholders to
identify problems and hazards in the work environment and to develop solutions. Studies
on health circles and their implementation point to the high acceptance, efficiency, and
popularity of the procedure.
In the United Kingdom, the Health and Safety Executive recommends that a mental
health policy should be an integral part of any organization’s health and safety policy.
Some large companies, such as Marks and Spencer, Astra, Zeneca, and The Boots
Company, have developed policies which have addressed mental health issues in the
workplace. Analysis of these policies has defined certain key elements of good practice in
relation to promoting mental well-being at work in the UK. The most fundamental step

12
for organizations is to recognize and accept that mental health is an important issue.
Introduction of a mental health policy embodies the organization’s commitment to mental
health. It is important to provide information on existing stress levels and mental ill
health within the organization, and to elaborate on ways in which organizational
structures and functions may be contributing factors.

The process of analyzing the current situation helps to identify areas and goals for
intervention via a mental health policy and to target the specific needs of the
organization. A mental health policy in the workplace can promote mental well-being,
reduce the stigma associated with mental ill health, and provide assistance to employees
suffering from stress or more serious mental health problems. The Polish situation
analysis notes the lack of information concerning workplace policies and programs on
prevention of mental health problems or promotion of mental health in the workplace. If
such programs take place at all, they are sporadic efforts undertaken at the local level.
Some employers have, however, been more active in establishing stress prevention
programs.
The Institute of Polish Occupational Medicine is piloting a stress management
programs involving the police force, and evaluating the effectiveness of individual and
organizational approaches to stress management. In general, health promotion is a
relatively new concept in Polish corporate culture and has not generated much interest
among Polish companies, partly due to the variable and weak financial conditions.
However, the interest in mental health issues is rising.

Mental Health at The National Level

Mental health at the national level begins with an overview of the prevalence of mental
disorders, stress, and burnout in Finland, with an emphasis on work-related problems.
The recession of the 1990s brought many changes to Finnish society and the Finnish
labor market, such as high unemployment, job insecurity, short-term contracts, and time
pressure. Several studies have connected the high prevalence of stress, burnout, and
depression to changes taking place in the labor market. However, so far epidemiological

13
studies are limited The situation analysis notes the increased economic burden related to
mental health problems.
In 1994, the total cost of mental health disorders to society in Finland was calculated as 2
% of GNP, with depression accounting for about half that cost. Mental health disorders
are the leading cause of disability pensions. In the realm of work, mental health problems
may reduce a person’s work ability and result in lowered productivity and increased
levels of absenteeism. They are therefore responsible for economic losses to both
employees and employers. However, their total human and social impact on individuals
and their families cannot be quantified.
The report examines individuals’ access to mental health care services in detail. Both the
municipal health care system, which covers all residents of Finland, and the occupational
health care system provide extensive services and cover mental health care. However, the
economic downturn of the early 1990s, which brought pressure to cut costs, resulted in
fundamental changes in the Finnish health care system, particularly in the realm of
mental health care. The number of inpatient beds was reduced dramatically. The new role
and responsibilities of outpatient care are evolving, but the quantity and quality of
services vary according to the municipality, and there are gaps between needs and
available services.
In Finland, the occupational health care services reach some 90% of the workforce.
However, they are short of the resources and trained personnel necessary to address
mental health care needs. Mental health care is also a relatively new area in the
occupational health care system.
Since the legislative reform of 1991, the occupational health care services have been
required to provide rehabilitation services to maintain employees’ work ability, including
their mental health. Despite scarce resources, the occupational health care services are
starting to address mental health issues, and rehabilitation services for people with mental
health problems are beginning to evolve. In terms of legislation, mental health disorders
are considered disabilities. A disabled person is defined in accordance with ILO
convention no. 159 on vocational rehabilitation and training of people with disabilities.
However, Finland does not have overarching anti-discrimination legislation or a quota
system for people with disabilities, who are covered under mainstream legislation. The

14
law does, however, guarantee access to the required specialized services. The situation
analysis briefly reviews some of the central legislation on working conditions and
employment of people with mental health problems. It also describes rehabilitation
legislation and the role of occupational health care services in providing early
rehabilitative interventions.

Managing Mental Health Issues in The Workplace

Most Finnish employees are able to participate in workplace programs which maintain
work ability. These are often organized jointly by employers and occupational health care
services. They usually address issues such as employees’ physical health, management,
workplace atmosphere, and occupational safety, which are all important to a supportive
and healthy work environment. Both employers and employees are satisfied with
activities maintaining work ability, and employers see them as cost effective.
Occasionally, however, the programs lack continuity and focus on narrow sub-
components of workability, without making the activities an integral and comprehensive
aspect of human resource policy.
Work ability programs often do not address mental health issues directly, even though
mental health is recognized as an essential part of work ability. Because of the high
incidence of burnout in Finland, there is a recognized need to make mental health a more
important focus of work maintenance programs and to improve early rehabilitation
services in the workplace for people with mental health problems. Integrating
rehabilitation services into the workplace would also be likely to reduce the stigma
attached to the use of specialized services.

The Economic Burden of Mental Illness

On average depression-related work incapacity lasts about two and a half times longer
than incapacity due to other illnesses. Depressive disorders account for a considerable
portion of premature retirements. In 1995 depressive disorders were responsible for

15
approximately 6.3% of the 297,164 early retirements. The average retirement age was
between 50 and 54. Work incapacity due to mental health disorders now accounts for 5.9
% of all days’ workdays lost. In the 1980s, mental health disorders were still considered
of secondary importance in the old Federal States.
Today, they are the sixth leading cause of absenteeism. While there is evidence of a
downward trend in most other large illness groups, the rate of mental health disorders is
growing. This is partly connected to a change in diagnostic criteria. Mental health
disorders constitute the third most important diagnostic group in hospitals, accounting for
11 % of treatment days. In 1995, approximately 1% of all registered hospital cases
(approximately 159,000 cases) were attributed to depressive disorders. The cost of this
in-patient treatment is estimated to be 2 billion DM per year. In 1995, individuals with
depression represented 3.3% of the 900,973 rehabilitation treatments paid for by pension
insurance.
Both direct and indirect costs of medical treatment, such as production losses due to
absenteeism, should be included in calculating the total cost of illness. For 1997, based
on statistics for employed persons (excluding the self-employed) and gross income from
employment, the Federal Institute for Occupational Safety and Health determined that the
annual volume of production lost because of illness related absenteeism came to 89.5
billion DM. According to this estimate, mental health disorders represent costs of 5.2
billion DM.

Prevalence of Mental Health Disorders

In terms of diagnosing mental health disorders, the ICD-10 international classification
was introduced in Poland in 1997. Since then the epidemiological data has been
comparable with data from other countries. The Institute of Psychiatry and Neurology in
Warsaw collects and publishes yearly statistics on mental health. The data indicates that
growing numbers of people, especially patients suffering from depressive disorders, are
receiving mental health care in outpatient and inpatient facilities. This trend can be
related to Poland’s socio-economic transformation and the concomitant rise in

16
unemployment and crime, the decreasing sense of security in the workplace, and anxiety
over the decline in living standards.

Mental Health and Working Conditions

Until the 1990s no research or analysis had been done on the relationship between mental
health and working conditions. Recently, a number of surveys have taken place. They
focused on:
• the relationship between somatic and depressive symptoms and stressful
working conditions;
• the occurrence of post-traumatic stress disorder as a psychological consequence
of traumatic events in the workplace;
• the rise in absenteeism due to mental health disorders during the period of socio-
economic transformation;
• the impact of unemployment on mental health status, e.g. the fear of job loss, the
correlation between unemployment and depressive symptoms, and the
consumption of psychoactive substances;
• the increase in suicide rates during the years of economic transformation.

Existing guidelines on stress management and educational initiatives in the area of mental
health are often based on experience in other countries, which is not relevant to Poland’s
transition situation. Though occupational medicine practitioners are responsible for
prevention of mental health disorders, these are not governed by any detailed legal
mandates, and so appropriate interventions are not taking place. There is no information
on workplace policies or programs of primary prevention in Poland. In 1997 the National
Centre of Workplace Health Promotion was established in the Institute of Occupational
Medicine in Lodz, but mental health promotion is not one of its specific targets.

17
3. Conclusion
In conclusion there is a growing awareness of the social and economic costs of mental
health difficulties and, in particular, of depression in all five countries examined in this
study. Various governmental agencies, employees’ and employers’ organizations and
NGOs are taking steps to address the growing needs of people experiencing mental health
problems. Company policies are moving in new directions and employers are showing an
interest in reducing costs related to absenteeism, improving their productivity, and
fulfilling their social responsibility toward their employees.
The increased concern about stress in the workplace has prompted a more open attitude
towards mental health issues and the growth of preventive programs in the workplace.
However, a broad, coordinated approach covering prevention, promotion, and
rehabilitation still needs to be developed. Much has to be achieved to move from policy
to concrete practices in promoting mental health in the workplace. In particular, the
importance of rehabilitation and of specific rehabilitation programs, which have proven
effective, demand increased recognition.
Hopefully, these reviews will assist government agencies and employers’ and workers’
organizations in developing policy and enterprise-specific programs which address the
prevention of mental health problems and the promotion of good mental health and
rehabilitation. The International Labor Organization, for its part, will continue to develop
guidelines for mental health promotion in the workplace.

18