How can we measure mental health at work?

Why measure mental health at work?

Well-being at work and the preservation of mental health have become major issues for companies and employee representatives. Mental workload results from several factors which, by interacting, affect the people exposed to them. The consequences vary from one person to another, from absenteeism to burnout, sometimes with serious outcomes. Preventing suffering at work therefore starts with identifying the situations that generate stress.

It is also a legal obligation in many countries. In France, article L4121-1 of the Labour Code requires employers to take the necessary measures to protect the physical and mental health of employees. In the United Kingdom, employers must assess health and safety risks, including work-related stress, and the Health and Safety Executive provides a framework for doing so.

Measuring is what turns a general concern into targeted action: knowing which teams, which situations and which factors are involved.

Questionnaires: the key tools

Mental health at work is assessed by analysing employees' answers to questionnaires about their working conditions. These questionnaires contain items chosen to be as factual as possible. Combining several indicators and cross-checking several answers on the same theme makes it possible to highlight stressful situations and to detect cases of severe mental overload, which can lead to a crisis and to psychosomatic disorders.

Among the measurement models used to assess occupational stress, those of Karasek and Siegrist dominate. They have been widely used in research and in companies for their ability to reveal signs of strain and to assess psychosocial risks.

The Karasek questionnaire: assessing job strain

The American sociologist Robert Karasek, who later taught at the University of Massachusetts Lowell, published in 1979 a model linking the work environment to stress, known as the job demand-control model. The questionnaire based on it measures psychosocial factors and job strain. It assesses mental health at work in a general way and helps link the way work is experienced with the risks it poses to health.

According to Karasek, a situation is at risk for health when it combines:

• high psychological demands (workload, time pressure, contradictory requirements);
• low decision latitude (little freedom in how to do one's job and little say in decisions);
• and, in the extended version of the model, a lack of social support from colleagues or managers.

The questionnaire therefore covers three components of the psychosocial work environment: psychological demands, decision latitude and social support. The short version widely used in France has 26 statements: 9 on psychological demands, 9 on decision latitude and 8 on social support. For each one, the employee indicates their level of agreement on a four-point scale.

Example of an item: "My job allows me to make decisions on my own."

• Strongly disagree: 1
• Disagree: 2
• Agree: 3
• Strongly agree: 4

Scores are calculated for each dimension. Employees combining high demands and low latitude are in a situation of "job strain"; when low social support is added, the risk is considered higher still.

The Siegrist questionnaire: the effort and reward imbalance

The model developed by the German sociologist Johannes Siegrist starts from a different idea: stress arises when the efforts made at work are not balanced by the rewards received in return. The questionnaire covers three dimensions:

• extrinsic efforts: the constraints and demands of the job (time pressure, responsibilities, physical load, growing demands, interruptions);
• rewards: salary, esteem and recognition, career prospects, job security;
• overcommitment: an excessive personal investment in work, which shows in anxiety, irritability, a strong need for approval or an inability to switch off from work.

An imbalance between high efforts and low rewards, especially when combined with overcommitment, is a risk factor for health. The two models are complementary: Karasek looks at how work is organised, Siegrist at what employees receive in exchange for their efforts.

Other tools and indicators

Other instruments are also used, depending on the country and the objective:

• the HSE Management Standards Indicator Tool in the United Kingdom, which covers six areas: demands, control, support, relationships, role and change;
• the Copenhagen Psychosocial Questionnaire (COPSOQ), which assesses a broad range of psychosocial factors;
• the WHO-5 Well-Being Index, a short five-question questionnaire on general well-being;
• the Maslach Burnout Inventory, which focuses on burnout (emotional exhaustion, depersonalisation, sense of personal accomplishment).

Questionnaires are usefully completed by indicators the company already has: absenteeism, staff turnover, overtime, workplace accidents, requests to occupational health services. None of these indicators is enough on its own, but their trends over time and their comparison between teams are informative.

How to run a measurement in your organisation

1. Involve the right people from the start: management, employee representatives, occupational health, HR. Explain why the survey is being done and what will be done with the results.
2. Guarantee anonymity. Present results only for groups large enough that no one can be identified.
3. Choose a validated questionnaire rather than writing your own, so that results can be interpreted and compared.
4. Share the results with the teams concerned and discuss them. The figures show where the problem is; discussion shows why.
5. Turn the findings into an action plan, with owners and deadlines, and follow it up.
6. Measure again after a year or so, to check that the actions have had an effect.

A survey that is not followed by visible actions does more harm than good: employees conclude that their answers were of no use.

What solutions to prevent mental overload?

• Learn to spot early signs, such as changes in behaviour: reduced alertness, irritability, aggressiveness, isolation.
• Give more room for manoeuvre and autonomy in decisions and in how tasks are carried out.
• Take the real workload into account by organising regular discussions with the team about problems, and review the organisation if necessary. Clear priorities help a great deal: see our 9 tips to manage your priorities better.
• Encourage mutual help and support when needed, for example with feedback or a second person to share the load.
• Give employees back control of their time and limit interruptions. Too many meetings or calls prevent concentration.
• Communicate transparently and build a relationship of trust.
• Recognise the work done, the efforts made and the difficulties encountered.
• Learn to delegate. Managers must also look after their own mental health: under pressure from many objectives, they must also protect their team from the pressure they are under themselves.

For the warning signs and the consequences of overload, see mental overload: symptoms and risks for employees and the company. Other management resources are gathered in our resources for effective managers.