Workplace Mental Health (WMH) is a sub-discipline concerned with psychological illness, injury and disability and the role of work as a causal or contributing factor. But, unfortunately, WHO announced that WMH is a ‘Cinderella’ subject. So, it is one of the most urgent demands facing the occupational health services (OHS).

1. Dr. Dalia El-Shafei
Assoc.Prof. of Occupational Medicine
Faculty of Medicine, Zagazig University
Workplace Mental Health:
Breaking the Silence

2. CONTENTS

3. INTRODUCTION

4. MENTAL HEALTH
Mental health is a state of well-being in which an
individual realizes his or her own abilities, can cope with the
normal stresses of life, can work productively and is able to
make a contribution to his or her community (WHO, 2004).
Actually, It is a discipline that raising attention
worldwide (Howatt, 2015).

5. Workplace Mental Health (WMH) is a sub-discipline
concerned with psychological illness, injury and disability and
the role of work as a causal or contributing factor. But,
unfortunately, WHO announced that WMH is a ‘Cinderella’
subject (Cox et al., 2004). So, it is one of the most urgent
demands facing the occupational health services (OHS) (Leão &
Gomez, 2014).
Workplace Mental Health (WMH)
http://uttermpaperfneu.woodshallcraftshop.com/mental-health-in-the-workplace-vytowoxas4793.html

6. https://www.paho.org/hq/index.php?option=com_content&view=article&id=13739:world-mental-health-day-2017&Itemid=42091&lang=en

7. WMHP FROM DIFFERENT
PERSPECTIVES

8. Worker
- Long-term
sick leave.
- Exclusion
from work.
Employer
Productivity
problem.
Health care
Passive sick
listing &
drug ttt
without any
active ttt
(Jansson & Gunnarsson, 2018)

9. THE IMPACT OF WORK
ENVIRONMENT ON
THE MENTAL HEALTH

10. Chemical
Metals “Pb-
Organic Hg-
Al”
Organic
solvents
“CS2”
Pesticides
Physical
Lighting
Temperature
Noise
Biological
Infectious
agents
Pollutants
Aeroallergens
Psychosocial
Imbalanced
job design
Occupational
uncertainty
Lack of
value &
respect
(Woo & Postolache, 2008) (Harvey et al., 2017)
Workplace Risk Factors

11. Unifying model of
psychosocial
workplace risk factors
(Harvey et al., 2017)
Psychosocial
Risk factors

12. AT RISK OCCUPATIONS
Emergency &
Rescue services
• Police officers
• Military personnel
• Firefighters
• Disaster response
personnel
Transport
control
• Pilots
• Taxi drivers
• Public transport
drivers
Human service
• HCWs
• Teachers
• Social workers
• Sales & customer
service
• Public relations
(Woo & Postolache, 2008) (Stansfeld et al., 2013) (Jansson & Gunnarsson, 2018)

13. CLASSIFICATION OF
WMHP

14. Classification
of WMHP
Psychological
distress
Sleep problems
Irritability
Mental disorders
Common mental
disorders (CMDs)
Anxiety
Mood disorders
Substance abuse
Severe mental
illness
Schizophrenia
Bipolar disorders
Major depression
(Nicholson, 2018)
Most MHPs in the workforce is
due to CMDs (Harvey et al., 2017)

15. MAGNITUDE OF THE
PROBLEM

16. PREVALENCE AMONG GENERAL
WORKING POPULATION
Prevalence in the general working population within the past 12 months
(Steel, 2014)
CMD
1:5 (17.6%)
Anxiety disorders
1:15 (6.7%)
Mood disorders
1:20 (5.4%)
Substance abuse
1:25 (3.8%)

17. PREVALENCE AMONG HIGH RISK GROUPS
Commercial
pilots
MDD: 12.6%
Suicidal ideation:
4.1% (Wu et al.,
2016)
Firefighters
PTSD: 12.7%
MDD: 11.3%
(Harvey et al.,
2016)
HCWs
MDD: 22.0%
Burnout: 27.0%
Suicidal ideation:
13.0% (Talih et
al., 2016)
Police Officers
PTSD: 15% for
men & 18% for
women (Hartley
et al., 2013)

18. ECONOMIC BURDEN OF WMHP
The cost of MH leave is, on
average, double the cost of a
leave for a physical illness.
(Moll et al., 2015)

19. The global cost of CMD
(World Economic Forum)
$2.5 trillion
$6 trillion
(Hassard et al., 2014)

20. “HIDDEN COST” OF WMHP
(Goetzel et al., 2018)
Hiring costs related to recruitment
↑ Absenteeism
↑ Presenteeism
↑ Accidents ↓ Performance
Overtime & overstaffing

21. SITUATION IN EGYPT

23. MHPs (18–64 years) in
the previous 12 months:
24.7%
Mood disorders:
The most prevalent
Depressive disorders: 43.0%
Drug abuse: 30.1%
National Mental Health Survey– Egypt - 2017

24. Higher
prevalenceOld age
Low
socioeconomic
status
+ve family
history
Lack of social
activities
Rural areas
“El-Menia”
Unskilled
workers

25. SOME EGYPTIAN
STUDIES ON WMH

26. HCWs at Tanta University Emergency Hospital: Violence:
Physical 30.6%-Verbal 76.5%- Sexual 4.7%- >1 type 28.8%. Nearly
25% of cases with physical & sexual violence needed a vacation after
the assault (Kabbash & El-Sallamy, 2019)
Industrial workers 5 factories in 10th of Ramadan
city: Substance abuse:18.3%. “Tramadol (66.2%),
cannabis (55.4%)” (Bassiony et al., 2019)
Teachers: Depression: 23.2% Anxiety: 67.5%.
(Desouky & Allam, 2017)
PHC Physicians : high burnout: 66.7% of the GPs,
26.7% of specialists (Farahat et al., 2016)

27. Temporary Hired Cleaners in Governmental Hospitals:
CMDs (59.1%), Substance abuse: tramadol (39.7%),
cannabis (Bango) (35.9%) (Abbas et al.,2013)
Aluminum industry: Depression: 43.0%
Anxiety: 70.0% (Moussa et al., 2013)
Emergency medical responders (EMR) in the
main ambulance service: PTSD “13.6%”
(Khashaba et al., 2011)
Pesticides formulators & applicators: Psychiatric
disorders 50% among formulators & 30.7% among
applicators (Amr et al.,1997)

28. PREVENTION

29. Strategy1:
Designing
work to
minimize harm
Strategy 2:
Building
organizational
resilience
Strategy 3:
Enhancing
personal
resilience
LEVELS & STRATEGIES OF PREVENTION
1ry prevention
To prevent disease or injury by reducing exposures to hazards.

30. 2ry prevention
Selective: high risk occupations ---- Indicated: early signs of WMHP.
Strategy 3: Enhancing
personal resilience
Strategy 4: Promoting
early help seeking
LEVELS & STRATEGIES OF PREVENTION

31. Strategy 5: Supporting recovery &
return to work
3ry prevention
To treat & reduce the impact of an ongoing illness or injury.
LEVELS & STRATEGIES OF PREVENTION

32. THE INTEGRATED APPROACH TO WMH
Mental health interventions should be delivered as part
of an integrated health strategy that covers prevention,
early identification, support and rehabilitation (WHO,
2019).

33. The integrated approach to WMH (LaMontagne et al., 2018)
2ry prevention
1ry prevention 2ry&3ry prevention

34. WMH IN EGYPT

35. 1993
1997
1998
‫صابر‬
‫فرحات‬
‫من‬ ‫االنتقام‬
‫الفندق‬ ‫ادارة‬
‫لفصله‬‫وابعاده‬
‫عزف‬ ‫عن‬
‫الموسيقى‬
‫لرواد‬‫الفندق‬!!

36. 2007
UN Convention on the Rights
of Persons with Disabilities
(CRPD)
‫اإلعاقة‬ ‫ذوي‬ ‫األشخاص‬ ‫حقوق‬ ‫اتفاقية‬
Everyone with a disability has
the right to work, should be
treated equally and not be
discriminated against, and
should be provided with
support in the workplace.
2009
Mental Health Act
‫النفسي‬ ‫المريض‬ ‫رعاية‬ ‫قانون‬
Establishment of a
National Mental Health
Council (NMHC)
(Fawzy, 2017)(WHO, 2019)
An Egyptian-Finnish Mental health reform programme
(EGYMEN) “2002-7”
(Jenkins et al., 2010)

37. The Egyptian MH strategy did not gain public or political acceptance
(Loza, 2010).
Lack of public awareness
of MH
Stigma of mental illness

38. https://www.skynewsarabia.com/images/v1/2017/12/15/1004904/1100/619/1-1004904.jpg

39. ‫الصحة‬ ‫خدمات‬ ‫فجوة‬ ‫سد‬ ‫مشروع‬
‫األولية‬ ‫الرعاية‬ ‫بوحدات‬ ‫النفسية‬

40. •‫اجراء‬‫مسح‬‫للكشف‬‫المبكر‬‫عن‬‫األمراض‬‫النفسية‬‫للمواطنين‬‫المترددين‬‫علي‬‫الوحدات‬.
•‫تقليل‬‫عناء‬‫الذهاب‬‫لمستشفي‬‫نفسي‬‫متخصص‬‫و‬‫تقليل‬‫الضغط‬‫علي‬‫مستشفيات‬‫الصحة‬‫النفسية‬
•‫تقليل‬‫وصمة‬‫المرض‬‫النفسي‬‫نظرا‬‫النه‬‫يتم‬‫عالجه‬‫في‬‫الوحدات‬‫الصحية‬‫كأي‬‫مرض‬‫عض‬‫وي‬.
‫الهدف‬
•‫طبيب‬‫األسرة‬:‫هو‬‫المسئول‬‫عن‬‫تشخيص‬‫حالة‬‫المريض‬‫وتحويله‬‫وكتابة‬‫الخطة‬‫العال‬‫جية‬
•‫فريق‬‫التمريض‬‫واألخصائيين‬‫االجتماعيين‬‫والنفسيين‬:‫أجراء‬‫المسح‬‫وتقديم‬‫ال‬‫دعم‬‫االجتماعي‬
‫الخدمة‬ ‫مقدمي‬
•‫األمراض‬‫البسيطة‬‫والمتوسطة‬:‫عالجها‬‫في‬‫الوحدات‬«‫القلق‬‫واالكتئاب‬‫واألمراض‬‫النف‬‫سية‬
‫الجسدية‬»
•‫األمراض‬‫الشديدة‬‫والمتخصصة‬:‫يتم‬‫تحويلها‬‫للمستشفيات‬‫المتخصصة‬«‫األمراض‬‫الذهنية‬
‫والفصام‬»‫لكتابة‬‫الخطة‬‫العالجية‬‫ثم‬‫يتم‬‫متابعتها‬‫في‬‫الوحدة‬‫شهريا‬‫والحصول‬‫ع‬‫لي‬‫األدوية‬‫كما‬
‫سيتم‬‫متابعته‬‫بشكل‬‫ربع‬‫سنوي‬‫في‬‫المستشفي‬،‫المتخصصة‬‫للتأكد‬‫من‬‫صحة‬‫المتابعة‬.
•‫األمراض‬‫النفسية‬‫الطارئة‬:‫يتم‬‫إجراء‬‫تدخل‬‫أولي‬‫في‬‫الوحدة‬‫ثم‬‫تحويلهم‬‫للمستشف‬‫يات‬‫النفسية‬.
‫الخدمات‬

41. CONCLUSION

42. Collaboration between academics, employers and policy
makers is urgently needed to design an integrated intervention
programs for WMH.
Optimal WMH is best facilitated by implementation of a
mixture of preventative strategies.
Workplace needs to be a key location for initiatives for reducing
the burden of MHPs.

43. RECOMMENDATIONS

44. Provision of
awareness raising
campaigns in all
workplaces
“Breaking The
Silence”.
Encouraging
employers to celebrate
the “World Mental
Health Day” on 10th
of October to raise
employees’ awareness

45. Training of
OHWs in the
detection &
management of
WMHP.
Research: to
evaluate the current
state of WMHP &
to implement
WMH programs.

46. Development of an
integrated
intervention program,
including OHWs,
psychologists, social
workers, and physical
therapists.
Legislative & policy
reform to address the
insufficient WMH
services that needed to
be included in the
country MH agenda.
WMH should be a
National priority

47. A National summit with experts
from government, universities,
business & media to explore the
current state & designing a start point
for moving forward