The value of the workplace wellness industry today is an astounding $53 billion globally, projected to grow to $96 billion by 2030. Company leaders are urged to invest in an enormous range of wellness programs and practices, ranging from in house yoga to nap rooms to supporting better preventive health practices.
Some of these efforts have important goals and may be worth a substantial investment if they can deliver on their promises. Most obviously, reducing the smoking, weight, drinking, blood pressure and blood sugar of employees by any means available will, if successful, lead to markedly decreased absenteeism and health care costs for the company. “If successful” is the key here. Behavior change is notoriously difficult to accomplish.
Things get a little murkier when it comes to programs designed to promote mental health and decrease or prevent stress and “burnout.” Some serious questions come to the surface and need to be answered.
What is mental health anyway? Can workplace programs improve it? And what is burnout, really? Can a Chief Wellness Officer prevent it? Is it possible that programs advertised as promoting mental health and preventing burnout could do more harm than good?
What is Mental Health?
The simplest and perhaps the best definition of mental health is attributed to Sigmund Freud—mental health is the “ability to love and work.” The ability to love and work implies the absence of severe mental distress. The ability to love involves the capacity for meaningful human connections and commitments, a set of values and the maturity to honor them. The ability to work means a person can chart a work or career path they find satisfactory or meaningful, concentrate when working and mobilize the cognitive, physical and emotional resources needed for their performance. But no one lives, loves or works in a vacuum. The ability to work is not just up to the individual. There must be a surround that makes it possible for them to work by providing needed structure and support.
For example, a trained trauma nurse can make a vital contribution in a catastrophe—an earthquake, or fire, or crime scene. But they can only sustain this level of work for a few hours, perhaps a day or two at the most. Inevitably, fatigue cannot be avoided, defenses against the impact of trauma crumble and the sustaining adrenaline rush crashes. The trauma nurse is normally supported by the structures of the hospital and emergency room they work in where there are support staff, team members, supervisors, equipment, limits on shifts and so on—practices, people and policies that enable the nurse to work effectively over sustained periods of time.
Mental health is also the absence of severe and disabling mental illness. Businesses need to help their employees avoid or treat serious mental illness by providing them with needed intervention services, adequate and flexible leave policies and first-rate health insurance coverage. There remain tremendous problems fulfilling the promise of parity for mental health care, but these issues are beyond the scope of this article. And they generally are not the target of wellness programs.
What is Burnout?
Burnout is not a psychiatric diagnosis, though in 2019 the World Health Organization gave it the status of a “syndrome.” It is not a medical term but arose from the observations of social and organizational psychologists. Dr. Christina Maslach, a social psychologist and major researcher in the field, defines burnout as a state of “overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment.”
According to researchers, burnout is the outcome of a three-part sequence: (1) job stress due to demands exceeding individual resources, leading to (2) exhaustion and anxiety leading to (3) changes in attitude such as cynicism in order to cope.
How might a wellness program help prevent burnout?
In order to have a positive effect an intervention program would need to radically change at least one of the three parts in the sequence above. Most wellness programs purporting to increase worker satisfaction or decrease burnout focus on the second step—the individual response of exhaustion and anxiety. Provide employees with the tools to meditate, or places to play, or even flextime. Establish peer support groups and affinity groups.
This may be structurally and ethically wrong. The first condition of burnout, when the workplace makes demands that exceed the individual’s resources, needs attention first. There are still too many instances of manufactured emergencies, young attorneys expected to work 16-hour days to prove their commitment, teachers bringing their own crayons and toilet paper to work and health care workers stretched beyond their capacity to function.
Employers should do everything they can to examine the demands they place on workers. Look at meetings, deadlines, urgent expectations that are not really urgent. Eliminate what can be eliminated and add flexibility wherever possible. Keep examining the balance between job demands and human capacity and adjust accordingly.
Beyond the balance between demands and personal resources, key elements that create mental health in the workplace are
1. A feeling that one is heard.
2. A meaningful say in operations, when relevant (giving the employee a feeling of agency).
3. A sense of meaning and purpose.
4. A work life that is compatible with a rich personal life. In practical terms, this means you get home in time to spend time with your young children before they go to bed.
Establishing a chief wellness officer in a hospital setting or a law firm is a meaningless investment unless they have the power to tell the leaders that young workers must be able to home to their families at a reasonable hour— and enforce this message.
Anything an employer can do to enhance the employees experience of meaning, purpose and agency will modify the balance of demand and resources in a positive direction.
In a hospital setting, ask the transporters for their views on improving patient transport. In a law firm, ask the junior associates for their thoughts about making their workload and schedules tolerable. Too often, it is the supervisor who is queried about procedures, if anyone, not the people actually handling day to day operations. And, obviously, follow through on the suggestions and guidance from front-line workers whenever possible. And explain why you cannot when that is the case.
A must-read book by organizational psychologist Peter Lazes and community psychoanalyst Marie Rudden, From the Ground Up: How Frontline Staff can Save America’s Healthcare, makes a fascinating and compelling case that the only effective path to improving organizational operations involves listening to front line staff and letting them take the lead in plotting a more effective and efficient course.
While Lazes and Rudden’s research is on organizational change rather than individual employee satisfaction, retention or burnout, their focus goes right to the heart of the remedy. No amount of feel-good amenities or well-intentioned wellness officers will decrease employee burnout and increase effectiveness and retention when the systems they work in are foolish, archaic, ineffective, brutal or inhumane.