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ONLINE-ONLY ARTICLE: The importance of employee wellbeing

Chris Athanasiades and Allan Winthrop on the role of psychological support in promoting wellbeing at work.

04 December 2007

Psychology has for sometime maintained an interest in the promotion of psychological wellbeing in the workplace. Peter Warr’s seminal work (see Warr, 1996) in the 90s has enabled our conceptual understanding of issues around employee wellbeing.

Subsequent research in this area has led to an understanding of the detrimental effect of work-related stress on employee health (Bond, 2004; Loretto et al, 2005). This has facilitated policy-making with the government openly encouraging employers to take measures that promote the work-life balance of their employees (DfEE, 2000). Additionally, the World Health Organisation’s 2005 Mental Health Action Plan for Europe (St John, 2005) has called for an improvement of employee mental health and has made specific recommendations for the provision of mental health care services in the workplace. These developments have important scientific and employment implications for psychology.

Occupational stress and employee wellbeing
Official figures show that 35% of the European workforce believe that their work affects their health (EFILWC, 2006). The Bristol Stress and Health at Work Study (Smith et al, 2000) showed that approximately 20% of the surveyed British employees suffered from high occupational stress. The same survey found that high occupational stress was significantly related to medical problems such as gastro-intestinal symptoms, fatigue, tension, depression and anxiety as well as to problems in the family (Smith et al, 2000).

Furthermore, stress was significantly associated with rates of sick leave, GP visits and accidents at work (Smith et al, 2000). The mental health charity Mind reports that stress is the highest cause of absence amongst non-manual employees which is associated with 12.8 million working days lost in Britain in 2003-04 whilst mental health problems in total result in the loss of 91 million working days every year. In addition, the 2005 Employer Survey of the Health and Safety Executive (Clarke et al, 2005) reveals that work-related injuries led to an estimated loss of 18,000 days of work per 100,000 employees whilst work-related ill-health led to a loss of 14,000 days off work per 100,000 employees. Work-related stress was the third most commonly reported health and safety risk (Clarke, et al, 2005).  

Understandably, the evidence on the adverse effects of stress on employee wellbeing are of immediate interest to the corporate world. This is partly due to concerns that stress-related difficulties can lead to accidents and medical problems which can result in inability to work efficiently and in lost productivity due to increased sick leave (Kalia, 2002; Teasdale, 2006). Hence management research has concentrated heavily on the links between employee wellbeing and productivity (Csiernik, 1995). It is beyond the scope of this article to expound upon the relevant evidence. Nevertheless, it should be stated that this link has been demonstrated consistently in research. For example, Wright et al (2002) found that psychological wellbeing is a more consistent predictor of performance at work than dispositional attributes of employees. Additionally, empirical evidence has shown that employees who are happier with their jobs are also more productive (Patterson and West, 1998; Wright and Cropanzano, 2000; Wright et al, 2002) and less likely to be absent from work (McKenna, 1994). Conversely, evidence shows that unhappiness with one’s life stemming from personal difficulties such as substance abuse, mental health difficulties as well as interpersonal conflict can negatively impact upon productivity (White et al, 1996). For example, Warr (1996) presents evidence which shows that employee anxiety and occupational stress have a negative effect on the ability to work efficiently.

Stress management is becoming more and more important as workload increases (Morris and Raabe, 2002). The World Health Organisation (WHO) estimates that there will be a gradual rise in the number of people experiencing mental health difficulties in the workplace to the year 2020 (Kalia, 2002). Considering that government-sponsored mental health resources are shrinking, it is anticipated that some of the responsibility for the provision of mental health services will be passed on to the employer (Arthur, 2000). Additionally, it is expected that the recruitment of more people with mental health difficulties due to equal opportunity legislation and policies will add additional pressure on employers to provide mental health resources to all their employees who need such vital services (McDaid et al, 2005).

The maintenance and promotion of employee wellbeing
Current trends indicate an emphasis on the employer’s responsibility to provide services that meet their employees’ mental health needs (Arthur, 2000; Coles, 2003). This is reflected in the fact that international organisations such as the European Union and the World Health Organisation have been making recommendations about the measures that employers need to take to tackle workplace stress and promote employee health (McDaid et al, 2005).

Cooper and Cartwright (1997) suggest that there are three ways in which occupational stress can be prevented. Primary prevention can include education on stress matters and training in the recognition of stress symptoms. Secondary prevention can focus on simple ways of dealing with stress such as relaxation, ways of altering stress-inducing thinking and ways of improving one’s lifestyle. Tertiary prevention can include psychological support in the form of counselling and other support services, often delivered from either internal or external Employee Assistance Programmes (EAPs: used here to refer to any Employee Assistance scheme that includes counselling and/or psychological therapies amongst its services). Cooper and Cartwright (1997) propose that psychological support in the workplace, or ‘workplace counselling’ as it is often referred to, has an important role in the maintenance and promotion of employee wellbeing. A similar perspective is adopted by White et al (1996) who emphasise the role that EAPs can play in the prevention of mental health difficulties in the workplace. White et al (1996) propose 3 levels of prevention: primary, secondary and tertiary. In primary prevention employees can be educated with regards to preventing or managing stress. In secondary prevention any mental health issues currently experienced can be assisted via parallel support and by ensuring that the client is adhering to any medication regimes. Finally, in tertiary prevention, an EAP can help by supporting the suffering employee and his/her family and by averting alienation and isolation.

In addition, it has been suggested that EAPs can be of good service to workers with genuine psychological difficulties (Arthur, 2002; 2005). In the UK, research has shown that around 86% of a sample of users of a British EAP suffered from psychiatric problems as measured by the General Health Questionnaire (Arthur, 2002; 2005). White et al (1996) state that EAPs can help with the identification and referral of employees with complex psychological needs. Most importantly, the prompt identification of mental health difficulties and the use of psychological intervention may help reduce the need for a referral and it may help prevent the exacerbation of the employee’s mental health which can, in turn, prevent absence from work (White et al, 1996). Additionally, whilst some employees can be helped in their adjustment to their working environment, others can be sufficiently empowered to make the decision to leave an unsatisfying job (Coles, 2003). It would seem that EAPs can fulfil an important role in the maintenance and promotion of employee wellbeing and awareness of the advantages of using an EAP should be raised with employees (Ruiz, 2006).

According to Arthur (2000) the UK is potentially the only EU country where the corporate world shows serious consideration towards stress at work and where EAPs are used to deal with stress management. Coles (2003) refers to evidence from the Employee Assistance Professionals Association – UK which states that 10% of 1137 organisations with a total of 2.26 million employees use an external EAP. Arthur (2000) claims that there exist three groups of countries in the EU with respect to how they deal with stress at work. These groups are: (1) Sweden, Finland and the Netherlands where legal frameworks guide the provision of psychological support systems in companies; (2) Belgium, Denmark, UK, Germany and Ireland where the EU directive on health and safety has been taken onboard in the absence of a legal framework; and (3) Italy, Greece and Portugal where stress remains unrecognised as a factor that can affect employee health and where companies have no systems in place to offer psychological support to their employees. In view of this, there may be scope for the better integration of workplace counselling in organisational structures across countries. This has important professional and scientific implications.

Clearly, there is an increasing recognition of the importance of good mental health in the workplace (Bond, 2004). In light of this, and on the basis of the evidence that shows that employee wellbeing and satisfaction with work can be increased by helping employees alter their negative thinking (Judge and Locke, 1993), it would seem that psychology has an important role in the maintenance and promotion of employee wellbeing. Banister (1992) had speculated that counselling services would be an integral part of the workplace in the future and that psychology would play an important role in the maintenance of a positive working environment. Additionally EAPs may have an important role to play in the management of employee issues in the future as increasing unemployment and an increase in dual-worker households may start to affect personal and family lives which may in turn affect work performance (Highhouse, 1999). Finally, Hannabuss (1997) regards workplace counselling to be an invaluable resource and suggests that it should be part of the modern corporate world if human resources are to have a meaningful presence at work.

Suitability of psychological interventions for use in the workplace
In discussing the suitability of psychological interventions for use at the workplace consideration should be given to who the consumer of workplace counselling is (Friery, 2006). In addition, there is recognition that there are dual clients in workplace counselling, the individual employee as well as the employer/employing organisation (Carroll, 1996). Suggestions have been made about the adoption of systemic approaches that would account for complex relationships between all stakeholders (Claringbull, 2006).Hannabuss (1997) argues that both the psychodynamic and the cognitive-behavioural (CBT) models are suitable for use in the workplace. Additionally, Coles (2003) provides examples of successful use of different therapeutic mode

ls in the workplace, such as the psychodynamic, the humanistic, the cognitive-behavioural and crisis interventions. Coles suggests that different models suit different individuals and different presenting difficulties. Orlans (2003) quotes evidence for the effectiveness of brief therapy and suggests it is a useful intervention especially where resources for counselling are limited. Finally, Carroll (1996) suggests the use of an integrative approach to workplace counselling according to the needs of the client.

Effectiveness of psychological interventions in the workplace
Perhaps the largest systematic study of workplace counselling in the UK was conducted by McLeod (2001). McLeod (2001) looked at the following themes: (1) psychosocial outcomes of workplace counselling; (2) studies of the economic cost and benefits of workplace counselling; (3) Studies of employee attitudes and utilisation; (4) research into further aspects of workplace counselling; (5) methodological issues in research into workplace counselling; (6) directions for future research. In summary, 34 studies were reviewed. The majority of these studies were conducted between 1983 and 2000. Only two studies were conducted earlier than 1983. McLeod (2001) evaluated the evidence from these studies on the basis of their methodological strengths. He concluded that there are three categories of studies: Those that provided ‘best evidence’ having the most robust methodologies, those with ‘supporting evidence’ where there were some methodological limitations and those with ‘authenticating evidence’ which provided descriptive information about the effectiveness of workplace counselling. In total, 11 of the 16 ‘best evidence’ studies provided evidence which was overwhelmingly in favour of the effectiveness of workplace counselling. This was also true for 4 of the 13 ‘supporting evidence’ studies and for 3 of the 5 studies in the ‘authenticating evidence’ category. The rest of the studies provided moderate support for the effectiveness of workplace counselling. Only 2 studies in the ‘best evidence’ category found workplace counselling to have no beneficial effect. McLeod concluded that there is strong evidence to suggest that workplace counselling has a significant beneficial effect on the wellbeing of employees. However, this study has been criticised for not providing negative outcomes and for ignoring the fact that therapy can do harm (Henderson et al, 2003). In fact there is some uncertainty with regards to the effectiveness of psychological interventions in the workplace. This is partly due to the inadvertent association of client satisfaction with intervention effectiveness (McLeod and Henderson, 2003). Nevertheless, employees seem to like psychological services in the workplace and some employees who use such services may not have been able to access independent or external mental health services (Kirk and Brown, 2003). Therefore, these services are of value to employee. In addition, the provision of psychological services in the workplace may be what Kirk and Brown (2003) have called “a socially responsible and humanitarian organisational initiative” (p. 142).

Opportunities for professional psychologists
Hannabuss (1997) argues that the use of psychological interventions in the workplace requires the skills and expertise of appropriately trained professionals. Carroll (1996) recommends that training in counselling in the workplace is included in training curriculums and quotes the Universities of Bristol, Roehampton and Birmingham as being amongst institutions that offer training programmes specifically on workplace counselling, indicating a training niche. In fact, the University of Southampton runs a 3-year professional postgraduate programme in Workplace Counselling. On the basis of this, academic programmes

in professional psychology would do well to include training in the application of psychological knowledge to employee and other organisational matters.In addition, the Association for Counselling at Work, a Division of the British Association for Counselling and Psychotherapy exists to promote the interests of professionals involved in the area of workplace counselling (Cullup, 2005). The Division re-launched its journal in 2002 and appointed, Andrew Kinder, a Chartered Occupational and Counselling Psychologist as its new Chair in 2004 (Cullup, 2005) which indicates a growing professional interest in workplace counselling. Furthermore, 2002 saw the establishment of the Employee Assistance European Forum, a non-profit organisation for individuals and organisations interested in the development of Employee Assistance and Work-Life services in Europe (EAEF, 2005).These are important developments and there is clear potential for psychologists with an interest and training in psychological counselling or psychotherapy to be involved in delivering psychological services to organisations. Such services could involve psychological therapies/interventions with employees and consultancy work to senior management with regards to workforce needs. Psychologists have a wealth of therapeutic knowledge and skills which could benefit employees and the organisations that work in them. There are currently great involvement opportunities for psychologists and these should not be missed.

-    Chris Athanasiades is Senior Teaching Fellow at the University of Leeds, E-mail: [email protected]

-    Allan Winthrop is a Consultant Chartered Counselling Psychologist and Programme Director of the Doctorate in Counselling Psychology at University of Teesside, E-mail: [email protected].


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