A few days after my mother died, I went back to work. I was in my early twenties, studying during the day and working nights as a barkeeper in an alternative jazz club. A colleague asked me how I was doing. I gave the answer you give when work is waiting and grief has no official place. \u201cIt\u2019s ok.\u201d He looked at me and said, \u201cNo, it\u2019s not.\u201d Then he patted me on the back.<\/p>\n\n\n\n
I have forgotten a lot of clever things people said to me since. I have never forgotten that. Because he did not try to comfort me. He did not explain grief, manage it, reframe it, or turn it into resilience. He simply refused the lie.<\/p>\n\n\n\n
\nThe Board Room Version: Mental Health at work is not just a personal problem. It is also a systemic issue. Maslach & Leiter describe burnout as a result of 6 mismatches between the person and the work environment – not of personal weakness or failure. This is the official WHO description. Karasek & Theorell describe the worst combination \u2014 high demand, low control and low support \u2014 the iso-strain job. Deci & Ryan name the fundamental needs of humans \u2014 autonomy, competence and connectedness \u2014 their absence produces measurable harm to mental health. And this often happens at work. The result of all of this is 1 trillion Dollar loss of productivity per year. WHO and ILO published a policy what to do against it: Prevent \u2014 Protect and Promote \u2014 Support. If any, companies only do the latter two. The first and most important would be to reshape work environments and content. Organisations which do not systemically enable human flourishing do not just produce stressed employees. They produce conditions in which responsibility, creativity and engagement are not possible.<\/em><\/p>\n<\/blockquote>\n\n\n\n
Maybe this is a good starting point for a discussion on mental health at work: not a program or a poster or a study or a clever book, but with the permission to say that something is not okay.<\/p>\n\n\n\n
Because it isn\u2019t. Because I have seen too many colleagues disappear some into illness, some simply gone. People I worked with closely. It happens again and again. I feel guilty. I should know better. I know that they are not weak links, I see work breaking them. I also see the despair of mental illness, I see the suffering, the changes. I see my own fear. I see my own powerlessness because I cannot change what is hurting people I care for. And on Monday morning I receive a newsletter at work. It tells me to Stay Balanced. <\/p>\n\n\n\n
And they keep coming, they keep giving me tips and tricks \u2014 DIY instructions for building a beautiful mind. Breathing, work\u2014life balance, mindfulness, healthy eating, communication, all wonderful. All insufficient. Then they roll out the big guns. The EAP \u2014 yeah, also had to look that up \u2014 the Employee Assistance Program. The employer-provided, confidential support service in the form of short-term psychological \u2014 sometimes also financial or legal \u2014 counseling programs. That\u2019s a good thing, right? Yes, it\u2019s the company saying: \u201cIn our last manager training we have learned to detect that you are struggling. Here is a phone number.\u201d <\/p>\n\n\n\n
The issue is that one major contributor to mental health issues is always dropped from the picture. The place where we spend a third of our day, the institution that gives us identity, a place where we belong, a second family, a place where we are managed and controlled. The company. <\/p>\n\n\n\n
And now for my recurring disclaimer and explainer: This is not done by conspiracy or villainous intention. It\u2019s a systemic issue. Scientists have documented this consistently and studied it empirically for more than fifty years. <\/p>\n\n\n\n
Take burnout as the first very apparent example. The psychology researchers Christina Maslach and Michael Leiter explained it in their book \u201cThe Truth about Burnout\u201d. Besides the book’s slightly on-the-nose title it gives a good analysis of what burnout is. It manifests in feelings of Exhaustion \u2014 emotional and physical \u2014 Depersonalization \u2014 distancing yourself from work and its environment \u2014 and Inefficacy \u2014 work does not matter or you cannot be effective in it. This is of course a problem for anyone trying to do good work. Because these things correspond to the main resources we need to work: Energy \u2014 depleted causing exhaustion \u2014, Involvement \u2014 destroyed by depersonalization \u2014 and Efficacy \u2014 literally the opposite of inefficacy. <\/p>\n\n\n\n
Those states of mind are not primarily caused by internal factors \u2014 you are not weak or have failed somehow. It is a mismatch between you and your work environment and conditions. These mismatches can happen in six different ways. Bear with me, but I need to explain them to you. Workload \u2014 too much of it \u2014 Control \u2014 when you have responsibilities but lack influence \u2014 Reward \u2014 effort is not recognized or compensated \u2014 Community \u2014 relationships at work break down \u2014 Fairness \u2014 decisions feel arbitrary or disrespectful \u2014 and Values \u2014 the job forces you to act against your beliefs. These mismatches most of the time appear in combinations. You have too much work and are not recognized for doing it. You are constantly controlled and have to act against what you believe in. This will over time erode you and lead to Exhaustion, Depersonalization and Inefficacy. You burn out.<\/p>\n\n\n\n
The WHO has included this exact description in its International Classification of Diseases. Note that in the ICD burnout is not categorized as a disease but rather \u201ca phenomenon in the occupational context and should not be applied to describe experiences in other areas of life\u201d and as \u201ca syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.\u201d So burnout results from the workplace and it is manageable. The organization has simply not managed it. The WHO does not say: the employee failed to breathe properly. It says: chronic workplace stress was not successfully managed. <\/p>\n\n\n\n
If we look beyond burnout, there is more research, medical research. In the peer\u2014reviewed medical journal The Lancet the occupational health researcher Reiner Rugulies and his colleagues published an umbrella review on the connection between working conditions and Depression and Anxiety. Sorry, short explainer: an umbrella review is when you look at a lot of studies, analyze them and if they are any good and fit the same definitions you combine their results. In 2023 they found that various negative work conditions had differing impacts on the likelihood of depression or anxiety occurring. The factors were between 1.1 to 1.8. That is not a lot but the consistency of the results was proof that there was a clear connection. Additional analysis published in The Lancet confirmed this: Job strain or organizational injustice having a factor of 1.5 and bullying having a 2.58 times increased risk. In the same Lancet series, John Frank and colleagues demonstrated that work is a major social determinant of health.<\/p>\n\n\n\n
And it\u2019s not just the researchers, in a survey from Mind Share 84% of workers reported at least one workplace factor negatively impacting mental health. Most common was emotionally draining work \u2014 37% \u2014 and challenges with work-life balance \u2014 32%.<\/p>\n\n\n\n
This is bad news, but as shown workplace conditions appear to be just one factor in all of this. Isn\u2019t that just always the case? Yes it is, but that doesn\u2019t make it better. Think of what we eat. We know there is bad food for our health. We know that poor nutrition is a major contributor to cardiovascular disease. But not everyone with poor eating habits gets heart disease. When these studies show only \u201cmodest\u201d statistical effects between high-strain jobs and mental health outcomes, that does not mean the work environment is only mildly harmful. It means that the data mainly captures outcomes that become measurable \u2014 the people, the cases where coping mechanisms, social support, family stability were not enough. The data only shows the ones who break. It does not show all the people who have to bend.<\/p>\n\n\n\n
Then there is something called the diathesis\u2014stress model. Sorry, again explainer: In clinical psychology and psychiatry, the diathesis-stress model explains that vulnerabilities or predispositions and stressors work together to cause a mental issue or illness. It also means that sometimes it doesn\u2019t. There is also a similar concept in physiological illnesses: Not everyone gets the flu if it spreads in your family for example. It may only manifest after a week with some people or not at all with others. Stress interacts with vulnerability. But that does not make the stressor harmless. It only means that people arrive with different thresholds, histories, and reserves.<\/p>\n\n\n\n
Modest effect sizes in studies do not reflect modest harm, but varied thresholds. They do not fully capture the harm experienced by everyone in negative work conditions.<\/p>\n\n\n\n
There are physical effects too, resulting from bad working conditions. Robert Karasek and T\u00f6res Theorell described the results of their studies in the book \u201cHealthy Work: Stress, Productivity, and the Reconstruction of Working Life\u201d published in 1990 and demonstrated the link to increased risk for cardiovascular disease. They showed that it is an outcome of higher blood pressure, elevated stress hormones and fatigue over longer periods of time. The health effects of long working hours have also been demonstrated by a joint WHO and ILO report published in 2021 \u2014 745,000 deaths per year from cardiovascular disease can be attributed to working 55 or more hours per week.<\/p>\n\n\n\n
All of this points to a clear and consistent connection between working conditions and mental and physical health. But how does this happen? What are the structural conditions that produce the damage?<\/p>\n\n\n\n
There have been many studies done in this field. Two of the most substantial bodies of research come from Karasek & Theorell and Deci & Ryan. While both basically come to the same conclusions, it is worth looking at both.<\/p>\n\n\n\n
For Karasek & Theorell I would love to show you their famous Demand\u2014Control table but I don\u2019t do excel here, sorry. They have basically mapped jobs on two dimensions: job demands \u2014 either high or low \u2014 and decision latitude \u2014 how much control do you have also in high or low. That of course gives you five \u2014 ha tricked you, no it\u2019s four \u2014 combinations or job types. Most interesting are the two where job demands are high and control either high \u2014 the active job \u2014 or low \u2014 the high strain job. That is for example the difference between a doctor and a warehouse worker. Both are very demanding jobs, but one has some authority over how the work gets done \u2014 not unlimited of course, just relative \u2014 the other has nothing much to say. Karasek & Theorell found that people with high\u2014strain jobs are more likely to suffer from mental health problems.<\/p>\n\n\n\n
That brings up an important point. The combination of high demand and low control can often be found in lower status jobs. Therefore mental health becomes a class issue. This has also been confirmed by Rugulies and colleagues in The Lancet. Occupational health problems occur disproportionately in lower status jobs.<\/p>\n\n\n\n
Karasek & Theorell added another dimension to their Demand\u2014Control Model: Social support. They then found that the most damaging combination is what they called iso\u2014strain which has high demand, low control and low support. How surprising?!<\/p>\n\n\n\n
Then what about the second pair of research buddies Edward Deci and Richard Ryan. They have independently and jointly worked on what is called Self-Determination Theory or SDT for more than 40 years. It\u2019s the study of intrinsic motivation \u2014 an expression you may have heard before. In psychology it is quite an important concept of which they are among the leading figures in the field. And believe me that we will hear more from them. Regarding mental health only some of it is relevant. Autonomy \u2014 a feeling of choice \u2014 Competence \u2014 a sense of effectiveness \u2014 and Connectedness \u2014 a feeling of belonging \u2014 are fundamental needs of us humans. The absence of any one of them produces measurable damage to our mental health. Of course it\u2019s not as simple as that, there are a lot of nuances. Like autonomy is not freedom from all constraints. That would be anarchy \u2014 sorry, no Chomsky here. Autonomy here is the ability to act with inner consent inside a world full of constraints. So you follow rules because you see the point and not because someone is watching. Another relevant point in SDT is that there is a distinction between controlling and informational input from the outside. The same kind of input can be experienced as controlling \u2014 then it undermines intrinsic motivation \u2014 or as informational \u2014 then it supports it. A company tells you how to lead a mentally balanced lifestyle \u2014 you know, just breathe and count \u2014 or it addresses the unbalanced workload. Now you guess which is the supporting one. Controlling management is by the way always bad for mental health. We have seen that Theory X leads to passivity and that is the lack of any kind of autonomy, competence or connectedness in employees. On top of that, it will reconfirm the controlling manager who puts even more controls. The Theory X death loop. The Theory X death loop operates at the managerial level. But something similar happens at the organizational level too.<\/p>\n\n\n\n
Not a death loop but a cascading effect is what you can see in many companies happening. Staff or other resources get cut. At the same time the expectations expand \u2014 all for the customer! This accumulates, more for the customer, more for the shareholder, more engagement, more health. And no matter how many posters you put up, employees see that this does not make sense. You cannot have more for less. All of Maslach\u2019s mismatches happen at the same time: overload, loss of control, reduced reward, broken community, fairness violation, values conflict. Deci & Ryan\u2019s autonomy, competence and connectedness get eroded and more and more jobs become iso-strain jobs: high demand, low control and low support. <\/p>\n\n\n\n
And how do companies respond to this cascade: They send you a newsletter. In which they tell you what you have to do, where your shortcomings are. This makes your mental health, your feelings, your emotions a personal matter. It\u2019s not the organization\u2019s responsibility, you have to manage it. The problem with that is that emotions are produced by social interactions. Organizations are social systems by definition. Ones that we spend a third of our day in. You cannot design a social system, populate it with humans and then say that the emotional consequences of that system are purely private. And that is not psychology or philosophy or whatever. That is just not logical. <\/p>\n\n\n\n
Of course someone will say: Yeah, yeah, man up. Work is just hard. OK, let\u2019s get that comment out of the way once and for all. Legitimizing suffering through work is an old moral assumption not based on any logic, not even any economic principle. It\u2019s just stupid talk. Max Weber analyzed the moral legitimization of work and suffering a hundred years ago and since then nobody has shown otherwise.<\/p>\n\n\n\n
So then if not stupid talk, then let\u2019s hear from a CEO. Maslach and Leiter describe a composite figure they call Dave, a CEO whose position on mental health at work is unfortunately all too familiar: \u201cMental health is a problem of the individual. It’s not the employer’s responsibility. It doesn’t have any real impact on productivity. And there’s not much the organization can do about it.\u201d<\/p>\n\n\n\n
These four points are a seemingly airtight logical defense to any liability from the company\u2019s side. In addition they are also all wrong. We have already seen that mental health is not just the problem of the individual but also of the social system the individual operates in, the company. We have looked at studies demonstrating that work conditions are at least a contributing factor to mental health. We have seen the models how this works. And yeah, what about the productivity claim? I wonder. How about 1 trillion dollars. That is the WHO and ILO stated global loss in productivity per year due to just depression and anxiety. Twelve billion working days lost every year. Or the 28% productivity loss that was found in the Mind Share Survey reported across all employees experiencing mental strain in their work. That is quite an impact I would say. As to what companies can do, there is quite a lot they can do. And more and more companies are doing some of them. Just not all and not the important stuff.<\/p>\n\n\n\n
In 2022, the WHO, and jointly with the ILO, published clear guidance on what companies should do: an easily explained three-point program. Prevent \u2014 Protect and Promote \u2014 Support. Companies tend to do the second and third, but usually skip the first and most important. Your manager training and newsletter on mental health are Protect and Promote. The EAP program is Support. Prevent, that would be \u201cReshape work environments to minimize psychosocial risks and prevent workers from experiencing mental health conditions\u201d. Well, that\u2019s not breathing. <\/p>\n\n\n\n
Dave is not as generic a figure as you might think. I have experienced similar things, when facilitating workshops on ISO 45001. There was this one CEO who brushed off any responsibility concerning mental health of his employees by saying: \u201cWell, I\u2019m not their nanny.\u201d He then put his name on the mental health newsletter anyway. I did not say anything at the time but I should have. The answer is clear: \u201cFirst \u2014 correct, you are not a nanny. Nannies are for children. Adult employees need a leader who creates conditions for good work. Second \u2014 does anyone actually believe that newsletter came from your desk and not some communications consultant? Your employees certainly don\u2019t.\u201d In the APA 2022 Work and Well-being Survey 47% of workers said their company’s wellbeing and culture initiatives are mostly for show. Nearly half. The audience knows it’s a performance.<\/p>\n\n\n\n
Since I mentioned ISO 45001, the management system standard for occupational health and safety, I have to stress here that it requires companies to evaluate their health and safety risks and address them. This currently already includes mental health risks but in its next revision \u2014 to be published in 2027 \u2014 is expected to further strengthen this aspect, which will align exactly with the WHO\/ILO policy advice to Prevent. And with risk management in ISO 45001 we have an established process for it, even the excel templates are already made. The framework exists. The tools exist. The question is whether organizations choose to use them for what they were designed for.<\/p>\n\n\n\n
This whole discussion always comes back to a simple point. Why should companies do something about work conditions which are obviously harmful to employees? There are some like me who say it\u2019s foremost an ethical question. No economic activity should generate bodily or mental harm, because the worth of the human being is higher than the shareholder value. But even if we put ethics aside, doing nothing is strategically stupid. Even within the system of companies it does not make sense.<\/p>\n\n\n\n
Reiner Rugulies did another study regarding leadership and mental health. Changes toward a more positive \u2014 supporting, less controlling \u2014 leadership style led to a decrease in depressive symptoms with employees. That demonstrates that organizational change produces measurable health outcomes. The WHO and ILO confirmed that organizational interventions \u2014 changing working conditions \u2014 reduce emotional distress and improve work outcomes. The same cannot be said if only individual stress management is implemented. Deci showed in a study he did at Xerox that autonomy-supportive management produces measurably better levels of satisfaction, lower stress levels and even reduced compensation demands \u2014 I can see the CFOs suddenly paying attention. He also demonstrated that managers can be trained in this, it\u2019s not wishful thinking. A Lancet study showed that between 17% and 35% of depressive disorders in Europe would be preventable by just eliminating negative psychosocial working conditions. Controlling compliance systems are expensive to maintain. A method based on intrinsic motivation is self-sustaining. And for all you money-obsessed: 1 trillion dollars lost per year. <\/p>\n\n\n\n
Organizations that systematically prevent the conditions for human flourishing are not just producing stressed workers. They are producing the conditions in which genuine responsibility, creativity, and engagement become impossible.<\/p>\n\n\n\n
Bing, another newsletter lands in my inbox. I think of the colleagues who disappeared. I think of what the evidence says about why that happens. I think of what it would actually take to change it. Then I delete the email.<\/p>\n\n\n\n
I guess there is more to explore \u2014 just not in this newsletter. <\/p>\n\n\n\n