The link between physical and mental health

Stephen: Welcome to Health and Safety Uncut, a British Safety Council podcast, with me, Stephen Cooke standing in for Doctor Shaun Davis, who usually presents the podcast.

Today's guest is Rebecca Canham. Rebecca is principal scientist at Institute of Occupational Medicine (IOM) and a registered health psychologist with the Health and Care Professional Council.

She has over 17 years of research, training and consultancy experience spanning a variety of safety, critical and high hazard industries including healthcare, transport, utilities, energy, and emergency services.

Rebecca has designed and implemented a wide range of qualitative, quantitative, and mixed method approaches.

Her projects include researching workplace transmission of the COVID-19 virus as part of the Protect National Core study across diverse sectors including food processing, energy production and close contact retail settings.

Much of her work has sought to enhance understanding of human behaviour in the context of public health or a given occupation.

Rebecca, first, thank you for joining us on Health and Safety Uncut. And you've clearly got lots of experience and insight into this sector. So, what does health, safety and wellbeing mean to you?

Rebecca: So, yeah, I mean, thank you for inviting me to join you.

It's always been an area of interest for me coming out of university, I focused on understanding more about people's health and wellbeing behaviours, taking a qualification in health psychology. And also, since having my children, I myself have a long-term chronic condition. So, I've, I've seen and experienced first-hand the impact of that on my, my mental health, my stress, my energy levels, but also my physical capability and, and the interrelationship between those two things.

I also have an element of neurodiversity myself. So, I'm dyslexic. So, I've also seen first-hand some of the challenges within the workplace and thankfully benefited from a lot of support that's been provided to make work achievable and accessible to me in the role that I do.

But now as a principal scientist, I manage staff of my own, I manage projects. So, it's certainly something that now I can kind of feed that knowledge and experience forward with in terms of how I manage my staff and how we approach things in the workplace at the Institute of Occupational Medicine too.

Stephen: Well, thanks, Rebecca. And thanks for sharing that about yourself as well. It's very helpful as part of the context, I think for this discussion and what we're talking about, which is the link today between physical and mental health and what do we know about that? What do we know about that link between our physical and mental wellbeing?

Rebecca: So, there's, there's absolutely, and it's well documented in the literature, there's absolutely a, a clear link between the physical and the cognitive, the mental health elements. So, things along the lines, you know, chronic illness and injury can increase the risk of depression and anxiety. Obesity is also linked with high rates of diabetes and depression.

But then on the flip side, stress and anxiety can weaken immune response that makes individuals more susceptible to illness or, or high stress can also increase blood pressure and related heart conditions. So, there's, there's evidently a clear link, but I think it's, it's trying to unpick then where that relationship sits.

So, for example, lifestyle factors, so things like diet, exercise, sleep can have a massive impact on both physical, mental health. Socioeconomic factors such as finances, housing and the physical work environment can make a massive difference as well in terms of an individual's physical health or mental health risks.

And then psychosocial risk factors as well. So, things like high workloads, demands, resources, a lack of control, for example, can also increase levels of stress and have knock on effects documented in the literature with respect to musculoskeletal issues or people working longer against deadlines in order to meet challenging deadlines and therefore forgoing lunch and things.

So, you've got all of the indirect impacts too. So, they're absolutely interlinked and it's really important therefore that employers and workers themselves are thinking about this holistically. And they're not just thinking one sided about either the physical or the mental health elements, but rather they're looking to develop a holistic solution that works for each individual in order to avoid that otherwise negative cycle.

Stephen: So, we hear this word holistic, don't we? And I think the World Health Organisation actually uses it as a term, don't they, to, to define wellbeing as a whole. And I guess this is what we're talking about. So, we're talking about a virtuous circle or indeed a vicious circle here in terms of what can either boost us and, and help us and energise us and, and build us up or indeed drag us down.

I mean, and I suppose at what point does one become a virtuous or a vicious? And how do you know?

Rebecca: Exactly. And I think it's, it's I don't think there's a particular point where you hit that threshold and go, right, I'm doomed or right, that's a trigger that I now need to change.

I mean, some individuals do, but I think it's more small changes and incremental differences can make a massive difference. And don't forget, we spend a lot of our lives at work. And therefore, it's important not to underestimate the value and the impact that a work setting and a job role can have on someone's wellbeing.

So, you know, the more that we can focus on trying to make incremental changes and be that to physical or mental, then it becomes a self-perpetuating cycle. So, if we can have, you know, walking meetings or move more generally in the day, if we have that social cohesion and feel part of something bigger, then actually that enough can help us provide respite for other things that happening outside of work.

Our participation in work doesn't occur in a vacuum, and therefore it's also really important to acknowledge that actually there's stresses and strain and ill health and injury that's related completely outside of work, and we bring that in when we come to work to do our role that we're paid for.

So having a holistic approach not only ties together the physical and the mental considerations, but it's also thinking about the whole self and the full concept of the individual workers in an organisation. So, how can we support them, develop techniques or feel supported and empowered to then make changes outside of work in their wider world?

Stephen: So just walk us through some of the impacts on the workplace then of not addressing some of these things first.

Rebecca: So, I think, you know, organisations really need to start standing up and taking notice of the health and wellbeing of their workforce.

You know, physical and mental health has huge impacts in terms of productivity, concentration, human error rates, things like that. So, it's absolutely a work problem. Whether the challenge instigates within work or whether it's exacerbated by work, work is a real opportunity to make a difference.

And therefore, you know, as I say, nobody goes to work in a vacuum. We bring with us all that baggage of family life or relationships or financial challenges that we may have, but it represents an opportunity for a positive impact. So, fostering, as I say, social cohesion and social support, it acts as a buffer to either identify or catch or mitigate some of these issues and challenges.

It provides a, a physical and a hopefully a psychological safe space for individuals to engage and, be themselves. It's the integration of movement. So, generally, you know, if we are particularly going to a place of work, then it's, it's that movement to be getting there.

It's that active routine that helps cognitively too, but also, you know, movement around when you're at work, when you're in work, that that again supports a healthy lifestyle. Stephen: And, as well as mattering to the individual, this, this matters to the employers as well, doesn't it? And wider society.

Rebecca: So, there is absolutely a cost to a wider society. There’s a cost to the employer as well as a result of things like presenteeism, absenteeism. But there's also, as you mentioned in the introduction, I've done an awful lot of work with safe to critical and high hazard industries and the ability for frontline leaders to understand and recognise where their staff might be struggling.

Because human behaviour is a little bit like an iceberg and the mass of the iceberg is often underneath the waterline. The bit that you see is the very tip of the iceberg. But the people that have the greatest amount of contact with you are the people that are likely to identify when something is out of sorts or not quite right.

So particularly from a mental health perspective. So, a lot of the training that I've run previously is has focused on helping individuals recognise the signs, indications and triggers and almost acting as a first line responder to either signpost or have a conversation or something along those lines.

Because if you are not focusing on what you're doing when you're high up on a scaffold, if you're not, if you've failed to remember to clip on, for example, is these sorts of things that then turn into a safety issue and can have, you know, significant impact.

So, there's multiple issues. I think it's the hidden cost also, though, that is worth acknowledging. So, if you have a member of staff that either is absent on a regular basis or that is suffering from presenteeism, then ultimately, it's the burden that the wider workforce then are carrying as a result of those individuals.

So, and it's also the hidden cost of if somebody exits the workplace due to ill health because we're unable to accommodate their needs, then it's the hidden cost of having to recruit their replacement, the time taken to get up to speed and upskill the individual that then is brought in. So, there's huge ramifications from an organisation perspective in addition to equally damage and risk to brand and reputation.

Stephen: So, Rebecca, you obviously talked about an individual clipping themselves on or not to their scaffolding. And clearly the individual has a responsibility here. They have a responsibility for their own safety by and large. They also have a responsibility for their own mental health as well, I guess.

But so, the question I guess comes up in terms of the employer here and their role and I guess where they stand, you know what, what are the legal obligations for an employer in relation to obviously physical but also mental wellbeing, importantly.

Rebecca: Yeah, absolutely. And I think that's the bit that catches organisations out from my experience, is they forget that addition that the laws extend to physical and mental health. So, they have a general duty of care. They need to provide a safe and healthy work environment and take reasonable steps to protect employees from harm.

And that's not just physical harm, its mental harm, it's cognitive harm. So, under the Health and Safety at Work Act in the UK, you know there is an obligation for organisations to be undertaking a risk assessment and that is of physical and mental health hazards.

Now what I see, and experience commonly is either that risk assessment is very much focused on the physical or that that risk assessment is seen to be the action. And the risk assessment is the beginning. It gives you the information in the road map that you then need to walk with actions and mitigations that need to be put in place.

So, it's very challenging to put appropriate action in place without first undertaking the risk assessment. But the risk assessment itself is not the action. And I've seen a number of organisations that I've consulted with previously who often think that that's ticking the box. They’ve done what they need to, they've completed their risk assessment.

Whereas, actually, there is an obligation also for you to implement measures that then minimise the risks that you've identified and regularly review and put in place policies and processes that support that risk management.

Stephen: So, thinking practically speaking, how that works in practice, the sort of risk factors around mental health and we can imagine some around physical health obviously how you feel on a particular day, whether you're unwell, whether you've got an injury, certain things like that.

But mental wellbeing, it's harder to define and pin down even as the individual. So how does the employer to manage those risks?

Rebecca: It is, it's challenging, but we're talking about things like bullying, harassment, work related stress. And there are really good toolkits out there. So, the Stress Indicator Tool from the HSE, for example, which I believe is free for youth, for organisations that are under 50 employees, but that walks you through identifying some of the hazards potentially exposed to your workforce.

And it's things like, do the demands on your workers exceed the resources? So, it's things like that that unless you specifically consider these areas, it's actually quite difficult to identify and then put something in place to address them. But they are really important. So, we've touched on the Health and Safety at Work Act and also, we've since had the Equality Act in 2010 come in.

So ultimately employers can't be discriminating on the grounds of disability. So, they must make reasonable adjustments to enable staff with either physical or mental health conditions to perform their duties.

In terms of whose responsibility is it? Well, ultimately, it's everyone's responsibility. But I say that we all have an individual part to play. So, it's not a shared responsibility in that I won't bother because someone else will pick it up, which otherwise something that is everyone's responsibility ends up being no one's responsibility, quite the opposite.

So, organisations have an obligation to identify and manage the risks in the environment, policies, procedures and physical and mental hazards as I say to their workers. But line managers and leaders have responsibility for the day-to-day operations, for early detection and initial action and whether that action is signposting or having just an informal conversation.

And it's for them to then ensure that policies and processes are implemented. But then if we think about the individual's obligation, it's for them to take reasonable care of their own physical and mental health, but also for them to speak up and comply with any policy and process that's in place from their organisation and engage with the roles and support that are provided.

So, it's really a collaboration. It needs to be a collaboration between the organisation themselves, the individual managers within it, and the individuals themselves to be able to specify what it is that they need or what it is that they're challenged to do and what they're struggling with so that plans can be put in place and actions are relevant.

Stephen: So, I guess all of that is, is, is the case and all of that is true. And yet we also still find ourselves in a position where the pace of change things moving on changing in terms of technology changing things like AI coming into the workplace, social media, the pressures on individuals, you know, their own lives changing all the time.

How we live, how we communicate with each other, even more isolation in society and loneliness and things like that going on. I mean, some of these things are beyond the control, aren't they, of both the employer and the individual. And how far is that having an influence?

Rebecca: They are, and I think that's a really nice example of where work presents an opportunity because it is that opportunity for contact to be part of something bigger, to feel like you're making a difference, to have that social support, to see colleagues or and you know, I myself am a remote worker.

I work from home generally. So, my contact is, you know, generally via Teams or Zoom or other applications are available, but you know, it's, it's those conversations and those meaningful conversations and contact that you have with people.

But it absolutely does present a different challenge now to the challenge that was presented maybe 5-10 years ago pre COVID in that, you know, the proportion of organisations that have a dispersed workforce or a hybrid workforce and the variations, you know, the, the government strategy to increase employment, support people with ill health or disability to access and stay in work and enable continuation of work later in life than we have done before.

All then comes into play. Which again links back to from an employer's perspective, there's an opportunity that if you have great staff to retain them and keep them and nurture them because it benefits their wellbeing and their health, but it also benefits you as a company. But it does create some unique challenges that we need to be thinking about.

And again, I link back to undertaking that risk assessment from a physical and a mental health perspective will help you identify where some of these challenges come into play and therefore where you might need to make unique amendments to your working situation or setup in terms of how do you engage with your workers?

How do you check in and make sure that someone's OK when you don't see them in the office because they're remote? There’s all of these challenges and, and how do we nurture and support a diverse workforce, both demographically in terms of age, culture, religion, the mix, but also in terms of neurodivergence to acknowledge what individual workers need.

And therefore, how can we try, so far as possible, to provide that that allows each individual to flourish at work and at home?

Stephen: And just think about it from a work perspective then, because, because clearly there are certain things that can help here in terms of, you know, moving this on and also getting to the point where we actually do consider mental and physical health together and, and, and almost as equal really.

And that's the ultimate aim, isn't it, in a sense. So what? What sort of practical things are possible in the workplace?

Rebecca: Absolutely. And I think there's a lot that can be learned from the health and safety side of things and the prominence of that generally now within organisations. And the work that IOM undertook with the British Safety Council last year illustrates that in terms of there's a lot of organisations that said to us that they were looking at worker wellbeing through the health and safety lens.

And they were bringing it in as an additional or an integrated element of that, that stance to support their workers. Which meant that they could feed off all of the existing policy and prominence and awareness throughout the workforce to really make that front and centre as a priority within an organisation.

But I think also the role of the line manager can't be underestimated. They are absolutely critical. They are a pivotal point within the organisation to support workers sideways and down the chain, but also to cascade themes, trends, and information that they see, hear, and experience from those interactions up the chain to senior leadership to ensure that those policies, processes, and approaches are iterated to remain in step and in line with what the workforce need.

So, I think that the role of the line manager really is quite critical in terms of driving things forward. The other thing to think about within that mix is the organisational culture and the extent to which you have embedded psychological safety within your workforce.

Are your workers comfortable to come to you with challenges that they might encounter or, you know, highlight something that isn't working or something that's gone wrong and not gone well, but that presents a learning opportunity? How do you as a line manager present yourself?

What steps and actions are you demonstrating? Are you allowing a safe space for your workforce to come to you and share these things that ultimately support the organisation to evolve? In line with the way in which things are changing, so we mentioned about remote workers, the diversity of the workforce now an ageing workforce and other things like that.

It's ensuring that the conversation continues so that there are no surprises. We can't keep doing what we already have forever more because the world around us is changing. So, it's putting in place steps that allows us to track those changes and ensure that interventions and initiatives, communication methods remain in step to allow and enable that conversation to continue.

Stephen: So, if I'm an employer and I want some of this good culture that you've just been talking about, I want that for my organisation. Obviously, I don't want a bad working culture because it will be detrimental to what I want to achieve. But where do I begin? What do I do?

Rebecca: Yeah, I think a lot of organisations feel that way, or certainly those that I've kind of encountered and undertaken some work with.

And it’s really people think that they need to start from scratch. And I think the first thing to think about is what do you already do? What do you already have? What information do you have at your disposal that you're naturally collecting anyway? So, we generally organisations will record sickness absence data.

They'll record, you know, reasons for individuals leaving their workforce. But ultimately, we need to start moving towards a more proactive approach and a preventative approach. So, they're very what I would call latent measures. So, they'll tell you that there's a problem after the issue has occurred and we want to start to move towards a situation where actually we can proactive, proactively identify the risks and the hazards and manage them off.

So, it's thinking about what data do you also have? So, trends from line managers, for example, periodically having a debrief with line managers across your organisation to go what seemed to be common, both in terms of things that are working really well, successes and celebrate those, but also then what seem to be common challenges across the patch.

What other data and metrics do you have in place? So, do you undertake a regular pulse check, for example, in terms of workers contentment within the workforce? And there's a number of, variety of different tools that you can utilise to do that. And I think the main thing for me when undertaking a pulse check is to try where possible to keep that tool the same whichever one you choose, because then you can track those ebbs and flows and changes over time.

But it's, it's really thinking about, as I say, what already do you collect that you can make better use of from a collation perspective? But also, then what could be an add on? What’s an easy win that you know? Do you already undertake or have it or have a system in place that engages with your workforce?

Can you add a question in there that's conducted on a regular basis that gives you a source of information? What else can you do to really try and track and evaluate? Because I think the problem that we've found consistently in in the evidence base when we're trying to collate the research in this field is what works in practice.

And quite often organisations will panic and do something and therefore, but they'll do lots of things in one go which makes it then very difficult to distil down what are the active ingredients. So, speaking to your workforce, ask them, have sort of lunch and learn sessions or forums that they can add suggestions, ideas and thoughts.

What are the levels of engagement with different training modules, maybe on a monthly basis that you put out? And to what extent are your support systems being accessed and used? What’s the rate of click throughs, for example? But that will tell you in part how much your workers are drawing on what you've already got in place.

And therefore, what's what people think are working and what they're utilising and therefore where you might need to bolster or where you could save your attention and redirect it into something more impactful. Because quite often ultimately when we undertake research in this field with employers, there's very little focus on the evaluation element of it.

It's the doing that gets the focus. Whereas if we think about, well, how are we going to evaluate and analyse whether this worked, What's our pre and post? How do we confirm that what we think we've implemented has had an impact and absolutely a positive impact? So, thinking about that at the very beginning when you're putting these things in place can be really helpful to then generate meaningful outputs that allow you to then evaluate has it had the desired result and are we moving in the right direction.

Stephen: And even break taking it back a step further before that, I mean in terms of the job itself, in terms of what someone does, because I mean, some jobs you can't avoid stress, can you? You can't avoid quite tough working conditions. I mean, what sort of options do employees have in those?

Rebecca: Yeah, absolutely. So, we've got the traditional emergency services, healthcare and the care sector generally are often a demand focused and that demand comes outside of the organisation. How many people are going to walk through the emergency doors this morning? But there's elements of that also the with a bit of co-design, so, what are the workers within those settings and sectors needing? What are their biggest pinch points and challenges? We need to prioritise. And therefore, it's all well and goods, you know, hypothetically creating a lengthy program for workers to sit through, but you've got to free up the time to enable them to participate in those things.

So, I'm a huge advocate of worker co-design for anything like that. So just take a sample and it doesn't have to be loads, but a subset of your worker population and diversely, if you possibly can do and get them involved, get them to trial before you roll something out.

Can they access the way the platform or the format that you're about to create it on? Does the timing of it land at the worst possible point in the day where the general peaks and troughs occur? So having that worker voice as part of the design process in terms of keeping it grounded and rooted both practically and also meaningfully in terms of what that worker population want and need.

Stephen: So, Rebecca, each episode we like to ask our guests for one take away, one thing they would like people to go away with and have from this conversation to take forward in this area, which is obviously a big area.

There's a lot to consider, but can we boil it down? Can we give them that take away?

Rebecca: It’s challenging, isn't it? But I think if I had to pick the main thing, I would say try and focus on the whole person approach. So, it's not sufficient to just focus on the physical risks, the physical habits, the health and safety.

We need to be thinking about the mental health, the cognitive stresses and those sorts of things as well. So, encouraging physical activity in the workplace, yes, but also how are we risk assessing for stress management and cognitive risks, ergonomic workplaces, the physical environment there and the impact of that on people's physical and mental wellbeing, those sorts of things.

And if I can be really cheeky and sneak a little extra one in too, I would say it's that shift, move more towards the prevention because in a lot of cases we're very reactive. Mental health first aid is someone's fallen over, how do we pick them up, brush them off and get them back into work?

Whereas actually how do we stop them falling over in the first place, which is, comes back, I've mentioned already, you know, those risk assessments both for physical and cognitive risks. How do we get that in place and then map strategies or interventions in a way that controls these hazards proactively, rather than waiting for someone to leave our workforce and then having the financial burden and time to then recruit to replace them?

Moving the agenda forwards proactively to think forwards about what we can do now to protect our workforce in the future.

Stephen: Well, thank you, Rebecca, and obviously thank you for spending time with us today and bringing this really big subject a bit more in focus.

And I think your passion certainly is evident and in your interest in this personally, but also the clarity and the precision with which you've talked about it today and the kind of ability you have to bring this to sort of really practical things that employers can do in action as a result.

So, thank you very much. It’s been, really, brilliant.

Rebecca: Thank you very much. Thank you for having me.

Stephen: Rebecca Canham, Principal Scientist at The Institute of Occupational Medicine.

Links will be in the episode description.