Awareness / understanding (stigma)
Increasingly there is a unanimous, across-the-board awareness by all the stakeholders (government, social partners, enterprises, OSH personnel and public opinion) of the importance of mental health at work. As a result of negotiations on the quality of life at work, awareness of mental health at work is more comprehensive and this issue is no longer treated merely as a risk but also at the level of the work organisation itself. Moreover, it is noted that occupational health issues are now linked to public health issues.
Although the definition of psychosocial risks still remains vague, tools and methods are nevertheless available to monitor them, and plans and agreements have been adopted at the national level to encourage enterprises to take into account these risks. The following are mentioned, for example:
• The existence of national indicators
For example, the work performed by the expert committee (“collège d’expertise”) on the statistical monitoring of these risks, chaired by Michel Gollac (2011), made it possible to establish an initial overview of psychosocial risks at work in France, and propose national indicators to monitor six types of factors of psychosocial risks at work.
• Signature of national interprofessional agreements on work-related stress, harassment, workplace violence and the quality of life at work
The signature of these agreements shows the vitality of social dialogue in France and the will of the social partners to deal with this subject.
The 2010 – 2014 Occupational Health Plan of the Ministry of Labour, in which psychosocial risks are a priority.
• Nation-wide surveys
Several coming surveys will include a specific section on psychosocial risks (survey of working conditions, SUMER survey, etc.). The INSEE will also carry out a major survey on psychosocial risks in 2015, which will fit in between the surveys of working conditions carried out every seven years.
• The national network for vigilance and prevention of occupational diseases (“RNV3P”)
The national network for vigilance and prevention of occupational diseases (“RNV3P”) is an occupational health monitor-ing and prevention network which covers the 32 occupational disease consultation centres (“CCPPs”) in mainland France and a sample of occupational health services associated with the network.
Dissemination of good practices in enterprises
Numerous tools and brochures are available for enterprises, provided in particular by the ANACT and INRS.
However, the benchmark for all the players remains the website created by the Ministry of Labour entitled www.travailler-mieux.gouv.fr.
This site contains a large quantity of information on psychosocial risks and proposes tools intended in particular for small businesses to help them better understand psychosocial risks. This work is the result of collaboration by a working group set up and coordinated by the Ministry of Labour (Labour Department), involving the main OSH organisations. The “Faire le point” (“Review”) tool, developed by the INRS, allows enterprises to try to determine the presence of PSR or not by answering about forty questions. It provides keys for understanding and paths of action for prevention.
Mental health care system
The case management of sick employees by healthcare professionals is good. Employees affected by mental health problems can be identified by the occupational medicine department and then taken charge of by the health insurance organisation.
The establishment of a consultation network for victims of suffering at work in the consultation centres on occupational diseases is also a step forward, although there is not yet a sufficiently large number of these centres.
The network of industrial doctors, occupational risk prevention personnel and inter-company occupational health ser-vices can take charge of sick employees.
There are also support measures for sick employees in the form of therapeutic part-time work, financing for the adapta-tion of work staadapta-tions, or again measures for support and listening to sick employees.
However, the problem has still not been addressed for self-employed workers, who are hard to identify and include in this system and for whom a mental health problem has a major impact, because their family, their business and poten-tially their employees may be affected.
Implementation of OSH standards
The legal framework relating to mental health at work in France is rather controversial. Some find that it is not sufficiently precise and constraining for enterprises. Moreover, the sanctions in the event of companies’ failure to comply with their obligations are not very dissuasive.
The role of the committee for health, safety and working conditions (CHSCT) in psychosocial risk prevention is therefore emphasized by various players. In companies with more than 50 employees, the employer must present to the CHSCT a
written report reviewing the general situation with regard to health, safety and working conditions, and a programme for prevention of occupational risks and improvement of working conditions. In companies without a CHSCT, the employee representatives duly have all the responsibilities of that Committee.
In the event of a serious risk detected in the company or a major plan to change health and safety conditions or working conditions, the CHSCT can call on an authorized appraiser. The CHSCT can also take legal action when occupational health and safety law is not complied with by the employer.
This power of the CHSCT is appreciated, especially the possibility of calling on an expert appraiser outside the compa-ny. However, there are those who request that a reform of the CHSCTs be carried out in order to further reinforce their responsibilities.
Intersectoral cooperation (health and labour)
The existence of networks and good cooperation between the various stakeholders is therefore noted both at the na-tional level (between the Ministry of Labour, the ANACT and INRS, for example) and at the level of territorial networking between the Labour Inspectors, the network of pension and occupational health insurance funds (CARSATs), occupational health services and “Aract” organisations for working conditions.
However, it should be noted that there are no measures concerning mental health at work in the current 2001 – 2015 mental health plan promoted by the Health Department in the Ministry of Social Affairs and Health. Moreover, for the Ministry of Labour’s 2010 – 2014 Occupational Health Plan, the Ministry of Health was not involved in its preparation or as a partner for the planned initiatives.
In the case management of sick employees, it is also noted that there is very little interaction between the various play-ers: the family doctor, occupational doctor, human resources, OSH personnel, etc.
GERMANY
Joint Action on Mental Health and Well-being:
Mental Health at the Workplace
PROMOTION OF MENTAL HEALTH AT THE WORKPLACE
prepared by
• Brigitte Müller, mediCONcept, Wuppertal
• Dr. Gregor Breucker, Karsten Knoche, Dr. Reinhold Sochert,
BKK Dachverband (BKK Federal Association of Company Health Insurance Funds)