Key learning

4.1. Level of agreement concerning the most efficient / effective practise 

Members of national working group discussed different areas of great influence on effective mental health promotion at worksite. Assessment of these areas can be recapitulated as follows:

• legislative framework: The Mental Health Act introduced new possibilities for comprehensive and intersectoral care for active population, but the concrete programme and activities are still to be defined by special sublaw (resolution on national programme on mental health) which is still in the process of acceptance. The renewed Health and Safety at Work Act brings into force health promotion at worksite as employers’ obligation. How-ever the health promotion at worksites is still not a unique and standardized concept. According to the Act the guidelines will be prepared by the MoH. Mobbing (including measures and activities for prevention) is adequately defined by the Employment Relationship Act and Health and Safety at Work Act.

• awareness / understanding (stigma): In Slovenia mental disordes are still excessively connected with stigmatisa-tion – especially at worksites. People with mental disorders have troubles with their employability, easier loss of their jobs and are frequent victims of workplace bullying. Professional assistance and education of employers, changes in working environment and organisation of work as typical health promotion intervention are of greatest importance.

• business cases and the need for dissemination of good practice in enterprises: Recent evaluations of different trainings and seminars reveal the fact that employers would like to be informed about models of good practice.

In Slovenia there are several – for example those identified within the project called Mental health promotion at worksite (MentHealthWork): in DOMEL (company in Železniki) and HEALTH RESORTS (Radenci).

• mental health system: The most widespread internal activity in enterprises in Slovenia are different (educational) courses about stress at worksites where the responsibility for mental health is too much imposed to individu-als and their individual stress management. Only few interventions are devoted to working environment which should support mental health of workers. Only rarely do employers have a system to support workers with mental problems or to support workers who are back at work after long sickness leave due to mental problems. Again the understanding of health promotion and the standardised concepts for employers are of great importance. This refers to the role and knowledge of occupational medicine practitioners, too. Changes in the traditional functions and role of medical occupational medicine specialists and occupational psychologists in working ability surveil-lance and assessment of psycho-social risks of the worksites are needed, too.

• business cases and the need for dissemination of good practice in enterprises: recent evaluations of different health education and health promotion approaches expose the fact that employers want exchange known best practises in these fields overall. In Slovenia there are some utility models of good practise – for example mental health promotion at worksite (MentHealthWork) in DOMEL (company in Železniki) and HEALTH RESORTS (spa in Radenci).

• mental health system: The most widespread internal activity in enterprises in Slovenia are different (educational) courses about the stress at worksite where the responsibility for mental health is too much imposed to individ-uals and their individual stress management. Only few interventions are devoted to working environment which should support mental health of workers. Only rarely do employers have a system to support workers with mental problems or to support workers who are back at work after long sickness leave due to mental problems. Again the understanding of health promotion and the standardised concepts for employers are of great importance. This refers to the role and knowledge of occupational medicine practitioners, too. Changes in the traditional functions and role of occupational medicine specialists and occupational psychologists in working ability surveillance and assessment of psycho-social risks of the worksites are needed, too.

• implementation of OSH standards in relation to mental demands: New legislation demands from employers to add new assessments of psychosocial risks to traditional safety statements. However in Slovenia these assess-ments are still “too technical” (prepared mostly by safety engineers). In revisions of risk assessassess-ments psychosocial risks are identified and evaluated. It is important that new risk assessment tools or applications (in Slovenia there are a lot of efforts to adapt and promote OIRA application for small enterprises) should include comprehensive understanding of mental health promotion interventions.

• cooperation between health and labour sector: In Slovenia the cooperation between health and labour sector is not optimal. This refers to the processes of drawing-up legislative changes, organisation and financing of activities, where both sectors should closely cooperate. Partially certain activities in the field of workplace health promotion are taken over by the MoLFSAEQ, the Labour Inspectorate of the Republic of Slovenia and the Health Insurance Institute of Slovenia. A good example of cooperation is also the National Network for cooperation with European Agency for Health and Safety at Work (EU-OSHA) which is coordinated by MoLFSAEQ, i.e. the Slovenian Focal Point of the EU-OSHA.

• knowledge development: The knowledge and concept of workplace health promotion has been intensively devel-oped and expanded only in last decade. The most comprehensive educational programme is implemented within

“Fit for work programme” (performed by Clinical Institute of Occupational, Traffic and Sports medicine of Ljublja-na University Medical Centre). It is expected that the new legislative obligation of employers to perform health promotion at worksite will represent strong push to further development. For example in the year 2012 new educational programme for worksite health promotion within the specialisation of occupational medicine was prepared (in cooperation with international experts). Workplace health promotion is also a part of future training for nurses specialized in occupational health.

4.2. Level of agreement concerning the most relevant needs for improvement

At the second meeting in October 2013, members of the national working groups harmonized specific positions on the assessment of the situation and development prospects and adopted final recommendations for further actions in the field of health promotion, which cover major challenges for further development in both areas, which were the subject of the SWOT analysis (measures to promote mental health and support for the already affected workers).

Final recommendations were as follows:

1. In Slovenia, it is necessary to establish a uniform intersectoral development strategy (national programme) re-garding promotion of mental health at workplaces, which should:

• result from a detailed situation analysis regarding behavioural and mental disorders in the workplace and regard-ing implementation of existregard-ing programmes and projects for the promotion of mental health in the workplace;

• identify recommendations or solutions for various stakeholders – for general measures of promotion of mental health in the workplace and measures to support workers, who are already affected by behavioural and mental health, whereby it is necessary to strengthen the role of the occupational medicine provider and the role of the coordinator of activities in returning workers to the workplace;

• include protocols of mandatory inter-ministerial cooperation for individual measures and activities;

• provide trans-sectoral harmonized financial resources for projects, which will cover the field of mental health in the workplace and which will enable concrete programmes of promotion of mental health in companies;

• enable a continuous (analytic or research) monitoring of the implementation of the objectives.

In order to ensure specific grounds and decision-making to establish intersectoral development strategy, all relevant parliamentary committees and governmental bodies should be informed with the present situation in the field of mental health at workplaces and with labour issues and adapted employment for people with mental disorders.

In the preparation of the programme representatives of all key stakeholders in the field of health promotion at workplac-es should take part. National working group should be nominated by the Government.

2. In Slovenia certain effective programmes of promotion of (mental) health in the workplace are already being imple-mented. To ensure such programmes would not exist only in a few certain companies, it is necessary to establish a system for their systematic distribution among all economic operators with an appropriate taxation treatment of financial contributions of employers and the introduction of differentiated contribution rates for employers.

3. In Slovenia, it is necessary to carry out a relevant national campaign or systematic activities of information and education, which will sensitize and train various stakeholders, particularly employers, for the issues and the importance of promoting mental health in the workplace and measures for workers who are already affected by behavioural and mental disorders.

4. Because the government in Slovenia does not have a specially designed development vision regarding health of the (active) population, it is necessary to include measures for preserving (mental) health of workers (“survivors”

and dismissed workers) into measures and activities for restructuring or restart of the economy.

5. Regarding better care for the already affected workers, the following measures are essential:

• establishment of a highly adaptable system of patients returning to the work process after a long sick leave,

• establishment of flexible options to carry out works for people with disabilities (work at home, work on the com-puter etc.

• introduction of the care of employers for people with disabilities as a value or quality standard / excellence of the company

At the second meeting, members of the national working groups also unified views regarding the selection of models of good practice in the field of mental health in Slovenia, which are promising for dissemination in both domestic and in-ternational environment. Members of the national working group got acquainted with specific programmes and projects of promotion of (mental) health29 , implemented in workplaces in Slovenia. Those are the following programmes and projects:

• programmes and projects co-financed by the Ministry of Labour, Family, Social Affairs and Equal Opportunites of the European Social Fund (public tender for co-funding of projects of social partners in improving the working environment, 2010 – 2012)

• programmes and projects by the Health Insurance Institute of Slovenia (public tender for co-financing of pro-grammes and projects for the period 2011 / 2012)

• programmes and projects carried out by various institutions for public health in the promotion of (mental) health in the workplace

• programmes and projects carried out by various institutions for public health in the field of mental health for the general population

• programmes and projects carried out in the field of social entrepreneurship, so called cooperatives

Information compiled from the Statistical Yearbook of the Republic of Croatia 2012 (bilingual; Croatian and English) http://www.dzs.hr/Hrv_Eng/ljetopis/2012/sljh2012.pdf

Information compiled from the Croatian Health Service Yearbook 2012 (bilingual; Croatian and English) http://www.hzjz.hr/publikacije/00_2012_WEB.pdf

Information compiled from the Statistical Yearbook of the Republic of Croatia 2012 (bilingual; Croatian and English) http://www.dzs.hr/Hrv_Eng/ljetopis/2012/sljh2012.pdf

Information compiled from the Croatian Health Service Yearbook 2012 (bilingual; Croatian and English) http://www.hzjz.hr/publikacije/00_2012_WEB.pdf

Sectors to which individual stakeholders belong are marked by text in italics under each point.

29 For this purpose, a special list or review of programmes and projects of promotion of health in the workplace was prepared and is available in Supplemenmt 4 of this document.