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JICOSH Home > Guidelines > Guidelines for Promoting Mental Health Care in Enterprises (2000)

Guidelines for Promoting Mental Health Care in Enterprises (2000)
In Japanese

1. Purpose

Japan is now facing a drastic change in its economic and industrial structures. This change is expected to further accelerate, due to economic globalization, rapid progress in information technologies, and the trend towards a service-oriented industrial structure, leading to a fundamental transformation of the nation's economic and industrial structures. Aging of our society is also rapidly proceeding. On the other hand, it is observed that workers' mind about their works is changing and the forms of employment are being diversified. Under these circumstances, there is an increasing number of workers who claim to be suffering from misgivings, anguish and mental stress in relation to their jobs and working lives. It is much concerned that mental and physical burdens to workers are likely to increase because of qualitative changes in their working lives under the significant shifts in the economic and industrial environments.

The impact that mental health problems impose on workers, their families, enterprises, and the society as a whole is rapidly intensified in today's society. Therefore, it is an important issue to ensure the happiness of workers and their families as well as to implement actively the maintenance and promotion of workers' mental health in their workplaces from the viewpoint of the sound social development of our country.

This is a comprehensive guideline that provides the principle method of mental health care for the purpose of ensuring the adequate and effective implementation of basic measures which are desirable to be conducted by employers at workplaces. It is important for employers to begin with the measures that are practicable in a manner which is suited for the practical conditions of each enterprises.

2. Basic Concept of Mental Health Care

(1) Importance of mental health care in enterprises
A number of potential factors causing mental stress (hereinafter called "stress factors") can be found in jobs, working lives, households and local communities. It is important in promoting mental health for workers to recognize the existence of such stress factors and the necessity to deal with them by taking suitable measures (hereinafter called "self-care).

In offices or factories in which workers are employed, however, there are stress factors that cannot be eliminated by the workers themselves. Accordingly, employers must actively promote measures for mental health care in support of the efforts by workers. Well-organized and planned measures in enterprises always play an important role in maintaining and promoting mental health. The Industrial Safety and Health Law stipulates that "the employer shall make continuous and systematic efforts for the maintenance and promotion of worker health." Mental health care involves important activities to ensure the maintenance and promotion of worker health.

In order to promote mental health care activities at enterprises, it is important to fully understand from various viewpoints the aspects of stress factors at workplaces that affect mental health and try to improve these problems.

At the same time, providing workers with the proper knowledge of mental health plays an important role in resolving problems relating to mental health by encouraging voluntary participation by the workers themselves in consultation opportunities. Acquiring the correct knowledge is also essential for managers and supervisors in workplaces as well as in-house industrial health staff, etc., in promoting mental health, as they assume the responsibility for daily contact with workers.

Specifically, employers should take measures to accept claims brought by workers by setting up facilities for consultation and assisting in generating a friendly atmosphere for workers with mental health problems. Other important measures would include the structuring of networks with outside resources offering professional knowledge in mental health care, as these resources can be utilized for providing opportunities for education, training and consultation as well as in providing professional advice relating to workplace adaptation or medical treatment, or return to workplace after treatment if required.

(2) Precautions in promoting mental health care
Employers should consider the following matters in promoting mental health care measures.

(a) Specific nature of mental health problems
As objective methods to assess mental health problems have not been established even now, this makes the evaluation process very difficult. Moreover, the development process of mental health problems is also difficult to understand, as significant differences exist among individuals. We should also take note our own tendency to evaluate workers who have mental health problems from viewpoints other than health, despite the fact that mental health relates to every worker and potentially causes difficulties in their mental conditions. There are other problems that should be resolved, including a general misunderstanding of mental health.

(b) Consideration of individual worker privacy
It is important to carefully protect the privacy and choices of workers in promoting mental health care activities. In collecting and utilizing information on mental health, we should protect the confidentiality, as this is an essential condition to allow workers to participate in mental health programs with a sense of security and to enable mental health care measures at workplaces to be effectively developed.

(c) Relationship with personnel/labor management policies
The mental health of workers can be affected more significantly than physical health by various factors in personnel/labor management policies, including job assignments, job transfers, workplace organization, etc. In many cases, mental health care cannot be properly promoted without appropriate support through personnel/labor management policies.

(d) Problems coming from family or individual lifestyles
In many instances, the mental health of workers is affected by various problems that are not only work related, but also involve family or individual lifestyle issues. Personal character can be another important factor affecting mental health. These factors can relate to each other and interact, leading to a very complex situation.

3. Mental Health Promotion Program

Mental health care should be promoted in a continuous and well-planned manner on the basis of medium- and long-term perspectives. To this end, employers should use health committees to examine and clearly identify the current situation and problems relating to the promotion of mental health care at workplaces, and to establish a fundamental program (hereinafter called "mental health care promotion program") that details specific measures to resolve such problems in response to actual workplace conditions and needs.

Moreover, an effective way to promote a mental health care program is for employers themselves to express their determination to actively support such a program.

The mental health care promotion program should focus on the following objectives:

1) Measures to arrange a system to promote the mental health care at workplaces.
2) Measures to identify problems at workplaces and to implement the mental health care promotion program.
3) Measures to secure the human resources necessary to develop the mental health care promotion program and to utilize resources outside of the enterprise.
4) Measures to protect worker privacy.
5) Measures to take other steps necessary for mental health care promotion involving workers.

4. How to Develop Mental Health Care Activities

Mental health care activities can be developed only if the following four care activities are pursued in a continuous and well-planned manner:

* Self-care: workers should understand by themselves various problems relating to stress and mental health and take measures to prevent, reduce or treat such problems as necessary.
* Line care: managers and supervisors who have daily contact with workers should improve the working environment and consult with workers wishing to discuss their mental health.
* Professional care: Managers responsible for health management at workplaces should make proposals relating to the mental health care promotion program, promote the relevant activities and support workers and other managers and supervisors.
* Outside-care: Organizations and professional staff, etc., outside of enterprises should be utilized to support in-house mental health care activities.

In cases where securing the necessary human resources is difficult for small and medium-scaled enterprises, it will be effective to rely on outside resources.

(1) Self-care

(a) Providing education and training opportunities and information to workers:
Correct knowledge on mental health is essential for workers in conducting self-care activities. Employers should provide workers with education and training opportunities and information, including the following, to ensure adequate understanding of mental health problems.

a) Basic knowledge on stress and mental health care.
b) The importance of self-care and proper attitudes towards mental health problems.
c) How to recognize stress and related problems.
d) Methods to prevent reduce and deal with mental stress.
e) The importance of voluntary consultation with professionals.
f) Information on in-house consultation opportunities and outside resources.
g) Employer's policy on mental health care.

(b) Support for self-care:
It is important in promoting self-care to establish and improve in-house consultation systems that allow workers to discuss their mental health problems with managers or professionals. Accordingly, employers should establish in-house systems that can provide workers with consultation opportunities or employ outside organizations to listen to complaints or consult with workers. These arrangements can be effective in promoting an environment in which complaints from workers can easily be received and acted upon.
In addition, in order to allow workers to recognize mental stress as early as possible, it is desirable to provide workers with opportunities to check their mental health by conducting in-house stress-related surveys or providing self-checking systems through in-house LANs.

(2) Line-care

A. Promoting line-care systems

(a) Improving working environments
a) Targets of working environment improvements:
As there are a number of factors affecting worker mental health, it is necessary to improve them. These factors include the workplace environment (working environment, working methods, facilities and equipment to overcome mental and physical fatigue, and facilities and equipment necessary to improve workplace conditions), working hours, work quality and quantity, human relationships at workplaces, workplace organization and personnel/labor management systems, workplace culture and the climate in workplaces.

b) Evaluating working environments, etc., and identifying problems:
Managers and supervisors should identify and understand specific problems in the working environment, etc., through the results of daily workplace management activities and views expressed by workers or the results of working environment evaluation surveys related to mental stress that are conducted by in-house industrial health professionals using survey sheets.

c) Improving working environments, etc.
Managers and supervisors should make efforts to improve the working environment, etc., with respect to specific problems that are identified through daily workplace management activities.
Working environments should be improved by taking a wide variety of measures, including reviewing the working environment and working modes, enhancing manager/supervisor capabilities in coordinating human relationships in the workplace, and reexamining workplace organizations. The views of workers should always be respected in the process of working environment improvements. At the same time, listening to the advice and cooperation of in-house industrial health staff, etc., and outside resources are desirable in conducting improvement activities.
Improvement activities should be maintained in a sustained way to make various measures more effective by periodically evaluating the effects of measures and reexamining programs when the effects are not satisfactory.

d) Consideration given to individual workers:
Managers and supervisors should take into consideration each worker's capabilities, fitness and work contents by adequately understanding the daily labor burden on individual workers to prevent workers from suffering from excessively long working hours or heavy fatigue, onerous mental burdens or responsibilities.

(b) Consultation with workers
Managers and supervisors should make efforts to accept claims and requests from workers in the course of the daily activities at workplaces. In particular, they should try to listen to workers who are suffering from fatigue due to excessively long labor, those who have experienced serious events causing mental burdens, and others who require individual consideration. These workers should be provided appropriate information and opportunities to consult with in-house industrial health staff, etc., or outside resources or to undergo medical treatment.

B. Improving the environment to promote line-care activities

(a) Providing opportunities for education, training and information for managers and supervisors:
Employers should provide managers and supervisors with opportunities for education, training and information relating to the following subjects.
a) Basic knowledge on stress and mental health care.
b) The role of managers and supervisors and proper attitudes towards mental health problems.
c) Methods of evaluating and improving working environments, etc.
d) Methods of consulting with workers (how to listen to workers and provide information and advice).
e) Methods of supporting workers who have returned to workplaces with mental health problems.
f) Methods of maintaining communication with in-house industrial health staff, etc., and outside resources.
g) Methods of proceeding with self-care activities.
h) Information on in-house consultation organizations and outside resources.
i) Employer's policy on mental health care.
j) Considerations related to worker privacy.
k) Reasons for developing mental health care activities at workplaces.

(b) Support to managers and supervisors
Managers and supervisors at workplaces play a central role in taking such measures, including working environment improvements, consultation with workers and treatment of workers with mental health problems. Employers should understand and support activities by managers and supervisors by clearly indicating employers' policies on mental health policies at enterprises and measures to be taken for these policies.
At the same time, in order to smoothly promote line-care activities, employers should provide in-house industrial health staff, etc., with support in conducting the evaluation and improvement of working environment as well as taking measures for consultation. Managers and supervisors should also be provided with assistance from their employers to obtain the necessary information from outside resources.

(3) Professional care by in-house industrial health staff, etc.,

A. Promoting professional care activities by in-house industrial health staff, etc.,

(a) Improving working environments, etc.
a) Identifying and evaluating actual working environment conditions
In-house industrial health staff, etc., should identify and evaluate stress-causing factors at workplaces regularly or as necessary through workplace inspection tours, listening to managers and workers, and conducting inquiries via survey sheets on mental stress. In evaluating working environments, etc., it is desirable to pay attention to human relationships and the workplace organization by using checklists on working environments, etc.
b) Improving working environments, etc.
In-house industrial health staff, etc., should provide advice to managers and supervisors to improve working environments based on the results of working environment evaluation and make efforts for improvement in cooperation with managers and supervisors.

(b) Receiving consultation from workers and other assistance
a) Assisting workers to recognize mental problems and accepting claims:
In cooperation with managers and supervisors and utilizing working environment checklists, in-house industrial health staff, etc., should identify workers' stress and metal problems they are facing, help them find it, and provide services of health guidance and health consultation to them.
At enterprises where total health promotion measures (THP) are taken, assistance should be provided to workers allowing for the early recognition of problems through psychological consultation schemes by psychological consultants. In providing other guidance in THP programs such as physical exercise or health promotion guidance, it is also important to actively take up stress and mental health problems.
b) Guidance for workplace adaptation, medical treatment and return to workplaces;
In-house industrial health staff, etc., should assist workers suffering from mental health problems to enable them to adapt and return to their workplaces in cooperation with managers and supervisors. Health professionals should also provide workers with advice on the necessary medical treatment if professional treatment is required by introducing appropriate outside resources, while paying attention to the desires of workers. Guidance and assistance should also be provided to workers who have been absent from workplaces to allow them to return to their jobs in cooperation with managers, supervisors and outside resources.

(c) Creating and maintaining networks
In-house industrial health staff, etc., should play a central role in creating and maintaining networks between enterprises and outside resources.

B. Roles of in-house industrial health staff, etc.
In addition to the roles cited above, in-house industrial health staff, etc., have the following responsibilities depending on their assignments:

(a) Industrial physicians, etc.
Industrial physicians, etc., monitors the proceeding situation of measures implemented according to the mental health promotion program from the viewpoint of a person who has the responsibility of taking measures that require medical expertise among various measures to maintain and promote worker health, including the maintenance and control of working environments, health education, and consultation. They are also responsible for planning and implementation of education and training programs, collecting and disseminating information, and providing of advice and guidance as the providing services from the professional standpoint for the support of self-care and line-care activities. They should also participate in the coordination and liaison process with outside resources from the professional perspective for cases that require medical consultation and treatment.

(b) Health supervisors, etc.
On the basis of enterprise mental health promotion programs, advice and guidance provided by industrial physicians, etc., health supervisors, etc., should be responsible for the planning and implementation of specific education and training programs, the evaluation and improvement of working environments, etc., and creating the favorable atmosphere and system with which the consultation of mental health with workers can be easily conducted. Health supervisors should also assist in the promotion of self-care and line-care activities, identify problems in their implementation, and carry out liaison and coordination activities with outside resources in cooperation with industrial physicians, etc.

(c) Public health nurses and hygienists, etc.
In cooperation with industrial physicians and health supervisors, etc., public health nurses and hygienists should assist self-care and line-care activities, respond to consultation from workers and managers/supervisors, and plan and carry out the necessary education and training programs.

(d) Professional mental health staff
Professional mental health staff, if assigned at enterprises, should carry out the assigned work such as the evaluation and improvement of working environments, education and training programs and consultation.

(e) Personnel/labor management staff
As there are a number of problems that cannot be resolved by managers and supervisors alone, personnel/labor management staff should investigate the specific effects of job assignments, personnel transfers, workplace organization and other personnel/labor management policy matters with respect to the mental health of workers, and give consideration to the improvement of working conditions, including working hours, and appropriate job assignments for workers.

C. Arrangement of environments to promote professional care by in-house industrial health staff, etc.

(a) Education and training and information providing
Employers should provide in-house industrial health staff, etc., with opportunities to undergo education and training and acquire the necessary knowledge on the matters listed below, including specific job-related professional matters.

a) Basic knowledge on stress and mental health care.
b) Roles of in-house industrial health staff, etc., and proper attitudes towards mental health problems.
c) Methods of evaluating and improving working environments, etc.
d) Methods of consulting with workers (how to listen to workers and provide information and advice)
e) Methods of worker guidance to support their return and adaptation to workplaces.
f) Methods of maintaining communications with outside resources (network formation).
g) Methods of education and training
h) Methods of introducing outside resources and promoting their utilization
i) Methods of establishing plans and systems for enterprise mental health programs.
j) Methods of self-care activities.
k) Methods of line-care activities
l) Information on in-house consultation facilities and outside resources.
m) Employer's policies on mental health care
n) Consideration for the privacy of workers
o) Reasons why mental health care activities are needed at workplaces

(b) Assistance, etc., to in-house industrial health staff, etc.
Employers should clearly indicate their policies on the maintenance and promotion of mental health to in-house industrial health staff, etc., and consign or instruct them in performing such duties while providing the necessary assistance.

In accordance with actual conditions in their workplaces, employers should establish in-house organizations and systems in which in-house industrial health staff, etc. can respond to voluntary requests for consultation from workers.

Employers should also take the necessary measures to enable in-house industrial health staff, etc., to utilize outside resources.

It is desirable for large-scale enterprises and employers exceeding certain scales to employ professional mental health care staff in their companies or enterprises. Employers are also requested to ask the views of in-house industrial health staff concerning the job assignments of workers who have mental health problems, and to respect such views.

(4) Care by outside resources

A. Effective utilization of outside resources
Employers are requested to effectively utilize outside resources as necessary in promoting mental health care activities in accordance with their respective roles.
In particular, if small and medium-scaled enterprises have difficulties in securing the necessary human resources to promote mental health care by in-house industrial health staff, etc., it is effective to utilize the capabilities of outside resources in accordance with their respective roles, including regional industrial health centers, prefectural industrial health promotion centers, the Japan Industrial Safety and Health Association, and Rosai hospital worker mental health centers.

B. Network formation with outside resources

(a) Large and medium-scale enterprises
If needed in promoting mental health care activities, large and medium-scale enterprises should request the necessary information and advice from appropriate outside resources via in-house industrial health staff, etc. Networks with outside resources should be formed in advance to introduce workers to medical and regional health organizations when necessary.
Companies exceeding certain scales should employ in-house professional industrial health staff to promote mental health care activities in their workplaces.

(b) Small-scale enterprises
As small-scale enterprises employing fewer than 50 workers are often find it difficult to secure their own human resources for mental health, it is effective for them to utilize outside resources such as regional industrial health centers as necessary. In such cases, in-house health promoters or safety and health promoters should establish and maintain contact with such outside resources.