In this video, we will continue talking about prevention but this time referring to those prevention strategies that can be thought of by employers and implemented within organizations. You may have heard of health and safety at work prevention programs that many companies run. These programs are aimed at preventing the occurrence of accidents at work and some specific diseases that are related to certain professional activities.
These programs follow current legislation guidelines. In the case of mental health, we can also think about this prevention program format in the same way as with other diseases, in other work situations. However, what we observe is that the initiatives regarding these mental health prevention programs are still very punctual, and very few.
And many of those that exist, lack consistency, systematicity, and continuity. Either they are punctual, that is, they don't have a broader program and use strategies that are very scattered, or else these programs are not broader programs that encompass the various factors involved in harmful situations to mental health. What do I mean by that?
Mental health prevention programs, in general, often end up including only actions aimed at individuals, at workers. And these actions, most of the time, have the objective of implementing changes in the behavior of these workers. For example, equipping them to deal better with stress, to reduce or manage their stress individually.
That is, these programs end up being very concentrated on acting on the effects that result from harmful work situations and end up failing to focus on the very harmfulness present at work. Thus, there is an attempt to modify behaviors without, however, intervening in what somehow, within the work context, is causing this suffering or this mental illness. So, it is clear that acting on these effects is important, equipping these workers to deal with stress is very important, but it is not enough.
So, these programs must also include the identification, analysis, evaluation, and intervention in those harmful factors present in work processes. Therefore, I would say that for these programs, to be truly effective, need to involve not only, strategies that promote transformations and changes in workers’ behavior, but also involve strategies aimed at changing the work contexts in order to minimize the risks, minimize those psychosocial risk factors that represent harmfulness at work, and so, consequently, you also lessen the effects of this harmfulness to the workers. Another aspect that needs to be emphasized is that these programs should not be carried out in just any way, or in a voluntaristic fashion.
As is done with other work-related illnesses and injuries, there needs to be a process containing several well-structured steps so that you can, in fact, identify and evaluate the points that need to be worked on based on very well-established parameters and criteria, and then, be able to plan these prevention activities and strategies. Regardless of what the assessment about the psychosocial risk factors that represent work-related harmfulness may be, the literature and studies have already shown that these prevention programs must take into consideration the promotion of some factors that greatly favor work-related mental health. What are these factors?
Psychosocial support, collective spaces for debate and reflection on work processes, and also, more democratic processes enabling workers to have a greater autonomy over their work. And what are the steps of this process of creating a mental health prevention program? There are basically four steps.
The first one is diagnosis. The second one is planning. The third is implementation.
And finally, we have the evaluation of the actions. Remembering that these steps are cyclic and dynamic. Therefore, this diagnosis needs to be permanent.
This planning needs to be permanent. This evaluation needs to be permanent. The idea is for these programs not to be occasional or sporadic, but to be present as a policy of this organization aimed at workers' mental health.
So, let's now see how each of these steps takes place. In the diagnostic stage, first, it is important to define who will participate in the diagnosis. It is important to compose a commission or a committee that will be responsible for conducting all diagnostic activities.
It is important that this commission not be composed only of managers or specialists in people management or occupational health and safety, but that it can also be a space in which the worker is an active member and has the possibility of talking about their experience, about the know-how they have accumulated from their daily work routine. Therefore, a commission needs to ensure the workers’ participation, because it is assumed that the workers are the ones who know most about their work, and the knowledge they have about the workplace, about the task, about the processes is fundamental for the success of the programs. Based on this definition, it is also important to think about what the scope of the program will be.
Will this program be aimed at the entire company, or will some sectors be prioritized? And, which sectors are more problematic and perceived as requiring more attention? Once this has been defined, it is important to outline the profile of these sectors in order to work on them.
What is this profile? It is detailing its characteristics, who are the people who work there, what is done there? It is characterizing the place We are talking about.
Having done this, it is possible to assess the work situation. This assessment will focus on an analysis of the physical work environment; It will also focus on the work organization, the content of this work, what is done, what this work requires, and also aspects of interpersonal relationships. To perform this diagnosis, we can use a variety of instruments or tools.
Interview the workers; Conduct polls and questionnaires; Talk with groups of workers; Promote reflection groups or use focus group strategies; Observation of the workplace is also very important to better understand the daily routine; And, ergonomic work analysis. So, there are a series of relevant tools that can be used for the purpose that has been stipulated. Once the diagnosis is made, it is possible to identify what needs to be worked on.
Then it's time to plan the interventions. Once again, at this point, it is important to define who will participate in this planning stage, always remembering that it must of course be conducted by technicians and specialists in the area of health and safety, but must also include the participation of workers from different sectors of the organization. So, it is important to think about which strategies and interventions are possible in the face of the problems, and the issues that were identified in the diagnosis.
And it is important to remember that for all these strategies, it is essential to set goals and also, what activities will be done to achieve each of the goals. Once that is done, it is time to communicate and publicize this program to the broader set of workers. This step is very important, and it is essential that it is done well, that people understand what the objective is, and what it proposes.
Because the more transparency there is, the better the strategy is understood, and the greater the possibility for workers to engage, contribute, and adhere to the proposal. An important part of this intervention project is the forecast of a moment to evaluate the actions. It is important to stipulate after how long these interventions will be evaluated to find out if they were successful in what they proposed, and to find out if the situation that was identified in the initial diagnosis has changed in any way.
So, it is important to make this assessment, and to make this assessment, it is necessary to use some indicators. These indicators can be very diverse, they can be indicators of participation, they can be process indicators, but there are some indicators which are very good indicators of the success of a prevention program. What indicators are these?
The number of sick leaves; an assessment of general health conditions; the productivity, and the satisfaction of the worker; and whether or not there was a reduction of failures or losses in work processes. These are interesting indicators to be used. And an important thing to think about when we are designing this intervention, this program, is that there are levels of intervention that need to be thought about.
I will talk to you here about four levels of intervention: the organizational level, the group level, the individual level, and the issue of rehabilitation. When I talk about interventions at the organizational level, I'm talking about that level that refers to the work organization. And some examples of what can be thought of as strategies will include: the improvement of communication processes; the development of prevention programs for various issues that can be identified; restructuring, redesigning, and remodeling workstations; a clearer definition of the functions of each worker, and the implementation of a reward system that is fairer and more transparent.
These strategies depend, to a considerable degree, on the decision-making power of managers within the organization. At the group level, we can think of strategies such as strengthening social bonds between work groups and teams; fostering healthy interpersonal relationships; promote training, and disseminate information considered to be important. At this level of intervention, we can involve managers, workers, and also the team that is responsible for health and safety within the organizations.
At the individual level, we can think about offering training, to better equip workers in problem-solving, and conflict resolution; developing better assertiveness; stress management training; and also, on how, for example, to disconnect from work after the workday is done. These strategies can also involve both managers and workers, as well as the organizations’ health and safety teams. And finally, we also need to foresee in this program, strategies aimed at the rehabilitation of workers who are already ill.
This is indicated in those cases in which mental illness has already been verified. These rehabilitation strategies include psychological support, counseling, support in processes of reintegration or re-adaptation to work. And this can be done by the health teams responsible for the health and safety issues.
A fundamental principle that must be observed across all these intervention levels is the guarantee of the workers’ participation in the process, so that this health and safety program is a reflection of a broad debate between the expertise of specialists, and the knowledge of the workers’ experience. The third prevention strategy refers to the diffusion of knowledge about the factors that generate work-related mental illness. There is a teacher called Edith Seligmann Silva, who is also a psychiatrist and has been working for many years in the area of work-related mental health, and she says that one of the challenges facing all the professionals who work in the field of work-related mental health, is what she calls the educational challenge.
What would that be? She says that in addition to listening, observing, and carefully apprehending all the knowledge that the worker has about their work, it is also necessary to build with that worker, another knowledge, other basic knowledge about those factors that are harmful to their health, and that result from the conditions to which these workers are exposed. And she says this is extremely important because this knowledge is often deliberately denied to the worker.
And why is it denied? Because if workers don't fully understand the reasons, conditions, and the determinants of their illness, what conditions will they have to intervene, claim their rights, or fight for their right to health? So, from the perspective of guaranteeing workers’ rights, the expansion of the fight for health, the construction of this knowledge, the dissemination and disclosure of these notions about these factors that are involved in mental illness, is an essential tool for empowering workers and strengthening these groups.
And in the case of mental health, I would say we have an additional challenge. Why? Because mental health issues, are still very unfamiliar to the general public, and these are very complex issues.
In addition, many stigmas, taboos, and prejudices with regard to mental health still persist today. Therefore, it is important to discuss, to talk more and more about work-related mental health. I think this is part of the educational challenge that Professor Edith Seligmann Silva proposes.
She invites us to talk about what mental health is, about what it means to have a mental disorder, and what is related to this mental disorder. So, it is necessary to deconstruct taboos, deconstruct the prejudices that involve mental illness. It is also necessary to recognize the size of the problem.
Nowadays, what we observe is a sharp increase in mental health issues, which impact work absences and leaves, and the increase in social security benefits. It is important for us to remember that there is a regulatory standard, which is the NR 01, in which it is established that it is the employer’s duty to inform the workers about: any existing occupational risks in the workplace; The control measures adopted by the company to reduce and eliminate these risks; The results of medical exams, and complementary diagnostic exams to which the workers have been submitted; The results of environmental assessments carried out in the workplaces. Not everyone knows this, and it is crucial that in our interventions, we think about how to get this information to the workers.
Employers are not the only ones who carry this responsibility. Public authorities also have this responsibility, and various public policy sectors can also contribute. Here we can cite the example of the health sector, at all levels of care.
From primary care, to specialized care, and emergency services. Everyone can contribute to promoting, sharing, and disseminating information about work-related mental health. Another example from the public sector is the Ministry of Labor, which, by the way, already does a very interesting job in terms of disclosing information, which aims at promoting guidance and building knowledge on occupational health.
Another player I consider to be important in this process is the labor union. The labor unions are the entities that represent the interests of the workers, therefore, they are very close to the workers, and they have direct access to the workers. Therefore, they occupy a strategic position.
So, unions need to be equipped with knowledge in this area in order to be able to work with their bases later on. And finally, another participation, which is also very important, is the participation of higher education institutions. It is in these institutions that much of the knowledge that is later used in the area is produced.
And the university has much to contribute to the strengthening of these worker collectives. This can be done by proposing research and intervention projects, extension projects, and internship projects, that can be an initiative of the educational institutions themselves or might be demanded, either by labor unions, or by public policies, and public services sectors to form a partnership and work on these issues of information on work-related mental health. So, we have seen that there are several sectors that can contribute to mental health prevention through the production and dissemination of knowledge about work-related mental health.
That's it for now.
