Saturday, July 13, 2024

Mind Your Health

It's May - Mental Health Awareness Month! Let's break the silence and shine a light on the essential aspects of our wellbeing.

Driving Mental Health Transformation: Insights from Christopher Prinz, an OECD Policy Analyst

Christopher Prinz is a prominent policy analyst within the Organization for Economic Co-operation and Development (OECD), who has dedicated parts of his career to addressing the critical issue of mental health. Christopher’s work at the OECD mainly focuses on the links between mental health, skills and work on a broad level, and the need for early action, low-threshold intervention and integrated types of approaches. With mental health issues steadily increasing, OECD recognizes that policy has a key role to play in retaining people with mental health problems in employment and helping them to perform at work, and in preventing mental illness at all ages including youth and adults.

Christopher brings a robust background in policy development, research, and advocacy to his role within the OECD. Drawing from extensive experience in both public and private sectors, Christopher possesses a unique understanding of the complexities surrounding mental health and the intricate web of factors that contribute to individual and societal well-being.

Having recognized the urgent need to address mental health as a central pillar of sustainable development, Christopher has played a pivotal role in shaping the OECD’s agenda, working collaboratively with member countries to design evidence-based policies and practical frameworks that promote mental health at various levels. His innovative approach combines rigorous research, international collaboration, and a deep understanding of the social, economic, and cultural factors that influence mental well-being.

With a passion for social justice and a firm belief in the power of data-driven decision-making, Christopher continues to work tirelessly toward bridging the gap between research, policy, and practice.

Today we are extremely honored and proud to share our conversation with Christopher and offer his valuable insights about wellbeing, the dire need for mental health competence across sectors, and how lifestyle changes can impact our overall mental health.

My first question is very relevant to what’s happening in the world right now. A few years ago, we were hit by a global pandemic – to say it was a tough time would be a mere understatement. As we recover from it, there are wars across the world, inflation, and all kinds of crises that are beyond individual control. For instance, the pension reforms in France have been stirring a lot of public protests lately and have been creating chaos and stress in people’s lives. Why are wellbeing and mental health still considered private matters to take care of? According to you, how can policymakers be more proactive, and what can be done so that the situation improves, and people can live a normal, happy life without stress?

It’s a very grand question to start. We’re definitely living in a period of crisis. But crises are also often an opportunity. The greatest opportunity I see from already starting back from the pandemic is a much larger awareness of the importance of our mental health. It’s very clear that the COVID pandemic very quickly turned into a mental health crisis. The data shows that the proportion of people reporting mental distress, symptoms of depression or anxiety, doubled overnight, and in some countries, even tripled. It was a real mental health crisis, and the good thing about that crisis was that it was really the first time that we spoke about mental health in a different way. It was the first time that countries started to collect data and evidence on this subject at large scale.

Actually, we at the OECD started to work on mental health more than 10 years ago. Working on pension policy and disability policy, we realized that the biggest barrier for policymakers in these fields is mental health. Disability claims due to mental health conditions exploded, and policymakers didn’t know what to do with it. The whole system, both the health system and the social system, was not prepared for and not geared toward mental health issues. That meant a lot of things needed to be changed, including building programs and access methods for people with mental health conditions. The systems were not made for that, and that was 10 years ago when we started working on the subject. One of the biggest problems we had was the lack of data. We knew so little about it.

There have been some significant changes in data collection during the pandemic. For example, in France, they started collecting data every second week to measure how the situation was changing. In other countries, data collection methods have also changed, but much of it has been maintained. This increased availability of data is crucial for better policymaking, as we cannot create effective policies without understanding the issues and evaluating the impact of different interventions. Although we are slowly getting into a better position, as you mentioned, new crises keep arising, and the challenges for society and policymakers seem endless.

I think the issue of awareness is very important as it allows us to actually talk about what the issue here really is. One of the issues that you mentioned was why mental health is considered a personal issue rather than a societal and government issue. I think that’s probably true for many other issues too. Yes, we also have our own responsibility for our health, whether it’s physical or mental health. We need to take care of ourselves by watching what we eat, exercising regularly, etc. However, there’s always a societal and public health perspective to consider when it comes to promoting healthy lifestyles. In particular, with mental health, awareness is so important because it’s such a stigmatized area. There’s a lot of stigma around mental health conditions and a real lack of self-awareness regarding one’s own mental health. That’s what makes awareness so important because it allows different actors in society and in the economy to identify mental health issues early on and be competent in addressing them. This mental health competence is incredibly important, not just in psychiatric hospitals, which are of the least concern to me, but in our daily lives and activities.

So, it’s extremely important to have high mental health competence and the confidence:

  • In schools, particularly for teachers.
  • In the workplace, particularly for managers and human resource departments.
  • Among welfare and employment service officers because many people who are looking for jobs struggle with mental health issues, which may be the main reason why they have difficulties accessing the labor market.
  • And in the health sector, especially among general practitioners and nurses.

The key is that there are many challenges around mental health. Some mental health conditions are very complex and require psychiatric care. But the large majority of health issues, including mental health issues and conditions, do not need such large-scale treatment. Even when people approach the health sector with a mental health concern, 80% of all cases are handled by general practitioners and no more than that.

However, in the past, we have seen that general practitioners have had almost no knowledge about mental health. It was not part of their curriculum in any country, and they only received maybe a two-hour course to get a hint of what it is. Therefore, awareness and competence in all these areas are so important that we can address mental health issues everywhere people are confronted with them, including students, workers, patients, and job seekers facing a mix of issues, including mental health issues, where we can help them early on.

Exactly, even though we are not clinically certified as mentally ill, many people in the workforce are struggling with depression or other mental health problems in today’s fast-paced world. In addition, untreated mental illness is growing. In fact, a report from WHO suggests that only 1 in 3 people with depression receive the care they need. So, awareness is definitely one of the crucial aspects here. What can policymakers and governments do so that societies at large are at ease, and not constantly stressed or burned out? Do you have any key policies that are being discussed or implemented that can help us in this regard?

The first thing that governments can do is to ensure that all the key actors actually understand the issue and have the competence to identify those issues that they need to address.

There are two aspects that we need to keep in mind. One side is the whole area of promoting good mental health and preventing the onset of burnout and other mental health issues. The other side is that when problems arise, we should be able to react very quickly. Of course, this goes hand in hand; it’s two sides of the same issue, but it still requires very different policies. And I think the mental health competence of a teacher, for instance, combines both aspects.

This means being aware of the situation in which children are under pressure and noticing when a child’s behavior changes, so that we can react quickly and seek professional support early on or start talking about it. We cannot let things slip through the cracks, as the lack of treatment is a huge difference between mental and physical health. Half of all mental health conditions go untreated, and typically it can take ten years from the first moment an issue is spotted until people receive the first real treatment. This is especially delicate when dealing with young people because it is not healthy to label someone with a mental health condition when they are 14 years old.

One of the big challenges with mental health issues is that they typically start very early in life, with every second mental illness having its onset during adolescence. This is why we need to act early when people are young. However, there is a dilemma because we want to avoid labeling someone with a mental health condition. Research shows that once you are labeled, your outcomes worsen due to the stigma and discrimination you face.

One of the possible solutions where policymakers can come in is ideally providing effective services to people without having to diagnose them. Very often, interventions depend on whether you have a diagnosis; once you have a diagnosis, we have all kinds of support to provide.

We want to offer low-threshold services without the need for a diagnosis to avoid labeling. Places like youth centers are excellent locations to provide such services, where young people can express themselves without the aim of talking to a psychiatrist or doctor. We need non-stigmatizing, free-of-cost, and easily accessible walk-in services that people can benefit from without going through a destructive diagnostic process.

Yes, I completely agree. I can share a real-life incident that relates to what you’ve just mentioned about non-stigmatizing solutions. A colleague of mine was suffering from burnout and wanted to address it and take a break from work. But the fear of being labeled as ‘mentally ill’ and the uncertainty of his future job prospects stopped him from addressing his underlying issue. 

This is a perfect example of the dire need to remove the stigma associated with mental health issues and make it easier for people to seek support without worrying about being labeled or facing negative consequences in their personal or professional lives.

People are scared to disclose mental health problems, often because they have had, or think they would have bad experiences when disclosing, and therefore they avoid seeking help. Even if you know about things like your colleague’s experience, you might still be afraid of disclosing, maybe for no reason. I think it’s also related to the fact that once you have experienced burnout, you never trust yourself again, which is a silly thing to do because mental health issues, just like other health issues, often go away with time. It’s not something that you necessarily have for life.

The term “burnout” is interesting because it’s not considered a mental health condition. Burnout is more acceptable to speak about because you can say “I’m burned out because I work so hard and I’m exhausted.” The truth is that most people who have a burnout actually have an underlying depression, which they might not want to talk about or are even aware of. The term “burnout” is a way to get around the stigma of mental ill-health. When you say you’re burned out – it doesn’t sound like you’re ill, but that you have worked hard and deserve a break. At the same time, it’s a good example of how workplaces exhaust people to their limits. We have not been sufficiently aware of the long-term impact of this.

That’s where policy comes in.

Employers do not bear the cost of their behavior. There’s a lot we can do as policymakers with better incentives and stronger responsibilities. For example, if a company creates all these individual and societal costs related to burning people out, they should bear these costs themselves. They will quickly see that this is not good workplace policy, and very expensive. Companies will realize that they do much better if they give people enough breaks and support them early. This increases both productivity and output of the company. However, this is not the case if they can simply get rid of these people once there’s an issue; this is not a sustainable solution.

Now, in this period where we see labor shortages in most sectors of the economy, something good is happening because it forces employers to be more careful with their workers. The labor shortages that we now see are not driven by the current crisis; this is a long-term structural issue. But it comes at a good moment because it might double up this shift towards a higher awareness of how important good mental health actually is for people’s performance. I’m always surprised because, for employers, it’s very easy to measure what they’re doing. They have data themselves to measure the absence rates and productivity of their staff because it’s not just people being absent more often; it’s also people being at work but not very able to work. This is also called presenteeism.

There’s a third element, which is turnover, and this is also very costly for employers. Good practice employers who are leading in this field, typically look at their data and realize that it economically makes a lot of sense to take care of their employees and do things differently. Not because they are such good-hearted people and want their staff to be happier, but because they want to run a good company with high economic output and high profits.

Companies can easily use data to leverage better outcomes. For instance, they can introduce some well-being programs or confidential support groups where an employee can turn to without thinking that they are disclosing information to their management. If companies put these things in place, they can very easily measure the impact in terms of retention rates, sick leave, presenteeism, and all that. They have the tools in their own hands.

The second aspect, when we talk about the workplace, is that a lot of issues come down to high-quality management. I think we have no idea really about how important management is to all that and how bad management is in place in most companies.

Yeah, I think what you mentioned about mental health competence, that’s also lacking across leadership and management.

This is very much part of that.

If there’s one thing that would change workplaces, it’s leadership and good management. This will make more difference than any other more specific wellbeing or mental health-related intervention because it is an overarching or mainstream approach that improves the situation for everyone. In the US, there’s better awareness of the importance of the quality of management. And there’s much more practice of actually hiring managers who know what good management is. In Europe, for a lot of companies, people who move into management positions have performed well in the jobs they did, but they’re not trained managers and often know little about what good management is about. The management task is often seen as a burden and not what they’re really looking for. So, people just stay in the job for 10 years and they’re like, OK, now let me become a manager even with no expertise in leadership. It’s a big mistake.

You have hit the nail on the head. The other day, I spoke to the CEO of Four Day Work Week Global, and he shared some insights on how healthy and happy employees not only boost productivity but are also good for businesses. It touches on the point that you just mentioned – it’s not that businesses are kind-hearted and generous to take care of their employees, but it’s good for their business too. It’s a win-win strategy.

Exactly because people have enormous potential to be more or less productive and to be more or less engaged with their work. There is not a lot of data, but some data suggest that the large majority of workers are not engaged at work. If you could fully engage them, you can get much higher productivity and much happier people.

Now I’d like to touch upon OECD countries, as Finland is known to be one of the happiest countries and consistently tops the World Happiness Index. Assuming the statistics are correct and Finns are the happiest people, what do they do differently than other countries?

However, I also have a counterargument to this. I shared a conversation with a happiness expert who shared statistics showing that Finns are not as happy as they seem to be. In fact, the Scandinavian countries have some of the highest suicide rates in the EU, yet these countries seem to be among the happiest countries in the world. So if they are not so happy, should we revisit the parameters we consider for happiness? What are your thoughts on this from a policymaker’s point of view?

To answer in a complex way, I have doubts about happiness measures and research. The data we use is not happiness indicators, but mental health and disability indicators, among other things. The Nordic countries are not necessarily doing so well on our indicators, and if you have been to Finland and talked to Finns, you might not feel like it’s a happy society. They often talk about themselves with relatively low self-esteem and consider themselves sad.

On the other hand, it’s worth discussing what these countries are doing well. One of the things that work is that they have more equal societies – there is lower wage and income inequality than in other countries. Additionally, higher taxation is accepted by the population in Nordic countries rather as there is a greater understanding that taxation is used for good purposes like childcare and elderly care. Whereas in other countries people complain about the taxes they pay. Their society has something which is very mainstream, like gender equality, for instance, it is much higher than elsewhere, and that goes through all areas of life, with implications for everything.

Also, society is designed in a way that doesn’t induce more issues, I guess. For example, the crime rate is relatively low compared to other countries.

Of course, there is a risk that the Nordics become like other countries because of globalization and international influence. For example, if they think they need to change things and increase productivity in the same way as the US does eventually things will have a negative impact. Unfortunately, it is getting more difficult for these countries to operate their own societal models because of the interconnectedness in the world.

So, should they re-evaluate and realign their policies accordingly keeping the consequences of globalization in mind?

It is important to be more aware of these comparisons to see what they have and not destroy that for no reason. That’s how they grew up, and they think it has to be that way. The rest of the general population is not aware that they’re quite special in almost all indicators because they don’t make these comparisons.

Yeah, they might think that’s how the world works. So perhaps they need to study themselves from a comparison point of view, and see what are they doing differently than others and maybe play on their strengths in the long run.

That is what the OECD as an organization does. We do comparisons across countries, and that is incredibly enriching because whenever you compare countries, you immediately realize new things. In every country there are, of course, some people who look into this, but generally, people don’t. Generally, people know about their own society, and think that’s how things are and that the next society over is working the same way. It’s rewarding to be part of the OECD mainly because there’s so much input we can give to other countries just by looking at what they are doing differently.

Every country can learn from any other country. There’s always something you can benefit from by seeing what others are doing. Even if the systems are very different, the questions that they try to address are the same. There are always elements that we can recommend adopting to other countries. You cannot copy another system because you have your own grown structures and systems that you cannot and don’t want to destroy. But there are always interesting elements you can bring in.

Can you share a recent success story in that regard? For example, a successful policy in one country, and later was also recommended or implemented in another country? Has anything like that happened lately?

It’s always challenging to find a policy that we can recommend because there is still very little evaluation of policies and their impact. Of course, in the mental health field, it is particularly difficult because it is a societal issue, making it challenging to measure the impact of one particular policy. It’s often not clear which outcomes you could possibly measure and really associate with a particular reform, rather than other things that may have happened in the same period. So, when we suggest that a particular policy seems like good practice, it’s a bit of a qualitative assessment on our side because we don’t have 100% evidence that the policy really delivered better outcomes.

However, let me give you an example. The UK is probably one of the leading countries in the mental health field, particularly in terms of understanding how health policy, employment policy, social policy, and working styles are connected; these are different worlds, but to address mental health, both in terms of promoting good mental health and early intervention when support is needed, we need to see them as one.

We cannot say, “Well, there’s a health issue, go to the health system.” The truth is that health interventions, employment interventions, and social interventions need to be integrated and provided at the same time. That’s very difficult for countries to do because they are structured in silos, and different institutions and stakeholders are responsible for health and employment.

For instance, it becomes a nightmare for a more integrated approach if, just as an example, social issues are dealt with by the municipality, health issues at the national level, and employment issues at the regional level.

And so, the pockets of good, successful policy stories for me are mostly where one of these sectors tries to offer a more integrated service itself. It’s almost impossible to bring all these people together all the time at these different levels of government. It’s important to have the understanding that if I’m an employment service, I also need to address social issues and health issues. This is part of my routine task. I cannot say to someone coming with some health issues; you go to your doctor, solve your health issues, and when you’re fully recovered, you come back, and I help you find a job. That’s an absolutely crazy approach. You need to address these health issues at the same time as you address any employment issues and maybe also social issues, right away. And as you cannot so easily connect with all the other systems.

For instance, we have seen good practices in private employment services in Denmark working with psychologists in the service itself. They were virtually hassle-free with mental health issues as they could address many mild/moderate issues themselves without even involving the health sector.

Another example is the UK, a country that really commits to implementing evidence-based practices. When it comes to mental health interventions, a well-studied and effective approach is cognitive-behavioral therapy (CBT). CBT is a short-term intervention typically consisting of six to ten sessions. Its focus is on behavior change to address challenges. The success of CBT led to its widespread implementation, but it was soon realized that integrating employment specialists into the service was crucial, especially considering its connection to employment. Therefore, the UK successfully ensured that individuals accessing CBT also received support from employment specialists. This integration proved to be a significant advantage.

I believe that in the case of your colleague who was burned out, he was afraid to report to the Health Department and seek help. If there was an integrated “one-stop” service, he could have received help for burnout or depression, such as CBT, while also receiving assistance to find his next job. This would have reduced his fear of losing his job and would have been very beneficial.

Of course, different people have different situations. Some may be experiencing more severe health problems and feel that they are unable to work. In such cases, doctors may suggest taking a few months off work. However, this is not always the best advice, as it can lead to a loss of contact with the working world.

Studies have shown that if you are absent from work for four or five months due to sickness, it is very difficult to ever return. Therefore, it is crucial for doctors to understand that while rest may be necessary, it is important to also speak with an employment specialist as soon as possible to determine if the current job is not suitable and find the right type of work. Acting immediately can prevent the person from being advised to do nothing for six months.

Perhaps being transparent about one’s health issues with the employer can be beneficial, but it requires careful consideration from the individual. If work-related stress is the cause, it’s advantageous for the manager or employer to be aware of it. However, if the stress is due to personal life matters, it’s not advisable to share that with them.

This raises another important issue. Most countries have a sickness policy where employees can take sick leave and obtain a sickness certificate from their doctor, which determines the duration of their absence based on country regulations. However, labor laws often prohibit employers from communicating with employees on sick leave, due to confidentiality and privacy concerns. Employers cannot inquire about the reason for the absence or address any potential work-related issues. This situation is counterproductive because it hinders communication when problems arise despite the signal provided by the sickness absence.

Confidentiality practices vary among countries, resulting in employers being unaware of the employee’s status during sick leave. There is a lack of information regarding their return date and their health details, which are rightfully protected. However, it would be valuable for employers to receive updates on the employee’s capacity to work, as often individuals on sick leave can still contribute to some extent. Maintaining contact is crucial because extended periods of non-communication increase the likelihood of prolonged absence. This policy is detrimental as it can lead to long-term health-related job loss, making it challenging to secure new employment due to skepticism surrounding prolonged absences. It is important to avoid this vicious cycle.

I want to talk about policies around maternity and mental health. Several working women suffer from Postpartum depression (PPD) after their pregnancies. And some of these women struggle to get back to their jobs or lack the necessary support to return to work and raise their children at the same time. As a policymaker, what do you think we can do to improve this situation and eventually achieve good levels of gender equality?

Well, I think this is a nice example of how all these things are linked together and need to be addressed together. We started talking about mental health, gender equality, and maternal policy, and this is correct because they are all interconnected. From the data we see, mental health issues are more prevalent among women than men, and it varies by country and group. It also depends on the extent to which these issues are disclosed. If we include substance abuse, men are typically overrepresented, whereas depression is more common among women, and some of it is related to childbirth, but not all.

I think this is a good example of where we need to take a holistic approach, and there are many other issues to consider. The fact that we still have very conservative societies where all the burden rests with the mother when a child is born, and the father doesn’t see much of a change in his career is one of the issues. Maybe he takes one week of paternity leave, but that doesn’t change anything. Suddenly the burden that the mother is facing is enormous, and all the childcare and parental leave policies are actually mental health policies. We generally need better policies in all areas so that we achieve better mental health outcomes on all fronts.

In some OECD countries, gender equality is high, and the quality and availability of childcare is also high. However, in other countries, there is no childcare available for children under age three, or if there is, it is unacceptable to the mother, who would rather take care of her child herself. There are so many maternal pressures that come in at the same time, apart from post-partum depression.

What is quite frequent is that many women experience a very short period after childbirth, which some can quickly get over, but others cannot. Unfortunately, this is another example of an issue that is not adequately discussed or addressed. It has both positive and negative aspects.

What is your personal advice to our readers from your experience or in general, so that they can be mentally healthy and improve their lives?

One critically important element is to speak to others. Don’t keep whatever problems you seem to struggle with to yourself. Find someone you can talk to, whether it’s a family member, a friend, or a professional. Ideally, if it’s an issue that you face at work, find ways to talk to your management, superiors, or line management, and at least initially, someone confidential, a service that hopefully your employer might offer. But seek ways to talk about it. Of course, you need to be self-aware and realize that there is something you need to talk about in the first place. But don’t avoid speaking about it because things will not necessarily go away, you need to find ways to address it.

Thank you so much, Christopher. This was so great and insightful, and we really appreciate the time that you took to share your thoughts with AlignThoughts. Take care!