Six resources to prevent work-related mental illness

In France, work-related men­tal health issues are on the rise, with fig­ures doub­ling between 2007 and 2019, accord­ing to Santé Pub­lique France. Anxi­ety and depress­ive dis­orders top the list and, in the most ser­i­ous cases, range from burnout to sui­cide¹. There is also a marked gender inequal­ity among these dis­orders: in 2019, 6% of women were affected, com­pared with 3% of men. This is a pub­lic health issue that is not suf­fi­ciently recog­nised as an occu­pa­tion­al health problem.

A psychoso­cial risk (PSR) is expos­ure to occu­pa­tion­al factors which, through repe­ti­tion and amp­li­fic­a­tion, lead to “decom­pens­a­tion”, i.e. psy­cho­lo­gic­al deteri­or­a­tion in indi­vidu­als. People who are exposed to poor work­ing con­di­tions over a long peri­od of time may devel­op inap­pro­pri­ate cop­ing beha­viours, such as addic­tion to alco­hol or drugs, or exper­i­ence burnout. In 2011, a pan­el of experts com­mis­sioned by the French Min­istry of Labour pro­posed a clas­si­fic­a­tion of PSRs, which is now con­sidered reli­able and serves as a frame­work for effect­ive pre­ven­tion². This grid com­prises six main cat­egor­ies, the con­tent of which is reg­u­larly updated to take account of new risks (Table 1).

As such, meth­ods exist to dia­gnose these risks with­in organ­isa­tions³ and thus pre­vent them. These strategies con­sist of ensur­ing that people avoid exper­i­en­cing these over­whelm­ing situ­ations. Bey­ond the prob­lem and the risk itself, it is more import­ant to focus on the approach to be taken and there­fore the atti­tude to be adop­ted to address the issue. This atti­tude cor­res­ponds to a skill that can be developed by cul­tiv­at­ing what Yves Clot, pro­fess­or emer­it­us of occu­pa­tion­al psy­cho­logy at the Con­ser­vatoire Nation­al des Arts et Méti­ers, calls “Psychoso­cial Resources”⁴ (Table 2). These cor­res­pond to the con­di­tions for a job to be done well and dif­fer­en­ti­ate between being tired from mean­ing­less work and the “healthy tired­ness that comes from a job well done”. On this basis, we will review each of the risk factors and show which psychoso­cial resource enables a pos­it­ive approach to work, when the con­text allows.

Have you ever found your­self absorbed in a demand­ing activ­ity, so inves­ted in it that you couldn’t think of any­thing else? Time no longer mattered, everything flowed smoothly, and your con­cen­tra­tion was at its peak? This state of total con­cen­tra­tion has a name: it is called “flow”. It is an optim­al psy­cho­lo­gic­al state in which you are com­pletely immersed in an activ­ity, with a feel­ing of fluid­ity, intense con­cen­tra­tion and pleas­ure in express­ing your skills. In this case, the intens­ity of the work is entirely bear­able, it is accom­pan­ied by motiv­a­tion rather than stress, and it brings the sat­is­fac­tion of a job well done.

Thanks to stud­ies in occu­pa­tion­al psy­cho­logy, the factors that pro­duce “flow” have been described:

1. Hav­ing a chal­lenge to take on while know­ing that you have the indi­vidu­al or col­lect­ive skills to meet it.
2. Hav­ing clear object­ives and rap­id feed­back, for example from your manager.
3. Not being inter­rup­ted and hav­ing the means and flex­ib­il­ity to carry out the activity.

Work intens­ity is there­fore not a psychoso­cial risk in itself as long as it is car­ried out under favour­able con­di­tions. But remove these con­di­tions and add irrit­ants such as fre­quent unex­pec­ted inter­rup­tions, unso­ci­able hours, a lack of feed­back and eval­u­ation of the work done, unlim­ited ver­sat­il­ity, a lack of recov­ery time, etc. the psychoso­cial risk becomes real and inevitable.

Many of us have exper­i­enced those moments when our body speaks to us and tells us to “stop”, even though we have had no warn­ing signs. For some, it hap­pens too late, and the body sud­denly and viol­ently gives way: the accu­mu­la­tion of these small addi­tions ends up weigh­ing more heav­ily than we had ima­gined. Rap­id digit­al­isa­tion is accel­er­at­ing this down­ward spir­al by adding small, harm­less, inex­pens­ive actions that are freely chosen but ter­ribly enga­ging. The right ques­tions to ask your­self in order to pri­or­it­ise “flow” and avoid the pit­falls of intens­ity primar­ily con­cern the clar­ity of the work­ing envir­on­ment (real­ist­ic, clear and shared object­ives; avail­able resources; reas­on­able dead­lines and sched­ules); mana­geri­al feed­back (feed­backs) (includ­ing what we do well) and men­tal resources (in par­tic­u­lar, room for man­oeuvre and oppor­tun­it­ies for recov­ery, just like an ath­lete: recov­ery is not an option!).

In many pro­fes­sions, dir­ect con­tact with users or cus­tom­ers involves intense or dif­fi­cult-to-man­age emo­tions, such as aggres­sion, anger, the dis­tress of oth­ers, or even social depriva­tion. A simplist­ic and often-used solu­tion is to try to strengthen employ­ees’ resi­li­ence. To this end, sev­er­al meth­ods have emerged in recent years, such as relax­a­tion and stress man­age­ment work­shops. How­ever, these approaches tend to focus on employ­ees rather than their envir­on­ment. Psy­cho­lo­gic­al research has shown them to be inef­fect­ive⁵ and even harm­ful in some cases: for example, people who have under­gone stress man­age­ment train­ing but are unable to reg­u­late their stress effect­ively and there­fore feel guilty. Or people who believe they can with­stand more stress because they have become overly resilient.

It is clear that we all exper­i­ence stress­ful situ­ations at work: avoid­ance is not a real­ist­ic solu­tion, nor is simply try­ing to become more resi­li­ent. Hid­ing your emo­tions will only cause them to resur­face. The solu­tions lie in devel­op­ing the abil­ity to “read and share emo­tions”: know­ing how to dis­so­ci­ate emo­tion­al reac­tions from the emo­tions them­selves, learn­ing to name one’s emo­tions, explain them and share them socially, with the aim of obtain­ing expli­cit sup­port from one’s work envir­on­ment^6,7,8. In prac­tic­al terms, this means set­ting aside short, reg­u­lar peri­ods of reflec­tion or debrief­ing after crit­ic­al situ­ations to express emo­tions and dif­fi­culties. Being will­ing to dis­cuss vul­ner­ab­il­it­ies, not with the aim of dis­tan­cing one­self from emo­tions, but rather to integ­rate them as an integ­ral part of the work situ­ation and thus be able to con­sciously assess their risk. This emo­tion­al bur­den is also the source of a feel­ing of work over­load: learn­ing to identi­fy it there­fore has a double pos­it­ive impact in terms of prevention.

We all need self-determ­in­a­tion, i.e. the abil­ity to make decisions, with some room for man­oeuvre⁹. When we feel that we no longer have any autonomy, we devel­op what psy­cho­lo­gists call a pos­ture of resig­na­tion: we no longer both­er, we no longer want to make an effort, to pro­gress, to work with or for the col­lect­ive, or to be cre­at­ive. But taken to the extreme, autonomy itself becomes a con­straint, a facade where the indi­vidu­al remains under impli­cit pres­sure to pro­duce res­ults, but without any real support.

Work is nev­er reduced to the exe­cu­tion of rules or pro­ced­ures: there are unfore­seen events and neces­sary work­arounds that will require adjust­ments to enable a job to be done “well”. It is there­fore neces­sary to determ­ine the rules with­in which autonomy will oper­ate, and to do so we can rely on a dia­gnos­is of the three forms of autonomy iden­ti­fied at work¹⁰:

• Autonomy in work plan­ning: “how to do it”? To do this, clear object­ives must be set (using the SMART meth­od­o­logy), but a mar­gin of free­dom must be left as to the means of achiev­ing them, thus avoid­ing unne­ces­sary “micro­man­age­ment”.
• Autonomy in organ­isa­tion: “when to do it”? For example, the pos­sib­il­ity of adjust­ing the tim­ing one­self in response to unfore­seen events.
• In decision-mak­ing: “what to do”? For example, the abil­ity to test a new way of tak­ing orders.

Regard­less of pos­i­tion in the hier­archy, it is import­ant to be able to explain the degree of autonomy that is needed: how much power an indi­vidu­al is giv­en to influ­ence their work” is giv­en to each indi­vidu­al, based on their skills and also their interests? This is one of the keys to well-being at work. The same applies to respons­ib­il­ity, since the ques­tion of autonomy can­not be sep­ar­ated from the assump­tion of respons­ib­il­ity and there­fore, ulti­mately, from risk. To reas­sure indi­vidu­als, it is always advis­able to define and cla­ri­fy the levels of respons­ib­il­ity accord­ing to each person’s status and pos­i­tion. These ele­ments help to cla­ri­fy roles and reduce related tensions.

Con­flict pre­ven­tion is often based on a tru­ism heard in child­hood: “it’s not nice to argue”¹¹As a res­ult, rather than anti­cip­at­ing con­flict, we tend to avoid it. In busi­ness, this trans­lates, for example, into “bene­vol­ent man­age­ment”, which has become increas­ingly pop­u­lar, par­tic­u­larly since the Cov­id-19 health crisis. Sci­entif­ic journ­als¹² draw our atten­tion to two biases: on the one hand, the con­cep­tu­al and meth­od­o­lo­gic­al catch-all nature of bene­vol­ent man­age­ment (which broadly con­sists of avoid­ing or even deny­ing con­flicts); on the oth­er hand, very few stud­ies seek to assess wheth­er there are any neg­at­ive effects of bene­vol­ent man­age­ment. How­ever, bene­vol­ence in social rela­tion­ships and com­pas­sion in a pro­fes­sion­al con­text can have power­ful para­dox­ic­al effects, such as excess­ive emo­tion­al depend­ence, the mask­ing of real suf­fer­ing, par­tic­u­larly in the con­text of deteri­or­ated social rela­tion­ships, or unreal­ist­ic per­form­ance pres­sures. To such an extent that some authors refer to the “pos­it­ive tox­icity” of bene­vol­ence¹³, the con­sequences of which are now well estab­lished: guilt, deni­al, manip­u­la­tion, and the mask­ing of deep-seated prob­lems¹⁴.

It is import­ant to cul­tiv­ate an assert­ive atti­tude, which means know­ing how to defend your rights and needs without infringing on those of others

This does not mean that we should not be bene­vol­ent! But how best to avoid avoid­ance? On the one hand, by being clear about the lim­its that must not be crossed, since they are pro­hib­ited by law, and on the oth­er hand, by cul­tiv­at­ing assert­ive skills. It is import­ant for com­pan­ies to expli­citly reit­er­ate cer­tain obvi­ous facts and their leg­al pre­ced­ents: mor­al har­ass­ment is defined by the French Labour and Crim­in­al Codes. Some com­pan­ies have chosen to include codes of good prac­tice in their intern­al reg­u­la­tions, which reit­er­ate the rules in force, accom­pan­ied by pro­ced­ures in the event of non-com­pli­ance, dis­trib­uted intern­ally and known to all. All of this is a bonus to accom­pany mana­geri­al dis­course: mutu­al respect works bet­ter when the rules are reit­er­ated! It should also be noted that in any com­pany with more than 250 employ­ees, a rep­res­ent­at­ive must be appoin­ted to sup­port the fight against sexu­al har­ass­ment and sex­ist behaviour.

In addi­tion, it is import­ant to cul­tiv­ate an assert­ive atti­tude^15,16, i.e. know­ing how to defend one’s rights and needs without encroach­ing on those of oth­ers. In addi­tion to know­ing your rights, this involves devel­op­ing skills in dia­logue, speak­ing up and arguing your case, which allows you to set bound­ar­ies while remain­ing con­struct­ive. It is a fun­da­ment­al psychoso­cial resource that allows you to anti­cip­ate deteri­or­at­ing social rela­tion­ships, favour­ing con­struct­ive con­front­a­tion rather than destruct­ive con­front­a­tion or creep­ing passiv­ity. Assert­ive­ness pre­vents us from turn­ing a blind eye to con­flicts that we think will resolve them­selves; it pre­vents the emer­gence of seem­ingly harm­less sex­ist beha­viours, which tacitly allow oth­er, much more prob­lem­at­ic beha­viours to devel­op, which are then dif­fi­cult to elim­in­ate once they have become established.

“Be spon­tan­eous”: this is a typ­ic­al example of what is known as a para­dox­ic­al injunc­tion, bring­ing togeth­er two oppos­ing entit­ies. Spon­taneity can­not be com­manded; you can­not do one thing without deny­ing the oth­er. The same applies when we tell someone to be cre­at­ive in a highly restrict­ive envir­on­ment, or to express their per­son­al­ity and be them­selves, while remain­ing in con­trol of their emo­tions in front of their team. Why are there so many para­dox­ic­al injunc­tions? Organ­isa­tions are riddled with con­tra­dict­ory logic: they must com­bine qual­ity and prof­it­ab­il­ity, speed and rigour, autonomy and con­trol, col­lab­or­a­tion and com­pet­i­tion. This is a real­ity. And there is noth­ing patho­lo­gic­al about it in itself; it is nor­mal. How­ever, it becomes abnor­mal when there is no arbit­ra­tion or reg­u­la­tion by the hier­archy, i.e. when indi­vidu­als are left alone to deal with these demands.

These para­doxes give rise to what are known as value con­flicts, which affect six out of ten work­ers in France¹⁷. These are situ­ations where indi­vidu­als must per­form actions that go against their per­son­al eth­ics, or activ­it­ies that are com­pletely mean­ing­less, or where they are no longer able to do their job prop­erly (known as “work impede”, which is even more true in tra­di­tion­al, craft-based pro­fes­sions that require pre­ci­sion). If these value con­flicts are borne solely by indi­vidu­al employ­ees, then they con­sti­tute real risks whose effects can have ser­i­ous con­sequences, includ­ing leg­al ones.

Value con­flicts are per­haps the most subtle and invis­ible aspect of psychoso­cial risks. But it is clear that they are not the least import­ant. Some­times what is left unsaid makes more noise than grand speeches. To pre­vent this risk, it is import­ant to learn to identi­fy para­dox­ic­al injunc­tions and even false dilem­mas. To do this, spaces for dis­cus­sion can be cre­ated to identi­fy para­doxes, incon­sist­en­cies and con­tra­dic­tions, but also eth­ics and obstacles to work, for example dur­ing “free zone” meet­ings, where every­one can express what is con­tra­dict­ory in their work, thereby enabling man­age­ment to take respons­ib­il­ity and make clear decisions on how to proceed.

Will you be demoted at work one day? Will you be replaced by AI? How will you keep up? Will you be able to con­tin­ue doing your job until you are 67? It is legit­im­ate to ask your­self these ques­tions from time to time. But it becomes prob­lem­at­ic if they take centre stage in our head­space. Job insec­ur­ity is the most dif­fi­cult issue to grasp because, on the one hand, it is inde­term­in­ate (no one can pre­dict the future) and, on the oth­er hand, it is often per­ceived by man­agers as bey­ond their con­trol, as it involves decisions that are not theirs to make: stra­tegic, eco­nom­ic and polit­ic­al decisions. How­ever, it is one of the aspects covered in man­dat­ory career devel­op­ment inter­views, as these dis­cus­sions focus on future pro­spects, skills, train­ing, aptitudes and, in oth­er words, change.

This is why it is neces­sary, on the one hand, for these inter­views to be con­duc­ted at a dif­fer­ent time from per­form­ance reviews, so as not to dilute their import­ance, and, on the oth­er hand, to stand­ard­ise the inter­view guide so that man­agers can sup­port and accom­pany their employ­ees’ devel­op­ment plans. We need to con­sider the train­ing and skills devel­op­ment avail­able, intern­al job oppor­tun­it­ies with­in the com­pany, how employ­ees’ cur­rent aptitudes can sup­port the skills of tomor­row, etc. The chal­lenge is to make impli­cit know­ledge expli­cit¹⁸: talk­ing about one’s work (in activ­ity ana­lys­is, among peers) makes skills that would oth­er­wise be invis­ible and there­fore unsus­pec­ted vis­ible and transferable.

Accept­able peri­ods of intens­ity, as they respect sat­is­fact­ory work­ing con­di­tions; expli­cit sup­port from man­age­ment to sup­port and accom­pany the emo­tions inher­ent in cer­tain pro­fes­sions. A degree of agreed autonomy to increase the power to act; reg­u­lar remind­ers of good prac­tices in social rela­tions to rein­force assert­ive­ness; spaces for dis­cus­sion to address and resolve con­flicts of val­ues; and cla­ri­fic­a­tion of everyone’s skills to secure career paths. Our ana­lys­is rein­forces the idea that pre­vent­ing psychoso­cial risks is not about strength­en­ing indi­vidu­als’ abil­ity to with­stand pres­sure, but rather about put­ting in place frame­works that respect and value each person’s psychoso­cial resources. This is by no means a uto­pi­an ideal; many com­pan­ies already oper­ate in this way, recon­cil­ing eco­nom­ic and human success.