1 Recommendations

This is NICE's formal guidance on promoting mental wellbeing through productive and healthy working conditions. When writing the recommendations, PHIAC (see appendix A) considered the evidence of effectiveness (including fieldwork data and comments from stakeholders). Full details are available at online.

The evidence statements underpinning the recommendations are listed in appendix C.

The evidence reviews, supporting evidence statements and economic analysis are available at online.

PHIAC considers that the recommended measures are cost effective. For the research recommendations and gaps in research, see section 5 and appendix D respectively.

National strategies and initiatives

This guidance will support implementation of related national strategies and guidance as well as a number of legal requirements regarding employment, including employers' duty of care. These are:

  • 'Health, work and wellbeing' (Department for Work and Pensions 2005; 2008).

  • 'Dame Carol Black's review of the health of Britain's working age population Working for a healthier tomorrow' (Department for Work and Pensions and the Department of Health 2008).

  • 'Mental health and employment strategy' (Department for Work and Pensions and the Department of Health 2009).

  • Employment laws regarding equality, anti discrimination, health and safety, maternity and parental leave and flexible working[1].

In addition the Health and Safety Executive's standards for managing work-related stress may provide a valuable tool in implementing this guidance[2] .

Why work is important to employees' mental wellbeing

The following definition of mental wellbeing is used in this guidance:

'Mental wellbeing is a dynamic state in which the individual is able to develop their potential, work productively and creatively, build strong and positive relationships with others and contribute to their community. It is enhanced when an individual is able to fulfil their personal and social goals and achieve a sense of purpose in society.'[3]

Mental wellbeing at work is determined by the interaction between the working environment, the nature of the work and the individual.

Work has an important role in promoting mental wellbeing. It is an important determinant of self-esteem and identity. It can provide a sense of fulfilment and opportunities for social interaction. For most people, work provides their main source of income.

Work can also have negative effects on mental health, particularly in the form of stress. Work-related stress is defined as 'the adverse reaction people have to excessive pressure or other types of demand placed upon them'[4]. Although pressure can motivate employees and encourage enhanced performance, when pressure exceeds an employee's ability to cope, it becomes a negative force in the form of stress.

Working environments that pose risks for mental wellbeing put high demands on a person without giving them sufficient control and support to manage those demands. A perceived imbalance between the effort required and the rewards of the job can lead to stress. A sense of injustice and unfairness arising from management processes or personal relationships can also increase stress and risks to mental health. Other stressful conditions include physical factors such as material hazards, noise, dust and dirt.

Stress is not a medical condition, but research shows that prolonged stress is linked to psychological conditions such as anxiety and depression as well as physical conditions such as heart disease, back pain and headache.

Why employees' mental wellbeing is important to organisations' productivity and performance

Promoting the mental wellbeing of employees can yield economic benefits for the business or organisation, in terms of increased commitment and job satisfaction, staff retention, improved productivity and performance, and reduced staff absenteeism (see footnote for examples[5]).

The costs associated with employees' mental health problems are significant for businesses and other organisations. These costs are associated with loss in productivity because of sickness absence, early retirement, and increased staff turnover, recruitment and training. Evidence also shows that productivity can be reduced through the lower level of performance of employees who are at work but experiencing stress or mental health problems. This is known as 'presenteeism'. A recent report estimated that impaired work efficiency associated with mental heath problems costs £15.1 billion a year, which is almost twice the estimated annual cost of absenteeism (£8.4 billion)[6] .

Recommendation 1: strategic and coordinated approach to promoting employees' mental wellbeing

Who should benefit?


Who should take action?

  • Employers in organisations of all sizes. In larger organisations this might include chief executives and board members, human resources directors and senior managers. In micro and small businesses[7] this will usually be the owner-manager and in medium-sized businesses the business manager.

  • Trade unions and other employee representatives.

What action should they take?

  • Adopt an organisation-wide approach to promoting the mental wellbeing of all employees, working in partnership with them. This approach should integrate the promotion of mental wellbeing into all policies and practices concerned with managing people, including those related to employment rights and working conditions.

  • Ensure that the approach takes account of the nature of the work, the workforce and the characteristics of the organisation.

  • Promote a culture of participation, equality and fairness that is based on open communication and inclusion.

  • Create an awareness and understanding of mental wellbeing and reduce the potential for discrimination and stigma related to mental health problems.

  • Ensure processes for job design, selection, recruitment, training, development and appraisal promote mental wellbeing and reduce the potential for stigma and discrimination. Employees should have the necessary skills and support to meet the demands of a job that is worthwhile and offers opportunities for development and progression. Employees should be fully supported throughout organisational change and situations of uncertainty.

  • Ensure that groups of employees who might be exposed to stress but might be less likely to be included in the various approaches for promoting mental wellbeing have the equity of opportunity to participate. These groups include part-time workers, shift workers and migrant workers.

Recommendation 2: assessing opportunities for promoting employees' mental wellbeing and managing risks

Who should benefit?


Who should take action?

Refer to recommendation 1.

What action should they take?

Adopt a structured approach to assessing opportunities for promoting employees' mental wellbeing and managing risks. This approach involves:

  • Ensuring systems are in place for assessing and monitoring the mental wellbeing of employees so that areas for improvement can be identified and risks caused by work and working conditions addressed. This could include using employee attitude surveys and information about absence rates, staff turnover and investment in training and development, and providing feedback and open communication. In small organisations systems may be more informal. It is important to protect employee confidentiality and address any concerns employees might have about these processes of assessment and monitoring.

  • Making employees aware of their legal entitlements regarding quality of work and working conditions. Employees should be made aware of their responsibilities for looking after their own mental wellbeing. For example, employees need to identify concerns and needs relating to support or improvements in the working environment.

  • Using frameworks such as Health and Safety Executive management standards for work-related stress to promote and protect employee mental wellbeing.

  • Responding to the needs of employees who may be at particular risk of stress caused by work and working conditions, or who may be experiencing mental health problems for other reasons. Well-implemented policies for managing employee absence are important for ensuring that employees who are experiencing stress can be identified early and offered support. Support could include counselling or stress management training provided through occupational health and primary care support services. Interventions for individual employees should be complemented by organisation-wide approaches that encompass all employees.

  • Different approaches may be needed by micro, small and medium-sized businesses and organisations for promoting mental wellbeing and managing risks. Smaller businesses and organisations may need to access the support provided by organisations such as the Federation of Small Business and Chambers of Commerce.

    (Employers may also wish to refer to 'Managing long-term sickness absence and incapacity for work' NICE public health guidance 19).

Recommendation 3: flexible working

Who should benefit?


Who should take action?

Refer to recommendation 1.

What action should they take?

  • If reasonably practical, provide employees with opportunities for flexible working according to their needs and aspirations in both their personal and working lives. Different options for flexible working include part-time working, home-working, job sharing and flexitime. Such opportunities can enhance employees' sense of control and promote engagement and job satisfaction.

  • Promote a culture within the organisation that supports flexible working and addresses employees' concerns. Managers should respond to and seek to accommodate appropriate requests from employees for flexible working and should ensure consistency and fairness in processing applications. Managers' ability to manage teams with flexible working patterns may need to be developed.

  • Consider particular models of flexible working that recognise the distinct characteristics of micro, small and medium-sized businesses and organisations.

Recommendation 4: the role of line managers

Who should benefit?

Line managers and employees.

(The line manager may be the owner-manager in micro and small businesses.)

Who should take action?

  • Employers in organisations of all sizes. In larger organisations this will probably include human resources directors and senior managers. In many micro and small businesses it will usually be the owner-manager, and in medium-sized businesses the business manager.

  • Training and professional organisations concerned with management.

What action should they take?

Strengthen the role of line managers in promoting the mental wellbeing of employees through supportive leadership style and management practices. This will involve:

  • promoting a management style that encourages participation, delegation, constructive feedback, mentoring and coaching

  • ensuring that policies for the recruitment, selection, training and development of managers recognise and promote these skills

  • ensuring that managers are able to motivate employees and provide them with the training and support they need to develop their performance and job satisfaction

  • increasing understanding of how management style and practices can help to promote the mental wellbeing of employees and keep their stress to a minimum

  • ensuring that managers are able to identify and respond with sensitivity to employees' emotional concerns, and symptoms of mental health problems

  • ensuring that managers understand when it is necessary to refer an employee to occupational health services or other sources of help and support

  • considering the competency framework developed by the Chartered Institute of Personnel and Development, the Health and Safety Executive and Investors in People as a tool for management development[8].

Recommendation 5: supporting micro, small and medium-sized businesses

Who should benefit?

Employees and employers in micro, small and medium-sized businesses.

Who should take action?

  • Primary care trusts, primary care services and occupational health services.

  • Those working on national initiatives and programmes from government, voluntary, charitable and business sectors to promote mental wellbeing at work.

  • Federation of Small Businesses.

What action should they take?

  • Collaborate with micro, small and medium-sized businesses and offer advice and a range of support and services. This could include access to occupational health services (including counselling support and stress management training).

  • Establish mechanisms for providing support and advice on developing and implementing organisation-wide approaches to promoting mental wellbeing. These could include tools and approaches for risk assessment, human resources management and management training and development.

[1] HM Government (1996) Employment Rights Act. HM Government (2005) The Disability Discrimination Act. HM Government (2006) The Work and Families Act.

[2] Health and Safety Executive (2008a) Management standards for work-related stress.

[3] Foresight Mental Capital and Wellbeing Project (2008) Final project report. London: The Government Office for Science.

[5] Health and Safety Executive (2008a) Management standards for work-related stress and Pricewaterhouse Coopers (2008) Building the case for wellness.

[6] Sainsbury Centre for Mental Health (2007) Mental health at work: developing the business case. Policy paper 8. London: Sainsbury Centre for Mental Health.

[7] A micro business employs fewer than 10 people. A small business employs fewer than 50 people and a medium-sized business employs fewer than 250 people.

[8] Chartered Institute of Personnel and Development, Health and Safety Executive, Investors in People (2009) Line management behaviour and stress at work.

  • National Institute for Health and Care Excellence (NICE)