Burnout, depression, work-related stress, anxiety. These concepts carry significance. That’s why Kari-Pekka Martimo, Specialist in Occupational Health and Consulting Physician for Ilmarinen Mutual Pension Insurance Company, does not favour any of the aforementioned terms but prefers to talk about employee distress.
“This concept is better because it isn’t as limiting in terms of the approach to improve the situation. Medicalisation should only be the approach if medical solutions are being offered to resolve the situation. I don’t think it’s right to medicalise states of fatigue or give them too specific a name. The result is that it could potentially hinder and slow the process of finding solutions”, says Martimo.
If fatigue is diagnosed, for example, as depression, with the result that anti-depressants and therapy are offered as treatment, the most effective solutions might never be tried.
Kari-Pekka Martimo views it as important to discuss coping mechanisms before one has reached their breaking point.
“Fatigue occurs when work is organised in a way that drives people to a state of distress. At that point, solutions should be sought specifically from the work and its reorganisation.”
Fatigue is a reflection of an individual’s situation but, more accurately, it is a sign that there is something wrong with the work itself.
Legislative support
Martimo feels that the current discourse seems to focus more on burnout and harmful stress than on ways to resolve such situations. Different approaches can gain backing, for example, from legislation or occupational safety and health structures.
Firstly, the Occupational Safety and Health Act contains an obligation to bring risks and excessive workload factors to an employer’s attention. If one employee feels unreasonably overloaded, there may be others in the work community who are in the same situation or developing fatigue.
“It is, of course, understandable that the law, on its own, may not necessarily be the best support for employees in this situation. If there is not courage, willingness or the drive to raise the issue with a supervisor, an employee can always turn to the occupational health provider, a shop steward, a labour protection delegate or HR representative. There is always someone who is ready to listen. It’s best if the employee is not already at their breaking point when they bring their situation to someone’s attention, so initiating the discussion early on is key”, states Martimo.
He specifically recommends addressing fatigue with a supervisor, since they have the immediate ability to affect the work methods and means of reducing stress. Occupational healthcare, for example, does not have the same possibilities to directly influence the work itself.
Employers are obligated to act
Martimo encourages employers to increase the possibilities for employees to affect their own work. As a starting point, analyse work situations and related stress together as well as potential ways to work smarter and reduce stress and strain.
If an employer doesn’t show any interest in developing the organisation of the work and adopts an indifferent attitude towards fatigue, there are other supportive routes available to employees.
One such route is the notification form published by the occupational safety and health authorities (Ilmoitus työnantajalle työssä kuormittumisesta (tyosuojelu.fi)) that enables an employee to report work-related stress that threatens to harm their health.
“This form is unfortunately used quite infrequently, even though it’s a low-threshold method. The reason may be that the notification must be submitted in one’s own name; the idea is for the notification to serve as a starting point to resolve an individual’s distress.”
The employer is obligated to react to such a notification. A suitable reaction might be, for example, that the occupational health service would be called in to assess the stress and strain of the work. According to the law, an employee is entitled, for a justified reason, to receive a statement assessing, for example, the length of working days, the number of overtime hours, the proportion of unpaid work, the timeliness of competence and the number of patients or clients. The statement is then discussed with both the individual experiencing stress and a representative of their employer.
Another approach touched on by Martimo is work ability negotiations, the purpose of which is to gain an understanding of the situation and to consider solutions.
“These negotiations are used to consider what work could be carried out with the existing level of work ability and how the work might be adapted, as permitted by the supervisor, so that the employee might continue working. Often, people ask whether it is mandatory to participate in such negotiations. Coercion is not an approach utilised by occupational healthcare, rather, such activities should be realised by common agreement.”
An employee can request that a shop steward or labour protection delegate be present at the work ability negotiations for additional support.
Shifting the focus from the individual to the whole team
Occupational healthcare plays a significant role in maintaining work ability and preventing physical and mental loading.
“The responsibility for practices that support well-being rests on the workplace, but when it comes to mental well-being, occupational healthcare is an important partner for the workplace”, says Vera Gergov, Chief of Professional and Public Affairs for the Finnish Psychological Association, Clinical Psychologist with specialist degree in Psychotherapy; Psychotherapist.
As vital elements of good co-operation, Gergov mentions a clear division of work and responsibilities, low-threshold communications and well-prepared meetings. Additionally, it is wise to ensure that the representatives of the employer and occupational healthcare are talking about the same issues and phenomena.
“It is also important to critically evaluate enacted measures and to actively seek innovative solutions that meet the needs of the workplace.”
Martimo states that although occupational health providers co-operate really well with individual patients, more work with entire work communities or teams is needed in order to assure the comprehensive development of working conditions and methods.
“Although this requires more work and time, it is worthwhile, as it specifically develops work ability for everyone at the community level.”
This would also add the aspect of peer support, which has been proven effective.
Gergov criticises the fact that the treatment of burnout focuses too much on the individual. Individuals need support, of course, but it would be better if the measures also included changes to the overall work conditions. Such changes would apply to a larger group and their general work methods.
Vera Gergov criticises the fact that the treatment of burnout focuses too much on the individual. Individuals need support, of course, but it would be better if the measures also included changes to the overall work conditions.
Research data shows that a successful return to work is particularly supported by the positive approach and attitude of the employee’s supervisor. It is essential that the work community views any enacted changes as being just and fair.
From identification to action
Identify, plan, implement, evaluate. Simply put, these are the steps to improve work ability and mental well-being within the workplace.
“Firstly, we should recognise the psychosocial and cognitive resource and stress factors in the workplace and, on that basis, identify the needs for mental health support”, Gergov outlines.
Then a plan of the applicable measures is drawn up. Once the measures have been implemented, it’s time to evaluate their impacts.
The expertise of the occupational healthcare provider should be incorporated at all stages.
The significance of proactive prevention cannot be overstated.
“We already have a lot of knowledge about the type of work that supports mental health and health in general”, states Martimo.
It is important, however, to work on increasing the ability to solve problems, starting with the ways issues are raised within the workplace. Employees should bear their share of the responsibility for this.
“All too often people just grit their teeth and decide that they would rather not say anything. This is not the right approach. Even though supervisors are trained to utilise the early support model, it does not make them mind readers. They also need to hear where the problems lie”, says Martimo.
What possibilities does, for example, a fixed-term employee have to raise issues related to coping?
“Fixed-term employees are also entitled to support from shop stewards, labour protection delegates and occupational healthcare. If an employee issues a complaint regarding an unreasonable workload to one of the aforementioned resources, they can issue a recommendation to survey the entire personnel as a means of establishing the actual demands of the work”, Martimo explains.
In terms of prevention, the psychological safety of the work community is fundamental.
“When it becomes natural to discuss the work and goals as well as the successes and failures within the work community, and issues are addressed, this supports the timely implementation of preventive measures”, remarks Gergov.
A proactive approach to work ability maintenance that serves the entire work community is more cost efficient than having to resolve individual cases of employees who are already fatigued.
Text: Iida Ylinen
Photo: Ida Pimenoff (theme photo), Ilmarinen (Kari-Pekka Martimo), Veikko Somerpuro (Vera Gergov)
