ABSTRACT
Fixed standards should not be used to review the suitability of primary prevention. Instead, policies that have been proven effective in an individual workplace should be permitted, the essence of successful examples should be actively incorporated in laws and policies, and incentives backed by “soft” law (e.g. guidelines) should be enhanced. Policies should assess psychosocial risks (PSRs), and they should also combine risk assessment and an assessment of good practices (such an assessment examines an organization’s strong points and elaborates upon them). When compiling successful examples, their assessment should not be limited to a dogmatic adherence to laws and ordinances or maintaining order in the workplace.
Final indices include and are not limited to the incidence of work-related illnesses, the voluntary separation rate, work performance, job satisfaction, and work-related stress. When deciding indices, emphasis should be placed on the company’s management philosophy and policy and the consent of the employer and employee. Emphasis should also be placed on interim indices that might affect final indices (formulation and implementation of a mental health improvement plan, appointment of supervisors, opportunities for dialogue with the employer, etc.).
Japanese and British legal theories determine an employer’s civil liability based on a general determination in light of the individual circumstances of a case and the course of cases overall. Strangely enough, those theories probably play the same role. That said, there are cases where an undue burden is placed on the employer.
Companies need to have specific rules to prevent mental health issues from occurring and properly address them should they occur, so proper rules need to be devised. Expert and competent personnel are essential to devising rules, so employers must foster and call upon those personnel. Personnel with general expertise as well as a familiarity with an organization’s circumstances need to be fostered.
Improving working conditions for individuals with congenital disabilities, including those with personality or development issues, may help to improve working conditions for individuals who are developing a mental disorder, individuals with mental health issues, and healthy individuals by enhancing the culture of diversity and inclusion in the workplace. That said, such individuals may be treated differently depending on the goals of recovery. In addition, procedures to justify the placement of an employee on leave or termination if he or she does not attempt to adapt (job accommodations at the discretion of an occupational physician and reasonable accommodations such as a suitable job assignment, opportunities for treatment, training and instruction, and follow-up) should be clearly laid out.
Measures to deal with an illness or disorder depending on whether it is work-related or not are seldom differentiated in health though they are differentiated in law. The countries studied do not generally recognize a stress-related illness as work-related, but they have implemented primary prevention backed by law, and they stress that mental illnesses be addressed through secondary and tertiary prevention. Potential solutions to psychosocial issues may be more important than the causes of those issues.
A distinction between work-related mental disorders and non-work-related mental disorders may not necessarily be required. If that distinction is made, however, an independent organization should be established to rationally and reasonably determine whether a mental disorder is work-related or not and that can reach a definitive decision. Proposals for employees to bear fixed costs should also warrant consideration. If that distinction is not made, then generous job and income security should be provided even in the event of a personal illness or injury and opportunities should be created for regular talks between employees and an employer in order to prevent that illness or injury from occurring or recurring, as both happen in Northern Europe and Germany.
Tertiary prevention requires active, multifaceted, sustained, individually tailored, and expert support in terms of a leave of absence, reinstatement, or continued employment. Prevention efforts are based on an appropriate assessment of work capability in accordance with the nature and severity of the disability. Intensive efforts should be undertaken, as they are under the Danish system, before an illness or injury is prolonged. Dutch efforts gauge an employee’s desire to return to work and an employer’s desire to reinstate the employee. If either party fails to fulfil its obligations, a penalty should be imposed in terms of job or income security.
The creation of agencies that employ individuals with a mental disorder and that assist them in finding general employment (e.g. social firms and Remploy in the UK) and agencies that aid employers in helping individuals who have taken a leave of absence to return to work (e.g. specialized rehabilitation facilities [re-integratiebedrijf] in the Netherlands) and public assistance also warrant consideration.
