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Issue date: November 2009

Quick reference guide

Promoting mental wellbeing at work

This quick reference guide presents the recommendations made in ‘Promoting mental
wellbeing through productive and healthy working conditions: guidance for
employers’. It is for those who have a direct or indirect role in, and responsibility for,
promoting mental wellbeing at work. This includes all employers and their
representatives, irrespective of the size of the business or organisation and whether
they are in the public, private, or voluntary sectors. It may also be of interest to
professionals working in human resources or occupational health, employees, trade
unions representatives and members of the public.

The guidance complements, but does not replace, NICE guidance on workplace
promotion of physical activity and smoking cessation and also on depression (see
related guidance, page 8 for a list of publications).

NICE public health guidance 22

This guidance was developed using the NICE public health intervention process.
NICE public health guidance makes recommendations on the promotion of good health and the
prevention of ill health. This guidance represents the views of NICE and was arrived at after careful
consideration of the evidence available. Implementation of this guidance is the responsibility of local
commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility
to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination
and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted
in a way which would be inconsistent with compliance with those duties.
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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 society1.’
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 them2’. 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.

1 Foresight Mental Capital and Wellbeing Project (2008) Final project report. London: The Government Office for Science.
2 Health and Safety Executive (2004) Working together to reduce stress at work: a guide for employees [online]. Available from
www.hse.gov.uk/pubns/indg424.pdf

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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 examples3).
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)4.

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 working5.
In addition the Health and Safety Executive’s standards for managing work-related stress
may provide a valuable tool in implementing this guidance6.

3 Health and Safety Executive (2008) Management standards for work-related stress [online]. Available from www.hse.gov.uk/stress/ and
Pricewaterhouse Coopers (2008) Building the case for wellness [online]. Available from www.workingforhealth.gov.uk/documents/dwp-
wellness-report-public.pdf
4 Sainsbury Centre for Mental Health (2007) Mental health at work: developing the business case. Policy paper 8. London: Sainsbury Centre
for Mental Health.
5 HM Government (1996) Employment Rights Act [online]. Available from www.opsi.gov.uk/acts/acts1996/Ukpga_19960018_en_1
HM Government (2005) The Disability Discrimination Act [online]. Available from www.opsi.gov.uk/acts/acts2005/ukpga_20050013_en_1
HM Government (2006) The Work and Families Act [online]. Available from www.opsi.gov.uk/acts/acts2006/pdf/ukpga_20060018_en.pdf
6 Health and Safety Executive (2008) Management standards for work-related stress. Available from www.hse.gov.uk/stress/

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Recommendations • Promote a culture of participation, equality

and fairness that is based on open
Recommendation 1: strategic and communication and inclusion.
coordinated approach to promoting • Create an awareness and understanding of
employees’ mental wellbeing mental wellbeing and reduce the potential for
discrimination and stigma related to mental
Who should benefit?
health problems.
• Employees. • Ensure processes for job design, selection,
Who should take action? recruitment, training, development and
appraisal promote mental wellbeing and
• Employers in organisations of all sizes. In reduce the potential for stigma and
larger organisations this might include chief discrimination. Employees should have the
executives and board members, human necessary skills and support to meet the
resources directors and senior managers. In demands of a job that is worthwhile and
micro and small businesses7 this will usually offers opportunities for development and
be the owner-manager and in medium-sized progression. Employees should be fully
businesses the business manager. supported throughout organisational change
• Trade unions and other employee and situations of uncertainty.
representatives.
• Ensure that groups of employees who might
What action should they take? be exposed to stress but might be less likely
to be included in the various approaches for
• Adopt an organisation-wide approach to promoting mental wellbeing have the equity
promoting the mental wellbeing of all of opportunity to participate. These groups
employees, working in partnership with include part-time workers, shift workers and
them. This approach should integrate the migrant workers.
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.

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.

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Recommendation 2: assessing opportunities – Using frameworks such as Health and

for promoting employees’ mental wellbeing Safety Executive management standards
and managing risks for work-related stress to promote and
protect employee mental wellbeing.
Who should benefit?
– Responding to the needs of employees
• Employees. who may be at particular risk of stress
caused by work and working conditions, or
Who should take action?
who may be experiencing mental health
• Refer to recommendation 1. problems for other reasons. Well-
implemented policies for managing
What action should they take?
employee absence are important for
• Adopt a structured approach to assessing ensuring that employees who are
opportunities for promoting employees’ experiencing stress can be identified early
mental wellbeing and managing risks. This and offered support. Support could include
approach involves: counselling or stress management training
– Ensuring systems are in place for assessing provided through occupational health and
and monitoring the mental wellbeing of primary care support services. Interventions
employees so that areas for improvement for individual employees should be
can be identified and risks caused by work complemented by organisation-wide
and working conditions addressed. This approaches that encompass all employees.
could include using employee attitude – Different approaches may be needed
surveys and information about absence by micro, small and medium-sized
rates, staff turnover and investment in businesses and organisations for
training and development, and providing promoting mental wellbeing and
feedback and open communication. In small managing risks. Smaller businesses and
organisations systems may be more organisations may need to access the
informal. It is important to protect employee support provided by organisations such
confidentiality and address any concerns as the Federation of Small Business and
employees might have about these Chambers of Commerce.
processes of assessment and monitoring.
(Employers may also wish to refer to ‘Managing
– Making employees aware of their legal long-term sickness absence and incapacity for
entitlements regarding quality of work and work’ NICE public health guidance 19).
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.

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Recommendation 3: flexible working Recommendation 4: the role of line

managers
Who should benefit?
Who should benefit?
• Employees.
• Line managers and employees.
Who should take action?
(The line manager may be the owner-manager
• Refer to recommendation 1. in micro and small businesses.)
What action should they take? Who should take action?
• If reasonably practical, provide employees • Employers in organisations of all sizes. In
with opportunities for flexible working larger organisations this will probably include
according to their needs and aspirations in human resources directors and senior
both their personal and working lives. managers. In many micro and small
Different options for flexible working include businesses it will usually be the owner-
part-time working, home-working, job manager, and in medium-sized businesses the
sharing and flexitime. Such opportunities can business manager.
enhance employees’ sense of control and
• Training and professional organisations
promote engagement and job satisfaction.
concerned with management.
• Promote a culture within the organisation
that supports flexible working and addresses What action should they take?
employees’ concerns. Managers should • Strengthen the role of line managers in
respond to and seek to accommodate promoting the mental wellbeing of employees
appropriate requests from employees for through supportive leadership style and
flexible working and should ensure management practices. This will involve:
consistency and fairness in processing
– promoting a management style that
applications. Managers’ ability to manage
encourages participation, delegation,
teams with flexible working patterns may
constructive feedback, mentoring
need to be developed.
and coaching
• Consider particular models of flexible working
– ensuring that policies for the recruitment,
that recognise the distinct characteristics of
selection, training and development of
micro, small and medium-sized businesses
managers recognise and promote
and organisations.
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

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– ensuring that managers are able to identify Recommendation 5: supporting micro, small
and respond with sensitivity to employees’ and medium-sized businesses
emotional concerns, and symptoms of
mental health problems Who should benefit?

– ensuring that managers understand when • Employees and employers in micro, small and
it is necessary to refer an employee to medium-sized businesses.
occupational health services or other
Who should take action?
sources of help and support
• Primary care trusts, primary care services and
– considering the competency framework
occupational health services.
developed by the Chartered Institute of
Personnel and Development, the Health and • Those working on national initiatives and
Safety Executive and Investors in People as a programmes from government, voluntary,
tool for management development8. 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.

8 Chartered Institute of Personnel and Development, Health and Safety Executive, Investors in People (2009) Line management behaviour and
stress at work [online]. Available from www.cipd.co.uk/NR/rdonlyres/898B09D3-6F8A-49AF-BD11-
66EC76B086D4/0/stress_at_work_updated_guidance_for_line_managers.pdf

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Implementation tools Related NICE guidance

NICE has developed tools to help organisations For more information about NICE guidance that
put this guidance into practice. For details see has been issued or is in development, see
our website at www.nice.org.uk/PH22 www.nice.org.uk
• Depression. NICE clinical guideline 90 (2009).
Available from www.nice.org.uk/CG90
Further information • Long-term sickness absence and incapacity for
You can download the following from work. NICE public health guidance 19 (2009).
www.nice.org.uk/PH22 Available from www.nice.org.uk/PH19
• A quick reference guide (this document) for • Promoting physical activity in the workplace.
professionals and the public. NICE public health guidance 13 (2008).
• The guidance – the recommendations, Available from www.nice.org.uk/PH13
details of how they were developed and • Workplace interventions to promote smoking
evidence statements. cessation. NICE public health guidance 5
• Details of all the evidence that was considered (2007). Available from www.nice.org.uk/PH5
and other background information. • Computerised cognitive behaviour therapy for
For printed copies of the quick reference guide, depression and anxiety. NICE technology
phone NICE publications on 0845 003 7783 appraisal guidance 97 (2006). Available from
or email [email protected] and www.nice.org.uk/TA97
quote N2009.
Updating the recommendations
This guidance will be updated as needed.
Information on the progress of any update will
be posted at www.nice.org.uk/PH22

© National Institute for Health and Clinical Excellence, 2009. All rights reserved. This material may be freely
reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or
for commercial purposes, is allowed without the express written permission of NICE.
National Institute for Health and Clinical Excellence ISBN 978-1-84936-094-4
MidCity Place, 71 High Holborn, London WC1V 6NA, www.nice.org.uk N2009 1P 20k Nov 09