Work, the Workplace, and the Mental Health of Workers : ACSM's Health & Fitness Journal

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Columns: Worksite Health Promotion

Work, the Workplace, and the Mental Health of Workers

Pronk, Nico P. Ph.D., FACSM, FAWHP

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ACSM's Health & Fitness Journal 27(3):p 50-52, 5/6 2023. | DOI: 10.1249/FIT.0000000000000859
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Work is a strong driver of health and well-being. Work can provide meaning in people's lives and resources to care for one's family, provide proper housing, and access to medical care. Similarly, the work environment — both the physical and psychosocial environment — can have a major impact on the physical and mental health of workers. When exposure to hazards in the work environment is limited, workers are more protected from potential on-the-job accidents and injuries. Workers can successfully deal with workplace stressors when there is a supportive work environment, when leaders are visibly engaged in building a culture of health and well-being, when workers themselves are actively engaged in workplace decision-making, and when clear opportunities for career advancement and personal growth are available and accessible. Hence, both work itself and the workplace environment influence the levels of physical and mental health of workers.


By the numbers, mental health concerns pose significant challenges for employers. In the United States today, almost 20% of adults (approximately 52.9 million in 2020) live with a mental health disorder (1). Efforts to treat mental health disorders are costly — estimated by the World Economic Forum to approximate $16.3 trillion globally — and generate a significant loss in economic output. Furthermore, in the United States, roughly 50% of mental health treatment costs will be borne by employers. The American Heart Association estimates, based on national surveys, that among U.S. employees, 76% struggle with at least one mental health concern, 42% have been diagnosed with a mental health disorder, and 63% of those with a diagnosis have not disclosed this to their employer (2). In addition, almost 90% of employees surveyed think employers have a responsibility to support mental health, 42% would like more information on mental health benefits and resources, and 40% would like to see their employer provide training for managers and supervisors that addresses mental health issues and identification of mental distress among workers. Hence, it is clear the mental health problem is significant for employers. Yet, it also is recognized that employers can address mental health in a constructive and positive way. The workplace is an appropriate venue in which to intervene on mental health concerns.


Mental health at work can be addressed along several lines of action. As suggested by the World Health Organization (WHO) and International Labor Organization, mental health at work can be addressed through prevention, protection and promotion, support, and the creation of an enabling environment (3). The accompanying WHO Guidelines on Mental Health at Work provide more detail on evidence-based recommendations to promote mental health, prevent mental health conditions, and enable people living with mental health conditions to participate and thrive at work (4). The guidelines describe organizational interventions, manager training and worker training, individual interventions, and return-to-work.

Due to the high prevalence of mental health disorders, the costs to society in general, and to employers more specifically, are significant. Hence, the costs of inaction are not acceptable, and employers can benefit from well-coordinated efforts to prevent work-related mental health conditions and provide access to treatment and ongoing, equitable support to all workers.


The recent introduction of the U.S. Surgeon General's Framework for Workplace Mental Health and Well-Being represents an excellent model for implementing action (5). The Figure presents the framework and represents an approach organized around the central purpose of ensuring a participatory approach for workers (“the voice of the worker”) and pursuit of a more equitable policy and practice environment. Around the axis of the worker voice and equity, there are “five essentials” to guide leaders, managers, and supervisors. These essentials, along with two specifically called-out human needs, include:

The “Five Essentials of Workplace Mental Health & Well-Being” from the Office of the U.S. Surgeon General.
  • Protection from harm: A focus on safety and security.
  • Connection and community: A focus on social support and belonging.
  • Work-life harmony: A focus on autonomy and flexibility.
  • Mattering at work: A focus on dignity and meaning.
  • Opportunity for growth: A focus on learning and accomplishment.

A set of additional components to the Framework support the need for implementation plans that effectively address mental health needs. The Table presents these components and underlines the need for underlying and overarching systems to ensure leadership engagement and accountability, data-driven management, ongoing evaluation and reporting, and compliance (6).

TABLE - Components of the Workplace Mental Health & Well-Being Framework Along With Underlying System Elements for Sustained Action
Framework Essential Component
Protection from harm • Prioritize workplace physical and psychological safety
• Enable adequate rest
• Normalize and support mental health
• Operationalize norms, policies, and programs according to diversity, equity, inclusion, and accessibility principles
Connection and community • Create cultures of inclusion and belonging
• Cultivate trusted relationships
• Foster collaboration and teamwork
Work-life harmony • Provide more autonomy over how work is done
• Allow for flexible scheduling
• Increase access to paid leave
• Respect boundaries between work and nonwork time
Mattering at work • Provide a living wage
• Engage workers in workplace decisions
• Build a culture of gratitude and recognition
• Connect work with organizational mission
Opportunity for growth • Offer quality training, education, and monitoring
• Foster equitable access to career advancement
• Ensure relevant, reciprocal feedback
Sustaining Systems
Leadership Engaged and visible leadership, accountability for performance, ensuring access to resources
Management Head + Heart, Together – building a culture of inclusion, appreciation, and belonging
Data-driven Ongoing evaluation, reporting, and continuous improvement
Compliance Meeting regulatory requirements and safeguarding individual-level data
Policies and environmental supports Develop, implement, and communicate a detailed mental health plan for the organization
Participatory approaches Involving employees in decision-making related to workplace operations
Community partnerships Use connections to community partners to promote internal and external objectives of the mental health program
Information based on references 2, 5, and 6.


Every company has a culture. Not every company has a culture of health and well-being” (7). Leadership has to provide visible and active engagement to build a culture that reflects a healthy attitude toward the mental health of workers. Furthermore, resources need to be applied to ensure equitable access to both prevention and treatment programs. Despite the costs associated with efforts to increase accessibility, it is highly likely that benefits in terms of cost savings are likely, whereas inaction will prove too costly due to issues such as lost productivity. Furthermore, flexible work arrangements are likely to reduce worker stress while supporting the increased burden of caregiving and other work-life issues.

Workplace mental health and well-being are closely linked to safe, healthy, and positive working environments where people are enabled to work productively. The benefits extend to both employers and workers and their families. Workplaces represent an important venue for sustained efforts to ensure equitable access to optimal mental health and psychological safety.


1. National Institute of Mental Health Web site [Internet]. Mental health statistics. [cited 2022 December 9]. Available from:
2. American Heart Association Web site [Internet]. Mental health: a workforce crisis. [cited 2022 December 9]. Available from:
3. World Health Organization and International Labor Organization. Mental health at work: policy brief. [cited 2022 December 10]. Available from:
4. World Health Organization Web site [Internet]. WHO Guidelines on Mental Health at Work. [cited 2022 December 10]. Available from:
5. U.S. Public Health Service Web site [Internet]. The U.S. Surgeon General's Framework for Workplace Mental Health and Well-Being. 2022. [cited 2022 December 10]. Available from:
6. Pronk NP. Best practice design principles of worksite health and wellness programs. ACSMs Health Fit J. 2014;18(1):42–6.
7. Pronk NP. Building cultures of health and well-being: creating and sustaining supportive organizational environments. ACSMs Health Fit J. 2018;22(3):40–2.
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