1. Purpose
Japan is now facing a drastic change
in its
economic and industrial structures.
This
change is expected to further accelerate,
due to economic globalization, rapid
progress
in information technologies, and the
trend
towards a service-oriented industrial
structure,
leading to a fundamental transformation
of
the nation's economic and industrial
structures.
Aging of our society is also rapidly
proceeding.
On the other hand, it is observed that
workers'
mind about their works is changing
and the
forms of employment are being diversified.
Under these circumstances, there is
an increasing
number of workers who claim to be suffering
from misgivings, anguish and mental
stress
in relation to their jobs and working
lives.
It is much concerned that mental and
physical
burdens to workers are likely to increase
because of qualitative changes in their
working
lives under the significant shifts
in the
economic and industrial environments.
The impact that mental health problems
impose
on workers, their families, enterprises,
and the society as a whole is rapidly
intensified
in today's society. Therefore, it is
an important
issue to ensure the happiness of workers
and their families as well as to implement
actively the maintenance and promotion
of
workers' mental health in their workplaces
from the viewpoint of the sound social
development
of our country.
This is a comprehensive guideline that
provides
the principle method of mental health
care
for the purpose of ensuring the adequate
and effective implementation of basic
measures
which are desirable to be conducted
by employers
at workplaces. It is important for
employers
to begin with the measures that are
practicable
in a manner which is suited for the
practical
conditions of each enterprises.
2. Basic Concept of Mental Health Care
(1) Importance of mental health care
in enterprises
A number of potential factors causing
mental
stress (hereinafter called "stress
factors")
can be found in jobs, working lives,
households
and local communities. It is important
in
promoting mental health for workers
to recognize
the existence of such stress factors
and
the necessity to deal with them by
taking
suitable measures (hereinafter called
"self-care).
In offices or factories in which workers
are employed, however, there are stress
factors
that cannot be eliminated by the workers
themselves. Accordingly, employers
must actively
promote measures for mental health
care in
support of the efforts by workers.
Well-organized
and planned measures in enterprises
always
play an important role in maintaining
and
promoting mental health. The Industrial
Safety
and Health Law stipulates that "the
employer shall make continuous and
systematic
efforts for the maintenance and promotion
of worker health." Mental health
care
involves important activities to ensure
the
maintenance and promotion of worker
health.
In order to promote mental health care
activities
at enterprises, it is important to
fully
understand from various viewpoints
the aspects
of stress factors at workplaces that
affect
mental health and try to improve these
problems.
At the same time, providing workers
with
the proper knowledge of mental health
plays
an important role in resolving problems
relating
to mental health by encouraging voluntary
participation by the workers themselves
in
consultation opportunities. Acquiring
the
correct knowledge is also essential
for managers
and supervisors in workplaces as well
as
in-house industrial health staff, etc.,
in
promoting mental health, as they assume
the
responsibility for daily contact with
workers.
Specifically, employers should take
measures
to accept claims brought by workers
by setting
up facilities for consultation and
assisting
in generating a friendly atmosphere
for workers
with mental health problems. Other
important
measures would include the structuring
of
networks with outside resources offering
professional knowledge in mental health
care,
as these resources can be utilized
for providing
opportunities for education, training
and
consultation as well as in providing
professional
advice relating to workplace adaptation
or
medical treatment, or return to workplace
after treatment if required.
(2) Precautions in promoting mental
health
care
Employers should consider the following
matters
in promoting mental health care measures.
(a) Specific nature of mental health
problems
As objective methods to assess mental
health
problems have not been established
even now,
this makes the evaluation process very
difficult.
Moreover, the development process of
mental
health problems is also difficult to
understand,
as significant differences exist among
individuals.
We should also take note our own tendency
to evaluate workers who have mental
health
problems from viewpoints other than
health,
despite the fact that mental health
relates
to every worker and potentially causes
difficulties
in their mental conditions. There are
other
problems that should be resolved, including
a general misunderstanding of mental
health.
(b) Consideration of individual worker
privacy
It is important to carefully protect
the
privacy and choices of workers in promoting
mental health care activities. In collecting
and utilizing information on mental
health,
we should protect the confidentiality,
as
this is an essential condition to allow
workers
to participate in mental health programs
with a sense of security and to enable
mental
health care measures at workplaces
to be
effectively developed.
(c) Relationship with personnel/labor
management
policies
The mental health of workers can be
affected
more significantly than physical health
by
various factors in personnel/labor
management
policies, including job assignments,
job
transfers, workplace organization,
etc. In
many cases, mental health care cannot
be
properly promoted without appropriate
support
through personnel/labor management
policies.
(d) Problems coming from family or
individual
lifestyles
In many instances, the mental health
of workers
is affected by various problems that
are
not only work related, but also involve
family
or individual lifestyle issues. Personal
character can be another important
factor
affecting mental health. These factors
can
relate to each other and interact,
leading
to a very complex situation.
3. Mental Health Promotion Program
Mental health care should be promoted
in
a continuous and well-planned manner
on the
basis of medium- and long-term perspectives.
To this end, employers should use health
committees to examine and clearly identify
the current situation and problems
relating
to the promotion of mental health care
at
workplaces, and to establish a fundamental
program (hereinafter called "mental
health care promotion program")
that
details specific measures to resolve
such
problems in response to actual workplace
conditions and needs.
Moreover, an effective way to promote
a mental
health care program is for employers
themselves
to express their determination to actively
support such a program.
The mental health care promotion program
should focus on the following objectives:
1) |
Measures to arrange a system to promote the
mental health care at workplaces. |
2) |
Measures to identify problems at workplaces
and to implement the mental health care promotion
program. |
3) |
Measures to secure the human resources necessary
to develop the mental health care promotion
program and to utilize resources outside
of the enterprise. |
4) |
Measures to protect worker privacy. |
5) |
Measures to take other steps necessary for
mental health care promotion involving workers. |
4. How to Develop Mental Health Care Activities
Mental health care activities can be
developed
only if the following four care activities
are pursued in a continuous and well-planned
manner:
* |
Self-care: workers should understand by themselves
various problems relating to stress and mental
health and take measures to prevent, reduce
or treat such problems as necessary. |
* |
Line care: managers and supervisors who
have daily contact with workers should improve
the working environment and consult with
workers wishing to discuss their mental health. |
* |
Professional care: Managers responsible for
health management at workplaces should make
proposals relating to the mental health care
promotion program, promote the relevant activities
and support workers and other managers and
supervisors. |
* |
Outside-care: Organizations and professional
staff, etc., outside of enterprises should
be utilized to support in-house mental health
care activities. |
In cases where securing the necessary
human
resources is difficult for small and
medium-scaled
enterprises, it will be effective to
rely
on outside resources.
(1) Self-care
(a) Providing education and training opportunities
and information to workers:
Correct knowledge on mental health
is essential
for workers in conducting self-care
activities.
Employers should provide workers with
education
and training opportunities and information,
including the following, to ensure
adequate
understanding of mental health problems.
a) Basic knowledge on stress and mental
health
care.
b) The importance of self-care and
proper
attitudes towards mental health problems.
c) How to recognize stress and related
problems.
d) Methods to prevent reduce and deal
with
mental stress.
e) The importance of voluntary consultation
with professionals.
f) Information on in-house consultation
opportunities
and outside resources.
g) Employer's policy on mental health
care.
(b) Support for self-care:
It is important in promoting self-care
to
establish and improve in-house consultation
systems that allow workers to discuss
their
mental health problems with managers
or professionals.
Accordingly, employers should establish
in-house
systems that can provide workers with
consultation
opportunities or employ outside organizations
to listen to complaints or consult
with workers.
These arrangements can be effective
in promoting
an environment in which complaints
from workers
can easily be received and acted upon.
In addition, in order to allow workers
to
recognize mental stress as early as
possible,
it is desirable to provide workers
with opportunities
to check their mental health by conducting
in-house stress-related surveys or
providing
self-checking systems through in-house
LANs.
(2) Line-care
A. Promoting line-care systems
(a) Improving working environments
a) Targets of working environment improvements:
As there are a number of factors affecting
worker mental health, it is necessary
to
improve them. These factors include
the workplace
environment (working environment, working
methods, facilities and equipment to
overcome
mental and physical fatigue, and facilities
and equipment necessary to improve
workplace
conditions), working hours, work quality
and quantity, human relationships at
workplaces,
workplace organization and personnel/labor
management systems, workplace culture
and
the climate in workplaces.
b) Evaluating working environments,
etc.,
and identifying problems:
Managers and supervisors should identify
and understand specific problems in
the working
environment, etc., through the results
of
daily workplace management activities
and
views expressed by workers or the results
of working environment evaluation surveys
related to mental stress that are conducted
by in-house industrial health professionals
using survey sheets.
c) Improving working environments,
etc.
Managers and supervisors should make
efforts
to improve the working environment,
etc.,
with respect to specific problems that
are
identified through daily workplace
management
activities.
Working environments should be improved
by
taking a wide variety of measures,
including
reviewing the working environment and
working
modes, enhancing manager/supervisor
capabilities
in coordinating human relationships
in the
workplace, and reexamining workplace
organizations.
The views of workers should always
be respected
in the process of working environment
improvements.
At the same time, listening to the
advice
and cooperation of in-house industrial
health
staff, etc., and outside resources
are desirable
in conducting improvement activities.
Improvement activities should be maintained
in a sustained way to make various
measures
more effective by periodically evaluating
the effects of measures and reexamining
programs
when the effects are not satisfactory.
d) Consideration given to individual
workers:
Managers and supervisors should take
into
consideration each worker's capabilities,
fitness and work contents by adequately
understanding
the daily labor burden on individual
workers
to prevent workers from suffering from
excessively
long working hours or heavy fatigue,
onerous
mental burdens or responsibilities.
(b) Consultation with workers
Managers and supervisors should make
efforts
to accept claims and requests from
workers
in the course of the daily activities
at
workplaces. In particular, they should
try
to listen to workers who are suffering
from
fatigue due to excessively long labor,
those
who have experienced serious events
causing
mental burdens, and others who require
individual
consideration. These workers should
be provided
appropriate information and opportunities
to consult with in-house industrial
health
staff, etc., or outside resources or
to undergo
medical treatment.
B. Improving the environment to promote
line-care
activities
(a) Providing opportunities for education,
training and information for managers
and
supervisors:
Employers should provide managers and
supervisors
with opportunities for education, training
and information relating to the following
subjects.
a) |
Basic knowledge on stress and mental health
care. |
b) |
The role of managers and supervisors and
proper attitudes towards mental health problems. |
c) |
Methods of evaluating and improving working
environments, etc. |
d) |
Methods of consulting with workers (how to
listen to workers and provide information
and advice). |
e) |
Methods of supporting workers who have returned
to workplaces with mental health problems. |
f) |
Methods of maintaining communication with
in-house industrial health staff, etc., and
outside resources. |
g) |
Methods of proceeding with self-care activities. |
h) |
Information on in-house consultation organizations
and outside resources. |
i) |
Employer's policy on mental health care. |
j) |
Considerations related to worker privacy. |
k) |
Reasons for developing mental health care
activities at workplaces. |
(b) Support to managers and supervisors
Managers and supervisors at workplaces
play
a central role in taking such measures,
including
working environment improvements, consultation
with workers and treatment of workers
with
mental health problems. Employers should
understand and support activities by
managers
and supervisors by clearly indicating
employers'
policies on mental health policies
at enterprises
and measures to be taken for these
policies.
At the same time, in order to smoothly
promote
line-care activities, employers should
provide
in-house industrial health staff, etc.,
with
support in conducting the evaluation
and
improvement of working environment
as well
as taking measures for consultation.
Managers
and supervisors should also be provided
with
assistance from their employers to
obtain
the necessary information from outside
resources.
(3) Professional care by in-house industrial
health staff, etc.,
A. Promoting professional care activities
by in-house industrial health staff,
etc.,
(a) Improving working environments,
etc.
a) Identifying and evaluating actual
working
environment conditions
In-house industrial health staff, etc.,
should
identify and evaluate stress-causing
factors
at workplaces regularly or as necessary
through
workplace inspection tours, listening
to
managers and workers, and conducting
inquiries
via survey sheets on mental stress.
In evaluating
working environments, etc., it is desirable
to pay attention to human relationships
and
the workplace organization by using
checklists
on working environments, etc.
b) Improving working environments,
etc.
In-house industrial health staff, etc.,
should
provide advice to managers and supervisors
to improve working environments based
on
the results of working environment
evaluation
and make efforts for improvement in
cooperation
with managers and supervisors.
(b) Receiving consultation from workers
and
other assistance
a) Assisting workers to recognize mental
problems and accepting claims:
In cooperation with managers and supervisors
and utilizing working environment checklists,
in-house industrial health staff, etc.,
should
identify workers' stress and metal
problems
they are facing, help them find it,
and provide
services of health guidance and health
consultation
to them.
At enterprises where total health promotion
measures (THP) are taken, assistance
should
be provided to workers allowing for
the early
recognition of problems through psychological
consultation schemes by psychological
consultants.
In providing other guidance in THP
programs
such as physical exercise or health
promotion
guidance, it is also important to actively
take up stress and mental health problems.
b) Guidance for workplace adaptation,
medical
treatment and return to workplaces;
In-house industrial health staff, etc., should
assist workers suffering from mental health
problems to enable them to adapt and return
to their workplaces in cooperation with managers
and supervisors. Health professionals should
also provide workers with advice on the necessary
medical treatment if professional treatment
is required by introducing appropriate outside
resources, while paying attention to the
desires of workers. Guidance and assistance
should also be provided to workers who have
been absent from workplaces to allow them
to return to their jobs in cooperation with
managers, supervisors and outside resources.
(c) Creating and maintaining networks
In-house industrial health staff, etc.,
should
play a central role in creating and
maintaining
networks between enterprises and outside
resources.
B. Roles of in-house industrial health
staff,
etc.
In addition to the roles cited above,
in-house
industrial health staff, etc., have
the following
responsibilities depending on their
assignments:
(a) Industrial physicians, etc.
Industrial physicians, etc., monitors
the
proceeding situation of measures implemented
according to the mental health promotion
program from the viewpoint of a person
who
has the responsibility of taking measures
that require medical expertise among
various
measures to maintain and promote worker
health,
including the maintenance and control
of
working environments, health education,
and
consultation. They are also responsible
for
planning and implementation of education
and training programs, collecting and
disseminating
information, and providing of advice
and
guidance as the providing services
from the
professional standpoint for the support
of
self-care and line-care activities.
They
should also participate in the coordination
and liaison process with outside resources
from the professional perspective for
cases
that require medical consultation and
treatment.
(b) Health supervisors, etc.
On the basis of enterprise mental health
promotion programs, advice and guidance
provided
by industrial physicians, etc., health
supervisors,
etc., should be responsible for the
planning
and implementation of specific education
and training programs, the evaluation
and
improvement of working environments,
etc.,
and creating the favorable atmosphere
and
system with which the consultation
of mental
health with workers can be easily conducted.
Health supervisors should also assist
in
the promotion of self-care and line-care
activities, identify problems in their
implementation,
and carry out liaison and coordination
activities
with outside resources in cooperation
with
industrial physicians, etc.
(c) Public health nurses and hygienists,
etc.
In cooperation with industrial physicians
and health supervisors, etc., public
health
nurses and hygienists should assist
self-care
and line-care activities, respond to
consultation
from workers and managers/supervisors,
and
plan and carry out the necessary education
and training programs.
(d) Professional mental health staff
Professional mental health staff, if
assigned
at enterprises, should carry out the
assigned
work such as the evaluation and improvement
of working environments, education
and training
programs and consultation.
(e) Personnel/labor management staff
As there are a number of problems that
cannot
be resolved by managers and supervisors
alone,
personnel/labor management staff should
investigate
the specific effects of job assignments,
personnel transfers, workplace organization
and other personnel/labor management
policy
matters with respect to the mental
health
of workers, and give consideration
to the
improvement of working conditions,
including
working hours, and appropriate job
assignments
for workers.
C. Arrangement of environments to promote
professional care by in-house industrial
health staff, etc.
(a) Education and training and information
providing
Employers should provide in-house industrial
health staff, etc., with opportunities
to
undergo education and training and
acquire
the necessary knowledge on the matters
listed
below, including specific job-related
professional
matters.
a) Basic knowledge on stress and mental
health
care.
b) Roles of in-house industrial health
staff,
etc., and proper attitudes towards
mental
health problems.
c) Methods of evaluating and improving
working
environments, etc.
d) Methods of consulting with workers
(how
to listen to workers and provide information
and advice)
e) Methods of worker guidance to support
their return and adaptation to workplaces.
f) Methods of maintaining communications
with outside resources (network formation).
g) Methods of education and training
h) Methods of introducing outside resources
and promoting their utilization
i) Methods of establishing plans and
systems
for enterprise mental health programs.
j) Methods of self-care activities.
k) Methods of line-care activities
l) Information on in-house consultation
facilities
and outside resources.
m) Employer's policies on mental health
care
n) Consideration for the privacy of
workers
o) Reasons why mental health care activities
are needed at workplaces
(b) Assistance, etc., to in-house industrial
health staff, etc.
Employers should clearly indicate their
policies
on the maintenance and promotion of
mental
health to in-house industrial health
staff,
etc., and consign or instruct them
in performing
such duties while providing the necessary
assistance.
In accordance with actual conditions
in their
workplaces, employers should establish
in-house
organizations and systems in which
in-house
industrial health staff, etc. can respond
to voluntary requests for consultation
from
workers.
Employers should also take the necessary
measures to enable in-house industrial
health
staff, etc., to utilize outside resources.
It is desirable for large-scale enterprises
and employers exceeding certain scales
to
employ professional mental health care
staff
in their companies or enterprises.
Employers
are also requested to ask the views
of in-house
industrial health staff concerning
the job
assignments of workers who have mental
health
problems, and to respect such views.
(4) Care by outside resources
A. Effective utilization of outside
resources
Employers are requested to effectively
utilize
outside resources as necessary in promoting
mental health care activities in accordance
with their respective roles.
In particular, if small and medium-scaled
enterprises have difficulties in securing
the necessary human resources to promote
mental health care by in-house industrial
health staff, etc., it is effective
to utilize
the capabilities of outside resources
in
accordance with their respective roles,
including
regional industrial health centers,
prefectural
industrial health promotion centers,
the
Japan Industrial Safety and Health
Association,
and Rosai hospital worker mental health
centers.
B. Network formation with outside resources
(a) Large and medium-scale enterprises
If needed in promoting mental health
care
activities, large and medium-scale
enterprises
should request the necessary information
and advice from appropriate outside
resources
via in-house industrial health staff,
etc.
Networks with outside resources should
be
formed in advance to introduce workers
to
medical and regional health organizations
when necessary.
Companies exceeding certain scales
should
employ in-house professional industrial
health
staff to promote mental health care
activities
in their workplaces.
(b) Small-scale enterprises
As small-scale enterprises employing
fewer
than 50 workers are often find it difficult
to secure their own human resources
for mental
health, it is effective for them to
utilize
outside resources such as regional
industrial
health centers as necessary. In such
cases,
in-house health promoters or safety
and health
promoters should establish and maintain
contact
with such outside resources.
|