Psychiatric Annals

Guest Editorial Free

Workplace Mental Health

Gaurava Agarwal, MD

When I submitted the idea for this issue in the winter of 2019, there was growing enthusiasm about the incremental positive changes that were being seen in the world of workplace mental health. Experts in occupational and organizational psychiatry, employers, payors, clinicians, employees, and society in general seemed to be coalescing around four ideas: (1) there is a strong business and moral case for employers to care about the mental health and well-being of their employees; (2) stigma needs to be reduced; (3) workers expected their employer's to play a significant role in providing them with mental health resources; and (4) access to evidence-based mental health care needed to be improved. I thought this would be a perfect time for an issue of Psychiatric Annals that highlighted how mental health professionals can play an active and useful role in helping employees and employers have a productive and healthy relationship.

Although the basic premise for this issue remains unchanged, everything else in our present times seems to be different and the change has not been incremental. In February 2020, nearly 159 million people in the United States were employed.1 Since that time, millions of people have lost their jobs, businesses are fighting for survival, and worldwide people are experiencing distress as the world grapples with the fallout from the coronavirus disease 2019 (COVID-19) pandemic.2

You might think that given the economic conditions, some of the momentum that existed for employers to commit resources and attention toward workplace mental health may be diminished. Although there have been cutbacks in certain industries, one of the silver linings of the COVID-19 pandemic may well be that talking about mental health, loneliness, isolation, and stress are suddenly the topics de jour. Employers that fail to lead during this pandemic and ignore their employees' mental health may lose trust and talent. Digital mental health apps, video conferencing, collaborative care models, employee assistance programs, manager training, and well-being resources are suddenly widely visible on the front pages of employer websites and key topics in all email communications.

However, the conversation is no longer just about employee well-being and mental health, organizational climate and culture, and access to care. The conversation has expanded to the nature of work itself. How we work, where we work, who we work with, when we work, and what we do are all in question now. There is a palpable sense that we will not be going back to the way things were whenever this COVID-19 pandemic ends. The implications of that are unknown and the ripples of the changes have the potential to change long-term societal trends such as urbanization, global trade, social safety net commitments, and climate change.

As an occupational and organizational psychiatrist, thinking about these changes is beyond exciting. There is hope that things could actually be better than before. Our quality of life could be improved. Our harmony with nature could be improved. We could be able to spend more time with our loved ones and out of congested traffic. However, what I suspect will not change is that work will remain a central part of our identity and the source of much meaning and purpose.

In addition, workplaces (in whatever form they will take) are likely to continue to play a key role in health promotion due in part to our employer-based health insurance system, which provides access to health care for millions of families. The workplace environment is also the source of both great joy and great stress for many people, depending on how they are constructed and led. The ability to effectively construct an environment where people can thrive will be a competitive advantage for employers who want to recruit and retain the best people in a knowledge economy. Finally, businesses have a material interest in their workers' mental health because they bear both direct and indirect costs when workers' mental health is not well. Direct costs borne by employers include the cost of medical claims and pharmacy benefits. This can be from the cost of behavioral health treatment alone, but it is important to note that this cost is far exceeded by the additional medical costs that employees with behavioral health problems incur. Indirect costs include presenteeism, absenteeism, replacement costs due to turnover, and work disability. Absenteeism refers to days lost when an employee does not attend work. Presenteeism refers to when an employee does attend but due to symptoms of their illness their productivity is reduced compared to peak performance. Employees and employers benefit when these costs are minimized, so employers can reinvest more of their money into their products, research and development, customer service, and employees.

Mental health clinicians can provide a valuable service to society by helping employers and employees navigate various mental health issues. Organizations such as the Center for Workplace Mental Health, Academy of Organizational and Occupational Psychiatry, the National Institute for Occupational Safety and Health, the American Heart Association, and the World Health Organization have provided frameworks and resources that we can use to help educate our patients and their employers about the joint responsibility they have in creating and maintaining healthy workplaces. There is much to learn, and the hope is this that the articles in this issue will provide mental health clinicians with key concepts that will allow them to provide nuanced care to their patients around work-related concerns, advise organizations on the difficult medico-legal issues related to workplace mental health, and advocate nationally as experts whose voices should provide value as we not only rebuild from the COVID-19 pandemic, but perhaps reimagine a new relationship with work.


  1. Bureau of Labor Statistics, US Department of Labor. The employment situation-- December 2020. Accessed January 13, 2020.
  2. Xiong J, Lipsitz O, Nasri F, et al. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J Affect Disord. 2020;277:55–64. doi:10.1016/j.jad.2020.08.001 [CrossRef] PMID:32799105
Gaurava Agarwal, MD

Gaurava Agarwal, MD, is an Associate Professor, Departments of Psychiatry and Behavioral Sciences and Medical Education, Northwestern Feinberg School of Medicine; and the Director of Physician Well-Being, Northwestern Medicine Medical Groups.

Address correspondence to Gaurava Agarwal, MD, Northwestern Memorial Hospital, Stone Institute, 446 E. Ontario Street, Suite 7-100, Chicago, IL 60611; email:

Disclosure: The author has no relevant financial relationships to disclose.


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