review article an evaluation of the policy context on...

Review ArticleAn Evaluation of the Policy Context on PsychosocialRisks and Mental Health in the Workplace in the EuropeanUnion: Achievements, Challenges, and the Future

Stavroula Leka,1 Aditya Jain,2 Sergio Iavicoli,3 and Cristina Di Tecco3

1Centre for Organizational Health & Development, School of Medicine, University of Nottingham, Jubilee Campus,Wollaton Road, Nottingham NG8 1BB, UK2Nottingham University Business School, University of Nottingham, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, UK3Italian Workers’ Compensation Authority (INAIL), Department of Occupational and Environmental Medicine,Epidemiology and Hygiene, Via Fontana Candida 1, Monteporzio Catone, 00040 Rome, Italy

Correspondence should be addressed to Stavroula Leka; [email protected]

Received 5 April 2015; Revised 13 August 2015; Accepted 1 September 2015

Academic Editor: Barthelemy Kuate Defo

Copyright © 2015 Stavroula Leka et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Despite the developments both in hard and soft law policies in the European Union in relation to mental health and psychosocialrisks in the workplace, a review of these policies at EU level has not been conducted to identify strengths, weaknesses, and gapsto be addressed in the future. Keeping in mind that the aim should be to engage employers in good practice, ideally such policiesshould include key definitions and elements of the psychosocial risk management process, covering risk factors, mental healthoutcomes, risk assessment and preventive actions, or interventions. The current paper aims to fill this gap by reviewing hard andsoft law policies on mental health in the workplace and psychosocial risks applicable at EU level and conducting a gap analysisaccording to a set of dimensions identified in models of good practice in this area. Our review of ninety-four policies in totalrevealed several gaps, especially in relation to binding in comparison to nonbinding policies. These are discussed in light of thecontext of policy-making in the EU, and recommendations are offered for future actions in this area.

1. Introduction

It is generally accepted that “work is good for you,” contribut-ing to personal fulfillment and financial and social prosperity[1].There are economic, social, andmoral arguments that, forthose who are able to work, “work is the best form of welfare”[2–4] and is the most effective way to improve the well-beingof these individuals, their families, and their communities.Moreover, for people who have experienced poor mentalhealth, maintaining, or returning to, employment can alsobe a vital element in the recovery process, helping to buildself-esteem, confidence, and social inclusion [5]. A betterworking environment can help improve employment rates ofpeople who develop mental health problems. Not doing thisputs additional costs on governments that have to providesocial welfare support for people who would prefer to be inemployment.

There is also growing awareness that (long-term) unem-ployment is harmful to physical and mental health, so itcould be assumed that the opposite must be true that workis beneficial for health. However, that does not necessarilyfollow [1]. Work is generally good for your health and well-being, provided you have “a good job” [1, 6]. Good jobs areobviously better than bad jobs, but bad jobs might be eitherless beneficial or even harmful. In fact, a study byWesterlundet al. [7] shows an improvement in fatigue and depressivesymptoms associated with the retirement event, especially forthose exposed to the worst work environment.

This paper focuses on mental health in the workplaceand adopts a comprehensive approach and an inclusivedefinition of mental health with a focus not only on (theabsence of) mental health disorders but also on positive stateof psychological well-being. This approach underlines theneed to address mental health in its totality by recognising

Hindawi Publishing CorporationBioMed Research InternationalVolume 2015, Article ID 213089, 18 pageshttp://dx.doi.org/10.1155/2015/213089

2 BioMed Research International

interrelationships among risks tomental health, subthresholdconditions of poor psychological health and well-being (suchas stress), which may have not yet resulted in a diagnosedmental health disorder but may severely affect their expres-sion, and diagnosed mental health disorders. According tothis perspective, efforts to tackle mental ill health should notfocus on particular problems in isolation, such as depression,for example, but they should seek to put in place policiesand practices that will tackle a wider range of risk factorsto mental health by appropriate interventions. These shouldprioritise prevention and tackling problems at source whilealso developing awareness and facilitating treatment.

This paper focuses on the workplace where one ofthe key states of suboptimal mental health that can havesevere consequences is work-related stress. Work-relatedstress is the response people may have when presentedwith work demands and pressures that are not matchedto their knowledge and abilities and which challenge theirability to cope [8]. The European Commission [9] definedstress as a pattern of emotional, cognitive, behavioural, andphysiological reactions to adverse and noxious aspects ofwork content, work organisation, and work environment.In the framework agreement on work-related stress [10],stress is defined as a state, which is accompanied by physical,psychological, or social complaints or dysfunctions andwhich results from individuals feeling unable to bridge a gapwith the requirements or expectations placed on them.

A substantial body of evidence is now available onwork-related risks that can negatively affect both mentaland physical health with an associated negative effect onbusiness performance and society [11]. Although risks in thephysical work environment can have a direct negative effecton mental health that is accentuated by their interactionwith risks in the psychosocial work environment. In addition,psychosocial hazards (also often termed work organisationcharacteristics or organisational stressors) have been shownto pose significant risk and have a negative impact on mentalhealth, mainly through the experience of work-related stress[11, 12].These hazards are closely associatedwith the changingnature of work.

1.1. The Prevalence and Impact of Work-Related PsychosocialRisks and Mental Ill Health in the EU. In 2005 and againin 2010, every fourth participant of the European WorkingConditions survey believed that their health is at risk dueto work-related stress [13]. Even from early 2000, studiessuggested that between 50 and 60% of all lost workingdays have some link with work-related stress [14] leadingto significant financial costs to companies as well as societyin terms of both human distress and impaired economicperformance. In 2002, the European Commission reportedthat the yearly cost of work-related stress and related mentalhealth problems in 15 Member States of the pre-2004 EU wasestimated to be on average between 3 and 4% of the grossnational product, amounting to C265 billion annually [15].

In addition, the estimates for the proportion of theworkforce in Europe that may be living with a mental healthproblem at any one time range from one in five [16] to two infive [17], with a lifetime risk of at least two in five [16]. In the

EU-27, it was found that 15% of citizens had sought help for apsychological or emotional problem, with 72% having takenantidepressants [18].

A report by EU-OSHA summarized the economic costsof work-related stress illnesses. It reported that, in France,between 220,500 and 335,000 (1–1.4%) people were affectedby a stress-related illnesswhich cost the society between C830and C1.656 million; in Germany, the cost of psychologicaldisorders was estimated to be EUR 3,000 million [19]. Eachcase of stress-related ill health has been reported to lead to anaverage of 30.9 working days lost [20]. Estimates from theUKLabour Force Survey indicate that self-reported work-relatedstress, depression, or anxiety accounted for an estimated11.4 million lost working days in Britain in 2008/09 [21].This was an increase from earlier estimates, which indicatedthat stress-related diseases are responsible for the loss of 6.5million working days each year in the UK, costing employersaround C571 million and society as a whole as much as C5.7billion. A recent study concluded that the “social cost” ofjust one aspect of work-related stress (job strain) in Franceamounts to at least 2-3 billion euros, taking into accounthealthcare expenditure related to absenteeism, people givingup work, and premature deaths [22].

1.2. Policies on Psychosocial Risks and Mental Health in theWorkplace. Psychosocial risks and their management areamong employers’ responsibilities as stipulated in the Frame-work Directive 89/391/EEC on Safety and Health of Workersat Work as it obliges employers to address and manage alltypes of risk in a preventive manner and to establish healthand safety procedures and systems to do so. In addition tothe Framework Directive, a number of policies and guidanceof relevance to mental health have been developed and areapplicable to the European level. These include both legallybinding instruments (such as EU regulations, Directives,decisions, and national pieces of legislation) and other “hard”policies (such as ILO conventions) developed by recognisednational, European, and international organisations as wellas nonbinding/voluntary policies (or “soft” policies) whichmay take the form of recommendations, resolutions, opin-ions, proposals, conclusions of EU institutions (Commission,Council, and Parliament), the Committee of the Regions, andthe European Economic and Social Committee, as well associal partner agreements and frameworks of actions, andspecifications, guidance, campaigns, and so forth initiated byrecognised European and international committees, agencies,and organisations.

Regulatory instruments of relevance tomental health andpsychosocial risks are applicable to all EU member states.However, even though each of these regulations addressescertain aspects of mental health and/or the psychosocialwork environment, it should be noted that the terms “mentalhealth,” “stress,” and “psychosocial risks” are not mentionedexplicitly inmost pieces of legislation [23].Themain examplein this respect is the Framework Directive 89/391/EEC onSafety and Health of Workers at Work. Even though theDirective asks employers to ensure workers’ health and safetyin every aspect related to work, “addressing all types of riskat source,” it does not include the terms “psychosocial risk”

BioMed Research International 3

or “work-related stress.” However, it does require employersto “adapt the work to the individual, especially as regardsthe design of workplaces, the choice of work equipment, andthe choice of working and production methods, with a view,in particular, to alleviating monotonous work and work ata predetermined work rate, developing a coherent overallprevention policy which covers technology, organizationof work, working conditions, social relationships, and theinfluence of factors related to the working environment.”

The Directive further specifies that “health surveillanceshould be provided for workers according to national sys-tems. Particularly sensitive risk groups must be protectedagainst the dangers which specifically affect them.” In thissense, there is an indirect reference to, and provision for, risksrelated to mental health at work. This is also the case for theDirective on organisation of working time (93/104/EC), whilethe Council Directive onwork with display screen equipment(90/270/EEC) actually refers to “problems ofmental stress” inthe context of risk assessment. It should be noted here that, insome EUmember states, the national regulatory frameworksare more specific than the key EU occupational health andsafety Directives and do make reference to psychosocial risksand work-related stress.

A debate has been taking place in the scientific andpolicy literatures about the lack of clarity in regulatoryframeworks and related guidance on mental health at workand the management of psychosocial risks (e.g., [24–26]). Arecent European Survey of Enterprises on New & EmergingRisks (ESENER) which covered over 28,000 enterprises in 31countries across Europe has revealed that even though work-related stress was reported among the key OSH concerns forEuropean enterprises, only about half of the establishmentssurveyed reported that they inform their employees aboutpsychosocial risks and their effects on health and safetyand less than a third had procedures in place to deal withwork-related stress. The findings of the survey also showedthat 42% of management representatives consider it moredifficult to tackle psychosocial risks, compared with othersafety and health issues. The most important factors thatmake psychosocial risks particularly difficult to deal withwere reported to be “the sensitivity of the issue,” “lack ofawareness,” “lack of resources,” and “lack of training” [27].The second edition of EU-OSHA’s ESENER collected similarinformation on OSH management and workplace risks, witha particular focus on psychosocial risks, from almost 50,000enterprises in 36 countries across Europe. Recently published,first findings have revealed that psychosocial risk factors arereported as more challenging than other risks. The mostimportant factors that make psychosocial risks particularlydifficult to deal are “lack of information” and “lack ofadequate tools to deal with the risk effectively” as perceivedby almost one in five establishments reporting “dealingwith difficult customers” or “experiencing time pressure”[28].

Similar findings have also been found in stakeholdersurveys, which report that many stakeholders still perceiveworkplace hazards as primarily relating to physical aspects ofthe work environment. Furthermore, where issues relating to

mental health are reported to be important OSH concerns,there are significant differences among the perception ofstakeholders in different countries in the EU [29, 30]. Thesedifferences in perception (in terms of perspectives, priorities,and interests) of mental health at work between socialactors, particularly between employers’ organisations andtrade unions, are a challenge for effective social dialogue onthese issues and for the effective implementation of recentlyintroduced voluntary policy initiatives for the managementof psychosocial risks such as the European framework agree-ments onwork-related stress and on harassment and violenceat work [31].

In addition to the regulatory instruments, a significantlylarger number of “soft” policy initiatives of relevance tomental health and psychosocial risks in the workplace havebeen developed and implemented at the EU level. An EU-OSHA report on workplace mental health promotion citessome of the recent policy documents and initiatives withinthe EU relevant to mental health at work [32]:

(1) Lisbon Strategy: EU goal for economic growth andcompetitiveness;

(2) Community Strategy on Health and Safety at Work,2007–2012;

(3) Commission White Paper “Together for Health”;(4) Framework Agreement on Work-related Stress;(5) Framework Agreement on Harassment and Violence

at Work;(6) The Mental Health Pact.

The EU-OSHA report highlights the wide scope of policies inthis area, which range from broad EU strategies and publichealth policies to social dialogue initiatives. In additionto these, other policy initiatives of relevance to mentalhealth and psychosocial risks in the workplace include thesetting-up of formalised stakeholder committees, EU levelcampaigns, policies on managing disability, and initiativesby organisations such as the WHO and ILO. Many of thesesoft law initiatives and policies are directly relevant to mentalhealth in the workplace, psychosocial risks, work-relatedstress, and their management. However, very little evaluationhas been conducted on hard and soft law policies in Europe.

An evaluation of the implementation of the FrameworkDirective conducted a decade ago indicated that the tasksof risk assessment, documentation, and supervision are notuniversally spread, even in member states with a traditionbased on prevention [33]. The report also highlighted that,where procedures were in place in organisations, they gener-ally focused on obvious risks where long-term effects (e.g.,mental health) as well as risks that are not easily observedwere being neglected. There was also hardly any consid-eration of psychosocial risk factors, and risk assessmentswere often being considered to be a one-time obligationlacking continuity where the efficiency of the measures wasnot sufficiently monitored by employers. The findings of theevaluation indicated that much still needed to be done asregards psychosocial risks such as work control and work


organisation, preventing unreasonably intense work pace,and repetitivework.This suggested an insufficient applicationof some of the general principles of the prevention foreseenin the Framework Directive 89/391 [25].

Concerning the evaluation of the framework agreementsfor work-related stress and for harassment and violence atwork, the main activities that followed the signing of theagreements were their translation in national languages [34,35]; however, they did act as catalysts for the implementationof new or updated legislation in some countries (e.g., theCzech republic and Italy). It should be noted that there is arather mixed picture regarding the state of European socialdialogue in the area of psychosocial risks at work and, asa result, serious questions have been raised in the literatureas to the appropriateness and effectiveness of “autonomous,or voluntary, agreements” [36]. Indeed, Ertel and colleagues[31] call for focused activities at European level to harmonizestakeholder perspectives on the issue of psychosocial riskfactors and work-related stress.

As discussed before, in some EU member states (e.g.,Sweden, Belgium, Italy, Germany, the Czech Republic), leg-islation is even more specific than EU law and makes directreference to work-related stress, bullying and harassment, orpsychosocial risks [6], although in very few countries stress-related diseases are included in official lists of occupationaldiseases. In addition, good practice examples in this area existin a number of member states. Some examples include theManagement Standards in the UK and Italy, Work Positive inIreland, the Work and Health Covenants and Catalogues inthe Netherlands, ISTAS in Spain, SOBANE in Belgium, thetools developed by INRS and ANACT in France, and EU-OSHA’s online simple risk assessment tool for SMEs, OiRA[37]. Indeed, Iavicoli et al. [38] have called for a criticalevaluation of efforts employed so far to address psychosocialrisks and mental health in the workplace to be conductedin order to develop an approach at European level that willallow both flexibility at national level and a certain level ofbenchmarking across members states in terms of relevantdata and good practices applied.

1.3. The Current Study. Since policies are an importantstarting point in addressing key issues, it is first important toidentify the key elements policies in this area should address.Keeping in mind that the aim should be to engage employersin good practice, ideally such policies should include ele-ments of the psychosocial riskmanagement process, coveringrisk factors,mental health outcomes, risk assessment and pre-ventive actions, or interventions. However, a review of hardand soft law policies at EU level along these dimensions hasnot been conducted to identify strengths and weaknesses andgaps to be addressed in the future. The current paper aims tofill this gap by reviewing hard and soft law policies on mentalhealth in the workplace and psychosocial risks applicable atEU level and conducting a gap analysis according to a setof dimensions identified in models of good practice in thisarea. In particular, the review and gap analysis has used thePRIMA-EF model as a guide [11] which highlights the keysteps and principles of the psychosocial risk managementprocess.

2. Method

The first step in the process was to identify all relevanthard and soft law policies of relevance to mental health inthe workplace and psychosocial risks. This was based onreviews previously conducted by themembers of the researchteam (see [23]). This review was updated to include sectoralDirectives as well as policies of relevance to mental healthin the workplace more broadly speaking (and not solelypsychosocial risks andwork-related stress).The review there-fore included not only general and specific health and safetypolicies but also policies relating to working hours, part-time work, temporary work, parental leave, discrimination,organizational restructuring (job insecurity), and so forth.

On the basis of a set of defined criteria in the form of apolicy scorecard (see Table 1), a gap analysis was carried out toexamine the extent towhich the current EUpolicy frameworkcovered issues relating to mental health in the workplace.Each policy (regulatory or nonbinding) was scored on a scaleof “0–5” on the basis of its relevance/applicability to and/orcoverage of dimensions relating tomental health at work.Thefive dimensions were chosen on the basis of good practiceguidance [11] and according to the comprehensive definitionon mental health in the workplace adopted in this study.The five dimensions were reference to mental health to inthe objectives and scope of the policy, coverage of exposurefactors, mental health problems/disorders at work and relatedoutcomes, risk assessment aspects, and preventive actions inrelation to mental health in the workplace. Policies whichdid not cover or refer to mental health at work were givena score of 0 while policies which were directly relevant andcomprehensively covered each dimension were given a scoreof 5.

Each policy was reviewed by four researchers working inpairs to analyze the policy content and “assign scores” on theestablished criteria. To ensure interrater reliability, a methodfor qualitative data analysis for applied policy research pro-posed by Ritchie and Spencer [39] was used where bothpairs of researchers reviewed the policy text for hard andsoft law policies independently. The assigned scores werethen discussed and reflected upon by all four researchers.Where disagreement arose, an independent expert reviewedthe policy in question. The final assigned score on eachdimension was established by consensus in terms of themajority.

3. Results

Table 2 presents the policy scorecard of regulatory instru-ments of relevance to mental health and psychosocial risksapplicable to the EU member states. These include Euro-pean Union Directives and ILO conventions. These reg-ulations address certain aspects of mental health and/orthe psychosocial work environment; however, most policiesscored 5 or below across the five dimensions highlightinga lack of coverage and specificity. Directive 89/391/EEC,the European Framework Directive on Safety and Healthof Workers at Work, received the highest score [13] alongwith a Directive 2010/32/EU, implementing the Framework


Table 1: Policy scorecard: key dimensions and scoring criteria.

Key dimensions 0 1 2 3 4 5Mental health inthe workplacereferred to in theobjectives andscope of the policy

Not covered by thegeneral objectivesor scope of the

policy

Covered inprinciple butnot effectivelyaddressed

Only implicitlycovered by the

objectives/scope ofthe policy

Partially coveredby the

objectives/scope ofthe policy

Sufficient coveragebut lack of

definitions of keyterms within the

policy

Comprehensivelycovered by the

general objective orscope of the policy

Coverage ofexposure factors inrelation to mentalhealth in theworkplace

No reference to oracknowledge-

ment/coverage ofexposure factors inrelation to mental

health in theworkplace


Only implicitacknowledge-

ment/coverage ofsome exposure

factors in relationto mental health inthe workplace

Partial acknowl-edgement/coverageof exposure factors

in relation tomental health inthe workplace


specificity onexposure factors inrelation to mental


Comprehensivecoverage of

exposure factors inrelation to mental


Coverage of mentalhealthproblems/disordersat work and relatedoutcomes

No reference oracknowledge-

ment/coverage ofmental health

problems/disordersat work and related

outcomes



ment/coverage ofmental health


outcomes

Partial acknowl-edgement/coverageof mental health


outcomes


specificity onmental health


outcomes

Comprehensivecoverage of mental

healthproblems/disordersat work and related

outcomes

Coverage of riskassessment aspectsin relation tomental health inthe workplace


ment/coverage ofrisk assessment

aspects in relationto mental health inthe workplace



ment/coverage ofrisk assessment

aspects in relationto mental health inthe workplace

Partial acknowl-edgement/coverageof risk assessmentaspects in relationto mental health inthe workplace


specificity on riskassessment aspects


Comprehensivecoverage of risk

assessment aspectsin relation to

mental health inthe workplace

Coverage ofpreventive actionsin relation tomental health inthe workplace


ment/coverage ofpreventive actions




ment/coverage ofpreventive actions


Partial acknowl-edgement/coverage

of preventiveactions in relationto mental health inthe workplace


specificity onpreventive actions


Comprehensivecoverage of

preventive actionsin relation to

mental health inthe workplace

Agreement on prevention from sharp injuries in the hospitaland healthcare sector concluded by HOSPEEM and EPSU.Directive 2010/32/EU is, however, applicable only to thehealthcare sector.

Table 3 presents the policy scorecard of voluntary policyinitiatives, which directly address mental health and psy-chosocial risks in the workplace. These policy initiativeswere scored much more favourably as compared to bind-ing/regulatory policies. Eleven policy initiatives had overallscores of 20 or more, indicating that many policy initiativesexplicitly referred to mental health and psychosocial risks inthe workplace in the objectives and scope of the policy andsufficiently or comprehensively covered aspects relating toexposure factors, mental health problems at work and relatedoutcomes, aspects of risk assessment and preventive actions.

Further analysis explored the average coverage of eachof the review dimensions across binding and nonbindingpolicies (see Figure 1). The solid lines in Figure 1 depictaverage scores of all binding/regulatory policies and all non-binding/voluntary policy initiatives, while the dotted linesplot the scores of the highest scored binding policy (Directive89/391/EEC) and nonbinding policy (PRIMA-EF guidance)

on each dimension. It is clear that nonbinding/voluntarypolicy initiatives aremore explicit in their reference tomentalhealth and psychosocial risks in the workplace in the objec-tives and scope of the policy and cover aspects relating toexposure factors, mental health problems at work and relatedoutcomes, aspects of risk assessment and preventive actions,in more detail as compared to binding/regulatory policiesoverall and in each of the five dimensions. A comparisonof the highest scored binding and nonbinding policies alsoindicate the same finding.

4. Discussion

From the review and gap analysis presented on regulatoryand voluntary policy initiatives, it is possible to make someobservations. Keeping in mind that the policies reviewed arethose that apply at European Union level alone (and notmember state policies), it is encouraging to see that a largenumber of relevant policies exist both of a binding and avoluntary nature. Our review covered thirty-four regulatoryand sixty voluntary policy initiatives and, in the case of thelatter, the number is likely to steadily increase year on year,


Table2:Po

licyscorecard:regu

latory

instr

umentsof

relevancetomentalh

ealth

andpsycho

socialris

ksin

thew

orkplace

attheE

urop

eanlevel.

Instr

ument

Mentalh

ealth

inthe

workplace

referred

toin

theo

bjectiv

es/scope

ofthep

olicy

Coverageo

fexp

osure

factorsinrelationto

mentalh

ealth

inthe

workplace

Coverageo

fmental

health

prob

lems/d

isordersa

tworkandrelated

outcom

es

Coverageo

frisk

assessmentaspectsin

relatio

nto

mentalh

ealth

inthew

orkplace

Coverageo

fpreventive

actio

nsin

relatio

nto

mentalh

ealth

inthe

workplace

Overall

(max.25)

(1)D

irectiv

e89/39

1/EE

CtheE

urop

ean

Fram

eworkDire

ctiveo

nSafetyand

Health

atWork

23

04

413

(2)D

irectiv

e2010/32/EUim

plem

entin

gtheframew

orkagreem

ento

npreventio

nfro

msharpinjurie

sintheh

ospitaland

healthcare

sector

concludedby

HOSP

EEM

andEP

SU

05

15

213

(3)D

irectiv

e200

3/88

/ECconcerning

certainaspectso

fthe

organisatio

nof

working

time(consolidates

andrepeals

Dire

ctive9

3/104/EC

)

13

23

312

(4)D

irectiv

e90/270/EE

Cthem

inim

umsafetyandhealth

requ

irementsforw

ork

with

displayscreen

equipm

ent(fift

hindividu

alDire

ctivew

ithin

them

eaning

ofArticle16

(1)o

fDire

ctive8

9/391/E

EC)

33

03

211

(5)D

irectiv

e92/85/ECon

pregnant

workersandwom

enwho

have

recently

givenbirthor

areb

reast-feeding

33

03

110

(6)D

irectiv

e94/33/ECon

thep

rotection

ofyoun

gpeop

leatwork

32

02

18

(7)C

155Occup

ationalSafetyandHealth

Con

vention(ILO

),1981

32

01

17

(8)D

irectiv

e200

0/78

/ECestablish

inga

generalframew

orkfore

qualtre

atmentin

employmentand

occupatio

n0

20

23

7

(9)C

183MaternityProtectio

nCon

vention(ILO

),2000

02

02

37

(10)C

181P

rivateE

mploymentA

gencies

Con

vention(ILO

),1997

04

02

17

(11)D

irectiv

e200

6/54

/ECon

the

implem

entatio

nof

thep

rincipleo

fequ

alop

portun

ities

andequaltreatmento

fmen

andwom

enin

mattersof

employment

andoccupatio

n

02

02

37


Table2:Con

tinued.

Instr

ument

Mentalh

ealth

inthe

workplace

referred

toin

theo

bjectiv

es/scope

ofthep

olicy

Coverageo

fexp

osure

factorsinrelationto

mentalh

ealth

inthe

workplace

Coverageo

fmental

health

prob

lems/d

isordersa

tworkandrelated

outcom

es

Coverageo

frisk

assessmentaspectsin

relatio

nto

mentalh

ealth

inthew

orkplace

Coverageo

fpreventive

actio

nsin

relatio

nto

mentalh

ealth

inthe

workplace

Overall

(max.25)

(12)D

irectiv

e200

2/14/ECestablish

inga

generalframew

orkforinformingand

consultin

gem

ployeesintheE

urop

ean

Com

mun

ity

01

02

25

(13)D

irectiv

e200

2/15/ECon

the

organisatio

nof

workingtim

eofp

ersons

perfo

rmingmob

ileroad

transport

activ

ities

01

11

25

(14)C

187Prom

otionalFramew

orkfor

Occup

ationalSafetyandHealth

Con

vention(ILO

),2006

01

11

25

(15)D

irectiv

e96/34

/ECon

the

fram

eworkagreem

ento

nparentalleave

01

00

34

(16)D

irectiv

e200

0/43

/EC

implem

entin

gthep

rincipleo

fequ

altre

atmentb

etweenperson

sirrespectiveo

fracialor

ethn

icorigin

01

01

24

(17)D

irectiv

e200

9/104/EC

concerning

them

inim

umsafetyandhealth

requ

irementsforthe

useo

fwork

equipm

entb

yworkersatwo

rk(secon

dindividu

alDire

ctivew

ithin

them

eaning

ofArticle16

(1)o

fDire

ctive8

9/391/E

EC)

[replacin

gDire

ctive8

9/655/EE

C]

01

11

14

(18)D

irectiv

e200

8/94

/ECon

the

protectio

nof

employeesinthee

vent

oftheinsolvencyof

theire

mployer

(repealin

gDire

ctive2

002/74/ECand

Cou

ncilDire

ctive8

0/987/EE

C)

01

01

13

(19)D

irectiv

e98/59

/ECon

the

approxim

ationof

thelaw

softhe

mem

ber

states

relatingto

collectiver

edun

dancies

01

01

13

(20)D

irectiv

e92/91/EEC

concerning

the

minim

umrequ

irementsforimproving

thes

afetyandhealth

protectio

nof

workersin

them

ineral-extracting

indu

strie

sthrou

ghdrilling(eleventh

individu

alDire

ctivew

ithin

them

eaning

ofArticle16

(1)o

fDire

ctive8

9/391/E

EC)

01

01

13


Table2:Con

tinued.

Instr

ument

Mentalh

ealth

inthe

workplace

referred

toin

theo

bjectiv

es/scope

ofthep

olicy

Coverageo

fexp

osure

factorsinrelationto

mentalh

ealth

inthe

workplace

Coverageo

fmental

health

prob

lems/d

isordersa

tworkandrelated

outcom

es

Coverageo

frisk

assessmentaspectsin

relatio

nto

mentalh

ealth

inthew

orkplace

Coverageo

fpreventive

actio

nsin

relatio

nto

mentalh

ealth

inthe

workplace

Overall

(max.25)

(21)D

irectiv

e92/104/EE

Con

the

minim

umrequ

irementsforimproving

thes

afetyandhealth

protectio

nof

workersin

surfa

ceandun

dergroun

dmineral-extractingindu

strie

s(twelfth

individu

alDire

ctivew

ithin

them

eaning

ofArticle16

(1)o

fDire

ctive8

9/391/E

EC)

01

01

13

(22)Directiv

e89/65

4/EE

Cconcerning

them

inim

umsafetyandhealth

requ

irementsforthe

workplace

(first

individu

aldirectivew

ithin

them

eaning

ofArticle16

(1)o

fDire

ctive8

9/391/E

EC)

01

01

02

(23)D

irectiv

e89/65

6/EE

Con

the

minim

umhealth

andsafetyrequ

irements

forthe

useb

yworkersof

person

alprotectiv

eequ

ipmentatthe

workplace

(third

individu

aldirectivew

ithin

the

meaning

ofArticle16

(1)o

fDire

ctive

89/391/EEC

)

01

01

02

(24)D

irectiv

e90/26

9/EE

Con

the

minim

umhealth

andsafetyrequ

irements

forthe

manualh

andlingof

loadsw

here

thereisa

riskparticularlyof

back

injury

toworkers(fo

urth

individu

alDire

ctive

with

inthem

eaning

ofArticle16

(1)o

fDire

ctive8

9/391/E

EC)

01

01

02

(25)C

175Part-timeW

orkCon

vention

(ILO

),1994

01

01

02

(26)D

irectiv

e97/81/ECconcerning

the

fram

eworkagreem

ento

npart-timew

ork

01

00

12

(27)D

irectiv

e99/70

/ECconcerning

the

fram

eworkagreem

ento

nfixed-te

rmwork

01

01

02

(28)D

irectiv

e200

0/79

/ECconcerning

theE

urop

eanAgreemento

nthe

Organisa

tionof

Working

Timeo

fMob

ileWorkersin

CivilA

viation

01

00

12


Table2:Con

tinued.

Instr

ument

Mentalh

ealth

inthe

workplace

referred

toin

theo

bjectiv

es/scope

ofthep

olicy

Coverageo

fexp

osure

factorsinrelationto

mentalh

ealth

inthe

workplace

Coverageo

fmental

health

prob

lems/d

isordersa

tworkandrelated

outcom

es

Coverageo

frisk

assessmentaspectsin

relatio

nto

mentalh

ealth

inthew

orkplace

Coverageo

fpreventive

actio

nsin

relatio

nto

mentalh

ealth

inthe

workplace

Overall

(max.25)

(29)C

ouncilDirectiv

e200

1/23/ECon

thea

pproximationof

thelaw

softhe

mem

berstatesrela

tingto

the

safeguarding

ofem

ployees’rig

htsinthe

evento

ftransfersof

undertakings,

busin

esseso

rpartsof

undertakings

orbu

sinesses

01

00

12

(30)D

irectiv

e200

2/73/ECon

equal

treatmentfor

men

andwom

enas

regards

accessto

employment,vocatio

naltraining

andprom

otion,

andworking

cond

ition

s(amending

Dire

ctive7

6/207/EE

C)

01

00

12

(31)D

irectiv

e200

9/38

/ECon

the

establish

mento

faEu

ropean

Works

Cou

ncilor

aprocedu

rein

Com

mun

ity-scaleun

dertakings

and

Com

mun

ity-scalegrou

psof

undertakings

forthe

purposes

ofinform

ingand

consultin

gem

ployees(recast)

01

00

12

(32)D

irectiv

e93/103/EC

concerning

the

minim

umsafetyandhealth

requ

irements

forw

orkon

boardfishing

vessels

(thirteenthindividu

alDire

ctivew

ithin

them

eaning

ofArticle16

(1)o

fDire

ctive

89/391/EEC

)

01

00

12

(33)D

irectiv

e92/57/EEC

onthe

implem

entatio

nof

minim

umsafetyand

health

requ

irementsattempo

rary

ormob

ileconstructio

nsites

(eighth

individu

alDire

ctivew

ithin

them

eaning

ofArticle16

(1)o

fDire

ctive8

9/391/E

EC)

01

00

12

(34)D

irectiv

e91/38

3/EE

Csupp

lementin

gthem

easuresto

encourageimprovem

entsin

thes

afety

andhealth

atworkof

workerswith

afixed-durationem

ploymentrelationship

oratem

porary

employmentrela

tionship

01

01

02


Table3:Po

licyscorecard:voluntarypo

licyinitiatives

ofrelevancetomentalh

ealth

andpsycho

socialris

ksin

thew

orkplace.

Docum

ent

Mentalh

ealth

inthew

orkplace

referred

toin

the

objectives

and

scop

eofthe

policy

Coverageo

fexpo

sure

factorsin

relatio

nto

mental

health

inthe

workplace

Coverageo

fmental

health

prob

lemsa

tworkandrelated

outcom

es

Coverageo

frisk

assessmentaspects

inrelationto

mentalh

ealth

inthew

orkplace

Coverageo

fpreventiv

eactions

inrelationto

mentalh

ealth

inthew

orkplace

Overall

(max.25)

(1)G

uida

nce:EC

,199

9Guidanceo

nWork-Re

lated

Stress—Spiceo

fLife

orLissof

Death?

45

55

524

(2)G

uida

nce:EU

-OSH

A,200

2How

toTackle

Psycho

socialIssues

andRe

duce

Work-Re

lated

Stress

45

55

524

(3)G

uida

nce:WHO,200

8PR

IMA-

EF:G

uidanceo

ntheE

urop

eanFram

eworkforP

sychosocialR

iskManagem

ent:ARe

source

forE

mployersa

ndWorker

Representativ

es

45

55

524

(4)G

uida

nce:ILO,198

6Psycho

socialFactorsa

tWork:

Recogn

ition

andCon

trol

45

55

524

(5)G

uida

nce:ILO,2012SO

LVEAp

proach

45

55

524

(6)G

uida

nce:WHO,200

3,WorkOrganizationand

Stress

45

54

523

(7)W

HOHealth

yWorkp

lacesF

ramew

ork,20

10,

Health

yWorkplaces:AMod

elforA

ction:

For

Employers,Workers,Policym

akersa

ndPractitioners

45

44

522

(8)W

HOMentalh

ealth

declarationforE

urop

e,20

05,and

MentalH

ealth

Actio

nPlan

forE

urop

e5

44

44

21

(9)W

HOEu

rope

anMentalH

ealth

Actio

nPlan

,2013

45

53

421

(10)G

uida

nce:ILO,2012,StressPreventio

natWork

Checkp

oints:Practic

alIm

provem

entsforS

tress

Preventio

nin

theW

orkplace

45

44

421

(11)E

UHigh-levelC

onference,Br

ussels,

2010,

Investinginto

well-b

eing

atWork:Managing

Psycho

socialRisksinTimes

ofCh

ange

45

34

420

(12)C

ommittee

ofSenior

Labo

urInspectors

(SLIC)

,20

12,C

ampaignon

Psycho

socialRisksa

tWork

44

34

318

(13)C

ommun

icationfrom

theC

ommiss

ionCOM

(2014)

332on

anEU

StrategicF

ramew

orkon

Health

andSafetyatWork2014–2020

44

33

418

(14)F

ramew

orkAgreemento

nWork-relatedStress,

2004

European

SocialPartners—ET

UC,

UNICE

(BUSINES

SEURO

PE),UEA

PME,

andCE

EP3

43

34

17

(15)C

ommun

icationfrom

theC

ommiss

ion{SE

C(200

7)214–

216}

Improvingqu

ality

andProd

uctiv

ityat

Work:Com

mun

ityStrategy

2007–2012on

Health

and

SafetyatWork

43

33

417


Table3:Con

tinued.

Docum

ent

Mentalh

ealth

inthew

orkplace

referred

toin

the

objectives

and

scop

eofthe

policy

Coverageo

fexpo

sure

factorsin

relatio

nto

mental

health

inthe

workplace

Coverageo

fmental

health

prob

lemsa

tworkandrelated

outcom

es

Coverageo

frisk

assessmentaspects

inrelationto

mentalh

ealth

inthew

orkplace

Coverageo

fpreventiv

eactions

inrelationto

mentalh

ealth

inthew

orkplace

Overall

(max.25)

(16)E

U-C

onference,Be

rlin,

2011-PromotingMental

Health

andWell-B

eing

inWorkplaces

44

33

317

(17)E

NISO1007

5-1:1991

Ergono

micprinciples

Related

toWork-Lo

ad–G

eneralTerm

sand

Definitio

ns2

43

34

16

(18)R

194revisedan

nex,ILO20

10,R

ecom

mendatio

nconcerning

theL

istof

Occup

ationalD

iseases

andthe

RecordingandNotificatio

nof

Occup

ationalA

ccidents

andDise

ases

44

43

N/A

15

(19)E

NISO1007

5-2:1996

Ergono

micPrinciples

Related

toWork-Lo

ad–D

esignPrinciples

23

33

415

(20)O

pinion

oftheE

urop

eanEc

onom

ican

dSo

cial

Com

mittee,2013,on

theE

urop

eanYear

ofMental

Health

—Be

tterW

ork,Be

tterQ

ualityof

Life(2013/C

44/06)

44

13

315

(21)C

ouncilof

theE

urop

eanUnion

Con

clusions,

2002,oncombatin

gstr

essa

nddepressio

n-related

prob

lems

32

41

414

(22)E

urop

eanPa

ctforM

entalH

ealth

and

Well-b

eing

,200

8,To

gether

forM

entalH

ealth

and

Well-b

eing

33

23

314

(23)E

urop

eanPa

rliam

entresolutionT6

-006

3/20

09on

MentalH

ealth

,Reference

2008/2209(INI),

Non

legisla

tiveR

esolution

33

23

314

(24)G

reen

paper–

EC,200

5,Im

provingtheM

ental

Health

oftheP

opulation:

Towards

aStrategyon

Mental

Health

forthe

European

Union

32

32

313

(25)E

urop

eanPa

rliam

entR

esolution20

06/205

8(INI)on

ImprovingtheM

entalH

ealth

ofthe

Popu

latio

n:To

wards

aStrategyon

MentalH

ealth

for

theE

urop

eanUnion

33

22

313

(26)G

uida

nce:WHO,200

7Ra

ising

Awarenesso

fStressatWorkin

Develo

ping

Cou

ntrie

s:aM

odern

Hazardin

aTraditio

nalW

orking

Environm

ent:Ad

vice

toEm

ployersa

ndWorkerR

epresentatives

33

22

212

(27)G

uida

nce:EU

-OSH

A,2011W

orkplace

Violence

andHarassm

ent:aE

urop

eanPicture

22

23

312

12 BioMed Research InternationalTa

ble3:Con

tinued.

Docum

ent

Mentalh

ealth

inthew

orkplace

referred

toin

the

objectives

and

scop

eofthe

policy

Coverageo

fexpo

sure

factorsin

relatio

nto

mental

health

inthe

workplace

Coverageo

fmental

health

prob

lemsa

tworkandrelated

outcom

es

Coverageo

frisk

assessmentaspects

inrelationto

mentalh

ealth

inthew

orkplace

Coverageo

fpreventiv

eactions

inrelationto

mentalh

ealth

inthew

orkplace

Overall

(max.25)

(28)G

uida

nce:WHO,200

3Ra

ising

Awarenessto

Psycho

logicalH

arassm

entatW

ork

22

22

311

(29)C

harter

ofFu

ndam

entalR

ightso

fthe

Europe

anUnion

(200

0/C36

4/01)

24

10

411

(30)G

uida

nce:ILO,200

6Violence

atWork

22

22

311

(31)C

ommun

icationfrom

theC

ommiss

ionCOM

(2010)

682AnAgend

afor

New

Skillsa

ndJobs:A

European

Con

tributiontowards

FullEm

ployment

43

12

111

(32)W

HOAc

tionPlan

,2012forImplem

entatio

nof

theE

urop

eanStrategy

forthe

Preventio

nandCon

trol

ofNon

commun

icableDise

ases

2012–2016

13

13

311

(33)C

ouncilof

theE

urop

eanUnion

Con

clusions,

2003

onMentalh

ealth

–Con

ferenceo

nMentalIlln

ess

andStigmainEu

rope:FacingUptheC

hallenges

ofSo

cialInclu

sionandEq

uity

32

21

210

(34)C

ouncilof

theE

urop

eanUnion

Con

clusions,

2005

onaC

ommun

ityMentalH

ealth

Actio

n–Outcome

ofProceeding

s3

21

13

10

(35)O

pinion

oftheE

urop

eanEc

onom

ican

dSo

cial

Com

mittee,200

5on

theG

reen

PaperImprovingthe

MentalH

ealth

oftheP

opulation—

Towards

aStrategy

onMentalH

ealth

forthe

European

Union

(2006/C

195/11)

31

11

28

(36)E

C20

07-W

hitepa

per-To

gether

forH

ealth

—A

StrategicA

pproachforthe

EU2008–2013

21

13

18

(37)F

ramew

orkAgreemento

nHarassm

enta

ndViolence

atWork,20

07,Eu

ropean

Social

Partners-ETU

C,BU

SINES

SEURO

PE,U

EAPM

E,and

CEEP

13

11

28

(38)Th

eStand

ingCom

mittee

ofEu

rope

anDoctors

(CPM

E)Po

sitionPa

per,20

09,M

entalH

ealth

inWorkplace

Setting

s“Fitand

Health

yatWork”

32

10

28

(39)C

ouncilRe

solutio

n20

00/C

86/01o

nTh

eProm

otionof

MentalH

ealth

30

20

27

(40)M

entaland

PhysicalHealth

Platform

(MPH

P)20

09,Th

eMentaland

PhysicalHealth

Chartera

ndCa

llforA

ction

31

10

16

(41)R

ecom

mendatio

nsfrom

MentalH

ealth

Europe

(MHE),200

9WorkProgrammeo

fthe

Spanish

-Belg

ian-Hun

garia

nTrio

Presidency

ofthe

Cou

ncilof

theE

U(2010-2011)

31

10

16


Table3:Con

tinued.

Docum

ent

Mentalh

ealth

inthew

orkplace

referred

toin

the

objectives

and

scop

eofthe

policy

Coverageo

fexpo

sure

factorsin

relatio

nto

mental

health

inthe

workplace

Coverageo

fmental

health

prob

lemsa

tworkandrelated

outcom

es

Coverageo

frisk

assessmentaspects

inrelationto

mentalh

ealth

inthew

orkplace

Coverageo

fpreventiv

eactions

inrelationto

mentalh

ealth

inthew

orkplace

Overall

(max.25)

(42)R

ecom

mendatio

nsof

theE

urop

eanPa

rliam

ent

andof

theC

ouncil,

2006

,onkeycompetences

for

lifelo

nglearning

12

10

15

(43)C

ouncilof

theE

urop

eanUnion

Con

clusions,

2011,on“Th

eEurop

eanPactforM

entalH

ealth

and

Wellbeing

-ResultsandFu

ture

Actio

n”2

00

12

5

(44)C

ouncilDecision

2003/C

218/01,on

Setting

Up

anAd

visory

Com

mittee

onSafetyandHealth

atWork

11

01

14

(45)C

ouncilRe

solutio

n20

00/C

218/03,onactio

non

health

determ

inants

11

00

13

(46)C

ouncilof

theE

urop

eanUnion

,200

0,Lisbon

Strategy:tobecomethe

mostcom

petitivea

nddynamic

know

ledge-basedecon

omyin

thew

orld

capableo

fsustainablee

cono

micgrow

thwith

morea

ndbette

rjob

sandgreatersocialcoh

esion

01

01

13

(47)C

ouncilof

theE

urop

eanUnion

Con

clusions,

2001,onaC

ommun

itystr

ategyto

redu

cealcoho

l-related

harm

11

00

13

(48)F

ramew

orkAgreemento

nTelewo

rk,200

2,Eu

ropean

socialpartners—ET

UC,

UNICE

(BUSINES

SEURO

PE),UEA

PME,

andCE

EP0

10

11

3

(49)O

pinion

oftheC

ommittee

oftheR

egions,200

6,on

theP

ropo

salfor

aRecom

mendatio

nof

the

European

Parliam

entand

oftheC

ouncilon

Key

Com

petences

forL

ifelong

Learning

02

00

13

(50)C

ommiss

ionRe

commendatio

n20

08/867

/ECon

thea

ctiveinclusio

nof

peop

leexclu

dedfro

mthelabou

rmarket

01

10

13

(51)G

uida

nce:Eu

rope

anCom

miss

ion,

2009

,Report

ofAd

Hoc

ExpertGroup

ontheT

ransition

from

Institu

tionaltoCom

mun

ity-based

Care

11

00

13

(52)F

ramew

orkAgreemento

nInclusiveL

abou

rMarkets,2010Eu

ropean

socialpartners—ET

UC,

UNICE(BUSINES

SEURO

PE),UEA

PME,

andCE

EP0

20

01

3

(53)C

ommun

icationfrom

theC

ommiss

ionCOM

(2010)

2020

EURO

PE2020:A

Strategy

forS

mart,

Susta

inable,

andInclu

siveG

rowth

02

00

13


Table3:Con

tinued.

Docum

ent

Mentalh

ealth

inthew

orkplace

referred

toin

the

objectives

and

scop

eofthe

policy

Coverageo

fexpo

sure

factorsin

relatio

nto

mental

health

inthe

workplace

Coverageo

fmental

health

prob

lemsa

tworkandrelated

outcom

es

Coverageo

frisk

assessmentaspects

inrelationto

mentalh

ealth

inthew

orkplace

Coverageo

fpreventiv

eactions

inrelationto

mentalh

ealth

inthew

orkplace

Overall

(max.25)

(54)C

ouncilof

theE

urop

eanUnion

Con

clusions,

2011,onclo

singhealth

gaps

with

intheE

Uthroug

hconcertedactio

nto

prom

oteh

ealth

ylifesty

lebehaviou

rs1

10

01

3

(55)C

ouncilRe

solutio

n20

00/C

218/02,onthe

balanced

participationof

wom

enandmen

infamily

andworking

life

01

00

12

(56)F

ramew

orkof

Actio

nsforthe

Lifelong

Develop

mento

fCom

petenciesa

ndQua

lificatio

ns,

2002

European

socialpartners—ET

UC,

BUSINES

SEURO

PE,U

EAPM

E,andCE

EP

01

00

12

(57)F

ramew

orkof

Actio

nson

GenderE

quality

,200

5,Eu

ropean

socialpartners—ET

UC,

UNICE

(BUSINES

SEURO

PE),UEA

PME,

andCE

EP0

10

01

2

(58)E

C20

07-W

hitepa

pero

naS

trategyforE

urop

eon

Nutrition,

Overw

eightand

ObesityRe

lated

Health

Issues

01

00

12

(59)O

pinion

oftheC

ommittee

oftheR

egions

2008

onFlexicurity

01

00

12

(60)W

HOEu

rope

anMentalH

ealth

Strategy,2011

10

01

02


0.45 1.52

0.18

1.31.39

0.97

2 3

0

4

4

2.6

2.31

2.5

1.84

1.92.45

2.2

4

5

5

5

5

4.8

Mental health in the workplacereferred to in the objectives/scope

of the policy

Coverage of exposure factors inrelation to mental health in the

workplace

Coverage of mental healthproblems/disorders at work and

related outcomes

Coverage of risk assessmentaspects in relation to mental health

in the workplace

Coverage of preventive actions inrelation to mental health in the

workplace

Overall

Binding/regulatory policy instrumentsDirective 89/391/EEC the European Framework Directive on Safety and Health at WorkNonbinding/voluntary policy initiativesPRIMA-EF: Guidance on the European framework for psychosocial risk management∗

Figure 1: Gap analysis on coverage dimensions across binding and nonbinding policies. ∗Note: The EC 1999 Guidance on work-relatedstress: Spice of life or kiss of death? EU-OSHA 2002 Guidance on How to Tackle Psychosocial Issues and Reduce Work-Related Stress; ILO1986 Guidance on Psychosocial Factors at Work: Recognition and Control; and the ILO, 2012, SOLVE Guidance had the same score as thePRIMA-EF guidance on each dimension.

since mental health and psychosocial risks in the workplacerepresent a constant priority in Europe and other countries.The review and gap analysis also shows that higher scoreshave been assigned to nonbinding (or soft law) policies.Indeed no binding policy achieved a score higher than 2.5,while several voluntary policies achieved scores of 4.5 andhigher.This certainly reflects the focus of the specific policiesas well as their development process and regulatory nature.

Binding policies are the outcome of lengthy negotiationsamong various stakeholders. Depending on the issue at handand the extent to which it is considered controversial, thetext of the policy will reflect this. It is not surprising to seeless coverage of the review dimensions in binding regulationdue to the lack of agreement on psychosocial issues amongsocial partners and their perceived “sensitivity,” however gapsin terms of definitions and terminology cannot be ignored.As discussed previously, these issues have been raised in theliterature and there are several calls for clarifying the textof binding policies further through the inclusion of specificterms (such as work-related stress, psychosocial risks, andmental health at work). While from our review it can be

seen that there is more coverage of exposure factors, riskassessment, aspects and preventive action, this is still limitedin comparison to nonbinding policies.

On the other hand, voluntary policies are often developedby experts alone and usually do not involve negotiationbut rather a review process (which could still involve allrelevant stakeholders). They are more focused in terms ofaddressing specific issues andoften aimat providing guidanceon implementing good practice. As a result, terminology inthese policies is more specific and inclusive and coverage ofkey elements is more extensive (as also shown in Figure 1).

It is important to note that this review provides anoverview on the basis of the content of policies in this area.However, it does not draw any conclusions on the uptake andimpact of these policies in practice. Two key issues concernthe extent to which these policies offer specific guidance onmanaging risks in relation to mental health in the workplaceto enable organisations (and especially small and medium-sized enterprises) to implement a preventive framework ofaction and whether existing policies have actually fulfilledexpectations in practice in the area of mental health in


the workplace. Naturally, one would expect that the bindingnature of regulation means that they would be adopted morein practice. However, recent findings suggest that althoughoccupational health and safety legislation is seen by Europeanemployers as a key driver to address health and safety issues,it has been less effective for the management of psychosocialrisks and the promotion of mental health in the workplace[27, 40].

In relation to voluntary policy instruments, there is thequestion of whether they have been effective in supportingthe implementation of existing legislation and in guaran-teeing quality with regard to the “essential requirements”established by European binding policies. Unfortunately, verylittle evaluation exists in this area and it is difficult to drawany meaningful conclusions. A meaningful example in thisdirection comes from the last report on the implementationof the European framework agreement onwork-related stresssigned by the representatives of European social partners[41]. This agreement has had important positive effects,accelerating social dialogue and the development of policieson work-related stress in most of the EU countries. After10 years from signing, it has been implemented in most ofthe countries of the EU in different ways: being translatedin 8 countries, leading to the signing of national agreementswith social partners in 9 countries, being implemented innational legislation in 9 countries. In addition, an evaluationof soft lawwould not be sufficient unless national policies andrelevant initiatives were also taken into account. Traditionsof national level research into occupational health and safetyin general and specifically in relation to psychosocial risksand their management, national discourses on health andsafety definitions and priorities socially and politically, andthe practical application of research knowledge to workplacepractice are also important determinants of action in thisarea [42]. However, ESENER results do indicate low actionof European organisations and further need for guidanceand support [43]. Given the number of voluntary initiatives,one would expect further uptake at company level, andquestions in relation to effectively communicating theseto organisations/employers in a user-friendly manner, orhighlighting positive benefits, are relevant in order to engagethem in action.

According to the findings of our review and the widercontext of policy-making in Europe, if the status quo con-cerning the policy context to mental health in the workplaceis maintained, it is likely that a number of initiatives willcontinue to take place across the EU in this area, given theimpact of mental ill health on individuals, organisations,and society. However, there is uncertainty as to whetherthey will achieve the desired outcomes. Although there havebeen a number of policy initiatives for more than ten yearsin the EU, awareness in relation to mental health in theworkplace and the importance of preventive action still seemsto be lacking on the whole and especially among SMEs. Thisis despite the available data that map the prevalence andimpact both of risk factors and mental ill health outcomes.In addition, despite the fact that the Framework Directive89/391/EEC covers all types of risk to workers’ health andas the framework agreement on work-related stress clarifies,

including work-related stress, there still appears to be limitedawareness of this provision both by employers and otherkey stakeholders such as policy makers and inspectors indifferent countries. Limited awareness and expertise on howto conduct inspections on psychosocial risks associated withmental ill healthwere among the key drivers for the 2012 SLICcampaign [44]. However, with widespread budget cuts in thepublic sector, inspections in many countries are becomingmore reactive in nature [37].

In light of this, it would be advisable to revisit thecontent of the Framework Directive in relation to psychoso-cial risks and mental health in the workplace to providefurther clarity and harmonize terminology across other keypieces of legislation accordingly. In absence of this, a clearinterpretation of the legal provisions in this area by theEuropean Commission would be needed. There is also morescope for better and closer collaboration and coordination toachieve maximum impact in a cost-effective manner at EUinstitutional level since several policy initiatives and studieshave been implemented in this area, for example, from differ-ent EC Directorate Generals, the European Parliament, andthe European Agency for Safety & Health at Work. Finally, itis important that employer responsibility is strengthened andawareness is further developed both in relation to the policyframework on mental health in the workplace and specificpreventive measures that should be introduced to promotemental health, and the promotion of soft law initiatives isessential towards this end.

5. Conclusions

Mental health and psychosocial risks in the workplace havebeen recognised as priorities in occupational health andsafety in the European Union for at least two decades. Anumber of hard and soft law policies of relevance to themhave been developed over the years that have promotedawareness and action among policy makers, social partners,organisations, and indeed individual workers. This paperaimed to provide a review and gap analysis of hard andsoft law policies applicable at EU level in this area and offerrecommendations for the future. Our review of ninety-fourpolicies across five key dimensions revealed several gaps,especially in relation to binding in comparison to voluntarypolicies. According to the findings of our review and thewider context of policy-making in Europe, if the statusquo as concerns the policy context to mental health in theworkplace is maintained, it is uncertain whether desiredoutcomes will be achieved in practice since awareness inrelation tomental health in theworkplace and the importanceof preventive action still seems to be lacking. It is thereforerecommended that key EU legislation is made clearer in thisarea by either including specific terminology and harmo-nizing it across other key pieces of legislation accordinglyor by the development of a clear interpretation of the legalprovisions in this area by the European Commission. It isalso recommended that there is a better coordination at EUinstitutional level to achieve maximum impact and not iso-lated and indeed competitive and non-cost-effective efforts.Finally, it is important that soft law initiatives continue to be


promoted to strengthen employer awareness, responsibility,and engagement in preventive actions.

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper.

Acknowledgment

This work was completed with the support of a EuropeanCommission grant by the Directorate General for Employ-ment, Social Affairs and Inclusion.

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