A Commentary on Thomas et al. (2024): Band-Aids on Bullet Wounds

The taxonomy proposed by Thomas et al. (2024) is an excellent step in understanding the impact of workplace mental health offerings, as the dimensions of (a) primary purpose, (b) delivery agent location, and (c) latitude in providing, allow for testable predictions in experimental or quasi-experimental studies, and provide common ground for academic and organizational stakeholders to discuss the merits of different mental health offerings. Despite this, we encourage both academic and organizational stakeholders to also consider why workplace mental health offerings are necessary to begin with. In this commentary, we argue that there are often distinct organizational causes underlying work-related mental health problems (e.g., excessive workload, poor communication, social pressure, workplace bullying, etc.), which should not be overlooked in attempts to improve employee mental health. Moreover, we argue that mental health offerings should be suited to the unique and personal needs of the employee to be truly effective.

Current mental health offerings are often provided based on global evidence of poor mental health among employees (Marazziti et al., 2021; World Health Organization, 2022), and often take the form of skills trainings to reduce stress, increase job satisfaction, and improve mental health (Czabała et al., 2011). While any effort towards improving employee mental health may appear positive, the disconnect between employers’ offers and employees’ expectations about mental health offerings (Thomas et al., 2024) suggests that such “generalized” efforts may not be ideal. Indeed, studies suggest that generalized approaches to the implementation of mental health offerings may yield no tangible benefits to an organization (Tarro et al., 2020). Crucially, generalized efforts may even be detrimental to workplace mental health: Pedersen and colleagues (2015), for instance, demonstrated that a general intervention designed to promote mental health rather reduced mental health outcomes.

Such unfavorable intervention outcomes are likely the result of misalignments between (a) the root cause of employee mental health complaints in specific contexts and (b) the goal and outcome of specific mental health offerings (Kwok et al., 2020; McHugh et al., 2022). Here, the problem is two-fold: first, in delivering generalized mental health interventions, the root causes of mental health problems in the workplace remain unaddressed, despite systematic reviews (e.g., Nielsen et al., 2014) and meta-analyses (e.g., Meredith et al., 2021; Shoman et al., 2021) demonstrating that the main sources of poor mental health within organizations include high work demands, low perceived support from leadership, poor work-life balance, poor work autonomy, and little work control. Considering these findings, generalized efforts to implement mental health interventions become even more problematic when organizations do not consider that the implementation of- and participation in mental health offerings often require time and effort from employees (Corrente et al., 2024). Such resources may not be readily and equally available to all employees within the organization, particularly when participation in mental health offerings is not supported by a reduction in their other work demands (Paterson et al., 2024).

Second, efforts to address general mental health concerns do not align with the unique needs and circumstances of employees. Insights from the clinical field suggest that generalized mental health interventions are only effective for about half of the patients seeking them (Cuijpers et al., 2017) and thus cannot be effectively applied in a “one size fits all” format (Bruijniks et al., 2021). Thus, not unlike other types of organizational interventions, mental health interventions in the workplace also require contextual fit (Baloh et al., 2012; Kwok et al., 2020; McHugh et al., 2022). Existing meta-analyses of the effectiveness of different types of mental health interventions show a trend for beneficial effects on average, but consistently warn that the estimated effects are highly heterogeneous (Burnette et al., 2023; Miguel et al., 2023; Tarro et al., 2020; van Agteren et al., 2021). This heterogeneity suggests that the effects of mental health offerings are likely to differ across contexts, such as work characteristics (Tarro et al., 2020), industry sector (Kotera & Van Gordon, 2021), or employee cultural background (Kotera et al., 2020).

Taken together, a generalized approach in implementing mental health offerings in the workplace, without considering the unique contextual factors which shape employee mental health complaints, is akin to plastering a Band-Aid on a bullet wound – the Band-Aid covers up the wound neatly and seems to provide help, but the wound itself remains untreated and might begin to fester. We thus propose that a more comprehensive understanding of the effects of various mental health offerings, through use of Thomas, Foller, and Meglich’s taxonomy (2024), can only be of practical value when there is cause-to-context fit: where implemented mental health offerings directly address the root cause of mental health concerns in the workplace, and where the implementation of such offerings does not overlook relevant costs to the employee and the influence of organizational context factors.

Instead of adopting a generalized approach in addressing employee mental health concerns, we therefore encourage both academic and organizational stakeholders to consider the following steps:

First, we believe that it is important for academic and organizational stakeholders to consider the unique contextual circumstances present within organizations when implementing and evaluating the implementation of mental health offerings (Baloh et al., 2012; Kwok et al., 2020; McHugh et al., 2022). Based on collective evidence in systematic reviews and meta-analyses, organizations may choose to preventively implement interventions that promote physical activity (e.g., sports and lifestyle changes), psychosocial health (e.g., mindfulness or contemplative activities), or multi-component interventions (Miguel et al., 2023; van Agteren, 2021). However, we emphasize that it is crucial for organizational stakeholders to conduct preliminary assessments to pinpoint specific employee mental health issues and their causes, before later identifying the most appropriate mental health offerings to tackle these causes. For instance, a mental health promotion program conducted among multiple Chinese government agencies successfully improved self-reported employee mental health over the course of two years – an outcome attributed to comprehensive need- and risk assessments which accounted for distinct workplace characteristics at each agency prior to the implementation of the intervention itself (Jia et al., 2018). In a similar vein, Ammendolia and colleagues (2016) champion the use of intervention mapping (Bartholomew et al., 1998) in the workplace, to systematically assess the needs of employees, set objectives for specific populations, and subsequently design, implement, and evaluate interventions. In their study they demonstrated how intervention mapping can lay bare misalignments between organizational practices and employee needs.

Second, we believe that it is also important for organizational stakeholders to promote an organizational climate where mental health is not merely a concept, or perk which employees only have access to on their own time. Rather, we argue that it is important for organizational stakeholders to design work in such a way that allows employees to work in a way that is, by default, mentally healthy (Bonaccio et al., 2019; Holtermann et al., 2019). We thus argue for workplace mental health interventions that are tailored to both the organizational context and the personal needs of employees, without failing to address the contributions of healthy work design, and the possible root causes of poor mental health within the organization itself.

Such a tailored, contextual approach requires sufficient knowledge of the employee base, which may be challenging for larger organizations. For example, in often employed large-scale anonymous employee satisfaction surveys we tend to find organization-wide average scores, that do not speak to the needs and circumstances of the few that may need to be addressed. Some issues – for example high workloads, inefficient processes, bullying – may exist on a personal or departmental level, but not within the entire organization. For this reason, we suggest decentralizing (some of) the decision making processes regarding mental health interventions in the workplace. Moreover, if more specific (e.g. sectional, departmental, divisional) data collection regarding mental health and employee satisfaction is possible without losing anonymity, we strongly recommend doing so. Providing agents that oversee organizational parts with the necessary information and autonomy to provide suitable mental health offerings for their employees could be a great aid to ensure a person-intervention fit, as opposed to offering similar interventions throughout the entire organization. These agents may be supervisors, but might more suitably be decentralized HR-officers, to avoid conflicts of interest, and ensure professional knowledge of possible interventions directed at improving mental health in the workplace.