Mental health in low-wage workers

Mental illness impacts people from every demographic — be it age group, race, job type, socioeconomic group or gender. Still, despite these similarities, low-wage workers face unique challenges to addressing their mental health concerns. 

The Midwest Business Group on Health held a one-day conference on mental health access and stigma in the workplace last week, and one theme that came up in a few presentations was addressing mental health in low-wage workers.  

Also read: Mental illness cuts across the workplace hierarchy

Bruce Sherman — chief medical officer at the National Alliance of Healthcare Purchaser Coalitions, longtime researcher of health issues, and medical director, population health management at Conduent HR Services — did a presentation called “Do wages buy happiness?” He confirmed that, yes, wages are important in the sense that in the past 15 to 20 years, low-wage workers have gotten the smallest pay increases in relation to their income and high-wage workers have gotten the largest pay increases in relation to their income. 

Needless to say, wages do matter.

The conversation goes past that, though. Sherman is currently working on a research project on this topic whose results are not public yet, but he also provided a high level overview of some the issues low-wage workers may face with mental health care and access.

Worsening income inequality is one reason these workers may face trouble. Another major reason is productivity demands, Sherman said. 

Rising productivity expectations is not a surprise to me. Research for a few recent stories have led me to data points or findings that support this. For example, according to the 2018 European Agency for Safety and Health at Work report, “Managing Performance Enhancing Drugs in the Workplace: An Occupational Safety and Health Perspective,” workers in low-paid jobs that are not protected under standard labor laws may feel increased pressure to hit certain productivity levels, especially since they are increasingly being monitored by their employers. Not wanting to lose a job they rely on, they may turn to smart drugs. “Electronic means of monitoring employees are likely to be accompanied by an increase in the stresses on workers,” the article noted.

Also read: The workplace is not immune to the impact of social determinants of health

Sherman also informed the audience at MBGH’s event that the perception of mental health stigma may vary by socioeconomic status. There are two types of stigma — public stigma refers to discrimination or stereotyping from other people and private stigma refers to people internalizing stigma in a way that eats away at their self-worth. Low-wage workers often have a greater sense of personal stigma with behavioral health disorders, Sherman said. 

This type of personal barrier also exists among cost issues and broader, structural barriers, like the lack of available psychiatrists in their insurance network or the the lack of nearby mental health care based on where they live.  

Sherman suggested a few types of ways employers can address these issues. Through benefits design, they can consider eliminating mental health copays for employees so they can access behavioral health services. Ocean Spray is an example of a company who has done this, as of July 2019. 

In an article Workforce published last March, Sherman gave more suggestions for changes in benefits design to address mental health in low-wage workers: 

“Some employers offer hourly employees a half day every year specifically to see their doctor for preventive care services, he said. Other employers offer paid sick leave to all employees, including hourly workers. And other employers have ditched ‘just-in-time’ scheduling practices and opted for fixed work hours for all employees — a perk for hourly employees since variable scheduling limits predictable income for employees living paycheck to paycheck.”

Organizations can also leverage community social services that employees could take advantage of, Sherman said. Further, they can consider what workplace contributors may add to behavioral health problems and address those workplace issues. 

Also read: Business group releases employer guide for managing diabetes in low-wage employees

One final suggestion to address mental health in low-wage workers relates to mental health stigma, and I found it rather interesting. Diversity programs could include information that addresses the negative stereotypes associated with mental health problems. I don’t know of any diversity programs doing this, but I’d be interested in hearing from anyone who is involved with a program like that!

Final takeaways from the MBGH conference:

1. Jeremy Nobel —  the founder of The Unlonely Project who currently serves on the faculty of the Harvard Medical School in the Department of Global Health and Social Medicine — spoke about the negative impact of loneliness on people. He mentioned that LGBTQ+ employees, minorities and people with major illnesses or disabilities are especially susceptible to isolation, and mentioned some activities to help them feel connected.

This was interesting and valuable in its own way, but what I found was missing from his presentation was what external factors might make some of these groups of people feel isolated at work. These are groups of people that are likely to be discriminated against in the workplace compared to straight people, white people or people without disabilities. If your organization is pushing for these deeper connections between people but not addressing the reality that even casual discrimatation or harassment will stifle these connections, can it really address this issue?

2. What’s the actual definition of a crisis? Any time I attend a health-related conference, most every public health issue is deemed a crisis. While I understand some of this mentality, I also wonder how we as individuals, governments or organizations are supposed to pay attention to so many health crises at the same time and give them all the proper attention.

3. I wrote a little about generational stereotypes about mental health last week. My overall argument was that both older and younger employees have health issues, and only paying attention to how millennials or Generation Z “can’t handle stress” or whatever can be infantilizing. Also, it leaves older people out of a very important discussion about finally getting help for mental health issues.

I want to add one more thought. Business/health conferences tend to have an older crowd. That makes sense; they’re professionals who have a deep history in the industry. But where’s the voice of these “young people” who apparently have so many more mental health issues than generations before them?

What I think would be interesting is if there was a way for teenagers or young 20-somethings to share their perspective on the mental health of their generation versus older ones. It could be an opportunity for people in different generations to share their stories. For every “Kids these days get all their self-esteem from social media and that destroys their mental health!” from a 40-something parent, maybe a 16-year-old could clarify how common or uncommon that actually is. It could be an opportunity to address certain generational stereotypes head-on.