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Mental Wellness at Work

We spend a large portion of our adult life at work—and if you’re dealing with mental health concerns, it’s difficult to put them aside while on the job.

Reflecting increased attention to this reality, the National Institute for Occupational Safety and Health recently awarded $1.4 million to the School to establish a new Center of Excellence, the Johns Hopkins Psychosocial, Organizational and Environmental Total Worker Health Center in Mental Health, or POE Center. Co-directed by Mental Health chair M. Daniele Fallin, PhD, and Meghan Davis, DVM, PhD ’12, MPH ’08, associate professor in Environmental Health and Engineering, the Center is the first of its kind devoted to improving workforce mental health. The total five-year award is anticipated to be close to $7 million.

Workplace mental health took on more importance and visibility during the pandemic, when remote work and high-risk work environments caused or exacerbated workers’ psychological and behavioral problems.

 “The COVID experience has brought the issue to light for a lot of employers—clearly first responders and health care workers have been in the news a lot because of stress—but other employers have also started paying attention,” says Fallin.

 POE Center research and programs will focus on a variety of populations, including the health care workforce and veterinarians, workers across the food system, and essential low-wage workers.

 The Center will collaborate closely with the Johns Hopkins Education and Research Center for Occupational Safety and Health, Johns Hopkins Medicine, the NIOSH Northeast Center for Occupational Safety and Health, and the Bloomberg School’s Center for Mental Health in the Workplace to develop interventions that can be adapted across varied work settings.  

“Meeting a workforce where they are is going to take a deep understanding of what their experience is,” Davis says. “It’s essential to pair that understanding with delivery modes and interventions that are really tailored and adapted for success.”

 In this Q&A, Fallin and Davis discuss supporting mental health across different work sectors, how the POE Center came together, and why the Center’s name references Edgar Allan Poe.

Why is it important to address mental health, including prevention of substance misuse, in the context of the workplace?

DF: If you address psychological wellness as part of general wellness, as well as providing supports and treatment options for people who are experiencing mental illness like depression or anxiety, you can show a return on the bottom line in terms of financial costs, but also in [lower] turnover rates.

That’s the business case for it, but there’s also clearly a public health case for it. If we really want to touch the entire population, the vast majority of adults are employed.

There’s also good evidence that it improves the quality of the [work] product. [For example,] having a police officer who is able to cope with traumatic situations and is doing well psychologically leads to better policing. 

Can you give an example of how mental health support needs to be different for specific workforces?

DF: If we’re thinking about farm workers, there might be particular populations of people who are only in place certain months of the year. How do you localize those supports? Also, for some communities, it is possible that there may be more anxiety about immigration status than depression, so a tailored approach is important. Further, if a group only communicates via cell phone, in-person or computer-based tools may not be helpful. You’d want to think about cell phone or peer-driven tools and take language and culture into account.

That's very different than the health workforce. In general, the health system may need to address burnout. In the pandemic there’s more trauma exposure, in terms of everyday work, and more recently, there has been some shifting of societal norms. For example, nurses, who have typically been universally respected for their positive role in society, are now facing hostile environments from some who believe vaccines are harmful. Public health workers are experiencing similar hostility, and this clearly affects their mental health.

Meghan, as a former veterinarian, can you speak to mental health concerns in that field?

MD: I come from a profession where mental health and suicide are a gigantic problem. This was a crisis when I was in vet school in the ’90s and it remains a persistent challenge today.

In the veterinary field, many people are in either a small group or solo practice. I was at a three-doctor, mixed animal practice when I first got started and cared mostly for dairy cows. There's no emergency vet to cover for you for the large animals, and you may be it for the entire area. I remember frequent 90-hour work weeks, and I was able to get only one week off in three years. As veterinarians today share these kinds of constraints, when would anyone have time to seek mental health services? Balancing shift hours and accommodating the stresses of personal life as well as the stresses of professional life is quite challenging.

Our team recently studied veterinarians and animal care workers and their response to COVID-19, and almost 90% of our participants reported that they had concerns for mental health in the workforce as a result of COVID-19. With COVID-19, we have a zoonotic virus that can potentially cause disease in animals, so this workforce has a critical surveillance function for public health, and they also may have increased workload as part of their regular practice activities.

As you see it, why did NIOSH decide that now is the time to invest in a center with a mental health focus, and why was the POE Center a strong candidate to launch this initiative?

DF: I think NIOSH had a lot of feedback from a lot of stakeholders around the country that worker mental health is a critical part of total worker health. None of the Total Worker Health centers that they have been funding for a while were really focused on workers’ mental health. I think the time was ripe for NIOSH and CDC to say, when we invest in additional centers, we want to make sure some are working on mental health.

At the School, our Department of Mental Health recently soft-launched a Center for Mental Health in the Workplace through a relationship with the Luv u Project, a key donor and collaborator on workplace mental health initiatives and supporter of the POE Center.

Our Department has expertise and a deep bench on prevention, science, and intervention strategies for mental health at different parts of the life course, especially in work with school systems and in relation to aging-related dementia and Alzheimer’s disease. What we didn't have was anybody working specifically on the part of the life course where most people spend most of their adulthood—the workplace.

MD: NIOSH has a relationship with Johns Hopkins through the Johns Hopkins Education and Research Center for Occupational Safety and Health, established 50 years ago to promote traditional industrial hygiene training and outreach.

The POE Center is partnered with our ERC, so some of the things we'll be doing in the first five years will be developing mental health, substance use, and total worker health modules for integration into ERC workforce initiatives and outreach.

The POE Center’s focus is research and outreach. What will that some of that work look like?

DF: We’re developing a POEM (Psychosocial, Organizational, Environmental Measurement)  tool that will ultimately create a dashboard for an employer to monitor how their workforce and their organization is doing on these psychological, organizational, and environmental metrics in terms of worker health.

The outreach core will address how best to engage stakeholders. What does the agricultural workforce need in terms of mental health? What does IBM need? Then we’ll work with partners to disseminate that, whether it’s POEM software, the knowledge around how to use it, or why it’s important. If state or county health commissioners were required to have fundamental training in the importance of workplace mental health, [for example,] we could help to develop that training package. We’re partnering with the Johns Hopkins Carey Business School in thinking specifically about one of those models for business students and continuing education for business leaders.

POE stands for Psychosocial, Organizational and Environmental. How do these concepts fit together?

MD: One of the things that differentiates POE from some of the other Total Worker Health centers is that we are trying to [take into account] the environmental aspects in delivering mental health services delivery and well-being initiatives.

For example—and this is something that I’ve heard anecdotally—health care workers have mentioned how stressful it is when they can’t get to a patient quickly because of COVID-19 mitigation strategies. They have to don and doff masks, gloves, and other protective gear, and that takes time. If time is someone's life, then that's extremely stressful for a worker, whether that worker is a physician, a nurse, or another allied professional who needs to be able to get to that patient and deliver care. A solution to that might be providing mental health and other services so the workers feel like they have support in terms of the stress they’re experiencing.

When we think about this from an environmental perspective, that suggests different kinds of solutions that might also prevent some of that stress. Could we potentially engineer PPE that's faster to don and doff? Could we engineer workflow through an area such that it takes less time to get to critical patients? Could we change the way we administer and staff different areas in order to reduce the amount of time it takes to get to a patient—while still ensuring we meet the needs to protect the health of our workers?

What’s behind the POE Center’s name?

MD: When Dani and I were thinking around organizing principles, we quickly realized that we could orient this in a way that would be an homage to Edgar Allan Poe, who died and is buried in Baltimore, who experienced mental illness, and who famously penned the poem “The Raven.” We chose the raven as our graphic identifier [because] there’s a lot of stigma around these birds, and mental health and substance use are areas where there is a lot of stigma. Destigmatization is a critical piece of some of the work.

And it’s important to note that ravens are really smart! They're creative problem solvers and are able to adapt to challenges. I think the raven is a perfect emblem of the work we're trying to do to unmask and destigmatize [mental illness] so that people can fulfill their own potential in terms of their work and in terms of being human.

Jackie Powder is assistant editor of Hopkins Bloomberg Public Health magazine.