Australian e-Journal for the Advancement of Mental Health (AeJAMH), Vol. 1, Issue 3, 2002 ISSN: 1446-7984

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Mental health: overemployment, underemployment,unemployment and healthy jobs*

Maureen F. Dollard & Anthony H. Winefield

School of Psychology, Work & Stress Research Group, University of South Australia, Australia

*First published in:Morrow, L., Verins, I. and Willis, E. (2002). Mental Health and Work: Issues and Perspectives.Adelaide, Auseinet: The Australian Network for Promotion, Prevention and Early Intervention forMental Health

Re-published for the Australian e-Journal for the Advancement of Mental Health (AeJAMH),Vol. 1, Issue 3, 2002 www.auseinet.com/journal

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Abstract

Globalisation and regional economic imperatives have no doubt led to modern workenvironments increasingly characterised by ‘too much work’, ‘not enough work’ and ‘no work’rather than optimal ‘healthy-productive’ work. Besides negative implications for nationaleconomies, there is a strong belief that mental health problems and stress-related disorders arethe biggest overall cause of premature death in Europe (WHO 2001; Levi, 2002). Incomeinequality arising from such disparate work states seems to have negative health consequencesfor all members of society as social cohesion that characterises healthy egalitarian societiesprogressively breaks down (Wilkinson, 1996).

This paper explores the various work states, and draws upon a range of work stress andunemployment theories and empirical evidence to describe possible relationships between themeaning of work, work states, their features, and mental health. It also explores the ‘holy grail’:the balance between healthy work and productivity.

Mental health and work

There is increasing awareness of thefundamental importance of mental health ina range of life arenas – for physical health,quality of relationships, family life, workand education. The focus of this paper is thelink between work and mental health. TheAustralian National Action Plan forPromotion, Prevention and EarlyIntervention for Mental Health(Commonwealth Department of Health &Aged Care, 2000 p20) noted ‘there isevidence of significant increase over recentyears in the level of reported workplacestress and an associated increase in relatedmental health problems and mental healthcosts’.

The term ‘mental health’ is often usedinterchangeably with social, emotional, andspiritual wellbeing (Lehtinen, Riikonen &Lahtinen, 1997). Recently, the VictoriaHealth Promotion Foundation proposed a

new definition of mental health (VicHealth,1999) as:

…the embodiment of social, emotionaland spiritual wellbeing. It providesindividuals with the vitality necessaryfor active living, to achieve goals, andto interact with one another in waysthat are respectful and just (p4).

Mental health covers broadly the areas ofemotions, behaviours, relationships andcognitions. For example, a person may bephysically healthy but have difficulty withaggressive behaviours.

A particular definition of health adopted bythe Department of Health in the UnitedKingdom, which embodies emotionalwellbeing centrally and is understandable bymost people is ‘being confident, and able tocope with the ups and downs of life’(Stewart-Brown, 1998, p1608).

Contact: Maureen DollardEmail: maureen.dollard@unisa.edu.au

Citation: Dollard, M. F. and Winefield, A. H. (2002) Mental Health: overemployment, underemployment,unemployment and healthy jobs. Australian e-Journal for the Advancement of Mental Health 1(3)www.auseinet.com/journal/vol1iss3/Dollard.pdf

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Social determinants of mental healthIt has long been recognised amongresearchers that there are a number of socialdeterminants important in the developmentand maintenance of mental health. Alandmark publication by the World HealthOrganisation, Social Determinants of Health(Wilkinson & Marmot, 1998) presents asummary of evidence-based findings linkingsocial determinants such as social status,stress, early life, social exclusion, work,unemployment, social support, addiction,food and transport, and health in its broadsense.

Based on such considerations, the EuropeanCouncil of Ministers (15th Nov. 2001)concluded that:stress and depression related problems… are of major importance … andsignificant contributors to the burdenof disease and the loss of quality of lifewithin the European Union.

Further, they underlined that such problemsare:

common, cause human suffering anddisability, increase the risk of socialexclusion, increase mortality and havenegative implications for nationaleconomies (cited in Levi, 2002, piii).The work stress and unemploymentliterature is therefore very important to helpunderstand the link between work andmental health.

Income inequalityAssociated with the growing gap between‘good’ and ‘bad’ jobs has been an increasein income inequality. Wilkinson (1996) hasargued from international epidemiologicalstatistics that increased income inequalityhas negative health consequences (reducedlife expectancy) for all members of society –both rich and poor – and he proposes the

underlying mechanism for this is thebreakdown of social cohesion thatcharacterises ‘healthy egalitarian societies’.In such societies, according to Wilkinson,there is ‘a strong community life’; and‘people are more likely to be involved insocial and voluntary activities outside thehome’ (p4).

Wilkinson’s conclusions have been criticisedby Catalano (1998) who argues theepidemiological case is weak and that themain cause of concern should be growingeconomic insecurity, even among the moreaffluent. He points out that a 1996 USAsurvey found that 37% of Americanhouseholds reported they were‘economically insecure’ and 43% with anannual income of more than $50,000 fearedthat one of their members would be laid offin the next three years (Catalano 1998,p168). Another criticism of Wilkinson’sthesis is that he puts forward no evidence,other than anecdotal, to support the view thatincreased income inequality leads to abreakdown in social cohesion.

Employment has also become moreprecarious as workers are employedincreasingly on contract (Schalk, Heinen &Freese, 2001; Winefield, Montgomery,Gault, Muller, O’Gorman, Reser & Roland,2002) and the permanent job itself hasbecome more insecure, leading topredictions that by 2020 a quarter of theworkforce will be in non-traditionalemployment arrangements (Judy &D’Amico, 1997).

Developing identityWork has long been regarded as animportant facet to mental health and thedeveloping identity (Erikson, 1982). It hasbeen argued that employment (even badjobs) can provide latent benefits, including:

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a time structure for the waking day regular contact with people outside the

nuclear family involvement in shared goals a sense of identity enforced activity (Jahoda, 1982).

Extensive research has shown that job lossresults in a significant deterioration inaffective wellbeing (Cobb & Kasl, 1977;Linn, Sandifer, & Stein, 1985) and re-entryleads to significant improvements in mentalhealth (Warr & Jackson, 1985; Payne &Jones, 1987). However, researchers alsoargue that satisfaction with employment isthe key ingredient differentiatingemployment and unemploymentexperiences. Being satisfactorily employedenhances psychological growth and self-esteem, but being unsatisfactorily employedis detrimental to psychological health and ispsychologically as bad as being unemployed(Winefield, Tiggemann, Winefield &Goldney, 1993; Winefield, 2002). Clearempirical links between psychological andphysical ill health and work have challengedthe taken-for-granted assumption about thepositive mental health benefits of work.

Current work context: psychological andhealth costs

There are major changes occurring today invarious aspects of work that are impactingon the experience of work in Australia:1. The workforce is increasing in diversity

and complexity. The domination of theworkforce by men is declining and thereis an increase in the proportion ofwomen and people from ethnicminorities in the workforce. TheAustralian population is becomingincreasingly educated. School retentionrates have increased dramatically withinthe last two decades.

2. There is a relative decrease in thenumber of full-time jobs and a relative

increase in the number of part-time jobsavailable. In addition, there is anincreasing reliance upon casual andcontract labour.

3. The increased number of womenparticipating in the workforce meansthere is also an increase in dual-careercouples.

4. Those employed full-time are workinglonger hours according to the AustralianBureau of Statistics (2002). It remains tobe seen whether this trend can bereversed as in France, the world’s fourthlargest economy, where the governmentrecently enacted laws restricting theworking week to 35 hours. (Even if theFrench succeed, it is difficult to see howoverworked professionals whoseworking hours are not recorded mightbenefit).

5. There is a shrinking supply of paid workcompared to the growing numbers ofpeople seeking it. No matter how muchnational and global economies attempt togrow there appear to be inevitableenvironmental limits to such growth, aswell as recent demonstrations thateconomic growth occurs fitfully andunreliably, and does not always result ina proliferation of job opportunities.

Changes in the workplaceThe nature of the workplace is changingrapidly with increased demands fromglobalisation of the economy and the rapiddevelopment of communication technology(Cascio, 1995b; Schabracq & Cooper, 2000).Computers, telecommunication systems,robotics and flexible manufacturingoperations have led to a decreasing relianceon direct human labour, while at the sametime productivity is increasing (Winefield,Montgomery et al., 2002). Routine tasks areincreasingly being performed by automation,freeing employees to take on more variedand challenging tasks. This means thatemployees’ skills are becoming obsolete

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more quickly, necessitating an increasingfocus on continuing training and education.

Technological changes have also led to anincreasing amount of poor-quality work –‘work not fit for a machine to do’ – that isunsatisfying, offering low pay, low jobsecurity and unreliable hours. This ‘labourwork’ such as house-cleaning, waitressingand casual clerical work is often undertakenby women and cultural minorities(Winefield, Montgomery et al., 2002). Manyjobs in the fast expanding service sectorrequire workers to adopt a smiling andfriendly manner to consumers, which makesdemands similar to those involved in‘emotional work’.

Under the pressure of economic rationalism,workforce numbers have been reduced,although the amount of work to be doneoften has not. Overemployment means thatmany workers in full-time jobs areexperiencing increased pressure and fasterpace (Bousfield, 1999), increased workload(Townley, 2000), longer shifts and longerhours (Heiler, 1998; Winefield, Montgomeryet al., 2002), as well as demands for highorganisational performance (Kendall,Murphy, O’Neill & Bursnall, 2000).

Work-related risks to health and familyfunctioningTwo apparently opposite trends in workpractices seem to have similarly deleterioushealth effects, overemployment andunderemployment (Winefield, Montgomeryet al., 2002). Overemployment has beenlinked to cardiovascular disease for sometime (Breslow & Buell, 1960). The risk ofheart attack for those working long hours(for example, 11 hours) is 2.5 times the riskof those working an 8-hour day (Sokejima &Kagamimori, 1998). The resulting increasesin workload and in job insecurity havedeleterious effects on both the remainingworkers and the organisation. The stress ofoverwork can lead to psychological

problems, including depression, burnout andbreakdowns, to health problems, includingheart attacks and hypertension, and toorganisational problems, includingworkplace violence or accidents (Quick,Quick, Nelson & Hurrell, 1997). All of theseproblems can result in increased costs to theorganisation that cancel out the short-termcost savings made by downsizing, resultingin no real improvement in long-termprofitability (Cascio, 1995a).

The increased costs of occupational stress inthe form of absenteeism, reducedproductivity, compensation claims, healthinsurance and medical expenses has led to agrowing interest by researchers into itscauses, both in Australia and internationally(e.g. Cooper & Payne, 1988; Quick, Murphy& Hurrell, 1992; Cotton, 1995; Dollard &Winefield, 1996, 1998). Even jobstraditionally regarded as relatively stress-free, such as university teaching, arebecoming increasingly stressful (Winefield,A., 2000; Winefield & Jarrett, 2001;Winefield, Gillespie, Stough, Dua &Hapuarachchi, 2002).

Quinlan (2002) describes the results ofrecent reviews on the health effects ofprecarious (casual, short-term, temporary,self-) employment in 11 countries, from1986 to 2000 (Quinlan, Mayhew & Bohle,2001), and also on the health effects ofdownsizing/restructuring and job insecuritypublished in the international literaturebetween 1966 and 2001 (Bohle, Quinlan &Mayhew, 2001). Overwhelmingly thereviews found a measurable deterioration inhealth effects for precarious and survivorgroups. The latter review found that thosemost affected among surviving workers werecommitted workers, older workers, and thosesubject to ongoing insecurity.

Workers are now being required to performmultiple tasks, learn new skills, and self-manage to meet competitive demands.

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According to Kendall et al., (2000) this haslead to jobs that are more fluid (Cooper,Dewe & O’Driscoll, 2001), possiblyexacerbating role ambiguity and roleconflict, and leading in turn to work stressand illness (Dunnette, 1998).

For many workers the amount and scope ofwork has diminished with technologicaladvances leading to underemployment(Cooper et al., 2001) and this can also berisky. Research has found that those workingless than 6 hours per day have 3 times therisk of heart attack than those working an 8-hour day (Sokejima & Kagamimori, 1998).Winefield, Montgomery et al. (2002),however, point out that those working lowerhours may have been doing so because theywere already suffering from the stress of toohigh a workload.

Organisations have downsized andrestructured to improve flexibility andcompetitiveness or as a result of economicrecession (Kawakami, 2000) leading to bothmental and physical ill health (Chang, 2000).Flatter organisational structures arehazardous as workers find career optionslimited (Kasl, 1998). Belkic, Schnall,Landsbergis & Baker (2000) argue thatmodern work demands are squeezing out‘passive’ and ‘relaxed’ jobs (for example,scientists increasingly compete for funding;general practitioners participate in settings ofcorporate managed care) which may lead totwo classes of occupations: those with highcontrol and low control, but all with highdemands.

Emotional workEmotional work refers to all the time andenergy consuming activities that help othersto regulate their emotional states (forexample, peace-keeping and social skillstraining with children, negotiation of needsfor dependent elderly relatives, buildingcohesion in family and workplace units etc).These activities are usually unpaid (and

performed by women), although vital to theharmony and effective psychologicalfunctioning of many communities and theirindividual members (Strazdins, 2000).

Until the age of 60, women outnumber menas carers, reaching a peak in numbers aboutage 50 (Phillipson, 1982). Most of these, ifno longer caring for children now grown up,care for spouses, elderly parents orhandicapped relatives. Overall, women aremore likely to be carers than men, but afterage 60 caring for partners predominates,with slightly more men than women likely tobe the ‘principal resident carers’ as wivesbecome frail (McCallum & Geiselhart, 1996;Fallon, 1997).

The work of caring for disabled relatives canbe isolating and burdensome. Greaterrecognition from professional carers, andmore training and support resources, aresome of the policy initiatives that mightincrease family caregivers’ satisfaction fromthis work (Winefield, H., 2000).

Except in rare instances (such as thepayment of a ‘stipend’ by a husband to awife), work in the home is not regarded aspaid work in the same way as is payment fordomestic labour (for example, housekeeper,cleaning service). The latter is included inestimates of Gross National Product (GNP),whereas the former is not. Although muchwork in the home is tedious, repetitive andlaborious (in spite of technologicalinnovations), much familial work involveselements of benefit to others, interpersonal‘caring’ and reciprocity that are notdemanded to the same extent by any otherworkplace (Goodnow & Bowes, 1994).

Surveys in Australia (Bittman, 1991, 1994)indicate women spend more time on work inand about the home than men, in somestudies more than four times as much asmen. A common pattern often reported is thedivision of household work into ‘outside’

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(car, garden, repairs) and ‘inside’(everything else), with occasional sharing ofshopping and child-care. The patterns ofengagement by men and women inhousehold work are, however, changing(Bittman, 1994). Women are cutting back ontime spent in the kitchen and laundry, andare contributing more of their time totraditional male ‘outside’ duties. Men arespending less time in unpaid tasks thanwomen still do, but are spending more timeon childcare.

Research has shown that Australian coupleswho share housework and are prepared tochange conventional work roles attributetheir success to flexibility, appropriate stylesof ‘talk’, and ability to negotiate and ‘seeanother’s point of view’ (Goodnow &Bowes, 1994). Equity, sharing and turning aunited face to the world were commonvalues enunciated by the partners.

Correlates of poor mental health at work

Explorations of mental health issues at workare generally conducted under the rubric ofwork stress. A generic definition of jobstress given by the US National Institute ofOccupational Safety and Health (1999) is:…harmful physical and emotionalresponses that occur when therequirements of the job do not matchthe capabilities, resources, or needs ofthe worker. Job stress can lead to poorhealth and even injury (p6).Stressors may be physical or psychosocial inorigin and both can affect physical andpsychological health, and may interact witheach other (Cox, Griffiths & Rial-Gonzalez,2000). Physical stressors may includebiological, biomechanical, chemical andradiological, or psychosocial hazards.Psychosocial hazards (stressors) are ‘thoseaspects of work design and the organisationand management of work, and their socialand environmental contexts, which have the

potential for causing psychological, social orphysical harm’ (Cox & Griffiths, 1996, p87).

Exposure to stressors does not necessarilycause health problems in all people. In manycases while exposure to the stressors taxesthe psychophysiological mechanismsinvolved, within normal homeostatic limitsthe stressor need not cause lasting damage(Cox et al., 2000). While the experience maybe accompanied by feelings of emotionaldiscomfort, and may significantly affectwellbeing at the time, it does not necessarilylead to the development of a psychologicalor physiological disorder (Cox et al., 2000).In some cases however, the stressor couldinfluence pathogenesis: stress may affecthealth (Cox et al., 2000). Further, the healthstate itself may act as a stressor, as it maysensitise people to other sources of stress byreducing their ability to cope (Cox et al.,2000) and ‘the common assumption of arelationship between the experience of stressand poor health appears justified’ (Cox etal., 2000, p76).

Strain refers to reactions to the condition ofstress. These reactions may be transitory, butshort-term strains are presumed to havelonger-term outcomes (Sauter, Murphy &Hurrell, 1990). Occupational strain mayinclude psychological effects (for example,cognitive effects, inability to concentrate,anxiety, depression), behavioural effects (forexample, use of smoking, alcohol), andphysiological effects (for example, increasedblood pressure).

Work stress research in general attempts todraw links between taxing aspects of thework environment (stressors), perceptionsand appraisals of these, and manifestationsof strain including physiological,psychological, and behavioural changes thatmay result (Baker, 1985; Greenhaus &Parasuraman, 1987). Strain hasconsequences for both the work and non-work domains and can affect work

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performance, and result in absenteeism,industrial accidents and staff turnover all atconsiderable cost (Greenhaus &Parasuraman, 1987).

According to WHO (2001), mental healthproblems and stress-related disorders are thebiggest overall cause of premature death inEurope. In Australia, the AustralianWorkplace and Industrial Relations Survey(1995), reported that 26% of people ratework stress as the second largest cause ofwork-related injury and illness behindphysical strains and sprains, 43% (seeextract from the ‘Comparison of Workers’Compensation Arrangements in AustralianJurisdictions’, July, 2000).

Cost of poor mental health at work

In Australia workers are generally entitled toworkers’ compensation for stress when theclaimant’s employment significantlycontributed to stress, not including situationswhere reasonable disciplinary action orfailure to obtain a promotion, transfer orother benefit in relation to employmentoccurred. In South Australia and most otherstates, the ‘stress’ condition is required to be‘outside the bounds of normal mentalfunctioning’ (Workcover, 1999, p14), or is apsychiatric condition listed in the‘Diagnostic and Statistical Manual of MentalDisorders’, 4th edition, revised (AmericanPsychiatric Association, 2000) or the‘International Classification of Diseases:Classification of Mental and BehaviouralDisorders’, 10th edition (WHO, 1993).Examples include post-traumatic stressdisorder, stress adjustment disorder, clinicaldepression and anxiety.

The cost and prevalence of such claims varyfrom state to state. The following details aredrawn from the ‘Extract from theComparison of Workers’ CompensationArrangements in Australian Jurisdictions’,July, 2000, to give some insight into the

prevalence, cost, and peculiarities of stressclaims. In New South Wales in 1999/2000,there were 1,577 new claims comprising17% of all occupational disease claims, eachat an average cost of $20,617 per claim, withthe total gross cost being $33 million. Thelargest proportion of claims (20%) was fromHealth and Education where large groups ofprofessionals coalesce. In Victoria, 5% ofclaims were for stress in 1997/98 (1,587 newclaims). Apart from circulatory disease andback injury claims, stress claims were mostcostly and represented the highest averagepayment per claim. The VictorianWorkcover Authority declared stress as asignificant cause of 86 deaths since 1985,including 15 suicides.

In South Australia, there were 162 claims in1998/99 accounting for 2% of all injuriesand 3.5% of all income maintenance costs.In Western Australia, 601 claims werelodged in 1997/98 for work stress, 2.2% ofall claims with a claim cost of $23,399 twicethat of other claims (an increase of 34%from 1996/97). In Queensland, an increaseof 19% was found in 1999/2000 and anincrease of 28% in 2000/2001. The averagecost of the claim was $17,249 over twice thatof the next most expensive. A strikingstatistic is that the average duration of timeoff for psychological/psychiatric claims was96.1 days compared to 28.9 days for otherclaims.

In sum, most states report an increasingnumber of stress claims per annum, andalthough the percentage relative to all otherclaims is low, the cost per claim is generallymuch higher. It is difficult to derive a GDPfigure for stress at work in Australia, as datasets between state jurisdictions areincomplete. However, excluding Victoriaand Australian Capital Territory data,estimates are around $49 million in 1995/96(National Occupation Health and SafetyCommission, 1998) with an additional $38million for Commonwealth workers in

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1995/96 (Australian National Audit Office,1997).

Too much work

Work stress theories attempt to describe,explain and predict when work stress willoccur. A range of different theories has beenproposed and each has a different emphasiswhich, as will be seen, leads to differentimplications for intervention. In summary,there is a plethora of theories used asguiding frames for the interpretation of workstress problems (see Cooper, 1998), and wehave canvassed but a few here. As workstress has multiple origins, various theoriesand aspects of them have found empiricalsupport in the literature. However, thedominant view based on empirical evidenceis that work stress and its attendant mentalhealth issues are firmly grounded in the wayjobs are constructed, constituted andmanaged. In other words, they are sociallydetermined.

Demand Control Support ModelThis model of work stress emphasises socialdeterminants of mental health at work. Itargues that work stress primarily arises fromthe structural or organisational aspects of thework environment rather than from personalattributes or demographics of the situation(Karasek, 1979). According to Karasek,Baker, Marxer, Ahlbom & Theorell (1981):…strain results from the joint effects ofthe demands of the work situation(stressors) and environmentalmoderators of stress, particularly therange of decision-making freedom(control) available to the workerfacing those demands (p695).

Faced with high levels of demands and alack of control over decision-making andskill utilisation, the associated arousalcannot be channelled into an effectivecoping response (for example, participationin social activities and informal rituals).

Unresolved strain may in turn accumulateand, as it builds up, can result in anxiety,depression, psychosomatic complaints andcardiovascular disease. In this way mentaland physical health outcomes are sociallydetermined by the way in which jobs areconstructed.

According to the model, workers such asthose in machine paced jobs, assemblers,and service-based cooks and waiters,experience the highest levels of stressbecause they are in jobs high in demandsand low in control. Executives and someprofessionals on the other hand are morecommonly in jobs combining high levels ofdemands, but also high levels of autonomy.Therefore they do not experience high levelsof stress despite popular suggestions (that is,executive stress). Presumably high statusworkers have the opportunity to regulatehigh levels of demands through frequentopportunities to use control, and mobiliseresources (Karasek & Theorell, 2000).Social support at work is also a key buffer towork strain (Johnson & Hall, 1988). There isa considerable body of evidence on thebeneficial effects of social support, inparticular emotional support on aspects ofmental health such as depression andanxiety, and physical health such ascardiovascular, endocrine and immunesystems (Uchino, Cacioppo & Keicolt-Glaser, 1996). Jobs with high demands, lowcontrol and low support from supervisors orco-workers carry the highest risk forpsychological or physical disorders (highstrain-isolated jobs) with: increased risk of psychiatric disorder

over time (Stansfeld, Fuhrer, Shipley, &Marmot, 1999)

job dissatisfaction, burnout, depressionand psychosomatic symptoms(Landsbergis, 1998)

lower vitality and mental health, higherpain, and increased risk of both physicaland emotional limitations (Amick,

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Kawachi, Coakley, Lerner, Levine, &Colditz, 1998).

Burnout Theory‘Burnout’ is a term commonly used todescribe intense emotional exhaustion andhas been commonly associated with thetaxing emotional demands associated withworking with (troubled) people. Humanservice work is argued to impose specialstressors on workers because of the client’semotional demands (Maslach, 1978, 1982).Some studies have found, however, thatstressors such as clients’ emotionaldemands, or problems associated with theprofessional helping role (such as failure tolive up to one’s own ideals), were less potentin predicting stress than those associatedwith non-helping professions (Shinn, Morch,Robinson & Neuner, 1993; Collings &Murray, 1996). Moreover, organisationalvariables were more strongly associated withjob satisfaction and burnout than were clientfactors (Jayaratne, Himle & Chess, 1995;Barak, Nissly & Levin, 2001). Theoverwhelming empirical results indicatingthat organisational and job factors are thekey influences on burnout are furthersupported in Australian research on (N=813)human service workers (Dollard et al., 2001)and a longitudinal study of (N=123) ruralsocial workers (Lonne, in press). The originof burnout (occupational stress) is therefore‘fundamentally a systemic issue thatinvolves serious conflicts and tensions, butwhich manifests itself in psychological andhealth strains for individual workers’(Lonne, in press, p301).

Effort-Reward Imbalance Model (ERI)

This model (Siegrist, 1996, 1998) derivesfrom sociological and industrial medicalframeworks, and emphasises the socialframework of the job (for example, socialstatus of job). Workers expend effort at workand expect rewards as part of a socially(negotiated) organised exchange process. Inadult life the work role provides a crucial

link between self-regulatory functions suchas self-efficacy and self-esteem and a socialstructure within which to accessopportunities for fulfilment. When a workerputs in an effort at work that does not seemto be adequately rewarded, strain results.Similarly when workers experience a threatto their job security (status) an imbalanceresults that can lead to strain. In addition toimportant socially structured aspects of thejob, ERI further identifies the importance ofintrinsic efforts – a personal characteristic ofcoping, a pattern of excessive striving incombination with a strong desire for beingapproved and esteemed. Like Type Abehaviour, over-commitment maypredispose a high need for control andimmersion in the job, and probably apersonal perception of low rewards.Effort/reward imbalance and over-commitment are found to be important inexplaining adverse health effects such asgastrointestinal disorders, psychiatricdisorders and poor subjective health (seeSiegrist & Peter, 2000).

Person-Environment Fit Model

The Person-Environment (P-E) Fit Model(see French, Rogers & Cobb, 1974)emphasises the extent to which 1) individualskills and abilities match the demands of thejob and 2) personal needs are supplied by thejob environment. When misfit of either kindis present, strains such as job dissatisfaction,anxiety, depression and absenteeism canoccur.

Cognitive Phenomenological TheoryStress is defined in this approach as arelationship between the person and theenvironment that is appraised as taxing orexceeding resources, and endangerswellbeing (Lazarus & Folkman, 1984).Appraisal of stress is necessary. ‘[F]or threatto occur, an evaluation must be made of thesituation to the effect that a harm issignified’ (Lazarus, 1966, p44). If a situationis perceived as stressful and important then

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the worker mobilises different copingstrategies either to modify the person-environment relationship (that is, problemfocused coping) or to attempt to regulateresulting emotional distress (that is,emotion-focused coping). The situation isthen reappraised and the process repeated. Ifthe situation is resolved, coping ceases. If itis unresolved then psychological andphysiological strain persist resulting inlonger-term negative effects on health andwellbeing (Lazarus & Folkman, 1984). Thetheory has limitations in the work stresscontext as it cannot specify which aspects ofthe work environment would be stressfulbecause, according to the theory, differentindividuals might see the environment indifferent ways (Baker, 1985).

Evaluation of work stress theoriesOverall, empirical research has generallyshown that job factors are more stronglyrelated to job strain and burnout than arebiographical or personal factors (Maslach &Schaufeli, 1993). Job related stress andadverse psychological states appear to bedetermined situationally rather thanpathologically. A major criticism of thework environment approach is that it issimplistic and promulgates the notion of theindividual as passive, ignoring the strongmediation effects of cognitive as well assituational (contextual) factors in the overallstress process (Cox et al., 2000).

On the other hand when stress is understoodin terms of perception and individualdifferences it is likely to be viewed as anindividual problem and re-organisation ofwork processes may be avoided. Theseopposing views highlight the potentialconflict between broader notions of healthand safety in the workplace and theeconomic goals of business and industry inthe investigation of work stress (Baker,1985).

Not enough work

Unemployment has become a major socialissue during the past 20 years. Evencountries where unemployment remainedlow during the 1983 recession haveexperienced increased unemployment since1990, although by the end of the decadeofficial rates in many countries had declined.Globalisation has led to restructuring anddownsizing in many industrialised societiesand a shift, for many workers, from theprospect of secure, long-term employment,to unemployment or inadequate or insecureemployment. There is growing evidence thatthe negative consequences of this shift arenot merely economic, but alsopsychological. This section reviews therecent research literature examining thepsychological effects of unemployment andinadequate employment on mature job losersand on school leavers. Finally, it speculatesdeclining birthrates in many countries are alikely consequence of an increasing shiftfrom secure to insecure employment and thepossibility that in the future, society mightneed to encourage older retirees to re-enterthe workforce so they do not become anexcessive burden on younger workers.

Many economists view unemployment (orinadequate employment) as an economic nota psychological problem. The rejoinder tothis view is that although the causes ofunemployment may be economic, thepsychological consequences go beyond theeconomic (that is, financial disadvantage).But this rejoinder needs to be supported byempirical evidence.

Winefield (1995) presented a comprehensivereview of the literature on psychologicalcosts of unemployment. Research literaturehas demonstrated there are substantial costs,both to the individual and family, whichcannot be attributed solely to economicdeprivation. Psychological researchers havehad to address two issues in arriving at these

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conclusions. The first has been todemonstrate the psychological effects ofunemployment cannot be attributed toeconomic/financial factors alone, and thesecond has been to establish the causal linkunderlying the observed correlation betweenemployment status and psychologicalwellbeing.

Much published psychological research onunemployment has concentrated on thepossible damage to mental health orpsychological wellbeing caused byunemployment, with the ‘selection vsexposure’ issue a major pre-occupation (e.g.Hammarström & Janlert, 1997). That is,given the common observation thatemployed individuals are less depressed andshow higher self-esteem than theirunemployed counterparts, can we attributethe difference to employment status(‘exposure’), or does a pre-existingdifference in psychological wellbeinginfluence whether one will obtain and/orretain employment (‘selection’)?Sophisticated longitudinal studies have beencarried out designed to tease out selectionand exposure effects (e.g. Winefield et al.,1993). The evidence seems to suggest whenjobs are plentiful, unemployed individualstend to be generally unemployable or else‘workshy’ (Tiffany, Cowan & Tiffany,1970) in support of the selection hypothesis,whereas when jobs are scarce there is clearevidence supporting the exposure hypothesis(Winefield, 1995, 1997). Presumably thesame considerations would apply to theeffects of underemployment.

Psychological theories of unemployment

Stages Theory

Eisenberg and Lazarsfeld (1938) published areview article summarising much of the pre-World War 2 literature on the psychologicaleffects of unemployment. They concludedthe psychological response to unemploymentcould be described in terms of the following

discrete stages:

First there is shock, which is followedby an active hunt for a job, duringwhich the individual is still optimisticand unresigned; he (sic) still maintainsan unbroken attitude. Second, when allefforts fail, the individual becomespessimistic, anxious, and suffers activedistress; this is the most crucial stageof all. And third, the individualbecomes fatalistic and adapts himself(sic) to his new state but with anarrower scope. He (sic) now has abroken attitude (p378).Although subsequent commentators haveagreed about the stages, Fryer (1985) haspublished a highly critical review in whichhe argues the empirical evidence does notsupport the view that job losers progressthrough them in a unidirectional way, asassumed by the theory.

Frustration Theory

Dollard, Doob, Miller et al. (1939) proposedthe frustration-aggression hypothesis thatassumes a) frustration always leads toaggression, and b) aggression alwayspresupposes the existence of frustration. Thetheory was originally developed to explainreactions to economic deprivation during theGreat Depression, and has recently beenapplied to explain reactions to job loss (e.g.Catalano, Dooley, Novaco et al., 1993).

Life-span Developmental Theory

Erikson (1959) proposed 8 stages, each withassociated conflicts that need resolution forhealthy psychosocial development:1. Infancy – trust vs mistrust.2. Early Childhood – autonomy vs shame.3. Play Age – initiative vs guilt.4. School Age – industry vs inferiority.5. Adolescence – identity vs identity

diffusion. Identity refers to a) sexualidentity, and b) occupational identity.

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6. Young Adulthood – intimacy vsisolation.

7. Adulthood – generativity vs stagnation.8. Old Age – integrity vs despair.

In relation to adolescence, some researchershave reported evidence suggesting that youthunemployment retards healthy psychosocialdevelopment, as predicted by the theorybecause it prevents the acquisition ofoccupational identity (e.g. Gurney, 1980).

Deprivation Theory

Based on Freud’s view that work representsour strongest tie to reality, Jahoda (1981) hasproposed a theory that distinguishes betweenthe manifest benefits of employment (e.g.earning a living) and its assumed latentbenefits that serve to maintain links withreality. She identifies five latent benefits:9. Time structure.10. Social contact.11. External goals.12. Status and identity.13. Enforced activity.

Jahoda also believes that even bad jobs arepreferable to unemployment, ‘evenunpleasant ties to reality are preferable totheir absence…Leisure activities…are finein themselves as a complement toemployment, but they are not functionalalternatives to work’ (1981, p189).This belief has not been supported by theresearch evidence, with studies by O’Brien& Feather (1990), Winefield et al. (1993)and Dooley & Prause (2000) showing thatinadequate employment can be just aspsychologically damaging asunemployment. Some researchers haveattempted to measure access to the fivelatent benefits of employment and haveclaimed that in unemployed people, access(through leisure activities) is correlated withpsychological wellbeing (Evans & Haworth,1991).

Agency Restriction Theory

Fryer has proposed what he calls an AgencyRestriction Theory as an alternative toDeprivation Theory (Fryer & Payne, 1984;Fryer, 1986). He criticises Jahoda’sDeprivation Theory on the ground that thefive supposed latent benefits of employmentare all too often costs rather than benefits.He writes of ‘Arbitrary time structurewithout regard for human needs; autocraticsupervision; activity for unclear or devaluedpurposes; a resented identity; [and] thevacuous nature of imposed activities’ (Fryer1986, pp12-13).

The theory assumes that people are agentswho strive to assert themselves, initiate andinfluence events and are intrinsicallymotivated. In short, agency theory assumesthat people are fundamentally proactive andindependent, whereas deprivation theory, bycontrast, assumes them to be fundamentallyreactive and dependent.

According to Agency Restriction Theory,the negative consequences of unemploymentarise because they inhibit the exercise ofpersonal agency. The restrictions imposedby economic deprivation make it difficult orimpossible for people to plan and organisepersonally satisfying life styles. Most peoplework for the manifest benefit of employmentwithout regard to its so-called latent benefits.The regular income enables them to plan andorganise personally satisfying leisureactivities and to save for, and plan for asatisfying retirement. Fryer (1986) arguesthat the role of poverty has been under-emphasised in much of the contemporaryresearch on unemployment compared withthe research carried out in the 1930s.

The Vitamin Model

Warr’s (1987) Vitamin Model assumes thatnine features of the environment(opportunity for control, opportunity for skilluse, externally generated goals, variety,

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environmental clarity, availability of money,physical security, opportunity forinterpersonal contact, and valued socialposition) affect mental health in ananalogous manner to the way vitamins affectphysical health.

Some of the environmental features areassumed to resemble vitamins A and D inthat very high levels not merely cease to bebeneficial, but are actually harmful (AD is aconvenient abbreviation for ‘additionaldecrement’). Others are assumed to resemblevitamins C and E in that very high levels,while ceasing to be beneficial, are notactually harmful (CE is a convenientabbreviation for ‘constant effect’). Warrsuggests that three of the environmentalfeatures – availability of money, physicalsecurity and valued social position – mayreasonably be regarded as falling within theCE category, whereas the remaining six areregarded as falling within the AD category.

Like Agency Restriction Theory, but unlikeDeprivation Theory, the Vitamin Modeldraws no sharp distinction betweenemployment and unemployment but rathersees the overall quality of the environment(assessed in terms of nine characteristics) asimportant for mental health. It goes beyondAgency Restriction Theory in specifyingwhich features of the environment areimportant. On the other hand, most of thefeatures (e.g. opportunity for control,opportunity for skill use, availability ofmoney, physical security, opportunity forinterpersonal contact, and valued socialposition) would obviously facilitate theexercise of agency and are thus implied byAgency Restriction Theory.

Although Warr’s Vitamin Model differsfrom Jahoda’s Deprivation Theory in that itassumes no qualitative distinction betweenemployment and unemployment, Warrnevertheless acknowledges the importanceof Jahoda’s theorising and its influence on

his own thinking. For example, Jahoda’ssecond and fourth latent functions (contactwith people outside the nuclear family, andpersonal status and identity) appear asenvironmental features 8 and 9 in theVitamin Model (opportunity forinterpersonal contact and valued socialposition) and her other 3 latent functions areincorporated within ‘externally generatedgoals’.

Relative Deprivation TheoryRelative Deprivation Theory (Crosby, 1976;Walker & Mann, 1987) has recently beenapplied by Feldman, Leana and Turnley(1997) to explain reactions to unemploymentand underemployment. In relation toemployment status, relative deprivation maybe defined as a perceived discrepancybetween an individual’s actual status and thestatus that he/she expects and feels entitledto. It involves two cognitive components: aperception of violated expectations and ajudgment as to the legitimacy of theviolation (Walker, personal communication),both of which can be operationalised andmeasured.

Coping with organisational change

The increasing globalisation of theAustralian economy means that we are moreeconomically exposed to events taking placein other countries. Globalisation has meantincreased competition and opportunity forAustralian business. Successful businessesare the ones that can best adapt in responseto competition. Being able to adapt meansrelying on a flexible workforce that manageschange successfully. Yet people aregenerally more comfortable continuing towork in accustomed ways. People have anunderstandable need for job security and,because of the fear of job loss, tend to resistrationalisation, new technologies, and newprocedures. Organisations may resist changebecause of group inertia and the threat thatchange poses to established modes of

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decision-making. Negative reactions tochange, especially imposed change, includedistress in the form of anxiety anddepression, decreased job satisfaction,decreased organisational commitment,resistance to change, deterioration inorganisational morale, reduced jobperformance, increased voluntaryresignations, and absenteeism (Collins,1998).

There is now abundant evidence identifyingthe key role played by open communicationin successfully managing organisational andworkplace changes. Traditional managementpreferences for hierarchical and secretivedecision-making create an environment forgossip and rumour-mongering, which havedemoralising effects on workers. Informingworkers openly and fully, even of problemsfacing an organisation, facilitates theirparticipation in solving those problems andcoming to terms with necessary changes(Gowing, Kraft & Quick, 1997). There islittle evidence, however, of an increase inopen communication surrounding workplacechange. There is a continued use of secretiveand autocratic decision-making in the recenthighly public workplace changes (the 1998Melbourne waterfront dispute for example).The increasingly global economy mayincrease this trend as decisions aboutworkplace closures are made outside of theplant or section that is to be closed.

The continually changing face and nature ofwork today requires adaptive copingstrategies that allow for easier and expectedtransitions from one type of work to another,in a context of life-long learning and change.This may entail less dependence on definingwho one is exclusively in terms of what one‘does for a living’.

The traditional practice of obtaining one jobfor life is disappearing and it is increasinglythe pattern of employment for one person tohave a sequence of jobs, which may differ in

skill requirements, with possible periods ofunemployment in between. There is,therefore, a need for young people to learnwork-related skills, but these areincreasingly likely to be generic skills ratherthan preparation for a particular job.

These skills would require young people toview change as an inevitable part of life.This would entail seeing job security as areadiness and an ability to adapt rather thanexpecting to learn a certain set of skills thatwill guarantee life-long employment.However, the development of such anoptimistic attitude requires some opportunityto experience a sense of mastery. Our youngpeople have a basic right to reasonable levelsof respect, support and security within whicha realistic ‘can-do’ attitude can be fostered,particularly during transitional periods suchas leaving school.

The nature of employment in Australia in thefuture will require a readiness on the part ofemployees to manage change both while inthe workforce and when moving in and outof employment. Research has revealedseveral factors influencing people’s ability tocope with change. Different styles of copingare required as a function of situation, timeand person - that is, what works in onesituation may not work in another. Adistinction is often made between problem-focused coping and emotion-focused coping(Kinicki, McKee & Wade, 1996). Personsemploying problem-focused copingstrategies are likely to deal with the stressfulsituation by taking action that directly helpsto find a solution to the problem being faced.For a person who is unemployed, this mightmean taking steps to re-skill or to apply fornew positions. A person employing emotion-focused coping is likely to deal withpersonal feelings and reactions to theproblem and may avoid solving it. Thesecond strategy may be less adaptive in anunstable employment market and is morelikely to lead to related health problems.

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However, emotion-focused coping may bemore effective than problem-focused copingwhen a situation cannot be changed, such asa bereavement. For some job-seekers, thismay be a realistic assessment of theemployment market.

Research has suggested that those who aremore likely to use problem-focused copingare characterised by a greater sense ofoptimism and sense of mastery (Armstrong-Stassen, 1994). Optimism can be defined asa generalised expectancy that good thingswill happen. Sense of mastery can bedescribed as having a belief that one’s lifechances are under one’s own control incontrast to being determined by fate. Aperson with a strong sense of mastery andhigh level of optimism is likely to approachchange in a positive way. In addition,employees with these characteristics arelikely to exhibit a high level of workcommitment, even in the face of uncertainty.

Is it possible to increase the level ofoptimism and sense of mastery that peoplepossess? An individual’s attitude to life andwork, in particular, is influenced by personalupbringing, dispositional traits, lifeexperiences and cultural factors. Researchhas shown that children whose dispositiontends towards the pessimistic can be guidedinto thinking more optimistically (Seligman,1997).

Cross-cultural aspects of work

Many of our traditional ideas about ‘work’and ‘non-work’ are culture-bound.Westerners live in largely industrialisedsocieties and cultures with clearlydemarcated domains of ‘work’ or ‘gainfulemployment’ that is highly valued, whichcan dramatically impact on individualidentity and status, which largely determinesresidential location and often education, andwhich takes up a large part of people’s lives.The other side of this western

institutionalisation of work and the workethic is that not to ‘have work’ is to seeoneself as a failure: to have an indeterminateidentity and status; to be perceived as‘carried’ by the work of others; to bedependent; and to have an uncertain future.While it can and has been argued that ‘work’simply differs from culture to culture, withdifferent types of economies, the reality interms of cultural assumptions and meaningsystems is that the very construct of ‘work’differs profoundly from culture to culture.

Even in western European cultures, whichare superficially homogenous, work valuesdiffer markedly (e.g. Hofstede, 1980). Thedomain of work and cultural values is ofparticular interest in Australia, given thecultural heterogeneity of the population(including indigenous people andimmigrants), the high work aspirations ofmigrants, and a popular conception ofAustralia overseas that, in Australia, people‘work to live’ as distinct from America andparts of Europe, where people basically ‘liveto work’. There are also differences acrossgenerations, with Australia’s young peopleoccupying a different cultural space fromtheir parents, and often having differentvalues with respect to self, life and natureand importance of work (Frydenberg, 1994)

We need to keep in mind that westerncultural value stances and assumptions are inpart responsible for a number ofunfavourable stereotypes with respect todiffering rates of paid employment in othercultural contexts. For example, high rates ofunemployment in Aboriginal communitiesare regularly cited as negative socialindicators, yet these reflect both pervasivestructural inequalities as well as a verydifferent cultural value system. While therehas been some research on ‘work values’among indigenous Australians, it has beenalmost always in the context of non-Aboriginal and largely western culturalassumptions and in the context of

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community development initiatives aimed atproviding an ‘economic base’ and ‘self-sufficiency’, based on values alien toindigenous culture. Similarly, perspectiveson health inequalities for women and ethnicminorities closely reflect incomeinequalities:

Indeed, there seems to be a ‘culture ofinequality’, which is characterised bythe exercise of patriarchal power bymen over women, as well as highlevels of collective prejudice againstracial minorities. The health status ofsubordinated groups in society thusseems to be inextricably linked to thegeneral quality of the socialenvironment, and hence to economicinequality (Kawachi, Kennedy &Wilkinson, 1999, p447).

In western cultures we have tended to isolateand reify ‘work’ as a self-defining lifecontext, as the subject of intellectual andpopular discussions, as part and product of amotivational and economic engine thatdrives society and progress. We work ‘atwork’ and work ‘at home’, it’s what we ‘do’for a ‘living’. While many are questioningincreasing incompatibilities between havinga life and having a career, what drives anddefines the cultural ideal in Australia is aself-defining, self-satisfying ‘job’. These arerelatively strange and alien notions in manynon-western cultures, where ‘work’ is amore integral part of living and being and isnot a reflective object of consideration,study, and cultural elaboration.

A cross-cultural perspective allows us someintellectual purchase on where and how andwhat we identify as ‘work’ impacts onpeople’s lives. This is particularly valuableat a time when cultures and, indeed, thenature of self and society (e.g. Sampson,1989; Gergen, 1991) are changing rapidly. Itis true at both ends of the generationalcontinuum, with many older personsbridging a further generational divide and

living far past the traditional age of‘retirement’. Such a perspective cautions usagainst seeing alternative life styles asnecessarily problematic, while at the sametime understanding the self-defining,esteem-providing, and dignity-enhancingdividends that culturally valued ‘work’ canprovide in particular cultural contexts. Weclearly need some different ways ofunderstanding and thinking about ‘work’.We are entering a millennium in which‘work’ may become a less central part ofwho and what people are. We need toaccommodate better new culturalunderstandings of personhood, andconnections, and of meaning and self-fulfilment. The experience of other culturesallows us to broaden, redefine andreconstrue (e.g. Davidson & Reser, 1996)the nature of ‘work’ and its relation to lifesatisfaction and quality of life.

The balance: healthy productive work

Although the negative aspects of jobs seemhighlighted, there are positive combinationsof job elements with potential to lead tosatisfaction, efficacy, and high performance.A study of Australian correctional officers(N=419) by Dollard and Winefield (1998)showed that the level of active coping(seeking feedback from supervisors, seekingsupport) was significantly higher in jobscombining high demands and high controlthan in passive jobs (not enough demands) –consistent with the idea that workersexperiencing passive jobs, with littleopportunity for control, will show reducedmotivation to tackle new problems. AnotherAustralian study of human service workers(N=812) found those involved in active jobsalso had higher levels of efficacy, namelysatisfaction, personal accomplishment(Dollard et al., 2001), and this in turn wasnegatively associated with strain(psychological distress, emotionalexhaustion, physical health symptoms). Astudy of Australian clergy (N=359) also

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found a negative relationship between strainon the one hand, and efficacy on the other(Cotton, Dollard, de Jonge & Whetham, inpress). Taken together, these studies providesome support for the dynamic associationsbetween job strain and feelings of mastery(Karasek & Theorell, 1990). The higher thelevels of efficacy experienced by workersthe lower their levels of experiencedpsychological distress and physical illhealth. This may be due to emotional andphysiological toughening that occurs whenworkers have opportunity for both challengeand recovery in active jobs (see Dienstbier,1989). When faced with new challenges,active workers will have a positiveperceptual set that will enable them to meetnew challenges, but without the negativeconsequences of accumulated strain.

Another study found increased workermotivation in 381 insurance companyworkers in active jobs (Demerouti, Bakker,de Jonge, Janssen & Schaufeli, 2001).However the researchers also found greaterhealth impairment, leading to the conclusionthat the levels of demands were in fact toohigh, that they could not be reduced byincreasing control, and that neither too fewor too many demands are good foremployees (see Warr’s Vitamin Model,1987).

Recent meta-analytic studies from theUnited States suggest that the relationshipbetween job satisfaction and jobperformance is much higher than hadpreviously been assumed (Judge, Thoreson,Bono & Patton; 2001; Harter, Schmidt &Hays, 2002). Moreover, Koys (2001), usinglongitudinal unit-level data, has shown thathuman resource outcomes such as employeesatisfaction, organisational citizenshipbehaviour and turnover, affect organisationaloutcomes such as productivity and customersatisfaction, rather than vice versa.

The importance of social support at workfrom colleagues and supervisors isunderscored as it is consistently shown to belinked to better mental health outcomes forthose who experience it. Particularlyimportant appears to be the reaction oforganisations, especially supervisors, whenemployees become either mentally orphysically taxed, and also in return to workoutcomes (for example, a phone call fromthe supervisor) should the employee need tobe absent from the work environment(Linton, 1991; Dollard et al., 2001).Workers also need protection from violenceat work including bullying (in many casesperpetrated by supervisors), harassment andother intimidating behaviours, and theresponsibility for preventing thesebehaviours rests mainly with supervisors.The policy section below outlines furtherideas for the ideal work environment.

Research program for environmental andhealth action

An overall program for research andenvironmental and health action recentlyoutlined by Levi (2002, px) should aim atbeing: Systems oriented, addressing health-

related interactions in the person-environment ecosystem (e.g. family,school, work, hospital, and olderpeople’s home)

Interdisciplinary, covering andintegrating medical, physiological,emotional, behavioural, social, andeconomic aspects

Oriented to problem solving, includingepidemiological identification of healthproblems and their environmental andlifestyle correlates, followed bylongitudinal interdisciplinary fieldstudies of exposures, reactions, andhealth outcomes, and then by subsequentexperimental evaluation under real-lifeconditions of presumably health-

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promoting and disease-preventinginterventions

Health oriented (not merely diseaseoriented), trying to identify whatconstitutes and promotes good health andcounteracts ill health)

Intersectoral, promoting and evaluatingenvironmental and health actionsadministered in other sectors (e.g.employment, housing, nutrition, traffic,and education)

Participatory, interacting closely withpotential caregivers, receivers, planners,and policymakers

International, facilitating transcultural,collaborative, and complementaryprojects with centres in other countries.

Levi (2002) further emphasises theimportance of evaluating such interventions,to ensure harmful interventions areprevented, to safeguard human rights, toestimate costs-benefit of public expenditure,and advance knowledge of the future. Withinthis larger framework the following ideas forpolicies to improve mental health andwellbeing at work are offered.

Policies to improve mental health andwellbeing at work

A number of key policy implications fromthe evidence base, along with aphilosophical framework as well asprocesses to deal with new stressors as theyemerge were advanced as part of theNational Occupational Health and SafetySymposium on the Occupational Health andSafety Implications of Stress, Melbourne2001 (Dollard, 2001). The participation of arange of stakeholders in dialogue andresearch activities seems critical in thedevelopment of policy that is responsive tonew insights from the field. A notablefeature of the literature in the area is a dearthof large Australian national studies or indeedsystematic organisation of the Australian

evidence. This raises possibilities both at thenational and organisational level. Thefollowing excerpt is from the NOHSCSymposium (Dollard, 2001, pp3-57): National levelPolicies that could be pursued at the nationallevel include: providing further organisational support

and funds to enable greater dialoguebetween all stakeholders, and to enablemeaningful national engagement andparticipation in international discussionabout work stress and its solutions

convening further national conferencesand workshops on work stress in whichgovernment, social partners, workers andresearchers can participate

undertaking research comparingAustralian regulations, policies andpractices with those in other countries(Kompier, De Gier, Smulders &Draaisma, 1994)

promoting whole organisationalapproaches, healthy organisations,sustainable organisations and ethicalaction

developing a national network of workstress researchers

establishing a national monitoringsystem for identifying risk factors andrisk groups in the working populations(Kompier et al., 1994)

making a systematic attempt tobenchmark organisational performanceon work stress management, so thatintervention efforts can be moreeconomically focused, e.g. to sponsorresearch of national risk factors and riskgroups (Kompier et al., 1994)

making work stress research a priorityfor National Health and MedicalResearch Council

supporting research that promotespositive or productive aspects of worksuch as morale (e.g. Hart & Cotton,

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2002) and engagement (Maslach, 1998),and explores emerging issues e.g.emotional and cognitive demands(Houkes, Janssen, de Jonge & Nijhuis,2001) and workplace violence, its causesand consequences

developing more comprehensive nationaldatabases, e.g. NOHSC’s database ofworkers’ compensation statisticsincludes figures for work stress, but thereis no breakdown of the data to reflectpublic vs private sector experience, andsome jurisdictions’ data are omitted

conducting more research on the effectof new legislation on rates of acceptanceor rejection of stress claims

systematically identifying gaps betweenresearch evidence and policy

providing more education and trainingon work stress and interventions for allstakeholders to enable fullerparticipation in participatory processesfor prevention.

To date, most Australian case studies haveessentially focused on individual approachesto intervention (Williamson, 1994) incomparison to European efforts. In contrastto research about what causes stress andburnout, very little gold standard research,with case controls and randomisedapproaches, has been conducted oninterventions that reduce work stress orburnout. It is therefore recommended: Australian organisations be encouraged

to use best practice principles inimplementing interventions. At the sametime there is an urgent need to conductan evidence-based meta-analysis ofAustralian work stress prevention andinterventions

government, social partners, andresearchers participate in televisionprograms and videos on identificationand prevention of stress at work

development of a clearing house for allrelevant information and othereducational materials to be placed onwww.

Organisational levelAt the organisational level other measuresare relevant, for example: focusing on primary prevention of work-

related stress and ill health rather than ontreatment

promoting ‘internal control’ approachesto healthier workplaces (see below best–practice)

ensuring proper training and careerdevelopment for better person-environment fit

ensuring optimum conditions for theintroduction and uptake of newtechnologies, and integrating suchintroductions with stress prevention andhealth promotion

promoting workers’ motivations andadaptability through increasedinvolvement in planning andimplementation of change

promoting equal opportunities and fairtreatment of men and women, includingselection and re-entry of women into theworkforce and combining family andwork responsibilities, to ensure the ‘highlevel of human health protection’ calledfor in the Treaty of Amsterdam(European Communities, 1997, p39)

amending the education and trainingcurriculum of various professionals topromote both the modernisation oforganisational work and the preventionof work–related stress in an integratedmanner (e.g. in business schools, schoolsof technology, medicine, behaviouraland social sciences) (EuropeanCommission, 2000)

improving work design, organisation andmanagement (e.g. 360 degree evaluationof supervisors’/managers’ styles)

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specifically to improve communicationsand staff involvement, and to enhanceteam working and control over work;develop a culture in which staff arevalued; structure situations to promoteformal and informal social supportwithin the workplace; evaluate workdemands and staffing; reduce violentexposures; define roles more clearly;avoid ambiguity in job security andcareer development; design workschedules to be more compatible fornon-work responsibilities; and designforward, stable rotating shifts.

using local information to inform theexploration of stress. In a workplacecontext it is never sufficient to limit theexploration to general global variables.There is also a need for ‘local’ and morefocused information specific to theorganisation

providing secondary and tertiary supportas necessary.

Guidelines for best practice inorganisational implementation suggestthey: need to be stepwise and systematic require an adequate diagnosis or risk

analysis combine both work-directed and person-

directed measures use a participatory approach (worker

involvement) (Scheflen, Lawler &Hackman, 1971)

have top management support (Kompieret al., 1994)

are evaluated for costs and benefits ofthe intervention and in terms of healthand productivity outcomes (EuropeanCommission, 2000).

These recommendations are relevant andapplicable in the Australian workenvironment today.

Conclusions

Recent modern work environments areincreasingly characterised by ‘too muchwork’, ‘not enough work’ and ‘no work’ dueto economic rationalism and localimperatives. Each of these unfavourablework states, emerging themselves from theway jobs are constituted, constructed andmanaged, has been associated witheconomic and social costs (for example,family issues), and increased risk for stress-related disorders and mental healthproblems. Further, the latter are significantcontributors to the burden of disease, and areputatively linked to loss of quality of life andpremature death (Wilkinson & Marmot,1998; WHO, 2001). Income inequalityarising from such disparate work states hasnegative health consequences for allmembers of society as social cohesion,which characterises healthy egalitariansocieties, progressively breaks down(Wilkinson, 1996). Income and workinequalities (for example, emotional, careand house work) appear mirrored in healthinequalities particularly apparent in womenand ethnic/cultural minorities, clearlyimplicating a ‘culture of inequality’characterised by ‘patriarchal power by menover women as well as high levels ofcollective prejudice against racial minorities’(Kawachi et al., 1999, p447) in theworkplace.

In addition to workplace redesign and aredistribution of working hours among agreater number of employees withoutdiscrimination, building capacity withinworkers to cope is also an important idealgiven the rate of change to the nature ofwork. Aspects of the ideal work environmenthave been explored in the chapter along withan agenda for research and evaluation, andpolicies for implementation at the nationaland organisational level.

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