Pillar 1: Lay the Foundation for a Mentally Healthy Workforce by Focusing on Organizational Factors

July 18, 2023

This Guide informs the development and execution of a comprehensive mental health strategy built on three pillars: 1) Organizational factors that impact employee mental health; 2) Initiatives to promote mental health; and 3) Benefits and programs to treat mental health conditions and substance use disorders.

As described by numerous health-focused entities, including the World Health Organization, ISO (the International Organization for Standardization) and the U.S. Surgeon General’s Office, workplace structures and practices are a crucial part of an employer’s mental health strategy.1-3 Work can be a protective factor for mental health by providing the space and opportunity for employees to make positive connections, feel a sense of belonging and experience purpose and fulfillment.2 On the other hand, the workplace can contribute to poor mental health outcomes like chronic stress or burnout and/or exacerbate existing mental health conditions and substance use disorders.

Workplace risk factors that can lead to negative mental health outcomes are known as psychosocial risks and may be related to:4-6  

  • Job content (e.g., lack of variety, mismatch in skills, stressors related to inherent trauma in the job responsibilities);
  • Workload and work pace (e.g., shift working, inflexible hours, long work hours);
  • Interpersonal relationships at work (e.g., limited support from colleagues or managers, discrimination or exclusion, social isolation);
  • Organizational culture (e.g., unclear objectives, poor communication); and
  • Home/work tension (e.g., conflicting home/work demands, being away from home or work), among other factors.

The benefits of having a workplace that supports employee mental health are numerous. Reducing psychosocial risk factors protects employers’ investment in mental health and substance use disorder benefits because it creates workplace conditions that enable employees engaging with these benefits to be successful. Furthermore, a safe and healthy work environment affirms employers’ investment in employees and may result in better work performance, productivity, engagement, retention and reduced tension and conflict.5

Assessing and addressing any potential psychosocial risk factors that may be present in the workplace requires leaders from across the organization to acknowledge that benefits and programs alone are insufficient to effectively improve mental health and that every stakeholder across the company has a role to play in promoting mental health. Thus, creating a supportive workplace requires company-wide engagement and coordination, especially among leaders and those with responsibility for benefits and well-being.

While they may not be able to impact all psychosocial risk factors, benefits and well-being leaders are well-positioned to:

  • Help identify the factors affecting workforce mental health;
  • Create cultural change through top-down support from leaders, as well as encouragement of bottom-up efforts to improve workforce emotional well-being;
  • Influence work/life balance and flexibility, social connectedness and financial security through benefits, programs and policies; and
  • Encourage the leadership buy-in and communication that is crucial to the success of a company’s strategy.

Addressing Psychological Risk Factors in the Workplace

Solicit employee feedback on organizational factors that may impact their mental health, both positively and negatively:

Getting feedback from employees, whether through surveys, focus groups or employee resource groups (ERGs), allows employers to assess whether their current culture promotes positive mental health and identify any opportunities for intervention. It also sends a message to employees that the organization cares about their mental health and recognizes the role that the organization plays in it.7

Ideas for Action

Employers can assess organizational factors impacting mental health by:

  • Adding questions from validated tools, such as the Copenhagen Psychosocial Questionnaire (COPSOQ), to existing surveys, or deploy a questionnaire separately.
  • Creating a feedback loop so that employees know they have been heard and that the company is doing something with the information collected. It is particularly beneficial to solicit feedback from an array of employees, especially those with lived experience, and involve them in the planning of mental health policies and programs.1 Clear communications before and after soliciting feedback are necessary to set reasonable expectations among employees about what the organization can and will do with the information collected.
  • Making a plan to determine which psychosocial risks to prioritize and how to address them. This includes determining roles and responsibilities of leaders involved, as well as how progress will be measured, to ensure accountability.

Enable managers to gain the leadership skills necessary to promote positive mental health among team members:

Respondents to a 2022 global survey said that managers impact their mental health more than doctors or therapists and roughly as much as a spouse or partner.8 Research shows the best managers have a transformational style – they have a vision, encourage their team members to be creative and treat each employee as an individual – and have the biggest positive impact on employee mental health.9 On the other hand, the worst managers are aggressive, hostile and have the most negative impact on the mental health of their teams. Thus, coaching, training or leadership development programs that teach managers the necessary skills to lead a team well, including “helping managers identify specific actions and attitudes they should either adopt or avoid” can be an important cultural component of an employer’s mental health strategy.9,10 

While coaching and training may incorporate information on mental health, these programs may not include information specific to identifying and responding to mental health challenges, which is also important. Additional information on manager training specific to identifying and responding to mental health challenges can be found in Pillar 2 of this resource. 

Ideas for Action

Benefits and well-being leaders can encourage leadership skills that promote mental health by:

  • Making the case for leadership training or coaching across the company. Training should focus on how managers can learn skills considered to be transformational in style, and reinforce “the importance of an adequate balance between a clear definition of goals and work tasks and the building and maintenance of trustful, respectful, and considerate relationships.”10
  • Advocating for holding managers accountable for promoting mental health. This may include adding goals about mental health and/or organizational culture into manager performance reviews, including if and how they are upholding the organizational mental health strategy and how that impacts their teams. For example, at one Business Group on Health member company, leaders have a mandatory well-being goal: modeling and ensuring a culture of care for those they manage.

Work with organizational leadership to create an inclusive culture that prioritizes diversity, equity, inclusion and belonging (DEIB):

There’s a strong association between mental health and DEIB. When employees are able to share their experiences, feel included and understand that their employer considers diversity a strength, they report less stress, anxiety and tolerance for prejudice in the workplace.2,11,12 Inclusion may also lead to higher employee engagement.13

Leadership is an important factor in how employees perceive the inclusivity of their organization. When leaders show their genuine selves at work, employees are more likely to feel empowered to do so as well. Leaders can also inspire feelings of inclusiveness through their actions. Employees who say that their company leadership focuses on inclusivity through building team cohesion, for example, are 1.7 times more likely to feel included at work.14 Given differing cultural norms across the globe, buy-in from local leaders is all the more important.

Ideas for Action

There is meaningful cultural variation across the globe and even regionally within countries, something for employers to keep in mind when promoting inclusivity as part of their mental health strategy. Employers can promote feelings of inclusion and belonging at work by:

  • Hosting conversations on topics that impact employees’ feelings of inclusion and belonging at work, such as race and gender bias.15 Consider having leaders kick off these conversations by sharing their own experiences. Partner with ERGs to hold these discussions, but make sure to provide opportunities for employees unaffiliated with these groups to participate as well.
  • Preparing managers to feel confident in discussing DEIB topics with their staff members. In a recent survey, 39% of employees said that their manager had discussed DEIB topics with them over the last 12 months and 41% of managers said they felt comfortable doing so.16 Those who did were more likely to have attended a company-wide meeting, town hall or listening session on the topic. Providing these opportunities for managers may make them more likely to have DEIB conversations with employees.16
  • Evaluating mental health initiatives for alignment with organizational goals and practices related to DEIB.17 In 2023, 61% of employers will audit their health and well-being initiatives to assess their level of inclusivity. Most employers (81%) will solicit input from employees, internal DEIB leaders (77%) and external experts (59%) to assess inclusivity of their workplace.18

The Relationship Between Employee Engagement and Mental Health

According to a survey conducted in 2022, 40% of employees stated that work had a negative impact on their mental health in recent months.19 However, there were stark differences in responses based on employees’ level of engagement at work. Employees who were actively disengaged were six times more likely to say that their job had an extremely negative impact on their mental health. On the other hand, employees who were engaged at work were five times more likely than other employees to say that their job was a positive factor in their mental health.19 The implication? Focusing on employee engagement may provide a powerful opportunity to impact mental health.

Provide both predictability and flexibility in how and when work is done:

Lack of predictability in scheduling for hourly workers causes stress related to economic hardship and an inability to plan for childcare and transportation, impacting both physical and mental health.2,20 Studies show a correlation between low levels of control over work hours and depressive symptoms and a higher risk of psychological distress. Low levels of control may also lead to work and family conflict, which increases the risk of poor mental health.21

When it comes to flexibility, respondents to a 2022 survey conducted by the American Psychological Association stated that offering flexible hours was the most common employer benefit that would help their mental health.22 Moreover, studies show that flexible work has a modest positive impact on mental health and can result in less stress and burnout.21 It can also improve job satisfaction.23 However, it’s important to note that flexible work can lead to challenges like loneliness, decreased engagement and blurred work/life boundaries, so employers should keep an eye on these potential pitfalls when putting policies and programs in place.24

Ideas for Action

Employers can offer greater flexibility and predictability for employees by:

  • Considering flexible work arrangements (e.g., condensed work hours or work weeks, remote/hybrid work arrangements) based on their fit for the industry, job roles/positions, locations and business needs. While making this determination, assess how to address potential challenges, such as constraints related to working hours or location. For example, across the world, there are legal and business considerations that may impact flexible work, and in some countries, work councils and unions will dictate rules regarding working hours, overtime, flexibility and scheduling. Thus, for many employers, particularly those that are multinational, flexible work will likely vary across the organization as they seek to balance employee and business needs.
  • Creating greater predictability by setting schedules 2 or more weeks in advance so employees have time to plan childcare or appointments as needed. In addition, creating schedules that don’t change from week to week may mitigate the impact of psychological distress related to low levels of control over work hours.
  • Allowing employees to self-schedule or swap shifts, so instead of missing a work shift (and associated income) when a conflict arrives, employees can work at another time.24

For additional information and further recommendations, see Integrating Flexible Work and Well-Being.

Leave Programs as Part of a Mental Health Strategy

Some employers are rebranding sick leave as well-being leave or offering mental health days to communicate that employees may need time off to attend to their mental health in the same way they need time off for physical health needs. Others are providing compassionate leave, which is similar to bereavement leave, for difficult life situations that arise or offering unlimited leave. While leave isn’t a fix for all mental health needs, it does have a role in a comprehensive mental health strategy, especially when support for rest and time off is reinforced by leadership.25 For more information, see An Inclusive Look at Leave.

Promote social connectedness at work and at home:

At a time when loneliness is at a “problematic level” in many countries across the globe, including in the U.S., as highlighted by the Surgeon General, promoting social connectedness has never been more important to employers.2,26,27 Strong social connections can bolster physical health, combat symptoms of depression and anxiety and improve job satisfaction, performance and productivity. For example, employees who describe themselves as lonely are three times more likely to be dissatisfied with their job than non-lonely employees.26 Most employers (82%) include social connectedness as a part of their overall well-being strategy; based on how crucial social connectedness is to employee health and business outcomes, it also must be considered a part of the organization’s workforce strategy.18

Ideas for Action

Employers can promote social connectedness among the workforce by:

  • Facilitating cross-functional and quality interactions. Ideas include community service activities, shared meals, physical activity challenges or coffee chats organized by the company. Ensure that equal attention is paid to employees working in-person and remotely. Additionally, add variety to events, including some that do not center on food or alcohol, to be sensitive to employees who may be living with substance use or eating disorders.
  • Create opportunities for employees to learn about each other beyond work roles to deepen connections. When onboarding new employees, one expert recommends introducing them by mentioning their interests first rather than their work history. For both in-person and hybrid team meetings, encourage leaders to kick off conversations with an icebreaker question or informal check-in. Starting with an icebreaker creates a more relaxed environment, removes barriers to communication between colleagues, encourages the initiation of broader discussions, builds trust and encourages a shared ownership for participation among the team.28,29
  • Celebrating employees in big and small ways. Recognizing employees in front of their peers can help them feel honored and seen, which in turn can spark feelings of inclusion and belonging at work. Consider ways to celebrate employees for their well-being wins, as well as ways to work with leaders across the organization to celebrate work-related achievements or milestones.
  • Offering flexible work and leave policies to bolster connections outside of work. As described above, flexible work and leave can have an important impact on mental health. It also can play a role in combating loneliness by enabling more time spent with loved ones or in the community. With that in mind, it’s important to remember that time spent in the office is also important, with Gallup’s research showing that “that two to three days in the office resulted in the best outcomes for employee engagement and wellbeing and reduced job hunting and burnout.”30

For additional information and further recommendations, see Social Connectedness: Building Bonds in the Workplace and listen to Friends at Work: Why Connecting with Colleagues is Good For Business.

Support employees’ path to financial security:

Financial health and mental health are intertwined, with financial stress contributing to overall stress, and a likelihood of depression and sleep loss. Unfortunately, financial worries are widespread, with 60% of full-time employees reporting that they are stressed about their finances.31 Moreover, 55% of employees said that financial stress had a negative impact on their mental health.31 Financial stress also takes a toll on productivity, engagement and retention, which should make financial security a priority for leaders across an organization. As a result, 93% of employers report that financial well-being is a part of their well-being strategy and continue to add supports to address employees’ short and long-term needs. This includes things like financial health programs (83%), debt management and budgeting tools (78%) and programs to support emergency savings (40%).18

Ideas for Action

Employers can seek to alleviate stress and promote a path to financial security by:

  • Assessing employees’ financial well-being through surveys, ERGs, focus groups and/or employee compensation data. Determine employees’ biggest financial challenges; how these challenges differ based on demographics and location; and how social determinants of health like income, housing instability and food insecurity impact the financial -- and overall -- well-being of your employees.
  • Using data to advocate for paying employees an appropriate wage. Business Group on Health’s guide on social determinants of health outlines research from across the globe that shows the association between rising incomes and lower rates of depression and fewer chronic diseases.
  • Considering how your health care benefits may impact the financial security of employees and developing strategies that reduce the financial burden on lower-wage employees, such as wage-based cost sharing (e.g., premiums, deductibles, out-of-pocket maximums), which 37% of employers have in place in 2022 to reduce health inequities.32
  • Implementing financial programs and benefits that are focused on meaningful action (rather than just education, which is necessary but insufficient for many). Examples may include strategies to help employees generate emergency savings, pay down student loan debt or develop a budget.

For additional information and further recommendations, see Strategies to Support Financial Well-Being and Social Determinants: Acting to Achieve Well-being for All.

Create organizational communications free from stigmatizing or hurtful language about mental health conditions and substance use disorders:

Person-first language (e.g., “a person living with a mental health condition or substance use disorder” instead of “a mentally ill person”) recognizes that people have many different aspects of their personality and lives and are not defined by their medical diagnosis or disability status.33 Inclusive language practices also ensure that mental health-related language is not used in a derogatory fashion, (e.g., saying someone is “OCD” or acting “crazy”). Even when used unintentionally, this type of language can reinforce stigma and undermine efforts to create a culture where employees with mental health conditions or substance use disorders feel comfortable.

Ideas for Action

Employers can strive to create inclusive communications by:

  • Developing internal language guidelines for the organization. This can include a list of inclusive words as well as practical tools that can help employees use more neutral language.34
  • Working with corporate communications to evaluate internal and external documents, social media, job descriptions and company websites for potentially stigmatizing or hurtful language.
  • Reviewing existing benefits descriptions, well-being policies and program materials to ensure the use of inclusive and neutral language.
  • Choosing inclusive language ambassadors who will champion the initiative and help to reframe the use of exclusive words when they hear or see them in company documents.34
  • Encouraging organizational leaders to model inclusive communication about mental health, including by sharing their own mental health journeys.

For more guidance on inclusive language, see the American Psychological Association’s Inclusive Language Guidelines.

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More in Well-being and Workforce Strategy


  1. Solicit employee feedback on organizational factors
  2. Enable managers to gain leadership skills
  3. Work with organizational leadership
  4. Provide predictability and flexibility
  5. Promote social connectedness
  6. Support employees’ path to financial security
  7. Create organizational communications