MENTAL HEALTH
IN
INDUSTRY by Robert Murray
Dr. Murray is Medical Adviser Union
X ^ADE f?rce
ai)(j
background
Unions in
deal with mutual
powerful shaping public opinion are
a
lhat 'l ^Uencing government action so before considering their attitude t0 ?ntal health there is
some advanfew facts about their this country. At the Tran '~frL^on of 1962, one Congress ^Und w** and eighty two trade unions shir. rfPresented with a total memberarp ? 8,312,875. Not all trade unions 'ated to TUC but the total unio in the country is mernbership abou million out of a total working Poni i lation of 23 million. It often ?s a surPrise to people to learn of t ?n^ 40% of workers are members
re.caUing orta ^Sati?n in
a
c0? that68
trade unions. craft unions, industrial ma^ unio general unions or white collar
^ and they vary tha ^ach members to
in size from less over one million, *s autonomous, proud of the job ^oes anc* zealous in protecting and iHg Promoting the interests of its ^ conducts its affairs throti an elected executive council Wh0 Pr'nciPal officer is the General and operates through a series of each in the charge of a a Pa 71 secretary who is in most cases deDp v^me officer. At shop floor level, on e nature of the i^dust there are often several unio eac^ one (?r *n some cases a er ?f unions jointly) represented by tw shop steward who deals with Pay ?ement in the matter of rates of inter ,r yarious jobs, overtime and arrangements. Local bran ^ sworking ?f various unions form Pouncils, which represent the a interests of trade unions in the area Regional Advisory ComHiitte consisting of full-time union ass*st *n dealing with regional
-t?ne
^S'
Sec/? betary branrLnc^es>
Tra(j
general
?mcees-
Prob^ nuitib er
to the Trades Union
certain groups of industries and there is the Trades Union Congress administered by a General Council of 35 members chosen from among the affiliated unions. The function of the TUC is to indicate the general lines of trade union policy, to represent the interests of trade unions at the national level, to appoint representatives to serve on government committees, boards, commissions and councils and, by invitation of the unions con-
industries
cerned,
or
arbitrate
to
on
inter-union
disputes.
Thus, besides maintaining a close with the welfare of individual members, trade unions now share in the formulation and working out of national policy on a variety of issues. concern
They
are therefore deeply concerned with the question of mental health and have been following the development of this growing problem in the national interest as well as in the interests of their members. Representing as they do a cross section of the community one finds all shades of opinion and prejudice among individuals, but from the policy point of view, the trade unions form a consumers' association interested in obtaining the best possible service for their members.
Difficulties There
regarding
mental health
many difficulties in the attitude of workers towards mental ill health, chiefly because it is not yet generally recognised as an affliction. If a person is injured or suffers from an are
appendicitis
or
even
a
common
cold,
there is understanding and sympathy on the part of his workmates. But mental disturbance is often of gradual onset and the individual is judged in terms of his behaviour?bad tempered,
surly, difficult, moody, cussed?and, as people have their off-days, these characteristics are treated according to the position and influence of the
most
nati?nal level there are a of Federations of Unions who
Congress problems in
^
to say that "X" should not work a conveyor belt or that "Y" not be employed as a bus conduct^'
sufferer in the works hierarchy?with respect or fear or even ribaldry. Towards the severely disturbed person who may still be working there lurks in most people an irrational fear and this may show itself in unwillingness to work with him or in frank cruelty towards him.
sho1^
or post office cle>\| if the techniques were ava' able, are we in a position to use the extensively in industry? Who have the responsibility for case find'11* ?the employer or the community? ., The National Health Service, vVl all its advantages to the community a whole, is not designed to prom0 and maintain the health of workers to control the conditions giving 11 to CircU^ occupational disease. stances likely to give rise to me"' disturbances?the menopause, fan1'; bereavement, divorce, lack of pro111, tion, maladjustment? can be recog11. ; sed by the wise practitioner and the effects mitigated by appropr'L counsel but all too often the fa111'' practitioner has no knowledge of work situation. The function of Ministry of Labour through 11 Factory Inspectorate is to contf e mainly the physical and chemical (( ?vironment at work. No medical en? is deployed specifically towards control of mental stresses. And i* j can be shown that certain kinds work are liable to give rise to upset is it not the work which sho11 be changed rather than the worker? j Obviously, more research is into the relationship of work .aI\' mental disorder. Some investigation have been done, notably by the P? Office, to assess the extent of problem. But this work needs to expanded and repeated in a variety industries to determine whether it a the nature of a particular job or 0 i deeper malaise associated with modern way of life which is resp0l\ I sible for the enormous wastage t time and personnel on account mental conditions. The total numb , of days lost on account of mem ill health is of the order of 30 mill'0 ' . per annum, more than 10% of total number of working days 1? j-1 from all causes. The Ministry Pensions and National Insurance is
linotype operator And
even
sho^
mental health in industry There are three aspects of mental health in industry of particular interest to the trade unions? 1. the effect of industry on producing mental disorder; of the mentally 2. the impact disturbed individual on the work situation, and 3. the rehabilitation of the mentally disordered. 1. The effects of industry on producing mental disorder. The part played by industry in producing mental disorder is difficult to In the case of assess with accuracy. well recognised occupational diseases, such as lead poisoning or silicosis, the individual is exposed only while he is at work and the cause and effect relationship is easy to establish. Away from work he is recovering. It is not so with mental stress. While he is away from work the sufferer may go on thinking and worrying about his problem and there are often similar stresses in the community or home environment. The question of individual susceptibility looms even larger in the case of mental disease than it does, for example, in the case of industrial dermatitis. There is no doubt, however, that such tasks as conveyor belt work where a high speed is demanded, the loneliness of handling the control panel of a power station or oil refinery, alternating shift work and work demanding great concentration, especially where there are undesirable physical and environmental factors such as poor lighting or noise, are likely to precipitate mental disorder in susceptible individuals. But are who these susceptible individuals and is there any way to prevent them from being exposed? Are our techniques of recognising incipient disorders sufficiently refined
Aspects of
^
^
^ rnefl'j,
ne^
'JL ^
present engaged
an
survey to be 1964 and this may give
morbidity
'
j
on
occupatio^'
published an
indicat'0
92
J
mental upset is at^H^e-r With industries ed
some
^
{mpact
associthan others.
more
of the mentally disturbed
'"dividual
on
the work situation.
t a man breaks a leg or gets pneunia he stays at home, but he can
,
or
co
severely
ion and still
th
ill from
go on
havC a circumstances mai"ked effect
a
mental
working. In
illness may his efficiency jn,' depending on his position in the the effect may extend out^0r a considerable distance to infl the efficiency of his working UP- The advice of a trained dispasSj observer would do much to such situations arising, but to achieved? Can we the presence an of such erver in every work situation, and, distu ?ot> how are the effects of the individual to be recognised? Th e l victim himself does not always is ii' ant* ls unhkely to advice. Even if his illness is re he is often unwilling to t ^ is opiy m relativeiy rare cas an industrial physician is yecl who has the knowledge and to ^eai effectively w'th such
and
his on
^stry,
gr^Uence prna^e
hn^F11 f}S
ob?
?
SeelfW
acj??nised
aUt?
cases?rity '
Rehabilitation
of the mentally ill. is nature's best physiis essential for human happines The trade unions recognise the 0rn of Galen's words and fully Su the efforts being made to ret'ie mentally ill. There are, ho\v problems in introducing i^e ^ disabled persons into a work situ in normal industry. In the jjj Place, it is obviously undesirable un s'tuation where there is extensive more than to do di p'?y a token number of mentally Persons at the expense of fit rnen ?ut of a job. Secondly, the me % disabled should not be empl0 at a lower rate of pay as there Wiii suspicion that they are being evnl Thirdly, although the -0^ ?pinion towards mental ill is changing, there is still a stiam ,a attached to mental disease does not attach to the amputee or chronic bronchitic; the accept
Payment
cian
?
L]y,?rt
nfv,er' ?
fjrstatl?n
e^^Ployment
.
clj^0lted^ealn!e jT1
tance as a workmate of a mental defective or schizophrenic involves a greater share of loving-kindness than many people have. A great deal still has to be done to educate employers and trade unions to understand the needs of the mentally disabled as members of the community but experience has already shown that if the approach is made intelligently with full consultation of the unions, the integration of mental patients into normal work situations can be conspicuously successful. Thus the trade unions believe that the employment of the mentally disabled in open industry must only be undertaken in the interests of the patients themselves and not on a commercial basis, that there should be arrangements to ensure proper conditions and safeguards through the Ministry of Labour and that there must be full consultation with the workpeopleconcerned and their unions.
Conclusions As the expectation of life increases
and the stresses of modern life and more and more people are likely to suffer from mental disorder. It is obviously essential that the susceptible individuals should be recognised early and guided into appropriate employment, that stress situations in industry should be anticipated in order to mitigate their effects and that mental casualties should be adequately treated and returned as far as possible to work in normal industry in their own interests and those of the community at large. This involves the of medical students to education enable them to understand better the mental health problems of industry, the training of more psychiatric social workers to help in the assessment and control of the problem and the education of employers and workers to understand and accept the situation as it presents itself in modern industry. As our knowledge improves so it should be disseminated and applied in order that ultimately we may be able to tackle this problem as effectively as we have the conventional occupational diseases.
industry grow greater,
IN
INDUSTRY by Robert Murray
Dr. Murray is Medical Adviser Union
X ^ADE f?rce
ai)(j
background
Unions in
deal with mutual
powerful shaping public opinion are
a
lhat 'l ^Uencing government action so before considering their attitude t0 ?ntal health there is
some advanfew facts about their this country. At the Tran '~frL^on of 1962, one Congress ^Und w** and eighty two trade unions shir. rfPresented with a total memberarp ? 8,312,875. Not all trade unions 'ated to TUC but the total unio in the country is mernbership abou million out of a total working Poni i lation of 23 million. It often ?s a surPrise to people to learn of t ?n^ 40% of workers are members
re.caUing orta ^Sati?n in
a
c0? that68
trade unions. craft unions, industrial ma^ unio general unions or white collar
^ and they vary tha ^ach members to
in size from less over one million, *s autonomous, proud of the job ^oes anc* zealous in protecting and iHg Promoting the interests of its ^ conducts its affairs throti an elected executive council Wh0 Pr'nciPal officer is the General and operates through a series of each in the charge of a a Pa 71 secretary who is in most cases deDp v^me officer. At shop floor level, on e nature of the i^dust there are often several unio eac^ one (?r *n some cases a er ?f unions jointly) represented by tw shop steward who deals with Pay ?ement in the matter of rates of inter ,r yarious jobs, overtime and arrangements. Local bran ^ sworking ?f various unions form Pouncils, which represent the a interests of trade unions in the area Regional Advisory ComHiitte consisting of full-time union ass*st *n dealing with regional
-t?ne
^S'
Sec/? betary branrLnc^es>
Tra(j
general
?mcees-
Prob^ nuitib er
to the Trades Union
certain groups of industries and there is the Trades Union Congress administered by a General Council of 35 members chosen from among the affiliated unions. The function of the TUC is to indicate the general lines of trade union policy, to represent the interests of trade unions at the national level, to appoint representatives to serve on government committees, boards, commissions and councils and, by invitation of the unions con-
industries
cerned,
or
arbitrate
to
on
inter-union
disputes.
Thus, besides maintaining a close with the welfare of individual members, trade unions now share in the formulation and working out of national policy on a variety of issues. concern
They
are therefore deeply concerned with the question of mental health and have been following the development of this growing problem in the national interest as well as in the interests of their members. Representing as they do a cross section of the community one finds all shades of opinion and prejudice among individuals, but from the policy point of view, the trade unions form a consumers' association interested in obtaining the best possible service for their members.
Difficulties There
regarding
mental health
many difficulties in the attitude of workers towards mental ill health, chiefly because it is not yet generally recognised as an affliction. If a person is injured or suffers from an are
appendicitis
or
even
a
common
cold,
there is understanding and sympathy on the part of his workmates. But mental disturbance is often of gradual onset and the individual is judged in terms of his behaviour?bad tempered,
surly, difficult, moody, cussed?and, as people have their off-days, these characteristics are treated according to the position and influence of the
most
nati?nal level there are a of Federations of Unions who
Congress problems in
^
to say that "X" should not work a conveyor belt or that "Y" not be employed as a bus conduct^'
sufferer in the works hierarchy?with respect or fear or even ribaldry. Towards the severely disturbed person who may still be working there lurks in most people an irrational fear and this may show itself in unwillingness to work with him or in frank cruelty towards him.
sho1^
or post office cle>\| if the techniques were ava' able, are we in a position to use the extensively in industry? Who have the responsibility for case find'11* ?the employer or the community? ., The National Health Service, vVl all its advantages to the community a whole, is not designed to prom0 and maintain the health of workers to control the conditions giving 11 to CircU^ occupational disease. stances likely to give rise to me"' disturbances?the menopause, fan1'; bereavement, divorce, lack of pro111, tion, maladjustment? can be recog11. ; sed by the wise practitioner and the effects mitigated by appropr'L counsel but all too often the fa111'' practitioner has no knowledge of work situation. The function of Ministry of Labour through 11 Factory Inspectorate is to contf e mainly the physical and chemical (( ?vironment at work. No medical en? is deployed specifically towards control of mental stresses. And i* j can be shown that certain kinds work are liable to give rise to upset is it not the work which sho11 be changed rather than the worker? j Obviously, more research is into the relationship of work .aI\' mental disorder. Some investigation have been done, notably by the P? Office, to assess the extent of problem. But this work needs to expanded and repeated in a variety industries to determine whether it a the nature of a particular job or 0 i deeper malaise associated with modern way of life which is resp0l\ I sible for the enormous wastage t time and personnel on account mental conditions. The total numb , of days lost on account of mem ill health is of the order of 30 mill'0 ' . per annum, more than 10% of total number of working days 1? j-1 from all causes. The Ministry Pensions and National Insurance is
linotype operator And
even
sho^
mental health in industry There are three aspects of mental health in industry of particular interest to the trade unions? 1. the effect of industry on producing mental disorder; of the mentally 2. the impact disturbed individual on the work situation, and 3. the rehabilitation of the mentally disordered. 1. The effects of industry on producing mental disorder. The part played by industry in producing mental disorder is difficult to In the case of assess with accuracy. well recognised occupational diseases, such as lead poisoning or silicosis, the individual is exposed only while he is at work and the cause and effect relationship is easy to establish. Away from work he is recovering. It is not so with mental stress. While he is away from work the sufferer may go on thinking and worrying about his problem and there are often similar stresses in the community or home environment. The question of individual susceptibility looms even larger in the case of mental disease than it does, for example, in the case of industrial dermatitis. There is no doubt, however, that such tasks as conveyor belt work where a high speed is demanded, the loneliness of handling the control panel of a power station or oil refinery, alternating shift work and work demanding great concentration, especially where there are undesirable physical and environmental factors such as poor lighting or noise, are likely to precipitate mental disorder in susceptible individuals. But are who these susceptible individuals and is there any way to prevent them from being exposed? Are our techniques of recognising incipient disorders sufficiently refined
Aspects of
^
^
^ rnefl'j,
ne^
'JL ^
present engaged
an
survey to be 1964 and this may give
morbidity
'
j
on
occupatio^'
published an
indicat'0
92
J
mental upset is at^H^e-r With industries ed
some
^
{mpact
associthan others.
more
of the mentally disturbed
'"dividual
on
the work situation.
t a man breaks a leg or gets pneunia he stays at home, but he can
,
or
co
severely
ion and still
th
ill from
go on
havC a circumstances mai"ked effect
a
mental
working. In
illness may his efficiency jn,' depending on his position in the the effect may extend out^0r a considerable distance to infl the efficiency of his working UP- The advice of a trained dispasSj observer would do much to such situations arising, but to achieved? Can we the presence an of such erver in every work situation, and, distu ?ot> how are the effects of the individual to be recognised? Th e l victim himself does not always is ii' ant* ls unhkely to advice. Even if his illness is re he is often unwilling to t ^ is opiy m relativeiy rare cas an industrial physician is yecl who has the knowledge and to ^eai effectively w'th such
and
his on
^stry,
gr^Uence prna^e
hn^F11 f}S
ob?
?
SeelfW
acj??nised
aUt?
cases?rity '
Rehabilitation
of the mentally ill. is nature's best physiis essential for human happines The trade unions recognise the 0rn of Galen's words and fully Su the efforts being made to ret'ie mentally ill. There are, ho\v problems in introducing i^e ^ disabled persons into a work situ in normal industry. In the jjj Place, it is obviously undesirable un s'tuation where there is extensive more than to do di p'?y a token number of mentally Persons at the expense of fit rnen ?ut of a job. Secondly, the me % disabled should not be empl0 at a lower rate of pay as there Wiii suspicion that they are being evnl Thirdly, although the -0^ ?pinion towards mental ill is changing, there is still a stiam ,a attached to mental disease does not attach to the amputee or chronic bronchitic; the accept
Payment
cian
?
L]y,?rt
nfv,er' ?
fjrstatl?n
e^^Ployment
.
clj^0lted^ealn!e jT1
tance as a workmate of a mental defective or schizophrenic involves a greater share of loving-kindness than many people have. A great deal still has to be done to educate employers and trade unions to understand the needs of the mentally disabled as members of the community but experience has already shown that if the approach is made intelligently with full consultation of the unions, the integration of mental patients into normal work situations can be conspicuously successful. Thus the trade unions believe that the employment of the mentally disabled in open industry must only be undertaken in the interests of the patients themselves and not on a commercial basis, that there should be arrangements to ensure proper conditions and safeguards through the Ministry of Labour and that there must be full consultation with the workpeopleconcerned and their unions.
Conclusions As the expectation of life increases
and the stresses of modern life and more and more people are likely to suffer from mental disorder. It is obviously essential that the susceptible individuals should be recognised early and guided into appropriate employment, that stress situations in industry should be anticipated in order to mitigate their effects and that mental casualties should be adequately treated and returned as far as possible to work in normal industry in their own interests and those of the community at large. This involves the of medical students to education enable them to understand better the mental health problems of industry, the training of more psychiatric social workers to help in the assessment and control of the problem and the education of employers and workers to understand and accept the situation as it presents itself in modern industry. As our knowledge improves so it should be disseminated and applied in order that ultimately we may be able to tackle this problem as effectively as we have the conventional occupational diseases.
industry grow greater,
