Mental health policy and practice across Europe: an overview

Housing and employment 293
occupational health in practice). Initially developed in the United States in the
late 1970s and early 1980s, it has now developed its own specific character in
Europe (see the work of the European Network for Workplace Health Promotion,
www.enwhp.org). Unlike OSH legislation and practice, which emanated
from concerns over working conditions and their effects on health, WHP has its
origins in public health, where concerns about the major causes of mortality led
to the development of, initially, health education approaches in the 1970s, and
more recently to a more comprehensive health promotion approach. Within
the field of health promotion, the concept of settings, i.e. physical milieu, where
people spend significant parts of their lives and in which health and well-being
may either be influenced positively or negatively, is central to the approach.
One of these settings is the workplace.
WHP in Europe (unlike in the United States) emphasizes both the importance
of the individual and of the workplace in relation to the generation of health
and the creation of damage to health and well-being. It focuses its actions on
the attitudes, skills and behaviours of the individual workers, while at the same
time acting on the characteristics of the work environment (defined in its
broadest sense) that contribute to the generation of health. Thus, it is not
untypical to see WHP programmes that deal with issues as diverse as manual
handling techniques, machine design and teamworking. WHP is usually driven
by employee-defined health improvement needs, and in this context the issue
of occupational stress often comes to the fore.
Despite the efforts of occupational health services and WHP, which are essentially
focused on prevention and promotion, many workers succumb to illness
or accident, be it caused by workplace factors or otherwise. In this situation,
where workers have been absent from work for extended periods, many workplaces
have in place a set of policies that are designed to promote the reintegration
of the ill or injured worker. These policies, sometimes known as disability
management policies, are targeted towards the safe and early return to work of
the employee, either into the employee’s former job or certain types of modified
or alternative jobs. These policies are usually implemented by some combination
of the human resource management function and occupational health,
sometimes alongside training departments, since the effective return to work of
a worker who is absent long term depends not only on the health status of the
individual, but also on the process of reintegration, on the nature of the work to
be performed and on the residual skills and abilities of the worker. Although
disability management procedures can be relatively successful in returning
people to work, they are not yet widespread, they tend to be more successful
with workers who have physical illnesses or injuries and they are generally
confined (though not exclusively so) to members of the workforce who have
become ill or been injured.
A variation on this latter type of health intervention concerns the integration
of people with a disability into the workplace. Generally, though not
exclusively, these procedures are targeted at people who have a long-standing
disability, perhaps from birth, and they are often targeted at people who have
never worked in the open labour market. Workplaces themselves may adapt or
use their procedures for disability management when engaging an employee
with a disability who has never worked for them, but the challenge to the