Healthy living Mental health in the workplace

Many employees are familiar with mental stress in the workplace and the problems it causes. They feel that their work causes them mental strain or exposes them to stress. Symptoms such as tiredness, fatigue and sleep disturbances have increased among working people over the past number of years.

This is also evident in the statistics that point to increasing absenteeism from work. According to the report on absenteeism in 2023 conducted by the WIdO (the research institute of the AOK health insurance fund), mental health conditions were not the most frequent reason given for being unable to work but they did result in a significant portion of total days absent from work due to illness. People with mental health conditions were, on average, unable to work for longer periods than those absent due to other illnesses. 

A large number of claims for the reduced earning capacity pension (“Erwerbsminderungrente”) were also made by people experiencing mental health conditions. In 2023, around 42 percent of claims for reduced earning capacity pension were as a result of mental health conditions. A reduced earning capacity pension can be claimed by people who are no longer able to work or whose capacity to work is limited due to an illness. However, certain additional eligibility criteria must be met – for example, the person must be younger than the statutory age of retirement. 

Promoting mental health in the workplace is a shared responsibility involving many stakeholders. Employers have a particular responsibility. Various resources are available to employers seeking information and support in this area. These include initiatives organized by the federal government, the federal states, as well as by accident insurance providers, health insurance funds and other health sector bodies.

A person’s work environment and working conditions can affect their mental health. It has been proven that workplace stressors, such as high demands and limited scope for decision-making, increase the risk of an employee developing a mental health condition. 

Individual factors play a role in addition to the external environment. Personal attitudes and patterns of behavior can exacerbate workplace stress. For example, some people have unreasonably high expectations of themselves and have difficulty setting boundaries or accepting help from others.

It is estimated that the most common mental health conditions in Germany are depression, anxiety disorders and addictions such as alcohol dependence or addictions to prescription drugs.

Burnout resulting from chronic stress is also relevant when considering mental health in the workplace. However, burnout is currently defined as a condition of physical and mental exhaustion rather than an illness.

Mental health conditions have a significant impact on employee productivity. Some people may become unfit for work before retirement age and thus qualify for the reduced earning capacity pension.

According to one German study by the Techniker Krankenkasse statutory health insurance fund, the number of days of absence from work due to a mental health condition rose to its highest level in 2023 since figures began to be recorded (in 2000). In fact, the number of days of absence more than doubled within this period.

While mental health conditions are not the most common reason for being unable to work, they do account for a large proportion of total sick days taken. This has an impact on the cost of sick pay, for example – especially for companies that are required to pay this for the first 6 weeks.

Long-term mental stress can make you ill. It is therefore important to recognize the early warning signs – both in yourself and in others. It is more likely that a mental health condition will be prevented from developing if action is taken at an early stage.

Possible warning signs may include:

• sleep disturbances and intrusive negative thoughts at night
• persistent fatigue even after resting
• concentration problems
• irritability or mood swings
• difficulty switching off after work
• social withdrawal
• increased alcohol consumption
• physical symptoms without an identifiable physical cause, for example, headaches or gastrointestinal problems

If you notice these changes in yourself, you should seek help without delay. Simply opening up to a colleague often helps. A solution may also be found by having a conversation with your supervisor or manager. Larger companies also offer initiatives that take account of mental health as part of workplace health management. Employees can also approach their staff or works council in confidence. In some cases, changing company may be a necessary last resort. 

If you notice any early warning signs in a colleague, it may be helpful to talk to them and let them know you are ready to listen.

You can also get mental health first aid and advice from Telefonseelsorge helpline service, which you can contact by phone, e-mail or online chat. 

You can use the doctor search from gesund.bund.de to find a psychotherapist in your local area.

If necessary, you can book an appointment with a psychotherapist by dialing 116 117 or using the electronic appointments service of the Associations of Statutory Health Insurance Physicians.

It’s not always easy to pinpoint the precise causes of stress and mental health conditions. After all, stress and mental health conditions arise out of a complex interaction between various factors. These include biological predisposition and early life experiences in addition to current stressors, such as conflict or problems in the workplace. 

An overview study by the Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin) indicates a clear link between working environment and the development of mental health conditions. At the same time, a well-designed workplace can boost job satisfaction and promote employee well-being and mental health. 

Alongside external factors, individual attitudes also play an important role – for example, how people deal with demands, setbacks or conflicts. 

Scientific research indicates that the following work-related factors in particular have an influence on mental health:

• scope for taking the initiative and decision-making
• workload
• working hours
• working on multiple tasks at the same time (multi-tasking)
• repetitive, monotonous tasks
• work environment
• camaraderie and team spirit
• company culture/atmosphere and leadership
• safety in the workplace
• work-life balance

These factors can have positive or negative effects on mental health. For example, a good working atmosphere has a positive effect. Meanwhile, a bad atmosphere at work or frequent conflict with colleagues or management all have a negative effect. 

However, personal attitudes and beliefs also affect mental health significantly. Some patterns of thinking and behavior also have the effect of amplifying stress internally. Typical examples include:

• having unreasonably high expectations of yourself (perfectionism)
• ignoring your own limitations
• wanting to do everything yourself without delegating tasks
• being unable to ask for or accept help from others
• the desire to please everyone, even if it means sacrificing your own needs

The protection of mental health in the workplace is enshrined in legislation. The core regulations are laid down in Section 4(1) of the German Occupational Health and Safety Act (ArbSchG). According to this legislation, work must be designed to eliminate risks to life and to physical and mental health or to minimize these risks as far as possible.

One of the aims of the Occupational Health and Safety Act is to prevent work-related health hazards. This involves considering both mental and physical health. Various factors have a role to play in this context, including technology, work organization, social relationships and the influence of the working environment.

The legislation requires employers to identify and document all potential sources of mental and physical harm in the workplace. This information must be recorded in a risk assessment. The risk assessment then serves as a basis for formulating safety measures.

If mental health hazards exist, employers are legally obliged to introduce and implement suitable measures to protect mental health.

Other German laws are also relevant to mental health. These include:

• the Occupational Safety Act (ASiG)
• the Workplaces Ordinance (ArbStättV)
• the Machinery Regulation
• the German Social Code (SGB V, VI, VII)

Good mental health provides a solid basis for people to remain productive, motivated and satisfied in their daily working lives. In addition to working conditions, individual strategies for coping with stress play an important role in this context. Both employers and employees are responsible for creating and strengthening a health working environment.

What are the responsibilities of the employer?

Employers are legally obliged to protect the health of their employees, including their mental health. This obligation gives rise to specific tasks in the areas of workplace integration management and occupational health and safety. Both areas are pillars of workplace health management (WHM). 

As part of occupational health and safety, every employer must identify any hazards to mental health in the workplace. This risk assessment is a legal requirement. Suitable measures must be formulated in response to any hazards identified. These may include, for example, adjustments to organizational frameworks.

If employees are off sick from work for more than six weeks in total, they are entitled to have the options available to them under the workplace integration management (WIM) program assessed. This program does not distinguish between employees who are unfit for work for six weeks at a time and those whose total absence comprises several shorter periods of being unfit to work. WIM measures can relieve stress for employees, in particular for those returning to work following a mental health condition or currently dealing with one. 

Many companies go above and beyond their legal obligations to support the health of their employees as part of a voluntary workplace health promotion (WHP) program. Measures to reduce mental stress as part of a WHP may be supported by statutory health insurance benefits and may include:

• Courses on stress management and relaxation techniques
• Measures to promote movement 
• Measures to prevent workplace bullying
• Training for managers

Managers have a particular responsibility, as they play an important role in shaping the working atmosphere. An employee-focused management style that shows appreciation can reduce stress and build trust. Key approaches include:

• Identifying challenges within the team 
• Working together to find solutions
• Communicating on an equal footing
• Modeling a healthy work-life balance
• Taking part in training and professional development courses and enabling others on the team to do the same

More information about ways in which managers can strengthen their own mental health as well as that of their employees is provided in the leaflet Kein Stress mit dem Stress – Eine Handlungshilfe für Führungskräfte (“Don’t stress about stress – tips for managers”) published by the “psyGA” project (in German).

The AOK statutory health insurance fund also offers a free online healthy management program (“Gesund führen”) (in German). It includes interactive modules, self-tests and other resources for positive management.

It is largely up to the individual employer to determine whether measures to protect mental health in the workplace. Health insurance funds also support companies in establishing and strengthening structures to promote health through the benefits they offer as part of workplace health promotion programs. However, employees can also play an active role by raising issues with management that are causing them stress. For example, they can express their desire for further training or for more flexible working hours. 

You will find more information about workplace health promotion in our article dedicated to this topic. 

What can employees do for themselves?

There are many ways to strengthen your own mental health on a daily basis. The following healthy habits may be helpful:

• Taking regular breaks
• Movement
• Healthy eating
• Using relaxation techniques
• Getting enough sleep 
• Maintaining social contacts

Even small steps, like taking a short walk on your lunch break, can help reduce stress. 

It's just as important to actively reduce stress in your daily work routine. For example, you can work on prioritizing tasks, accepting help and setting boundaries. You may be causing additional pressure by having unreasonably high expectations of yourself (perfectionism) or failing to set boundaries. It’s also important to strengthen your inner ability to bounce back from adversity, i.e. your resilience. 

For more information about resilience and how to strengthen it, see our article dedicated to this topic.

The “psyGA” project published a leaflet called Kein Stress mit dem Stress – Eine Handlungshilfe für Beschäftigte (“Don’t stress about stress – tips for employees”), which provides more information (in German) about ways in which employees can boost their mental health and cope with workplace stress.

The “psyGA” project also developed a complementary interactive e-learning tool for employees with practical exercises and tips for reflecting and improving on how you deal with stress (available in German and English).

Many independent online sources provide detailed information on mental health in the workplace.

The resources developed by the psyGA project are especially comprehensive. This project was run by the New Quality of Work Initiative (INQA) initiative, which was launched by the Federal Ministry of Labor and Social Affairs in 2002. The INQA steering group includes, for example, the federal government, the federal states and local administration associations, employers’ federations, trade unions, companies, the Federal Institute for Occupational Safety and Health, and various other experienced experts.

The BKK Dachverband e.V. (Umbrella Organization of Company Owned Health Insurance Funds) has published a brochure about mental health at work. It is entitled Psychisch krank im Job (“Mental health conditions at work”) and provides extensive information about mental health conditions in the workplace (in German). It includes practical tips for avoiding and managing mental health problems and lists important points of contact for those seeking professional support for mental health.

The Psyche work program, part of the Joint German Occupational Safety and Health Strategy, provides lots of information and tips for conducting a risk assessment of mental health hazards. 

You can find more useful information about this topic on the website of the Federal Ministry of Labor and Social Affairs under Occupational Safety and Health and on the website of the Federal Institute for Occupational Safety and Health.