main topic Wien Med Wochenschr DOI 10.1007/s10354-013-0253-x
Good practice models for public workplace health promotion projects in Austria: promoting mental health Nathalie T. Burkert · Johanna Muckenhuber · Franziska Großschädl · Martin Sprenger · Gerlinde Rohrauer-Näf · Klaus Ropin · Evelyn Martinel · Thomas Dorner
Received: 18 September 2013 / Accepted: 10 November 2013 © Springer-Verlag Wien 2013
Summary Promoting mental health is a central public health issue since the Jakarta statement in 1997. In Austria, the nationwide organisation for health promotion is the ‘Fonds Gesundes Österreich’ (FGÖ), which has been established in 1998. The FGÖ funds and supports workplace health promotion projects; therefore, it cooperates with the Austrian Network on Workplace Health Promotion. In 2011, among others, two Austrian companies were honoured as best practice models for promoting mental health in the project ‘Work. In tune with life. Move Europe’. One of their central key success factors are the provision of equal opportunities, engagement, their focus on overall health as well as the implementation of behavioural and environmental preventive measures. Since mental health problems in the population are still rising, public health promotion projects which orientate on the best practice models have to be established in Austria. Keywords Public health · Health promoting projects · Mental health · Austria
Univ.-Ass. Mag. N. T. Burkert, MSc () · MMag. Dr. J. Muckenhuber · Dr. F. Großschädl, MSc, BSc · Dr. M. Sprenger Institute of Social Medicine and Epidemiology, Medical University Graz, Universitaetsplatz 6/I, 8010 Graz, Austria e-mail: [email protected] Mag. Dr. G. Rohrauer-Näf, MPH · Mag. Dr. K. Ropin Fonds Gesundes Österreich, Vienna, Austria Mag. Dr. E. Martinel Salzburger Gebietskrankenkasse SGKK, Salzburg, Austria Ass.-Prof. Doz. Dr. T. Dorner Center of Public Health, Institute of Social Medicine, Medical University Vienna, Vienna, Austria
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Modelle guter Praxis für betriebliche Gesundheitsförderungsprojekte in Österreich – Förderung der psychischen Gesundheit Zusammenfassung Die Förderung der psychischen Gesundheit ist ein zentrales Public Health Thema seit der Jakarta Deklaration 1997. Der 1998 gegründete „Fonds Gesundes Österreich“ ist in Österreich für die Förderung von entsprechenden Projekten zuständig, in Zusammenarbeit mit dem Österreichischen Netzwerk für Betriebliche Gesundheitsförderung. 2011 wurden neben andere Unternehmen zwei österreichische Firmen als beste Praxismodelle für die Förderung der psychischen Gesundheit im Projekt „Work. In tune with life. Move Europe“ ausgezeichnet. Deren zentrale Erfolgsfaktoren sind, dass diese Chancengleichheit bieten und sich durch Engagement, Fokussierung auf umfassende Gesundheit sowie die Umsetzung von verhaltens- wie auch verhältnispräventiven Maßnahmen auszeichnen. Da psychische Krankheiten nach wie vor zunehmen, ist die Umsetzung von entsprechenden Gesundheitsförderungsprojekten, die sich an den Modellprojekten orientieren, in Österreich dringend erforderlich. Schlüsselwörter Public health · Gesundheitsförderungsprojekte · Psychische Gesundheit · Österreich
Introduction Health includes overall aspects according to the definition of health by the World Health Organization (WHO), especially biological, psychological and social aspects. Thus, in health promotion, addressing mental health is a pre-requisite for its success. Since mental health problems are increasing in numbers, they are responsible for a significant detraction of quality of life, death or loss of productivity (presenteeism, sick leaves and early retire-
Good practice models for public workplace health promotion projects in Austria: promoting mental health
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main topic
ment due to disabilities) and a significant amount of health care costs, they represent a major health burden, both for individuals and for the society. Therefore, promotion of mental health is one of the biggest challenges in public health. Health promotion programs in general and regarding mental health should orientate on scientific evidence and on evaluated successful existing programs (good practice models) to facilitate an appropriate distribution of public money spent on the health of a population. In this article, promotion of mental health in the frame of health promotion in general is discussed, Austrian health promotion activities are outlined and good practice models are presented.
Health promotion The term ‘health promotion’ first occurred at the first International Conference on Health Promotion in 1986, initiated by the WHO, which yielded the Ottawa-Charta. Health promotion is defined as ‘the process of enabling people to increase control over and to improve their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions’ [1, 2]. To reach an overall physical, mental and social well-being, it is essential that the needs of individual persons as well as groups are pleased, that they perceive and try to realise their wishes and hopes, and that they are able to manage and modify environmental factors. Therefore, health is an essential feature of everyday life, and health promotion should focus not only on promoting health, but also on broad well-being [3, 4]. According to the WHO [4] the basics for health include (1) peace, (2) shelter, (3) education, (4) food, (5) income, (6) a stable eco-system, (7) sustainable resources, (8) social justice and (9) equity. Health promotion action in this context means building a healthy public policy, creating a supportive environment, strengthen community actions and support personal development [4]. Deficits in these conditions should be improved and equity in health should be achieved [5]. Therefore, health promotion strategies need to be modified according to the present conditions, taking social, cultural and economic factors into account [5]. The definition of health promotion was sharpened more by the WHO in 1997 at the fourth International Conference on Health Promotion in the context of the Jakarta statement. Health promotion was then defined as an element of health development and seen as a process that enables subjects to increase their control over their health as well as be able to improve it. It should reduce inequalities in health, promote human rights and build social capital. It was stated that the main goal of health promotion should be the prolongation of overall life expectancy and minimization of the gap in health between different groups. Moreover, it has been recognized that mental health problems have become a greater issue which needs an urgent response [4].
Studies have proved the effectiveness of health promotion by leading to lifestyle changes and also alterations in social, economic and environmental conditions, all of which have an influence on health [4]. Working conditions and a healthy workplace are essential requirements for physical, mental as well as social health of individuals [6]. The changes during the twentieth century had an impact on the working conditions and led to the development of new employment patterns such as part-time, temporary or tele-work. Besides, unemployment rates have risen [6]. Therefore, public health programs have to take into account the physical, mental, social, organisational and economic factors in the new work as well as private settings of their employees [6]. As part of the Jakarta statement the WHO developed a healthy work approach which consists of four basic principles: (1) health promotion, (2) occupational health and safety, (3) human resource management and (4) sustainable development [6].
Promotion of mental health Health promotion can be understood as ‘actions and advocacy to address the full range of potentially modifiable determinants of health, including actions that allow people to adopt and maintain healthy lives and those that create living conditions and environments that support health’. Mental health promotion ‘is an integral part of health promotion theory and practice. The interventions can be applied at population, sub-population and individual levels, and across settings and sectors within and beyond the health field’ [7]. Prevention of mental disorders includes ‘strategies to promote the mental well-being of those who are at risk, those who are at increased risk and those who are suffering or recovering from mental health problems’ [8]. Therefore, promotion of mental health refers to prevention and treatment of mental health issues as well as support of those factors that promote the psychological well-being [9]. Mental health is of special importance concerning individual, social as well as economic capital of a country. It can be defined as ‘a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’ [10]. The psychological state of individuals is determined by social, psychological and biological factors, as well as their interactions [11]. Moreover, interconnections between mental health and employment do exist [12] and occupational stress is one of the biggest problems leading to mental health problems in the European Union [13]. Suffering from mental health problems not only influences the output of work and sick leave rates, but also affects the relationships in a company and overall climate at work [13]. In the meantime, absenteeism rates and early retirements due to mental disorders have risen all over Europe, in both men and women [12], e.g. since 1990 sickness absence due to work stress has
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more than doubled [13]. Moreover, the rate of people suffering from mental problems is meanwhile in some countries even higher than those of subjects suffering from musculoskeletal problems [12]. According to estimations, 38.2 % of the EU population suffer from a mental disorder [14]. In 2011, the social insurance company in Austria proved evidence that 840,000 people in Austria got a prescription of psychotropic medications, and in the meantime more than 35 % of all new early retirements are due to mental health issues [15, 16]. This led national governments to encourage employers to heed their responsibilities for promoting mental health in the occupational context and reduce work stress [17].
Health promotion in Austria In 1988, 1 year after the Ottawa-Charta, the ‘Forum Gesundes Österreich’ was founded as a nationwide organisation for health promotion [3]. Since 1988, numerous networks for health promotion have been established, such as ‘healthy towns or communities’, ‘healthy schools’, ‘workplace health promotion’ or ‘health promoting hospitals’ [18]. In 1998 the Austrian Health Promotion Act was passed by the National Council of Austria and the ‘Austrian Health Promotion Foundation (Fonds Gesundes Österreich, FGÖ)’ was established to realise the targets of the act. The health promotion act regulates the realisation of health promotion projects in Austria and comprises measures to obtain, to promote and to improve the health of the Austrian population, to provide information about how to prevent diseases and to advise people about social influences on health. An annual total amount of 7.25 million € exists for respective projects. Since 2006, the Austrian Health Promotion Foundation is part of the Public Health Institute Austria (Gesundheit Österreich GmbH). The FGÖ is responsible for capacity building and for the funding of health promotion projects in Austria [19]. In particular, the Fonds has six fields of action: (1) health promotion in kindergarden/shools, (2) workplace health promotion, (3) health promotion in communities, (4) health promotion in social service organisations, (5) healthy nutrition and physical activity and (6) mental health [20]. It is one of the prerequisites for health promotion programs supported by the FGÖ, that the project is orientated on international scientific standards and on good practice models. In 1996, a contact point of the European Network was established in Austria by the Health Insurance Organization of Upper Austria. In 2000, the Austrian Network of Workplace Health Promotion was founded, which has regional centres and service centres in all Austrian regions. The Network offers a quality system for workplace health promotion (‘Österreichisches Netzwerk Betriebliche Gesundheitsförderung’, ÖNBGF) [21]. In 2012, ten health targets for Austria were passed by the council of ministers. Two of these include creating healthy working and living conditions and fostering mental health promotion [22, 23].
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Health promotion programs focussing on mental health: good practice examples The European Network for Health Promotion (ENWHP) worked out quality criteria for workplace health promotion for different types of companies in the Luxembourg declaration in 2007. Since then, 150 companies from 22 countries were honoured as ‘models of good practice’ for workplace health promotion projects by the ENWHP. In Austria, six large companies, three small- and mediumsized ones and two institutions in the public administration sector were labelled as models of good practice [13]. Moreover, companies can apply for seals of quality, which are time-limited for a duration of 3 years at the Austrian Network of Workplace Health Promotion (ÖNBGF) [21].
The project ‘Work. In tune with life. Move Europe’ A European campaign existed, which especially aims to promote/improve mental health and prevent mental disorders. The project called ‘Work. In tune with life. Move Europe’ was developed in Germany in 2009 and was conducted by the ENWHP, in Austria by the Austrian Network for Workplace Health Promotion (Österreichisches Netzwerk Betriebliche Gesundheitsförderung, ÖNBGF; www.netzwerk-bgf.at) [21]. The project had three main goals: 1. making mental health in the occupational context a broad issue, 2. to increase public attention and 3. collecting practical models of good practice. The campaign which took place between 2009 and 2010, was the eighth ENWHP-Initiative [13]. In a first step, companies filled out an online ‘mental health check’. Those who fulfilled the defined quality criteria were allowed to take part in the project and the organisations which were identified as being successful in promoting mental health were interviewed using a best practice questionnaire. Their concepts of promoting mental health were then evaluated to identify models of good practice. Overall, about 50 models of good practice were identified in the project ‘Work. In tune with life. Move Europe’ and evaluated. Of these, 20 were certified as best models [13]. Based on their results, documents were compiled to offer other companies materials of how to implement measures to promote mental health in the occupational context. Two of those 20 companies from Austria were labelled as Europe-wide good practice models: Deakon Degen GmbH from the administrative and support service sector and fairwurzelt, a regional work initiative for women, which is a non-profit organisation [13]. Those are described in detail in the following paragraphs.
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main topic Model of good practice 1: Deakon Degen GmbH Deakon Degen GMbH is a Styrian company which manufactures wires for over 20 years now, and has 19 employees. It was selected as a model of good practice because the manager of the organisation shows a lot of personal engagement, and high ratings of work satisfaction and appreciation were registered from all employees. The company stands out due to their woman- and family-friendly working conditions, which provide equal opportunities for all employees. The aim of Deakon Degen’s health promotion activities is to establish a safe and healthy environment concerning all aspects of health (mental, physical as well as social) for all employees. Moreover, the company aims to prevent illnesses and strengthen the health potential of their employees. Deakon Degen GMbH also tries to extend their health promoting actions. The mental health promotion activities carried out in this business in the past are: ●● promotion of mental health, ●● prevention of mental health problems, ●● dealing with (workers with) mental health problems at work and ●● (re-)integration of workers with mental health problems. The measures and activities of health promotion in this business have been carried out for many years and concern working conditions, management and production planning, trainings as well as promotion of individual health of the employees. The promotion activities concerning the strategic and operative realisation are planned by a three-person board. Besides, the board involves all concerned employees with the decision process regarding the realisation of a specific strategy (e.g. select appropriate measures, and plan and implement them). Examples of measures and activities to improve mental as well as physical health are the implementation of flexible working hours, use of ergonomically optical equipment, job rotation, constant training at no cost and providing offers concerning physical activities, massage and nutrition. Evaluation of all measures has been carried out two times. Moreover, Deakon Degen GMbH is networking with other companies and participates in training seminars concerning workplace health promotion regularly to keep up-to-date. The main success factors of the business are that the company benefits overall health, involves all employees and appreciates openness, appreciation, approval and transparency. Additionally, the company has already won many awards for their activities in health policy [24].
Model of good practice 2: fairwurzelt Fairwurzelt, established in 1996, is a company in Upper Austria which offers jobs for a maximum duration of 1 year to
women facing long-term unemployment. In that year they try to prepare their employees for work in the labour market. Thirty-two employees were recruited by the company in 2010. Fairwurzelt is a model of good practice because the non-profit company has set up good health promoting structures, considers different target groups (key and transit workers), has a focus on people who suffer from mental disorders, and implements behavioural as well as environmental preventive measures. One of the central goals of the company is to offer women a barrier-free access at all levels and provide psychosocial care in respective institutions. The company has a special focus on the strengthening of self-confidence of their employees. Besides, one of their challenges is that they have to deal with constantly changing employees (transit workers). Health policy is conveyed to personnel in person. Additionally, appointments, reflection meetings and workshops are realised at regular intervals. Fairwurzelt’s main health promoting activities concern: ●● ●● ●● ●● ●●
guidance; communication, feedback, supervision; time-, stress-, and conflict management; self-worth and health behaviour.
The project team of health-promoting activities includes members of the management, personnel development, social work as well as outplacement. Examples for activities of the company to improve mental health include: conductance of regular supervision during working hours, giving individual advice, promoting a confidential atmosphere and social support at work, measures to prevent bullying and gardening. Fairwurzelt has set a fixed budget for their health promotion activities. To ensure good quality, the company also evaluates their activities periodically [25].
Conclusions Public health promotion activities are conducted worldwide since the establishment of the Ottawa-Charta in 1986. Still, this field of action is very young, especially concerning the promotion and prevention of mental health. The fact that mental health problems have increased during recent years and that they lead to high numbers of early retirement, exemplifies the necessity to promote mental health. In Austria, two companies were honoured as best practice models for mental health promotion. Their key success factors include the focus on overall health, openness and transparency, involvement of all employees, personal engagement and strengthening of self-confidence. Besides, existing mental health problems are also addressed and appropriate therapies are offered. As a result, the employees in these companies are highly satisfied with their jobs. Therefore, public health promotion projects which also consider men-
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tal health issues and orientate on the quality criteria evolved, while gathering experience during health promotion projects (BGF-Projekten) over the years. Furthermore, the ENWHP offers good practice criteria, and guidelines for employers and employees, which give practical support on mental health promotion at the workplace [26, 27]. Conflict of interest The authors declare that there are no actual or potential conflicts of interest in relation to this article.
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14. Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, Olesen J, Allgulander C, Alonso H, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, van Os J, Preisig M, Salvador-Carulla L, Simon R, Steinhausen HC. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21:655–79. 15. Österreichische Sozialversicherung. Strategie Psychische Gesundheit. Krankheit verhindern, Versorgung verbessern, Invalidität verringern. 2011. http://www.hauptverband. at/mediaDB/948929_StratPsychGes_2012.pdf. Accessed: 5 Aug 2013. 16. Wallner E. Psychische Erkrankungen in Österreich: Neue Volkskrankheit oder angebotsinduzierte Nachfrage? Soz Sicherh. 2012;4:181–91. 17. Fonds Gesundes Österreich. Wie kann mentale Gesundheit verbessert werden. 2013. http://www.fgoe.org/ gesundheitsfoerderung/infos/wie-kann-mentalegesundheit-verbessert-werden. Accessed: 5 Aug 2013. 18. Gesundes Österreich. Magazin für Gesundheitsförderung und Prävention. September, 2006. 19. Rohrauer G., Waldherr K. Leitbegriffe der Gesundheitsförderung Glossar zu Konzepten, Strategien und Methoden in der Gesundheitsförderung. In: Bundeszentrale für gesundheitliche Aufklärung, editor. Gesundheitsförderung: Die Entwicklung in Österreich ab Ende der 1980er Jahre. Köln: BZGA; 2010. http://www.bzga.de/leitbegriffe/?uid=7f3c 067fc037f93eae49888a60aa56ab&id=angebote&idx=152. Accessed: 5 Aug 2013. 20. Bundesministerium für Gesundheit. Gesundheit und Gesundheitsförderung. 2013. http://bmg.gv.at/home/Schwerpunkte/Praevention/Gesundheit_und_Gesundheitsfoerderung. Accessed: 5 Aug 2013. 21. Betriebliche Gesundheitsförderung. Work. In tune with life. Move Europe. 2013. http://www.netzwerk-bgf.at. Accessed: 5 Aug 2013. 22. Bundesministerium für Gesundheit. Rahmen-Gesundheitsziele. Richtungsweisende Vorschläge für ein gesünderes Österreich. Langfassung. 2012. http://www.gesundheitszieleoesterreich.at/fileadmin/user_upload/pdf/Rahmengesundheitsziele_langfassung_gesamt.pdf. Accessed: 1 Aug 2013. 23. Fonds Gesundes Österreich. Arbeitsprogramm 2013. 2013. http://www.fgoe.org/der-fonds/infos/arbeitsprogramm2013-des-fonds-gesundes-osterreich. Accessed: 5 Aug 2013. 24. Deakon Degen GmbH. 2011. http://www.enwhp.org/fileadmin/downloads/8th_Initiative/Models_of_good_Practice/Austria_DEAKON.pdf. Accessed: 5 Aug 2013. 25. Fairwurzelt. 2011. http://www.enwhp.org/fileadmin/ downloads/8th_Initiative/Models_of_good_Practice/Austria_fairwurzelt.pdf. Accessed: 5 Aug 2013. 26. ENWHP. Work. In tune with life. Move Europe. Ein Leitfaden für ArbeitnehmerInnen zur Förderung der psychischen Gesundheit in der Arbeitswelt. 2010. http:// portal.tugraz.at/portal/page/portal/Files/bgm/files/pdf/ AN_Leitfaden_psychGesundheit_Arbeitswelt.pdf; http:// www.netzwerk-bgf.at/portal27/portal/bgfportal/channel_content/cmsWindow?action=2&p_menuid=70161&p_ tabid=3. Accessed: 28 Aug 2013. 27. ENWHP. Work. In tune with life. Move Europe. Ein Leitfaden für ArbeitgeberInnen zur Förderung der psychischen Gesundheit am Arbeitsplatz. 2010. http://portal.tugraz. at/portal/page/portal/Files/bgm/files/pdf/AG_Leitfaden_psychGesundheit_Arbeitswelt.pdf; http://www. netzwerk-bgf.at/portal27/portal/bgfportal/channel_content/cmsWindow?action=2&p_menuid=70161&p_tabid=3. Accessed: 28 Aug 2013.
Good practice models for public workplace health promotion projects in Austria: promoting mental health
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Good practice models for public workplace health promotion projects in Austria: promoting mental health Nathalie T. Burkert · Johanna Muckenhuber · Franziska Großschädl · Martin Sprenger · Gerlinde Rohrauer-Näf · Klaus Ropin · Evelyn Martinel · Thomas Dorner
Received: 18 September 2013 / Accepted: 10 November 2013 © Springer-Verlag Wien 2013
Summary Promoting mental health is a central public health issue since the Jakarta statement in 1997. In Austria, the nationwide organisation for health promotion is the ‘Fonds Gesundes Österreich’ (FGÖ), which has been established in 1998. The FGÖ funds and supports workplace health promotion projects; therefore, it cooperates with the Austrian Network on Workplace Health Promotion. In 2011, among others, two Austrian companies were honoured as best practice models for promoting mental health in the project ‘Work. In tune with life. Move Europe’. One of their central key success factors are the provision of equal opportunities, engagement, their focus on overall health as well as the implementation of behavioural and environmental preventive measures. Since mental health problems in the population are still rising, public health promotion projects which orientate on the best practice models have to be established in Austria. Keywords Public health · Health promoting projects · Mental health · Austria
Univ.-Ass. Mag. N. T. Burkert, MSc () · MMag. Dr. J. Muckenhuber · Dr. F. Großschädl, MSc, BSc · Dr. M. Sprenger Institute of Social Medicine and Epidemiology, Medical University Graz, Universitaetsplatz 6/I, 8010 Graz, Austria e-mail: [email protected] Mag. Dr. G. Rohrauer-Näf, MPH · Mag. Dr. K. Ropin Fonds Gesundes Österreich, Vienna, Austria Mag. Dr. E. Martinel Salzburger Gebietskrankenkasse SGKK, Salzburg, Austria Ass.-Prof. Doz. Dr. T. Dorner Center of Public Health, Institute of Social Medicine, Medical University Vienna, Vienna, Austria
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Modelle guter Praxis für betriebliche Gesundheitsförderungsprojekte in Österreich – Förderung der psychischen Gesundheit Zusammenfassung Die Förderung der psychischen Gesundheit ist ein zentrales Public Health Thema seit der Jakarta Deklaration 1997. Der 1998 gegründete „Fonds Gesundes Österreich“ ist in Österreich für die Förderung von entsprechenden Projekten zuständig, in Zusammenarbeit mit dem Österreichischen Netzwerk für Betriebliche Gesundheitsförderung. 2011 wurden neben andere Unternehmen zwei österreichische Firmen als beste Praxismodelle für die Förderung der psychischen Gesundheit im Projekt „Work. In tune with life. Move Europe“ ausgezeichnet. Deren zentrale Erfolgsfaktoren sind, dass diese Chancengleichheit bieten und sich durch Engagement, Fokussierung auf umfassende Gesundheit sowie die Umsetzung von verhaltens- wie auch verhältnispräventiven Maßnahmen auszeichnen. Da psychische Krankheiten nach wie vor zunehmen, ist die Umsetzung von entsprechenden Gesundheitsförderungsprojekten, die sich an den Modellprojekten orientieren, in Österreich dringend erforderlich. Schlüsselwörter Public health · Gesundheitsförderungsprojekte · Psychische Gesundheit · Österreich
Introduction Health includes overall aspects according to the definition of health by the World Health Organization (WHO), especially biological, psychological and social aspects. Thus, in health promotion, addressing mental health is a pre-requisite for its success. Since mental health problems are increasing in numbers, they are responsible for a significant detraction of quality of life, death or loss of productivity (presenteeism, sick leaves and early retire-
Good practice models for public workplace health promotion projects in Austria: promoting mental health
1
main topic
ment due to disabilities) and a significant amount of health care costs, they represent a major health burden, both for individuals and for the society. Therefore, promotion of mental health is one of the biggest challenges in public health. Health promotion programs in general and regarding mental health should orientate on scientific evidence and on evaluated successful existing programs (good practice models) to facilitate an appropriate distribution of public money spent on the health of a population. In this article, promotion of mental health in the frame of health promotion in general is discussed, Austrian health promotion activities are outlined and good practice models are presented.
Health promotion The term ‘health promotion’ first occurred at the first International Conference on Health Promotion in 1986, initiated by the WHO, which yielded the Ottawa-Charta. Health promotion is defined as ‘the process of enabling people to increase control over and to improve their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions’ [1, 2]. To reach an overall physical, mental and social well-being, it is essential that the needs of individual persons as well as groups are pleased, that they perceive and try to realise their wishes and hopes, and that they are able to manage and modify environmental factors. Therefore, health is an essential feature of everyday life, and health promotion should focus not only on promoting health, but also on broad well-being [3, 4]. According to the WHO [4] the basics for health include (1) peace, (2) shelter, (3) education, (4) food, (5) income, (6) a stable eco-system, (7) sustainable resources, (8) social justice and (9) equity. Health promotion action in this context means building a healthy public policy, creating a supportive environment, strengthen community actions and support personal development [4]. Deficits in these conditions should be improved and equity in health should be achieved [5]. Therefore, health promotion strategies need to be modified according to the present conditions, taking social, cultural and economic factors into account [5]. The definition of health promotion was sharpened more by the WHO in 1997 at the fourth International Conference on Health Promotion in the context of the Jakarta statement. Health promotion was then defined as an element of health development and seen as a process that enables subjects to increase their control over their health as well as be able to improve it. It should reduce inequalities in health, promote human rights and build social capital. It was stated that the main goal of health promotion should be the prolongation of overall life expectancy and minimization of the gap in health between different groups. Moreover, it has been recognized that mental health problems have become a greater issue which needs an urgent response [4].
Studies have proved the effectiveness of health promotion by leading to lifestyle changes and also alterations in social, economic and environmental conditions, all of which have an influence on health [4]. Working conditions and a healthy workplace are essential requirements for physical, mental as well as social health of individuals [6]. The changes during the twentieth century had an impact on the working conditions and led to the development of new employment patterns such as part-time, temporary or tele-work. Besides, unemployment rates have risen [6]. Therefore, public health programs have to take into account the physical, mental, social, organisational and economic factors in the new work as well as private settings of their employees [6]. As part of the Jakarta statement the WHO developed a healthy work approach which consists of four basic principles: (1) health promotion, (2) occupational health and safety, (3) human resource management and (4) sustainable development [6].
Promotion of mental health Health promotion can be understood as ‘actions and advocacy to address the full range of potentially modifiable determinants of health, including actions that allow people to adopt and maintain healthy lives and those that create living conditions and environments that support health’. Mental health promotion ‘is an integral part of health promotion theory and practice. The interventions can be applied at population, sub-population and individual levels, and across settings and sectors within and beyond the health field’ [7]. Prevention of mental disorders includes ‘strategies to promote the mental well-being of those who are at risk, those who are at increased risk and those who are suffering or recovering from mental health problems’ [8]. Therefore, promotion of mental health refers to prevention and treatment of mental health issues as well as support of those factors that promote the psychological well-being [9]. Mental health is of special importance concerning individual, social as well as economic capital of a country. It can be defined as ‘a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’ [10]. The psychological state of individuals is determined by social, psychological and biological factors, as well as their interactions [11]. Moreover, interconnections between mental health and employment do exist [12] and occupational stress is one of the biggest problems leading to mental health problems in the European Union [13]. Suffering from mental health problems not only influences the output of work and sick leave rates, but also affects the relationships in a company and overall climate at work [13]. In the meantime, absenteeism rates and early retirements due to mental disorders have risen all over Europe, in both men and women [12], e.g. since 1990 sickness absence due to work stress has
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more than doubled [13]. Moreover, the rate of people suffering from mental problems is meanwhile in some countries even higher than those of subjects suffering from musculoskeletal problems [12]. According to estimations, 38.2 % of the EU population suffer from a mental disorder [14]. In 2011, the social insurance company in Austria proved evidence that 840,000 people in Austria got a prescription of psychotropic medications, and in the meantime more than 35 % of all new early retirements are due to mental health issues [15, 16]. This led national governments to encourage employers to heed their responsibilities for promoting mental health in the occupational context and reduce work stress [17].
Health promotion in Austria In 1988, 1 year after the Ottawa-Charta, the ‘Forum Gesundes Österreich’ was founded as a nationwide organisation for health promotion [3]. Since 1988, numerous networks for health promotion have been established, such as ‘healthy towns or communities’, ‘healthy schools’, ‘workplace health promotion’ or ‘health promoting hospitals’ [18]. In 1998 the Austrian Health Promotion Act was passed by the National Council of Austria and the ‘Austrian Health Promotion Foundation (Fonds Gesundes Österreich, FGÖ)’ was established to realise the targets of the act. The health promotion act regulates the realisation of health promotion projects in Austria and comprises measures to obtain, to promote and to improve the health of the Austrian population, to provide information about how to prevent diseases and to advise people about social influences on health. An annual total amount of 7.25 million € exists for respective projects. Since 2006, the Austrian Health Promotion Foundation is part of the Public Health Institute Austria (Gesundheit Österreich GmbH). The FGÖ is responsible for capacity building and for the funding of health promotion projects in Austria [19]. In particular, the Fonds has six fields of action: (1) health promotion in kindergarden/shools, (2) workplace health promotion, (3) health promotion in communities, (4) health promotion in social service organisations, (5) healthy nutrition and physical activity and (6) mental health [20]. It is one of the prerequisites for health promotion programs supported by the FGÖ, that the project is orientated on international scientific standards and on good practice models. In 1996, a contact point of the European Network was established in Austria by the Health Insurance Organization of Upper Austria. In 2000, the Austrian Network of Workplace Health Promotion was founded, which has regional centres and service centres in all Austrian regions. The Network offers a quality system for workplace health promotion (‘Österreichisches Netzwerk Betriebliche Gesundheitsförderung’, ÖNBGF) [21]. In 2012, ten health targets for Austria were passed by the council of ministers. Two of these include creating healthy working and living conditions and fostering mental health promotion [22, 23].
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Health promotion programs focussing on mental health: good practice examples The European Network for Health Promotion (ENWHP) worked out quality criteria for workplace health promotion for different types of companies in the Luxembourg declaration in 2007. Since then, 150 companies from 22 countries were honoured as ‘models of good practice’ for workplace health promotion projects by the ENWHP. In Austria, six large companies, three small- and mediumsized ones and two institutions in the public administration sector were labelled as models of good practice [13]. Moreover, companies can apply for seals of quality, which are time-limited for a duration of 3 years at the Austrian Network of Workplace Health Promotion (ÖNBGF) [21].
The project ‘Work. In tune with life. Move Europe’ A European campaign existed, which especially aims to promote/improve mental health and prevent mental disorders. The project called ‘Work. In tune with life. Move Europe’ was developed in Germany in 2009 and was conducted by the ENWHP, in Austria by the Austrian Network for Workplace Health Promotion (Österreichisches Netzwerk Betriebliche Gesundheitsförderung, ÖNBGF; www.netzwerk-bgf.at) [21]. The project had three main goals: 1. making mental health in the occupational context a broad issue, 2. to increase public attention and 3. collecting practical models of good practice. The campaign which took place between 2009 and 2010, was the eighth ENWHP-Initiative [13]. In a first step, companies filled out an online ‘mental health check’. Those who fulfilled the defined quality criteria were allowed to take part in the project and the organisations which were identified as being successful in promoting mental health were interviewed using a best practice questionnaire. Their concepts of promoting mental health were then evaluated to identify models of good practice. Overall, about 50 models of good practice were identified in the project ‘Work. In tune with life. Move Europe’ and evaluated. Of these, 20 were certified as best models [13]. Based on their results, documents were compiled to offer other companies materials of how to implement measures to promote mental health in the occupational context. Two of those 20 companies from Austria were labelled as Europe-wide good practice models: Deakon Degen GmbH from the administrative and support service sector and fairwurzelt, a regional work initiative for women, which is a non-profit organisation [13]. Those are described in detail in the following paragraphs.
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main topic Model of good practice 1: Deakon Degen GmbH Deakon Degen GMbH is a Styrian company which manufactures wires for over 20 years now, and has 19 employees. It was selected as a model of good practice because the manager of the organisation shows a lot of personal engagement, and high ratings of work satisfaction and appreciation were registered from all employees. The company stands out due to their woman- and family-friendly working conditions, which provide equal opportunities for all employees. The aim of Deakon Degen’s health promotion activities is to establish a safe and healthy environment concerning all aspects of health (mental, physical as well as social) for all employees. Moreover, the company aims to prevent illnesses and strengthen the health potential of their employees. Deakon Degen GMbH also tries to extend their health promoting actions. The mental health promotion activities carried out in this business in the past are: ●● promotion of mental health, ●● prevention of mental health problems, ●● dealing with (workers with) mental health problems at work and ●● (re-)integration of workers with mental health problems. The measures and activities of health promotion in this business have been carried out for many years and concern working conditions, management and production planning, trainings as well as promotion of individual health of the employees. The promotion activities concerning the strategic and operative realisation are planned by a three-person board. Besides, the board involves all concerned employees with the decision process regarding the realisation of a specific strategy (e.g. select appropriate measures, and plan and implement them). Examples of measures and activities to improve mental as well as physical health are the implementation of flexible working hours, use of ergonomically optical equipment, job rotation, constant training at no cost and providing offers concerning physical activities, massage and nutrition. Evaluation of all measures has been carried out two times. Moreover, Deakon Degen GMbH is networking with other companies and participates in training seminars concerning workplace health promotion regularly to keep up-to-date. The main success factors of the business are that the company benefits overall health, involves all employees and appreciates openness, appreciation, approval and transparency. Additionally, the company has already won many awards for their activities in health policy [24].
Model of good practice 2: fairwurzelt Fairwurzelt, established in 1996, is a company in Upper Austria which offers jobs for a maximum duration of 1 year to
women facing long-term unemployment. In that year they try to prepare their employees for work in the labour market. Thirty-two employees were recruited by the company in 2010. Fairwurzelt is a model of good practice because the non-profit company has set up good health promoting structures, considers different target groups (key and transit workers), has a focus on people who suffer from mental disorders, and implements behavioural as well as environmental preventive measures. One of the central goals of the company is to offer women a barrier-free access at all levels and provide psychosocial care in respective institutions. The company has a special focus on the strengthening of self-confidence of their employees. Besides, one of their challenges is that they have to deal with constantly changing employees (transit workers). Health policy is conveyed to personnel in person. Additionally, appointments, reflection meetings and workshops are realised at regular intervals. Fairwurzelt’s main health promoting activities concern: ●● ●● ●● ●● ●●
guidance; communication, feedback, supervision; time-, stress-, and conflict management; self-worth and health behaviour.
The project team of health-promoting activities includes members of the management, personnel development, social work as well as outplacement. Examples for activities of the company to improve mental health include: conductance of regular supervision during working hours, giving individual advice, promoting a confidential atmosphere and social support at work, measures to prevent bullying and gardening. Fairwurzelt has set a fixed budget for their health promotion activities. To ensure good quality, the company also evaluates their activities periodically [25].
Conclusions Public health promotion activities are conducted worldwide since the establishment of the Ottawa-Charta in 1986. Still, this field of action is very young, especially concerning the promotion and prevention of mental health. The fact that mental health problems have increased during recent years and that they lead to high numbers of early retirement, exemplifies the necessity to promote mental health. In Austria, two companies were honoured as best practice models for mental health promotion. Their key success factors include the focus on overall health, openness and transparency, involvement of all employees, personal engagement and strengthening of self-confidence. Besides, existing mental health problems are also addressed and appropriate therapies are offered. As a result, the employees in these companies are highly satisfied with their jobs. Therefore, public health promotion projects which also consider men-
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tal health issues and orientate on the quality criteria evolved, while gathering experience during health promotion projects (BGF-Projekten) over the years. Furthermore, the ENWHP offers good practice criteria, and guidelines for employers and employees, which give practical support on mental health promotion at the workplace [26, 27]. Conflict of interest The authors declare that there are no actual or potential conflicts of interest in relation to this article.
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