How Will the Future of Work Affect Mental Health?

As we rebuild work after the COVID-19 pandemic, we have a choice: Will we fix work so it fuels our well-being, or will we let the conditions of work that damage our mental health grow unchecked?

This article was originally published on The Life I Want blog.

On a crisp, sunny winter afternoon outside the Long Street Café in Melbourne’s Richmond suburb, Dean Yates is showing me his tattoos.

Pulling up the sleeve of his T-shirt, he reveals an illustration of the looping green ribbon used to promote mental health. Inside one end of the ribbon are two place names, Iraq and Bali, signifying the time he spent as the Reuters bureau chief in Baghdad, where two of his Iraqi colleagues were killed in an attack by a U.S. Apache helicopter, and the time he spent in Bali covering the 2002 bombing that killed more than 200 people. The other ribbon says “Aceh,” where he covered the massive earthquake and tsunami that killed 166,000 people in 2004. Above the ribbon are the letters PTSD, for post-traumatic stress disorder, the diagnosis Yates got in March 2016. In the same place on his right arm, he wears an intricate tattoo commemorating his time at Ward 17, a psychological trauma recovery unit in Melbourne’s Heidelberg Repatriation Hospital, where he spent time in 2016, 2017, and 2018.

Yates has another “PTSD” inked across his left forearm, and his T-shirt also advertises his diagnosis. It’s not something he wants to hide; since leaving journalism, he has made a career for himself, at Reuters and beyond, advocating for the mental health of working people.

We all have mental health, and what happens at work is one of the primary determinants of our well-being.

Just before meeting with me, Yates had shared his story at a conference on spiritual care. His baritone voice filling the hall, he recounted how he had spent 20 years reporting overseas on natural disasters and war. How he had buried the trauma by focusing on the next big story. How all of it — the shame, guilt, anger — eventually caught up with him, in nightmares, in withdrawal from his family, and eventually in an idea to end his life. “I had always seen myself as the calm, detached, rational bureau chief,” he said. “But everyone has a breaking point. When mine found me, it nearly broke me and my family.”

Yates’ experience, while extreme, is not unusual: We all have mental health, and what happens at work is one of the primary determinants of our well-being, coalescing with a host of other factors, from our biology to our experience in the world. Most people think of mental health in terms of mental illness. But experts are reclaiming the term to raise awareness that mental health is something we need to tend to, just like physical health, and something we need to tend to collectively. One of the primary ways we can do that is through work.

According to a 2018 report by The Lancet Commission, every country is in a mental health crisis: Mental illness is the world’s leading cause of disability, and it is estimated to cost the global economy $16 trillion by 2030 — more than the estimated costs for both cardiovascular disease and cancer. In the United States, poor mental health has cost nearly $500 billion in care, lost earnings, and insurance, making mental health disorders among the most expensive medical conditions in the country.

For years, the mental health crisis has been a quiet epidemic — something people wore tattooed on their hearts, not on their arms. Compared to physical health, investments in mental health are pitifully low, and people are also much less likely to get treated for mental illness. But the advent of the coronavirus has made the mental health crisis much more acute. Not only is the pandemic stoking fears of illness, scores of people have seen loved ones die, have lost their jobs, and have watched their businesses close. Under the lockdown, billions of people have been confined to their homes, isolated from family and friends. Others are feeling anxiety as their communities reopen. Those who are lucky to have jobs are either going to workplaces where they risk getting exposed to the virus, or working from home, where they bear the stress of managing work, parenting, homeschool, and care for family all under one roof. Not surprisingly, nearly half of American adults in a recent poll said the virus has affected their mental health.

Like the coronavirus, poor mental health has a ripple effect, with massive cumulative impacts on our societies and economies. With the coronavirus making our future uncertain, the mental health crisis is likely to get worse. At the same time, work trends defining the future — from the precarity of the gig economy to the loneliness of remote work to the increasing demands of a competitive global economy — are placing a greater burden on our mental health. As we look to rebuild work after the pandemic, we have a choice: Will we fix work so it fuels our well-being, or will we let the conditions of work that damage our mental health grow unchecked?

What Work Has to Do with Mental Health

In 2015, Time magazine named Dr. Vikram Patel, the lead author of The Lancet Commission report and a professor at Harvard Medical School, one of the 100 most influential people in the world. Time called him “the well-being warrior.” Dr. Patel speaks with the clarity of someone who has spent decades translating complex science and development needs into one simple message: Everyone deserves mental health.

Good mental health and well-being are essential not only to us as individuals, but to our families, employers, communities, economies, and societies. As Dr. Patel put it: “Mental health is a personal asset that each of us has at every single moment of our life.”

Dr. Patel said work is incredibly important to our mental health because it’s so closely tied to our identity. “Work is central to us — our sense of well-being, our sense of efficacy, our sense of place in the world,” Dr. Patel explained. “It’s something that’s central to our person.”

But work is not working for our mental health. Working people across the economic spectrum are depressed, anxious, stressed, lonely, burned out, and fed up with toxic workplace culture, low pay, and shoddy benefits. One in five adults, 47.6 million Americans, experience mental illness, and conditions such as anxiety and depression are the second-most common reasons for workplace disability claims. This not only affects individuals and their families, it means businesses lose productivity and cash: Employers pay half of the costs of depression in the U.S.

It’s not just clinically diagnosable disorders like depression and anxiety; stress, burnout, and loneliness also take a toll. One study found that in any given month, three quarters of Americans experience stress, and work and money are the chief causes. Another study found that work-related stress in the U.S. costs upward of $187 billion, and another estimates that it’s responsible for 120,000 deaths every year.

“We now live in a world where work is not really work. It’s about profit-making for a few individuals, and the worker is essentially just a dispensable commodity.” — Dr. Vikram Patel

Burnout and loneliness are also concerns: In the United States, 67 percent of employees say they have experienced workplace burnout, which the World Health Organization now calls an “occupational phenomenon,” and 61 percent of Americans report feeling lonely, which experts believe is caused at least in part by workplace conditions and culture. More worryingly, America’s suicide rate increased by 31 percent between 2001 and 2017, and deaths of despair — preventable deaths from suicide, drugs, and alcohol — are now on the rise, with some economists laying the blame on capitalism.

Dr. Patel is concerned that corporate greed is getting in the way of humanity and values. “We now live in a world where work is not really work,” he said. “It’s about profit-making for a few individuals, and the worker is essentially just a dispensable commodity. So if the worker isn’t performing, you’ve just sacked them or you move to some other part of the world where workers have even less rights. I think this is a fundamental problem that actually underlies the lack of responsiveness of industry to the well-being of its workforce.”

Study after study outline the myriad ways work can diminish mental health, regardless of your job, pay, or field: Poor conditions, a risky setting, traumatic content. Too much work and too many hours, or not enough of either. No time for family and hobbies, or such unpredictable schedules that organizing things like childcare and doctor appointments is impossible. Low pay and insufficient benefits. Not enough recognition, or worse: a toxic workplace culture where people are bullied, harassed, or discriminated against. Low job security, isolation, a lack of agency. Your mental health may even suffer if your job is boring.

In the future of work, a lot of trends are poised to worsen mental health, from the precarity of the gig economy, to the loneliness of remote work, to the anxiety about job loss due to automation, to the increasing demands placed on workers as the global economy becomes more competitive. Already, some of these trends are playing out in certain jobs, and these fields provide a glimpse of what the future of work could look like when mental health is on the line.

International Aid: When Work is Remote, Risky, and Relentless

When Kabira Namit, an economist who consults on education and health for international aid organizations and governments, describes his job, it sounds harrowing: He travels eight or 10 months a year, and when I spoke to him, he had taken 57 flights in the last six months. “When people ask me where my home is, I say where I’m sleeping that night,” he said. He’s rarely at his apartment in D.C., and he has no time to indulge in his hobbies, reading, badminton, and squash. He gave me an example: “One night, I went to sleep at 1 o’clock, and I had to set the alarm for 3 o’clock to get up and start working again. That day, I worked for 22 hours.”

That was an extreme number of hours, even for him, but other aspects of his job are extreme, too: In Uganda, he was beaten up and robbed, and his passport was stolen. He described one scene like this: There’s a flashpoint, then a mob, then gunfire, then ducking. Once, on a flight over the Democratic Republic of the Congo, the plane’s engine failed, lost fuel, and the pilot had to glide the aircraft into an emergency landing. Namit works mainly in countries that have been scarred by violence, and he sees it up close: people in a refugee camp whose legs were blown off in a landmine, kids who lost their parents and have been raped, young girls who have been raped by a teacher and are now pregnant and infected with HIV. “You lose all faith in humanity; you lose faith in god, if you ever had any. It does shake you,” he said.

Namit, who is in his early 30s, is surprisingly equanimous. He knows his work is stressful and traumatic, and he knows he faces the possibility of burnout and anxiety. To cope, he has a strong support network, and he has used the World Bank’s therapists, who are available even to him, a contractor. He also has certain tricks: Whenever he goes to a country that he’s been to before, he stays in the same room in the same hotel, and he places some Polaroids he keeps in his wallet on the desk, so even when he’s staying in room 302 at the Kandawgyi Hill Resort in Myanmar, it feels a little like home. While he doesn’t have leisure time when he’s on a job, he plans big trips to remote places where no one can reach him so he can truly disconnect. Once he spent two weeks in Jordan sleeping in a tent under the stars. When we spoke, he was getting ready for his next vacation in Antarctica.

For many years, mental health in the field of aid and development was not openly discussed, according to Penelope Curling, a clinical psychologist who specializes in international humanitarian aid, stress, and trauma. Curling began her career working with refugees in Holland and South Africa, where she’s from. In 1999, she went to Albania at the height of the Kosovo War, and she began to notice the impact of the work itself on the aid workers. Since she had done some work with nurses suffering burnout, she asked the World Health Organization if anyone was helping the aid workers. “And they were like, oh, that’s an honorable idea,” Curling recalled when she spoke with me. After setting up a group to support the aid workers, she took on a similar project in Namibia, and was eventually recruited into UNICEF, where she was the only staff counselor in a group of 12,000 employees.

Since then, Curling said, international aid organizations have hired many more staff counselors, recognizing the need to provide therapy for aid workers during tough assignments. More recently, these organizations have pioneered preventative measures to reduce the impacts of trauma, long hours, loneliness, and work-life conflict that go hand-in-hand with aid work.

When Curling was working in the International Criminal Court in The Hague, for instance, she saw how court reporters, guards, and translators were affected by the horrific testimonies of war crimes, so she made it mandatory for everyone working in direct contact with the testimonies to check in with her every three months. “It’s such an insidious thing, vicarious trauma,” she said. “Whereas PTSD is something that happens after a major traumatic event, and there’s a turning point in your life, vicarious trauma slowly wears at you. People start closing themselves off emotionally or turning to substances or having nightmares, losing interest in work, burning out.”

Curling has seen aid agencies launch other preventative initiatives, including offering employees a choice about where they live when they are not on assignment, and making sure that hardship duty stations are built with places to exercise and socialize to give people healthy outlets to manage their stress. At the UN, Curling helped set up a peer-support network in which managers would nominate the natural helpers in their office, who would be trained in empathy and listening skills to provide support to local staff. The peer helpers also serve as an early-warning system to flag workplace issues that might be affecting employee mental health. “When I left UNICEF, the people who wrote to me the most touching thank-you letters were the peer helpers,” she said. “They wrote thanking me for training that they felt had changed their lives.”

In 2003 and 2009, Curling conducted surveys of aid workers and learned that the biggest challenge people experienced was not isolation, risk, or trauma but the long hours and workload — common issues that affect working people in many professions. “I was doing 60 hours standard and traveling over weekends and working over weekends, and it was just, ‘That’s your job. Just do it,’” she said.

“When you’re in this mode of hyper-growth, which so many tech firms are, this culture of overwork really develops, where work is privileged over the well-being of individual employees, and everybody at all levels of the organization feel an absence of agency about how to change that.” — Lynne Cripe, CEO, KonTerra Group

Lynne Cripe, CEO of KonTerra Group, which helps organizations operating in high-stress environments with mental health and resilience, said overwhelming workload is also a common problem among her clients. KonTerra’s main clients are organizations in the humanitarian and international development sector, but in recent years, KonTerra has taken on projects with technology companies. “Overwork is a function of modern life and a commonality among our humanitarian and development clients and technology firms,” Cripe said. “When you’re in this mode of hypergrowth, which so many tech firms are, this culture of overwork really develops, where work is privileged over the well-being of individual employees, and everybody at all levels of the organization feel an absence of agency about how to change that.”

Cripe, a social psychologist, is particularly interested in how organizations can change to reduce these pressures. “If, as a company, KonTerra only focused on individual support and helping people be more resilient and cope with the organizational stressors, our work would be incomplete,” she said.

One project Cripe is most proud of is eight years of work with USAID, which began with establishing the staff care program to support individuals and has evolved into making changes at the organizational level. To be clear, Cripe is not talking about perks like a yoga room or a ping-pong table. “No,” she said. “We would not discourage an organization from doing that, but what so many people report is really painful and taxing about work are what feel like intractable interpersonal issues: a boss who is a really ineffective leader, or divisions between staff.”

Addressing these issues takes more time and intention. Cripe told me about some of the recommendations KonTerra has provided to address root problems. “We might make recommendations around expanding some benefits that may not overtly appear to be mental health or resilience-related but can be very important for the overall well-being of the staff,” she said, pointing out that some organizations fail to extend all benefits offered at the headquarters level to front-line staff. While rectifying inequities within an organization may not appear to be a mental health benefit, Cripe said this can reduce the stress and isolation employees feel when they’re not treated equally.

“Sometimes there are much more difficult recommendations around really dealing with the pain that has been caused because of bullying or because of a culture of exploitation and thinking particularly how principles of restorative justice can be applied in organizations,” Cripe continued.

When it comes to the culture of overwork, KonTerra’s recommendations target leadership. “It’s super important to invite executive teams to explore their own values around work and recognition and how they feel needed,” Cripe said. “That needs to happen before the same work can happen at lower levels of the organization.”

I asked Curling and Cripe what other sectors could learn from their work in international aid. Cripe said organizations need to understand that mental health is a big priority among younger generations like Gen Z. “Organizations can really no longer credibly say that we don’t pay attention to this, or that people are on their own — that it’s a personal issue,” Cripe said.

Curling reflected on what she hoped employers would change in light of the challenges exposed by the coronavirus. In addition to a renewed appreciation for face-to-face meetings, she said she’d like to see more flexibility in work hours and location, and more appreciation for the value of taking breaks and switching out of work mode. And, she added: “More value for essential services, translating into better pay for those carrying out what are now low-paid, front-line jobs.”

Low-Wage Jobs: When Work Takes More than Gives

One issue the pandemic has made abundantly clear is that low-paid, front-line jobs cause people tremendous stress, and these jobs show just how much of a toll work can take on our mental health when our agency is stripped away.

Margarita Paredes, a bilingual clinical psychologist now based in Austin, Texas, spent years in New York counseling Latinx people and their families, many of whom worked low-paying jobs in construction and home health care that, as Paredes put it, “make New York a 24-hour, seven-day-a-week job market.”

Just as Cripe and Curling described in international aid, Paredes said that never-ending work is the biggest problem affecting her patients. “There is no work-life balance,” she said. “People work all day long.” Much of her practice, she said, is about “helping people live more and work less.”

For people in low-wage jobs, work can take away more than it gives: The hourly wage is often not enough to make ends meet, benefits like health insurance and paid sick leave may not exist, schedules are unpredictable, and people doing these jobs have very little say in their work. Because of this, low-wage jobs in retail and food and beverage are considered among the unhealthiest across 19 industries, causing workers more stress, work-family conflict, and more issues with poor mental health.

For the past five years, Daniel Schneider, a sociologist at the University of California, Berkeley, has been working with Kristen Harknett, a professor of social behavioral sciences at the University of California, San Francisco, to understand how conditions at low-wage jobs affect the well-being of the people doing the work. Through the Shift Project, Schneider and Harknett have collected data from 30,000 hourly workers at 120 of the largest retail and food service companies in the United States.

In October, they published a report revealing that one of the biggest factors affecting worker well-being is unpredictable scheduling — schedules handed out with little notice, on-call requirements, shifts canceled at the last minute, and schedules that involve “clopening,” when someone must work till close and then clock on again just a few hours later to open. The Shift Project found that 70 percent of workers who said they had scheduling instability experience psychological distress, compared to around 40 percent for workers with more predictable schedules.

In retail and food service jobs, there’s a lot scheduling uncertainty: Two thirds of workers said they got their schedules less than two weeks in advance, 80 percent said they received little or no say over their schedules, and 69 percent are required to be “open and available” to work whenever needed. In these jobs, the Shift Project found that women and people of color, particularly women of color, are subject to these challenges more often.

“When you hire someone, you’re hiring their whole family. You’re not just hiring that one person who is in front of you. — Margarita Paredes, clinical psychologist

Like Paredes, Schneider described this as work-family conflict, but the low-wage version of the story that doesn’t usually get told. “We’ve got literature on work-family or work-life conflict: Here I always think of the horrible clip art picture that’s got this woman in a suit, and she’s sitting in front of a 1990s laptop, and she’s got a big cellphone and a baby and a stack of paper, and she’s juggling these things,” Schneider said. “That has long been our vision of work-life conflict — it’s a problem of white-collar professionals.”

Schneider and Harknett wanted to understand what this looks like for low-wage workers and their families. “So we collected a lot of data on workers’ own reports of their health and well-being, their mental health, their sleep, and we asked parents all about parenting and parental stress and how their kids were doing,” he said. They also asked about economic insecurity.

The Shift Project has found that both aspects of scheduling uncertainty — the economic insecurity of having a 30 percent variance in work hours per month, and the stress of trying to live an organized life with unpredictable work hours — had detrimental effects on the mental health of not only the workers, but also their children.

“With schedule instability, we can draw some really clear lines between why those labor practices would reduce workers’ mental health and potentially negatively affect their children, having intergenerational effects,” Schneider said. “You could imagine that other forms of work time might also operate similarly. For instance, if you think about paid sick leave, the ability to stay home when you are sick, including for a cold but also for other episodes of illness, could have real beneficial effects. It could also have effects by helping you manage work-life conflict.” Indeed, paid sick leave has become one of the most prominent issues facing essential workers during the pandemic.

Paredes, who treats whole families and has done community-based care, has seen the intergenerational effects when this does not happen — when work denies people the time they need to care for themselves and their loved ones. She told me about one of her patients, a mom who was having panic attacks, whose son was starting to act out. When the daycare fired her kid, she lost her job. “When you hire someone, you’re hiring their whole family,” she said. “You’re not just hiring that one person who is in front of you.”

Some cities and states have passed fair scheduling laws, and some large companies have created policies to give retail employees more control over and notice about their schedules. However, Schneider said Shift Project data illustrate that what companies say they do and what workers report is actually happening sometimes clash. “We have a ton of data on workers by company that really lets us richly describe workers’ experiences by firm,” Schneider told me in December. At the time, he was weighing how to use that information. A few months later, when COVID-19 hit the U.S., he found a way, sharing with the New York Times data on which retailers offer paid sick leave and which do not. The paper’s editorial board used the data to publish a bruising opinion piece calling out those companies for “putting profits above public health.”

As the Shift Project has shown, the demands and conditions of low-wage work have a significant impact on people’s well-being. But these conditions, particularly the erosion of agency, are not just limited to low-wage jobs. As Schneider and Harknett wrote in their journal article, “precarious schedules have become a fact of life for a broad range of industry sectors and occupations.”

“In some ways, this is the future of work. It’s just we had the wrong gloss on it.” — Daniel Schneider, Shift Project

Schneider pointed out that the use of new technologies may also reduce workers’ agency. He and Harknett have started to collect data on the mental health impacts of trends like automation, surveillance, data-generated quotas for warehouse and assembly line work, and work alongside robots. In Schneider’s view, the future of work is here, and the job conditions don’t look great. “It’s exactly the opposite of these utopian visions of less work,” he said. “It’s less worked doled out extremely erratically and unpredictably without any worker empowerment. In some ways, this is the future of work. It’s just we had the wrong gloss on it.”

Placing a Business Value on Mental Health

When Dean Yates was getting ready to return to work at Reuters, his psychiatrist was blunt: Daily journalism was placing too much pressure on his mental health; he knew his career as a newsman was over. Working with colleagues at Reuters headquarters in New York, Yates reimagined his role and created a new position as a mental health and well-being advocate for other journalists at Reuters. For the next couple years, Yates worked mostly as a one-man team, launching several initiatives, including an internal blog where journalists could share their experiences and a mental health training program for managers.

In January, Yates realized his job was beginning to affect his mental health again, and he decided to leave Reuters. He explained that while he felt Reuters had started to shift culture around mental health, eliminating the stigma and making it easier for people who were suffering to get support at Reuters, he didn’t feel the company was doing enough to reduce the demands of the newsroom. And that pressure to change something he didn’t have the power to change affected his well-being. “I felt sidelined,” he said.

As Yates indicates, there two main ways employers can address poor mental health of employees: They can provide support and create a positive environment to help individuals experiencing poor mental health, and they can address the root causes that contribute to poor mental health in the first place. While more companies are providing programs to support individuals and cultivate well-being and resilience, it’s not clear how many employers are changing the demands of the work itself — the long hours, the unrelenting workload, the toxic conditions, and the decline of job control and agency that make people feel powerless.

For employers to take meaningful action, they need to start by understanding the value good mental health contributes to the organization and the cost poor mental health takes away. Curling said that the turning point for international aid organizations to change was the risk of litigation — a potential cost. And Cripe explained that one of the ways KonTerra has been able to make the case for investments in organizational change is through surveys that demonstrate the business benefits of those changes.

The story of how corporate social responsibility (CSR) became mainstream may provide a playbook for those trying to get companies to take employee mental health more seriously. CSR began gaining traction in the 1990s, when companies like Nike and Walmart got called out for poor supply chain labor practices. Other companies didn’t want to face similar scrutiny or legal penalties, so they began to proactively address social and environmental risks. More recently, companies have seen the opportunity to attract the growing class of conscious consumers and responsible investors by “creating value” for the environment and society. Many of the companies the Shift Project tracks have a strong “CSR sheen” as leaders in responsible business. But even these companies may have a blind spot when it comes to the mental health of their workforce. As Schneider put it: “There’s a disconnect between the corporate mission, or the ways the companies describe themselves, or even what they’re trying to do outside of their workforce. How their workers are treated is very real.”

To make the business case for action on social and environmental issues, CSR professionals rely on a common business mantra: What gets measured gets managed. This made me wonder: Do any companies track the cost of mental health to their business? If so, do they know what’s driving poor mental health, and are they addressing those factors? In the course of my reporting, I tried and failed to answer those questions. I thought Glassdoor’s research team might have looked into this, but their PR guy emailed to say that they haven’t. As a consolation, he sent me links to three pieces of generic thought leadership on workplace wellness. In my reporting on international aid, I had heard rumor of internal reports by two leading aid organizations finding that their retirees died younger than other professionals with a similar background. But I couldn’t get my hands on the actual reports. In the literature I reviewed on mental health in the workplace, I found a few examples of employers that assess worker mental health and stress levels, and only a couple that suggest they are tracking the business costs of poor mental health. Another step in the right direction is the movement by some companies to incorporate mental illness into diversity and inclusion conversations.

Business may be slower to take deep action, but a growing number of employees are taking the issue seriously. These employees see through perks like wellness programs and meditation apps and are demanding change — or leaving: One survey found that half of Millennials, three quarters of Gen Zers, and half of Black and Latinx respondents had left a role for mental health reasons caused by the job.

The media narrative is also helping change the conversation around mental health at work. In particular, the #MeToo movement has helped elevate the issue of toxic workplace culture. In the past, stories like the one in The Verge about the Away CEO shaming people on Slack and The New York Times Magazine’s expose of The Wing may not have gotten a second glance from editors; now they’re going viral. When Starbucks announced its baristas would get free access to the meditation app Headspace, they launched a petition on Coworker.org asking for the company to address what they say was really causing low morale: understaffing. That story went viral, too.

As coronavirus took hold, poor mental health began to get more media coverage. An article in Business Insider that called mental health benefits “America’s most competitive office perk in the age of coronavirus” noted that since mid-March, Headspace, the app Starbucks offered its employees, had seen a 400 percent increase in requests from companies. Using data from the Society for Human Resource Management, the article pointed out that it’s still relatively unusual for companies to provide mental health support for staff. It went on to list the steps some large companies are taking to support staff during COVID-19. But none of the examples — from therapy sessions to app-guided meditations to online platforms for employees to support each other — were about addressing the root factors at work that could be causing poor mental health.

“The [employer’s] emphasis mostly is still focused on the individual, rather than on the effects of work itself as a cause of poor mental health.” — Marnie Dobson, Healthy Work Campaign

In my search for companies that are measuring the cost of poor mental health in their workforce, the closest I got to an answer was from Marnie Dobson, an adjunct professor at the Center for Occupational and Environmental Health at the University of California, Irvine, School of Medicine, and codirector of the Healthy Work Campaign. Via email, Dobson said that while companies do measure things like employee engagement and presenteeism (when employees are present but not really getting much done), she believes few, if any, track the cost of poor mental health. “The emphasis mostly is still focused on the individual, rather than on the effects of work itself as a cause of poor mental health,” she wrote.

Mental Health as a Public Good

At least outside business, momentum is building to reframe mental health as a collective responsibility.

In the Lancet Commission report, Dr. Patel and his colleagues pointed out that global development investments in mental health are equivalent to 1 percent or less of what is spent on physical health. As a result, the percentage of people who receive care is also low. In the United States, only 43 percent of adults who have experienced mental illness have received treatment, and treatment rates are lowest for non-white communities, ranging from around 25 percent for Asian-Americans to 30 percent for Black Americans to 33 percent for Latinx Americans.

One of the primary problems, at least in the Western world, is that poor mental health is perceived as a burden individuals must bear, not a responsibility of society collectively. That’s starting to change.

The Lancet Commission positions mental health as a “global public good” and fundamental human right. Framed this way, supporting people with poor mental health and creating an environment that promotes good mental health is a critical role of society — something that can, as the authors write, “facilitate sustainable socioeconomic development, improved general health, and a more equitable world.”

Dr. Patel explained how poor mental health of an individual can create ripple effects across the economy: If someone is out of work due to mental illness, their household income declines. Since there’s a strong correlation between physical and mental health (called “comorbidity”) it’s likely that person is also experiencing a physical health condition. That may require another family member to take time off work to care for the ill person. Now the household income falls even more. “So there is a kind of incremental effect on the household, and then if you look at the level of communities, and you look at the overall burden that you multiply with affected households at the level of the population, you can begin to see economic loss at the level of the community as a whole,” Dr. Patel said.

“We’re actually all very interconnected, which means that if you’re spending a significant amount of your life in a work setting, and the well-being of the workforce is not good, it’s not good for you either.” —Dr. Carl Clark, Mental Health Center of Denver

Dr. Carl Clark, CEO of the Mental Health Center of Denver, described another way the mental health of an individual has a ripple effect on others: If you have a friend — or even a friend of a friend — with positive well-being, that has a measurable effect on your own positive well-being. The opposite is also true: We’re affected in a negative way by the poor mental health of those around us. “We’re actually all very interconnected, which means that if you’re spending a significant amount of your life in a work setting, and the well-being of the workforce is not good, it’s not good for you either,” Dr. Clark explained.

It’s for these reasons that some countries have started experimenting with ways to incorporate mental health measurements into national planning. Bhutan’s prime minister famously introduced the idea of “gross national happiness” as an alternative to the GDP in 1998, and last year, New Zealand revealed its well-being budget, which identified five priorities, including mental health, to invest in and measure the success of the country. Discussing the budget at the World Economic Forum in January 2019, Prime Minister Jacinda Ardern described mental health as both a moral and economic issue. “It affects your productivity, and there’s good reason why business should be taking this on, for both the moral imperative and that economic imperative as well,” she said. She also talked about how poor mental health affects society. “When you look at the connection between mental health and so many other issues — addiction, our criminal justice system — the linkage between all of these issues speaks to the fact that we have to take a general well-being approach,” she said.

The idea that mental health is a public good — that good mental health contributes a collective value and that poor mental health has a collective impact — parallels the notion of natural capital, a movement that seeks to assign an economic value to the goods and services provided by nature. Until recently, companies and markets failed to price the costs and benefits of the environment, dismissing them as externalities; but it has become clear that things like climate change and water scarcity have a material and measurable impact. Under this rubric, rather than assuming that mental health is a cost to be shouldered only by the suffering individual, companies should account for the mental health of their workforce on their balance sheets, and countries should account for the mental health of their citizens in their budgets.

We may not yet know the cost of poor mental health at the company level, but we do know that the global mental health crisis could cost society $16 trillion. Given how closely work is intertwined with our mental health, this cost could be viewed as an opportunity. Because while work can be a powerful force that detracts from our mental health, the opposite can also be true: Work can fuel our well-being. As Dr. Patel put it: Work is therapy.

“Work as a very important aspect of well-being is something that we must recognize in conversations about work,” he said. “Work isn’t just about the gig economy or GDP or industry. Work is a central element of the well-being of every human being. If we really adopt that idea of work being central to well-being, it then becomes a much more important conversation than the way it’s currently framed. It means that governments need to ensure that everyone is at work for their own sake and therefore the sake of the larger community that they belong in.”

Work Done Right

Danushi Fernando may live with PTSD, but the reigning emotion I got from my conversation with her is joy. The 35-year-old new mom loves her job — or, rather, all four of her jobs: In addition to working as director of the LGBTQ and Gender Resources Center at Vassar College, she runs her own private practice as a mental health counselor, and she volunteers as a mental health clinician for two different organizations: the South Asian Queer Collective in New York City, and Equal Ground, an organization that supports the queer community in Sri Lanka, where she grew up.

Like Yates, Fernando experienced significant trauma that led to her PTSD diagnosis, and she describes her time in a psychiatric ward as one of the best experiences of her life. It gave her a chance to heal from the trauma of sexual assault and abuse, and the therapy helped her accept her identity as a bisexual South Asian woman. It also affirmed her decision to work in mental health. “Being here and doing the work I’m doing is amazing for me because I get to really own my identity and how I’m living my life — because I’m bisexual, I have a child, and I have my straight, very hetero-cis man as my partner,” she said. “I’m really happy, and now that I’ve worked on myself and I’m comfortable talking about it, I want others to get the same support and feel they are supported as they make their journey.”

“Work done right is fundamental to mental health.” — Daniel Schneider, Shift Project

One of the things that surprised me about reporting this story was how hopeful the interviews made me feel. Reading the research, I had braced myself for bad news. The world is in a mental health crisis! One in five people experience mental illness! Suicide is on the rise! I didn’t think that by digging into the stories behind these facts I would get to joy. But I did, and the reason is this: The people I interviewed were passionate and, for the most part, optimistic about their work. One of the first things Margarita Paredes said when she was telling me about her 25 years as a clinical psychologist is that she really loves her work.

Daniel Schneider made this point, too, linking his personal happiness to the importance of work in our lives: “Work done right is fundamental to mental health. It actually might be a really bad idea to have people not work. That might be a real loss of meaning and purpose. I love my work. I get an enormous amount of mental health benefit from my work. That’s something that we can lose track of — is the upside to positive employment and positive engagement in work.”

As we look to create a better future of work, Schneider’s point is important: Work matters to our mental health, and work done right can support our well-being. This starts with understanding exactly how work affects mental health. That begins with individuals: Dean Yates recognized that his work was taking a toll on his mental health, so he changed his role — twice.

There are plenty of things employers can do as well, but the most important thing is understanding and fixing the things that drive poor mental health in their own organization. The factors that contribute to poor mental health are often the same across vastly different industries: Lack of agency, overwork, and poor leadership affect workers whether they’re high-paid software engineers or hourly retail employees.

Lynne Cripe pointed out that work can be challenging even in healthy organizations. “For so many of us, work is a place of distress rather than a place of health and of thriving,” she said. Cripe’s work at KonTerra shows that unhealthy organizations can change, toxic relationships can be rectified, benefits can be expanded. Work done right does not just mean that people flee bad jobs for good ones; it means fixing the ones that are broken. “I’m curious about positive deviance,” Cripe said. “What can we learn from organizations that have been able to shift?” Here, too, there’s a parallel with CSR: Nike was one of the first companies called out for poor supply chain labor practices, but the company made changes and is now considered a CSR leader. There’s also a clear need for policy changes to fix stubborn, less-reported, systemic challenges like the ones the Shift Project has revealed in low-wage jobs.

All of these changes require looking at mental health differently — framing at it as a public good to value and collectively protect. The good news is that if we do that, it’s possible to envision a better future of work, where work feeds mental health more than it does damage.

Amid the mountain of research I collected for this article, one fact was clarifying: A study in Bosnia and Herzegovina found that job loss has a “predictive role for mental health impairment of the working age population.” At face value, this sounds terrifying. Under COVID-19, 30 million Americans — more than the population of Australia — have filed for unemployment. Even before COVID, the threat of job loss due to automation was looming in the background, causing many Americans a great deal of anxiety.

But Dr. Patel has found another way to look at this problem: The unemployed are a potential workforce. “If there’s one kind of work that will never disappear, if there’s one kind of work that will never be replaced by a technology, if there’s one kind of work that is going to grow in the future, it’s this kind of work: the work of caregiving,” he said. “I actually think there’s a dramatic opportunity to redeploy the growing numbers of people who are facing lack of work in becoming involved with the caring professions.” But in order for this to happen, Dr. Patel cautioned, society must recognize the value of caregiving and pay for it.

Like everything else COVID-19 upended, the delivery of mental health services transformed almost overnight. Dr. Clark told me that within a matter of days, the Mental Health Center of Denver had transitioned much of its care to virtual settings and even began developing an app to expedite access to support. Dr. Clark said these things had been on the center’s strategic plan, but certain barriers, like insurance providers refusing to cover tele-therapy, stood in the way. “We had set a goal that we wanted to solve the access-to-care problem in Denver over the next five years,” Dr. Clark told me. “We knew we had an uphill battle being able to do this virtually, and that just got knocked down.” Now Dr. Clark and his colleagues have shifted the strategic plan to a political strategy. “Let’s let as much of this that we’re doing now to survive in the future,” he said. “We’ve got to expand the capacity of the people who are actually doing this work.”

Perhaps the silver lining of COVID-19 is that mental health will finally get its moment.

When I emailed Dr. Patel in April to find out how the coronavirus had affected his work, he replied that his fieldwork had been put on hold, but he had just launched a research application for an initiative called Empower, with an aim to build the world’s mental health workforce. I reminded Dr. Patel about what he had told me earlier — about his hope that people facing unemployment could be redeployed as caregivers, as long as their work is valued.

Now that this crisis has shown us just how important caregivers are to society, I asked, do you feel more optimistic about this happening?

“Of course!” he replied.