Early Career Occupational Hygienist Essay Award 2024 – Christopher Mirzaians

While the practice of Occupational Hygiene is traditionally associated with the protection of workers from the risk of disease and injury in the workplace (i.e. focused on the physical rather than the psychological), one could also put forward a strong case that Good Occupational Hygiene Practice can also support positive mental health in the workplace.

Additionally, while a handful of occupational hygiene consultancies partnering with occupational health and mental health practitioners are working hard to realise these mental health benefits in the workplace for their clients, there is also less commonly mentioned mental health benefits for the Occupational Hygienist themselves through this work.

This essay will primarily focus on occupational hygiene provided by consultancies but is equally applicable to embedded occupational hygiene roles where wider medical and mental health teams work in collaboration with occupational hygienists.

Occupational Hygiene, Mental Health, and the Workforce

From the occupational hygienist’s perspective, much of what makes up Good Occupational Hygiene Practice (GOHP) has historically been centred around the technical aspects of conducting the Recognition, Evaluation and Control process in various forms and in varying levels of detail. In many cases that also consists of carrying out surveys, risk assessments, and other forms through which risk is identified, categorised and, above all, prevented or controlled.
A Sense of Satisfaction? In that vein and to that purpose, GOHP often calls on the effective use of soft skills in dealing with clients. This can involve follow-up interactions and discussions and, where required, implementation effectiveness checks with site management, supervisors and worker’s representatives to support the implementation of recommendations. This represents what could commonly be regarded as a ‘good’ or ideally ‘best’ practice. Moreover, both the regulator (i.e. HSE in the UK) and experienced practitioners know that this approach brings benefits to all parties because it inspires not only confidence and trust but can also lead to increased commitment and buy-in from all stakeholders. In other words, this creates a path forward which speaks to real improvements in worker exposure risk and is often seen as uplifting for both the workforce and management, who have a duty to protect workers under their supervision. Through this a sense of satisfaction is achieved and, although the effect is very real, it is not often mentioned.

The Importance of Workplace Support Services

In the occupational hygiene profession, it is becoming increasingly well recognised that the structure of an organisation, and the availability of support services, can have a substantial and beneficial impact on mental health in the workplace. This is usually through the processes of issue identification, timely and carefully managed communications, and the provision of support service mechanisms (e.g. mental health and wellbeing services).
These processes work best in areas where companies operate a joined-up Occupational Health/Hygiene service, including Clinical (i.e. occupational physician and occupational nurse access in tandem with occupational hygiene services), either on-site or at a nearby location. This facilitates a number of processes, all of which benefit the mental health of workers through a sense of security provided by the ease of access a worker has to such services. Occupational Hygiene’s involvement here would include trained and competent practitioners with mental health awareness skillsets, field assessment processes which include mental health components in concert which traditional exposure assessment skills and, critically, a reporting and feedback process that highlights adverse observations for review and where needed, intercession.

More recently, occupational health consultancies have begun to not only recognise these 360 degree needs but also offer a combination of Occupational Health/Hygiene professionals able to work together to satisfy both the physical exposure and mental health needs of the modern workplace under one umbrella. One can also postulate that these types of organisations offer more than the sum of their parts although the evidence available at this time tends to be circumstantial rather proven. Nevertheless, subjective feedback appears to be very positive.

Occupational Hygiene and Mental Health – What Happens in the Field?

To understand better how Occupational Hygiene can yield benefits for worker mental wellbeing, there is value in considering what happens in the field based on the feedback of experienced Occupational Hygienists as well as narrative reports.

Starting with more direct effects, an Occupational Hygienist will often conduct short interviews with workers to better understand their work, whether conditions present during the survey are representative of normal working conditions, and other similarly informative lines of questioning. Considering that through the Occupational Hygienist going to the worker’s workplace and doing their job properly, they must spend time in that workplace in order to properly witness the three-dimensional nature of hazards present and how exposure risks manifest within the working environment. Presence in the workplace is important and adds a degree of authenticity that is crucial and visible for workers. Most professionals agree that proper exposure assessment cannot be done remotely (e.g. phone/videocall) because so much key information is missed. In other words, the Occupational Hygienist must be able to enter and comprehend the worker’s workplace, and it is in this proximity and direct contact that mental health issues are often identified in tandem with more physical ones.

Based on experiences reported as far back as the mid-1990s, and the author’s conversations with experienced occupational hygienists reporting experiences from the past, historical working examples of this have been garnered from reports written by hygienists conducting large scale DSE assessments. During the process of workplace assessments, interviews, and conversations, occupational hygienists reported noticing occasional symptoms of mental distress, agitation, or a “need to talk” among some of the workforce extending beyond basic social anxiety.
The fact that the worker had the full attention of a “health professional” in their own workplace often encouraged the mention of additional issues, often of a mental health nature. The Occupational Hygienist may be the first “health professional” that a worker with mental health difficulties and who struggles with the stigma attached actually confides in. In one study, this was noted to be particularly common among white male socio-demographic groups that made up the majority blue collar workers in the UK, which were also found to be the least likely demographic to speak to others about mental health issues due to the perceived stigma attached (S. Stickney, 2012).

In such cases, the engaged and aware occupational hygienist was (and would have been) in the position to either note and carry those findings back to a more qualified health professional for follow-up within the organisation or make useful recommendations to the individual. In some cases, that may also include a decision whether to advise the supervisor notwithstanding medical confidentiality aspects. It is not hard to see that it is a complex issue.
Interestingly, on occasion occupational hygienists have raised these observations during lectures, seminars, and awareness training. It could also be argued that it underlines the value of Occupational Hygiene as a strategic powerhouse for many combined-effort occupational health programmes, recognising the vital functional interlinks between the clinical and hygiene professions in delivering maximized health outcomes. To quote one such source “There are numerous reports of occupational hygienists identifying all manner of behavioural and psychosocial issues, clinical depression and anxiety, and indeed even more serious mental ailments in the course of their work at sites” (A. Bianchi. 2024). Bianchi argued that there was a strong case for Occupational Hygienists to be able to qualify more professionally in the field of occupational mental health and fulfil an even broader role in identifying and supporting mental health issues alongside physicians and mental health specialists.

Solvent Exposures and Aetiological / Pathophysiological links to Workplace Mental Health Risks

From both a toxicological and epidemiological standpoint we already know that workplace air quality and, in particular repeated acute and chronic exposures, can impair mental health.

Aetiological and pathophysiological processes are usually multi-step and complex in nature. The consequence of repeated exposures to poor air quality can result in a complex neuropsychiatric pathology with serious consequences for the individual. It is already understood that exposure to substances such as volatile organic compounds (e.g. toluene, xylene, and styrene), which cause depression of the Central Nervous System (CNS), can result in clinical depression, anxiety disorders and general problems for alertness, ability to sleep, and auditory problems (in the case of ototoxicity). The significance of these findings should not be underestimated as solvents are very commonly used in so many different types of industry throughout the developed world. Over longer periods of time, the consequence of elevated levels of exposure include an enhanced propensity towards neurodegenerative diseases similar to Parkinson’s Disease. As a sad finale to these diagnoses, studies show that the probability of an individual experiencing mental health issues only increases for patients diagnosed with such illnesses.

Similarly, various reports linking chronic exposures to high concentrations of various types of airborne dust, which in turn cause breathing difficulties, are also reported to inflict a negative effect on worker mental health, although the actual mechanisms are not always so clear.

Even with just these examples we can see that there is a clear link between the successful implementation of GOHP in the workplace and degrees of risk reduction for potentially serious mental health outcomes, as GOHP applied here would ameliorate a worker’s exposure to the agents which are key drivers of the health effects discussed.
Taking the issue beyond the immediate workplace to the local environment, there is a significant body of research highlighting mechanistic and, in some cases, hypothetical links between specific mental health conditions and exposure to air pollutants (E. Christoforou, 2023).

As an example, positive associations have been reported between the occurrence of psychotic disorders and ongoing exposure to NOx. Other studies found a statistically significant link between elevated ambient ozone levels and admissions to psychiatric emergency services (F. Bernardini, 2020). Given the better understood nature of ozone exposures for some types of welding (most notably TIG welding), and the better catalogued health effects of repeated ozone exposure (which includes motor disorders, cognitive impairment, clinical depression and, in some cases, suicidal thoughts), the case for identifying and driving down exposures becomes a very strong one, with
the mental health impacts of such exposures only serving to add impetus to the implementation of GOHP. While a number of more environmentally focused studies are centred around exposure to the general public, occasionally some useful parallels can be drawn between public and workplace exposure in terms of effect and its relationship to concentration and frequency. Returning to those working with solvents, a cluster of studies looking at long-term styrene exposure, traditionally associated with GRP boatbuilding and repair industry and fiberglass workers, in general found significant and irreversible neurophysiological impacts (P. Baxter, 2010). Other studies reported associations between styrene exposure and aggression and hostility (J. Challenor, 2000).

Links to hearing loss and dementia in later life?

There are additional factors to consider which further extend the value proposition for GOHP, especially when talking about certain solvent exposures. Today, the health sciences better understand the links between styrene and mental health issues, and exposure to toluene and its ototoxic effects which, especially when combined with noise exposure, appears to have enhanced ototoxicity. This hearing loss from noise and toluene exposure is accompanied by an adverse impact on mental health from this hearing loss. A study carried out by J. Fellinger, D. Holzinger, and R. Pollard (2012) investigated the impact of deafness on mental health, and found an increased incidence of common mental health issues among deaf people. Given that exposure to aromatic hydrocarbons, particularly toluene in this case, combined with noise exposure can result in varying degrees of deafness, and the condition of deafness, especially severe deafness, is associated with an increase in the incidence of common mental health disorders, and in some cases, to dementia as a consequence of a toxicity-related pathway, a link forms between exposure to aromatic hydrocarbons and mental health issues, which are otherwise preventable and minimizable through effective implementation of GOHP.

Adding information around the earlier reference to dementia, new data is beginning to emerge suggesting links between early onset deafness and dementia, with hearing loss being increasingly identified as a factor in triggering or aiding the complex dementia process (A. H. Ford et al. 2018).

Maslow’s Hierarchy of Needs

Exploring the indirect effects of implementation of GOHP on mental health, it is perhaps helpful to consider Maslow’s Hierarchy of Needs (A. H. Maslow, 1943). One could argue that effective implementation of GOHP, especially in a challenging (i.e. resistant to positive change) workplace, requires a mindset shift among company management and/or its ‘thought leaders’ over toward a more ‘worker health-centric’ way of thinking.

This mindset shift, if expressed properly and alongside implementation of GOHP in the workplace, sends a potent message to workers that their safety and health is important and that they are valuable enough (as people, as individuals, and as stakeholders) to the business to be protected. Whether the principal motivator from the business’ perspective is driven by the ethical need to protect their workers, to ‘keep the regulator off their back’, or to avoid a Public Relations disaster, the impact for the workers in practical terms is often similar.

Coming back to Maslow’s Hierarchy of Needs, the positive and constructive argument perspective is that the safety, security, and assuredness that a company is able to provide its workers through creation and sustaining of a healthy workplace is a crucial building block near the bottom of the hierarchy, which allows an individual to attain their higher-level needs. According to Maslow’s theory, an individual cannot satisfactorily attain their higher-level needs without first attaining the level(s) below (e.g. an individual is unlikely to have high levels of self-esteem without having basic physiological needs met, such as food and shelter).

Based on this, a lack of implementation of GOHP in the workplace will, therefore, likely have the opposite effect. Supporting this statement, a study published in 2020 investigated the mental health impact that a lack of sufficient safety equipment would have on the workforce, finding that in cases of a severe lack of safety equipment, and accurately perceived so by the worker, that there was a notable and measurable temporal increase in reported common mental health disorders, post-traumatic stress disorder, and emotional issues among the group studied (Simms, A., Fear, N.T. and Greenberg, N., 2020). One could argue that in the case where the correct safety equipment was provided, but the worker in question perceived and believed the opposite, they would still likely suffer the same mental health issues as the group studied by Simms et al. This line of thinking supports the concept that GOHP is more than just the provision of the correct safety equipment – it must also include use of soft skills to educate and inform the worker.

Figure 1: Maslow’s Hierarchy of needs (Bolman and Deal 2021)

Building on the points made above with respect to Maslow’s Hierarchy of Needs, it is important to note at this stage that work conditions and company policy are both ‘hygiene factors’ identified in Herzberg’s two-factor theory of motivation, which are a critical factor for an individual’s ability to benefit from ‘motivating factors’ such as recognition, advancement in their career, and growth, all of which are supporters of positive mental health for a worker (House, R.J. and Wigdor, L.A., 1967).

What about the Occupational Hygienist?

Occupational hygiene as a practice has certain ethics, morals, and values, as described by Hébert (1996) that, with all things being well, are uniform and ubiquitous across the profession in
question. While Hébert wrote with specifically medicine in mind, the same principles apply to every profession with a uniform set of ethics and values, which includes Occupational Hygiene. These ethics vary profession by profession but, overall, the principle remains the same and applicable to Occupational Hygiene. One could argue that adherence to the ethics of the profession and delivering good quality Occupational Hygiene and, in doing so, protecting workers from exposure to harmful agents, is incredibly motivating for the Occupational Hygienist. Allan et al (2018) propose a powerful link between meaningful work (in this case protecting workers from health risks) and mental health, which suggest that an Occupational Hygienist who follows GOHP, and successfully and effectively supports companies in protecting their workers, is likely to experience job satisfaction and positive mental health impacts. Graeber’s (2018) work supports this idea, saying “Could there be anything more demoralizing than having to wake up in the morning five out of seven days of one’s adult life to perform a task that one secretly believed did not need to be performed – that was simply a waste of time or resources, or that even made the world worse?”. Tying it all together, an Occupational Hygienist who does not/cannot abide by GOHP, whether by their own choices, or through lack of support from their employer, is likely to feel demoralised through the inability to deliver meaningful work and experience a negative mental health impact.

Bringing it all together

There is a substantially sized body of research which helps connect the exposure of an individual to harmful agents, the behaviours of company management towards worker health, and the way an Occupational Hygienist comports themselves, along with many other factors, with mental health issues in the workforce. The HSE is driving hard towards the improvement of worker mental health and Occupational Hygiene can and should play a crucial role in supporting positive mental health in the workplace, bridging the gap between a worker’s physical and mental health. Additionally, an Occupational Hygienist using GOHP not only has the power to support the improvement of worker mental health, but also can benefit themselves through the self-motivational effects of meaningful work that aims to serve a cause higher than themselves (Sinek, 2019). A motivated, driven, and effective Occupational Hygienist is likely to have a more positive impact on worker health and mental health, which in turn will only serve to enhance the self-motivational and mental health boosting effects discussed, creating a positive feedback loop leading towards the continued betterment of worker mental health.

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