These changes require leaders and employees to take decisions more autonomously, practise a higher degree of self-management, and display additional flexibility and creativity as they go about their jobs.

This is being accompanied by rises in the numbers of days of incapacity for work and people retiring on reduced earning capacity pensions due to mental illness.

Engagement with mental health in the world of work can open doors to the development of sustainable workplace prevention activities. Such prevention work should not revolve exclusively around the harmful aspects of work that function as stressors, but also place just as much emphasis on the beneficial aspects that function as resources - the dynamic interactions between work, the psyche, and social relationships for instance.

In addition, it is vital to build up networked structures dedicated to detecting mental overload and crises among employees as early as possible and supporting action to deal with them.

The aim is to prevent employees suffering from incapacity for work if at all possible and, where this has unfortunately happened, to ensure they return sustainably to the workplace. This demands the interplay of various approaches:

• the human-centred management of tasks and working times
• appropriate action from leaders and teams in response to the problems they encounter
• personal counselling and support services
• closer cooperation with the health system

The healthy management of work requirements and relationships and the integration of primary, secondary, and tertiary prevention within the organisation are of central salience.

The Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, BAuA) is conducting intervention studies on these issues that are examining the integration of different kinds of provision at (and above) the level of the individual organisation:

• the consortium project Early Intervention at the Workplace (Frühe Intervention am Arbeitsplatz, FRIAA)
• the cooperative project Intensified Return to Work (RTW) aftercare in psychiatric outpatient clinics situated in care clinics (Intensivierte Return to Work Nachsorge in psychiatrischen Institutsambulanzen von Versorgungskliniken, RTW-PIA)

In large and medium-sized enterprises, the integration of different forms of prevention can be ensured by their organisational health management systems. When it comes to small and micro enterprises, structures for the provision of services have to be developed above the organisational level.

Statutorily required OSH measures represent a good basis on which to initiate prevention activities. Key roles are played by risk assessment and the measures that follow from it. Return-to-work management can also be used as a starting point for action. Occupational physicians, OSH specialists, and the health insurance funds are among the actors that support and advise organisations establishing workplace health management systems and health promotion schemes in Germany.

Employees should be involved in these processes, for example through their organisation’s occupational safety and health committee, health circles, the bodies that represent workers’ interests, and participative research methods.