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Home  >  Medical Research Archives  >  Issue 149  > Legal and Normative Aspects Applicable to Workers' Mental Health: Bill to Regulate Psychosocial Risks in Brazil
Published in the Medical Research Archives
Aug 2023 Issue

Legal and Normative Aspects Applicable to Workers' Mental Health: Bill to Regulate Psychosocial Risks in Brazil

Published on Aug 29, 2023

DOI 

Abstract

 

Background: The post-pandemic historical moment of COVID-19 has had consequences on the mental health of workers, evidenced by the growing statistics of depression, anxiety, suicidal ideation, panic syndrome, burnout syndrome, psychotic episodes, alcohol and drug addiction, stress, fatigue, and professional exhaustion.

Aims: Analyse the recommendations of the International Labour Organization and the Brazilian laws applicable to occupational mental health to identify documents that address intervening laws in workers' mental health in the international scientific literature and introduce Bill 3,588/2020, which aims to regulate occupational psychosocial risks.

Methods: Narrative review of the scientific literature in the databases Scopus, Lilacs BVS, PubMed, Cinhal, and Ebesco and document analysis of Brazilian legislation and international recommendations on workers' mental health and norms related to exposure to occupational psychosocial risks and measures of intervention in mental health.

Results: The International Labour Organization established three Conventions to protect workers' health. In the Brazilian legal system, six broad and general norms were identified. The narrative prediction resulted in nine intervening laws that address the worker's mental health. Conclusion: In Brazil, there is no specific legislation regarding the worker's right to mental health, nor any regulation through Regulatory Norms, which demonstrates the need for the approval of Bill 3,588/2020, pending in the National Congress, which aims at regulating psychosocial risks, such as intervention, management, and prevention measures capable of minimizing mental illness at work.

Author info

Thaisa Cintra Rodrigues, Rita De Marchi Barcellos Dal, Carla Aparecida Ventura

INTRODUCTION
The concept of protecting decent and humanized work is guided by the principle of human dignity provided for in the Federal Constitution1. In its historic mission, it must promote productive, quality work, in conditions of freedom, equity, health, and safety, in line with the four strategic objectives of the International Labour Organization (ILO): (i) respect for rights at work, especially those defined as fundamental (freedom of association, right to collective bargaining, elimination of all forms of discrimination in terms of employment and occupation, and eradication of all forms of forced labour and child labour); (ii) promotion of productive and quality employment; (iii) expansion of social protection; (iv) and strengthening of social dialogue2. One of the essential aspects to achieve this objective is inserted in the health and physical and mental integrity of the worker through a humanized, safe, and healthy work environment, capable of mitigating the potential risks that result in accidents at work and occupational diseases3,4,5. In this sense, the knowledge of Occupational Health (OH), as an integral part of Collective Health, constitutes an interdisciplinary and pluri-institutional field of work as one of the leading social determinants of health. Considering the complexity of its object, it recommends an integrative way of acting that includes promotion, prevention, and assistance6,7.

Prevention actions employ different approaches from a theoretical and methodological point of view, with a greater or lesser impact on the determinants of the problems present in work situations. In this way, the actors in the OH area act collectively in the search for changes in work processes to improve working conditions and environments. They support an inter(trans)disciplinary and intersectoral approach in the perspective of the totality, with the participation of workers as subjects and partners capable of contributing with their knowledge to the advancement of the understanding of the impact of work on the health-disease process in the effective intervention to transform reality4,8. The right to protect the whole health of workers is based on the social value of work, human dignity, and the environment. It is considered a fundamental right1 so that the person can develop their work and, through it, constitute an achievement and build their identity since the pleasant experiences are manifested through satisfaction, fulfilment, knowledge, freedom, and appreciation at work. Such experiences constitute health indicators at work, as they enable psychic structuring, identity, and expression of subjectivity to facilitate negotiations, commitment, and resonance between the subjective and the concrete reality of work9,10.

The historical-sanitary moment of the COVID-19 pandemic brought consequences on workers mental health, especially those who work and deal directly with human life and health11. The statistics of depression, anxiety syndromes, suicidal behavior, burnout syndrome, psychotic episodes, problematic use of alcohol and other drugs, stress, fatigue, and professional exhaustion have been growing among workers11,12. These conditions demonstrate the processes of suffering and mental illness that broaden the understanding of potential causes, whose conceptions about the relationship between work and mental health should focus on the primary practices of care and an integral promotion of workers health (physical and mental)13,14. There is no human being without the collective and the relational. Unfortunately, the spread of desolation in organizational settings is a fact that has been intensified in the pandemic precisely because the processes of individualization of work, demobilization of collectives, and pursuit of overcoming others and oneself have given rise to new organizational models. Such models are based on subjectivation processes, practices for preventing sociopsychological pathologies, and on guidelines aimed at the mental health of workers, specifically on collective defences and cooperation, aligned with the effects of work in the adversities of the post-COVID-19 context5,8.

Concerning the increase in sick leave and leave due to work-related illnesses, mental disorders were already a reality. However, in the pandemic period, their consequences were undeniable, especially considering the negative impact generated, since nothing is neutral in the world of work - the central engine in the lives of workers, through which it could offer conditions for the development of subjectivity, professional growth, and construction of health and self- fulfilment15,16,17,18. In this context, two groups of suffering, illness, disability, or death of male and female workers are highlighted today: (i) the group of overload and strain pathologies (physical and mental fatigue; repetitive strain injuries/work- related musculoskeletal disorders - RSI/DORT); Burnout Syndrome, and deaths from exhaustion and overwork, among others; and the group of (ii) pathologies of loneliness or silence (depressive mental disorders and work-related suicide, among others)15,18.

In Brazil, from 2012 to 2017, 10 billion reais were spent on aid related to occupational diseases, of which R$ 8.5 billion was spent on aid for work-related accidents. From 2012 to 2018, R$ 23.9 billion represented expenses with disability pensions due to accidents at work. From 2016 to 2018, R$ 6.5 billion was spent on pensions for death due to an accident at work. Concerning absences due to common illnesses, expenses in 2018 represented R$ 2.4 billion reais, with a total of R$ 239.9 billion reais, expenses with disability pensions resulting from common illnesses from 2012 to201719. Depression and anxiety increased by more than 25% in the first year of the pandemic. The Comprehensive Mental Health Action Plan 2013– 2030, published by the World Health Organization (WHO), provides for global goals to transform mental health11,12.

According to the WHO, in 2019, nearly one billion people – including 14% of the worlds adolescents – were living with a mental disorder. Suicide accounted for more than one in every 100 deaths, and 58% of suicides occurred before age 50. Mental disorders are the leading cause of disability, causing one in every six years to live with disability11,12. Therefore, the collective and effective participation of all actors involved in this context (employers, employees, and society) is relevant to increase engagement in the respective class entities and social control, considering the process of mental illness so recurrent in work relationships. Such positioning is based on the perspective of a more humanized work, as the essential elements are achieved in the implementation of policies and programs of effective interventions in the work environment in order to develop promotional and preventive attitudes in the organization of work, capable of providing better working conditions, in compliance with constitutional and infra- constitutional laws for the protection and integrity of the workers physical and mental health20,14.

The present study describes the legal aspects of the Brazilian legal system and normative aspects of the ILO, applicable to workers mental health, and analyses possible labour laws in the international scientific literature that provide intervention measures for workers mental health. In Brazil, there is no specific regulation of occupational psychosocial risks as a form of management, prevention, promotion, and intervention. The intervention measure, proposed as Bill 3,588/202021, pending in the National Congress, is the result of Doctorate research and aims at standardizing psychosocial risks at work to minimize the workers mental illness. This study aimed to analyse the recommendations of the International Labor Organization and the Brazilian laws applicable to occupational mental health to identify, in the international scientific literature, documents that address intervening laws in the mental health of the worker and present Bill 3,588/2020, which aims to standardize occupational psychosocial risks.

METHODS
The study consists of a document analysis of the ILO norms and the Brazilian legislation about the right to occupational mental health, as well as bibliographical research of the international scientific literature that addresses the mental health of the worker and the possible applicable intervention measures. For the elaborated narrative review, the elaborated question was: What are the norms that address the workers mental health in the international scientific literature? The searches were carried out in five databases, namely: CINAHL, SCOPUS, LILACS BVS, PUBMED, and EBESCO, from the descriptors: (Legislação OR Legislações  OR Direito* OR Norma* OR Legislación OR Legislation OR Right OR Normalization*) (Saude mental OR Mental Health OR Salud Mental OR mh: OR Transtornos Mentais OR Mental Disorder) #3 (Trabalhador OR Trabajador OR Employee OR SAÚDE Ocupacional OR Salud Ocupacional OR Occupational Health OR Riscos Ocupacionais OR Risco Ocupacional OR Risco Profissional OR Riesgos Laborales OR Riesgo Laboral OR Riesgo Profesional OR Occupational Risk).

The review was carried out in September 2022, and the searches were limited to selecting articles by reading the titles and abstracts and choosing the studies that addressed the evidence of the legal aspects of workers mental health in the international scientific literature, including written texts in English, Portuguese, and Spanish, from 2016 to 2022. The research was submitted to the National Research Ethics Committee – CONEP. It was approved by the Research Ethics Committee of the School of Nursing of Ribeirão Preto, University of São Paulo, whose Opinion number is 4,859,650.

RESULTS
The result of the first stage of the research objectively demonstrates the ILO standards: (i) Convention 155 requires Member States to design a Policy in terms of Health, Safety, and the Work Environment22; (ii) Convention 161, which presents a normative set of preventive nature concerning Occupational Health Services23(p161); (iii) Convention 190, enacted in 2019, consolidates the effectiveness of human rights in the world of work24(p190). Then, the Brazilian norms, applicable to the right to health and safety of workers were analysed, set out in

(i) the Federal Constitution in Articles 1, items III and IV, 7, XXII, 170 and 2251;
(ii) Consolidation of Labour Laws, the devices provided for in Chapter V and Article 20025, (iii) Law 8080/1990 which provides the conditions for the promotion, protection, and recovery of health6,
(iv) Law 11,430 /2006, which established the causal epidemiological link between work and health problems26; (v) Ordinance No. 1823/2012 of the Ministry of Health, establishing the National Policy on Workers Health27; (vi) Decree-Law No. 9,571/2018, establishing National Guidelines on Business and Human Rights28.

Consequently, the result of the bibliographical research allowed the recovery of 969 references of scientific materials, scientific articles, and informative documents, 221 of which were duplicates. The first stage consisted of reading the titles and abstracts, which resulted in maintaining 33 documents for reading in full. In this stage, informative materials of legislation and articles were included, whose selection directed the materials that addressed the general legislation that dealt with the workers mental health. Therefore, nine articles did not address the scope of the research, and 15 (fifteen) of them were inaccessible for reading in full. Thus, the eligibility of nine documents available for reading was confirmed.

Table 1: Summary of rules applicable to workers health

Table 2 - Description of results and analysis of selected studies

Even though the laws that deal with and regulate the protection of workers health are relevant, Brazil has no legislative regulation to manage psychosocial risks. The complex relationship among man, work, and society, facing the workers rights to physical and mental health, integrity and dignity, the process of mental illness, and the norms that ensure a dignified, healthy, and safe work environment are challenges faced in a reality that goes far beyond the capitalist and neoliberal world since this field of investigation goes beyond the limit of the individual as a worker and business strategies, reaching intrinsic, social, cultural, and human aspects1,24. The analysis of documents found in the literature reinforces and suggests that measures to prevent and promote workers mental health and psychosocial risks can be strategically managed through norms and guidelines that aim to maintain health and safety psychology in the workplace8.

The management of stressors is a moral obligation and a good investment for employers since these are related to low productivity and financial impact. It should be an established legal imperative, consequently reducing the excess of absenteeism, presenteeism (workers who show up for work sick and are unable to perform their activities effectively), turnover, and increased rates of accidents and injuries10. Given this scenario, this study proposes a bill21 which, on April 3, 2023, is being processed by the Chamber of Deputies, aiming to include it in article 200 of the Consolidation of Labour Laws, which deals with the provisions of the Regulatory Norms, preventive measures, promotion, and management of psychosocial risks by the employer. It is suggested that psychosocial risks, despite subjectivity, should be systematically managed to maintain health and safety in the workplace, as with other risks (chemical, physical, biological, accidental, and ergonomic)3,29. Considering that the risks foreseen by the Regulatory Norms correspond to physical, chemical, biological, ergonomic, and accident risks, there is no regulation of psychosocial risks since NR 17 is restricted only to psychophysiological ergonomics issues, not considering the other factors present in the work environment, which can trigger occupational psychopathologies29,24.

The bills text forwarded to the Chamber of Deputies describes the rationale and the grounds for the proposed intervention measure. Regarding the Brazilian legislative process procedures, first, PL 3,588/202021 was approved by the Social Security and Family Committee (SSFC), in which five sessions, no amendments were presented. Currently, it is awaiting approval by the Committee for Work, Administration, and Public Service (CWAPS). The observation of countless workers who file claims in the Superior Labour Court to obtain compensation of psychic damages, makes visible the behavior of the employer and civil society in verifying the efficiency and effectiveness of preventive measures already legally proposed and adopted by the legal system. Likewise, it demands inquiries, studies, and actions that reinforce the insufficiency of people management within organizations and resources from areas dedicated to Occupational Health to build processes and policies for health promotion, prevention, assistance, and professional rehabilitation regarding psychological disorders at work4,7. With the new labour relationships, structural and organizational changes are necessary. The pandemic has enhanced this reflection, perhaps raising awareness by those involved, workers, employers, and society, recognizing that factors related to work-related mental disorders are fundamental to formulating measures, fostering elements for elaborating policies in the public and private sector10,12,11. Research limitations involve few scientific publications regarding the research object related to the workers right to mental health and the lack of regulation of psychosocial risks in the work environment.

CONCLUSION
In the international scientific literature, labour laws provide for measures of education, intervention, promotion, and prevention of workers mental health in specific segments, which may be the object of analysis to establish effective practices and actions in the Brazilian legal system. Moreover, bill No. 3588/202021 may regulate measures to raise awareness among those involved (worker, employer, and society) for a more humanized management through the investigation of measures based on scientific evidence applicable to the promotion of mental health and prevention of occupational epidemiology related to mental disorders, which would positively impact the workers life, integrity, health, and physical and psychological safety, resulting in fewer leaves and early retirements.
Funding Statement
I would like to thank the Coordination for the Improvement of Higher Education Personnel, CAPES, Brazil, for the Bolsa de Fomento during the study period. 
Conflict of Interest Declaration
The authors have no conflicts of interest to declare.

Acknowledgements
I would like to thank the co-authors who present themselves here, who contributed substantially to the conception or design of the study; analysis and interpretation of data collected in the study; reviewed the text of the manuscript and approved the final version to be published. 
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