Psychological Health Is Health and Safety: A Human Sustainability Approach

Author: Emily Pearson, Founder, CEO and Author

It is a question that deserves far more attention than it gets: if employers have had a duty to protect the health, safety and welfare of employees for decades, why has work-related stress sat so far outside mainstream health and safety practice?

It is not a small question, and it is not only a British one. In the UK, the Health and Safety at Work etc. Act 1974 is not called the Safety at Work Act. It is concerned with health, safety and welfare. Internationally, regulations related to psychological health and safety are equally broad. ISO 45003, published in 2021, is the first global standard giving practical guidance on managing psychological health and safety at work, and it treats psychosocial hazards as factors in the design and management of work. The World Health Organization names excessive workloads, low job control and job insecurity as risks to mental health.

The obligation has never been ambiguous. What has been ambiguous is where we chose to put it. In practice, psychological health has too often been treated as something separate. Handed to HR. Rebranded as wellbeing. Managed through awareness campaigns, mental health first aiders, resilience training and apps. Discussed as culture. Treated as care.

But if excessive workload, low control, poor management, bullying, job insecurity, fatigue, trauma exposure or unsafe leadership behaviors are causing harm, then this is not simply a wellbeing issue. It is a work design issue. It is a leadership issue. It is a governance issue. And it is a health and safety issue.

The law was never the missing piece

The duties are not new. What is changing is the level of attention, scrutiny and consequence. The UK’s Health and Safety Executive reports 1.9 million working people suffering from work-related illness in Great Britain in 2024/25, including 964,000 suffering work-related stress, depression or anxiety. Those cases accounted for 52% of all work-related ill health and 62% of all working days lost to it. Globally, the WHO estimates 12 billion working days are lost every year to depression and anxiety, at a cost of around US$1 trillion in lost productivity.

So the question is not whether psychological harm belongs in the health and safety conversation. It always did. The better question is why our systems have been so slow to treat it that way.

Physical harm has historically been easier to see, inspect and enforce. A fall from height, a faulty machine or an unguarded edge creates a clear incident trail. It fits the traditional model of hazard, control, inspection and compliance.

Psychological harm is different. It is cumulative. It is shaped by workload, power, control, fairness, relationships, staffing levels, leadership behavior and the way work is organized. There is not always one incident scene. There is often a pattern. And patterns require leaders to look at the system. That is uncomfortable. A broken machine is easier to inspect than a broken management culture.

What frontline experience reveals

My years of work in majority-male organizations, and in health and social care, point to the same conclusion. In those settings, men would rarely open a conversation by saying, “I am struggling with my mental health.” But they would talk about pressure. About fatigue. About not wanting to let the team down. About shift patterns, targets, unsafe banter, financial pressure, not sleeping, and the fear of being seen as weak. They would talk about the work.

Sometimes the issue is not that men do not care about mental health. It is that the language around it has not always made sense to them. In many male-majority workplaces, “mental health” can still sound personal, private or exposing. But “risk”, “safety”, “fatigue”, “pressure”, “workload” and “harm” are understood immediately.

Health and safety could have been one of the most powerful routes into men’s mental health at work. Not by asking men to disclose more, or making them perform vulnerability, but by treating the causes of psychological harm as legitimate workplace risks that employers have a responsibility to prevent. When we locate work-related stress only in wellbeing, we make it feel individual. When we locate it properly in health and safety, we name the system.

Health and social care shows the same pattern from the other direction. Harm there is rarely caused by one dramatic event. It is caused by repeated exposure to distress, impossible demand and staffing gaps, and that strain becomes normalized. People are praised for coping, and for absorbing pressure that should have been managed as organizational risk.

We would never accept repeated physical near misses without asking what was wrong with the system. But we have accepted repeated psychological near misses for years. Burnout. Stress absence. High turnover. Presenteeism. People quietly leaving roles they once cared deeply about. These are not individual wellbeing outcomes. They are system signals.

The question we need to be mature enough to ask

Has the health and safety profession, historically shaped by male-dominated industries and physical-risk cultures, been slower to recognize psychosocial risk because it did not fit the dominant model of what “real” risk looked like?

That is not a criticism of individual men. Some of the strongest voices in this field have been men, and many men have been harmed by the very cultures described here. This is about the professional cultures, industrial histories and leadership assumptions that shaped what organizations learned to see. When a profession is built around visible harm, measurable incidents and technical controls, it can struggle to see harm that arrives through work intensity, low autonomy, fear-based management, insecurity, bullying or chronic overload.

Psychosocial risk asks different questions. Who has power here? Who is carrying the pressure? What is being rewarded, and what is being ignored? Where is the work exceeding human capacity? Where are people being asked to cope with conditions that should be changed? Those questions are not soft. They are central to whether work is safe.

Wellbeing filled the gap, but it could not solve the problem

In the absence of strong psychosocial risk management, workplace wellbeing expanded into the vacuum. Many wellbeing interventions have helped people, and support services matter. But support was never designed to compensate for unhealthy work. That is where the model has failed. We have spent years asking wellbeing to carry what should have been held by governance, leadership, health and safety, job design, workforce planning and management capability. We have tried to solve a system problem with program activity.

You cannot out-campaign poor job design. You cannot wellbeing-wash excessive workload. You cannot train people to be resilient enough to withstand unsafe management practice. And you cannot keep asking employees to carry the health impact of work that has been badly designed.

The next evolution is Human Sustainability

Human Sustainability is the design of work, leadership and organizational systems so that people and performance can be sustained together. It does not reject health and safety. It completes it. It does not replace wellbeing. It matures it. It does not ask organizations to care more loudly. It asks them to govern more responsibly.

That means treating psychological health as part of health and safety, and workforce health as a strategic business risk. Making stress prevention part of governance rather than a wellbeing side project. Asking whether workload, autonomy, role clarity, management behavior and organizational change are creating foreseeable harm. And putting capable professionals close enough to strategy to influence the conditions that create or prevent that harm.

Capable wellbeing leaders need authority

This is where many organizations are still getting it wrong. They appoint someone to “do wellbeing”. Often that person is capable, committed and trusted. But they are not given the authority to challenge workload, access to risk governance, or a place in business planning. They cannot mandate manager capability, influence job design, or challenge decisions being made in the boardroom. And then we wonder why wellbeing does not move the dial.

We have professionalized almost every other business-critical function, but we still hand wellbeing to people without the development, authority or mandate to change the system. Not every organization needs a large wellbeing function. But every organization needs named ownership, clear accountability and real capability. Without that, duty of care remains a principle rather than a practice.

So the question is no longer “what wellbeing initiative should we buy?” It is: where is workforce health owned? Who has the authority to act when work itself is creating harm? Are support services a back-up, or a substitute for prevention? Is psychological health part of health and safety governance, or still sitting in a separate wellbeing lane? These are the questions that move wellbeing from activity to accountability.

The future of health and safety is fuller safety

The point is not that traditional health and safety was wrong. It was incomplete. We still need to prevent physical harm, with safe equipment, safe systems and serious compliance. But if we stop there, we are protecting bodies while ignoring the systems that are damaging minds, relationships, capacity and long-term health.

The next evolution of health and safety is not less safety. It is fuller safety. Safety that understands psychological harm, work design, leadership behavior, and power, voice, fairness and control. Psychological health was never separate from health and safety. We separated it culturally, not legally. Now the task is to put it back where it belongs: in governance, in leadership, in risk management, in work design, and in the boardroom. That is the shift from workplace wellbeing to Human Sustainability.

About the author

Emily Pearson is a strategic wellbeing leader and human sustainability expert who works with CEOs and boards to embed workforce health into business strategy, governance and work design. She is founder of the Wellbeing Lead Academy and author of Solving a CEO’s Blind Spot: Human Sustainability.

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