At Desert Waters’ webinar in March 2024, where the SafetyNet Accreditation program was introduced, several noteworthy comments were made regarding the relation between the provision of wellness programming and staff’s use of sick leave.
In response to our assertion that increased staff wellness could be expected to lead to long-term reduction in the use of sick leave, several participants indicated that, on the contrary, they would expect that sick leave use would increase as staff wellness increased. The reasoning was that, if wellness was prioritized in an agency, staff would take more time in a preventative way to go to medical appointments or take mental health days (which would go on the books as a sick day).
I found these comments to be very intriguing. The participants’ reasoning caught my attention, and prompted me to look into this matter a little more closely. The result is this article.
PRESENTEEISM
What some people call sick leave use or misuse is about absenteeism, not reporting to work even though there is no legitimate reason for that (at least as related to the employee’s contract with their employer).
However, what may increase sick leave use if the workforce culture becomes more wellness-conscious is a reduction in what has been called presenteeism, staff reporting to work while actually sick—if presenteeism is actually a problem in a workforce. This would be expected to lead to an increase in the use of sick leave.
Data from a sample of prison officers in Britain indicates that presenteeism may indeed be a problem in that population (Kinman, Clements, and Hart, 2019). Researchers found that a total of 84% of a sample of prison officers stated that they reported to work while sick, 53% of whom said they did that always and 31% stated that they did that sometimes. On the contrary, only 5% stated that they did so rarely, and only 11% stated that they never reported to work while sick.
Reasons given by the British prison officers for reporting to work while sick were related to the workforce culture. These reasons included (a) punitive systems regarding work absences, (b) pressure from management to report to work, (c) fears about dismissal for a poor sick record, (d) short-staffing and fear of letting colleagues down, (e) fear of disbelief and shaming, and (f) duty and professionalism.
If similar attitudes and concerns prevail among US correctional employees, that is, if presenteeism is a significant issue in US corrections, it is plausible that adoption of wellness-promoting attitudes may result in culture changes and an increase in sick leave use when staff are actually sick.
On the other hand, three other studies associate wellness with sick leave use.
An Australian study (Milligan-Saville,Tan, Gayed, Barnes, Madan, Dobson, Bryant, Christensen, Mykletun, and Harvey, 2017) explored the impact of support by supervisors on sick leave rates of fire and rescue subordinates. The intervention used involved mental health training of supervisors including how to interact with subordinates in ways that showed sensitivity toward mental health matters. It can be argued that such training would have a positive, wellness-promoting impact on the workforce culture. The results showed that, the intervention group (supervisors who took this training) showed a significant reduction in work-related sick leave (Worker’s Compensation), but not in standard sick leave (not for work-unrelated reasons), compared to a control group of supervisors who did not take that training. This suggests that a wellness-conscious approach can result in sick leave reduction when the sick leave is related to work. More specifically, during the 6-month follow-up after the training, the mean rate of work-related sick leave decreased by 28% in the intervention group and increased by 28% in the control group, a difference that was statistically significant and corresponded to a reduction of 6.45 sick leave hours per employee per 6 months.
A Canadian study of provincial correctional employees of various job roles (Stadnyk, 2003) indicated employees who met diagnostic criteria for PTSD self-reported using more sick days per year than correctional employees who did not meet such criteria. Mean days reported missed in one year by employees who met PTSD criteria was 37.01 as opposed to 13.01 by those who did not meet PTSD criteria—more than double.
A study of correctional employees of a number of different disciplines and job roles in the U.S. (Denhof and Spinaris, 2013) analyzed data in four groupings, according to whether employees who self-reported their use of sick leave met diagnostic criteria for neither PTSD and Depression, Depression only, PTSD only, or both Depression and PTSD. As in Stadnyk’s study, the results showed that the presence of these ill mental health conditions reported higher use of sick leave.
Employees who did not meet criteria for either Depression or PTSD (the Neither group) reported using 8.0 days of sick leave annually.
Employees who met criteria for PTSD only (the PTSD+ Only group) reported using 11.1 days of sick leave annually (3.1 more days compared to the group that did not meet criteria for either Depression or PTSD).
Employees who met criteria for Depression only (the Depression+ Only group) reported using 11.8 days of sick leave annually (3.8 more days compared to the group that did not meet criteria for either Depression or PTSD).
Employees who met criteria for both Depression and PTSD (the Both Depression+ and PTSD+ group) reported using 17.5 days of sick leave annually (9.5 more days compared to the group that did not meet criteria for either Depression or PTSD).
EMPLOYEES MET CRITERIA FOR SICK LEAVE DAYS REPORTED ANNUALLY
Neither Depression nor PTSD: 8.0 sick days
PTSD+ Only: 11.1 (3.1 more sick days)
Depression+ Only: 11.8 (3.8 more sick days)
Both Depression+ & PTSD+: 17.5 (9.5 more sick days)
For the number crunchers among you, it is also worthy of attention that the cost of backfill through time and a half overtime pay for these additional sick days annually associated with mental ill health is staggering given the high prevalence of these conditions among correctional staff. For example, the Denhof and Spinaris (2013) study found that the rate for custody staff scoring as Both PTSD+ and Depression+ was 21.9%, Depression+ Only 9.1%, and PTSD+ Only 12.2%.
[For those of you who are wondering about total rates, for custody staff in that study the total PTSD rate regardless of Depression status was 34.1%, and the total Depression rate regardless of PTSD status for custody staff in that study was 31.0%. These rates are similar to those found in other studies, such as Obidoa, Reeves, Warren, Reisine, and Cherniack, (2011), and Spinaris and Brocato (2019).]
These findings are one more very strong reason why staff wellness is mission critical for correctional agencies. It is not only the right thing to do, and crucial for the carrying out of operations; it is also a big savings in the long run. And as the authors note, there are less visible costs as well associated with mental ill health: “… the consequences of PTSD, Depression, and Comorbidity clearly manifest in a variety of other ways such as impaired work performance, elevated turnover rate, interpersonal conflict, etc. … financial cost estimates are likely to represent quite conservative estimates of the broader costs of elevated and unaddressed disorder prevalence in correctional settings (Denhof and Spinaris, 2013, p. 41).”
IN CONCLUSION
Here are some thoughts about what this information, even though limited, suggests regarding the impact of wellness programming on sick leave use of the correctional workforce.
If presenteeism is a significant issue in an organization, emphasis on staff wellness and staff tending to their health needs could lead to an increase in sick leave use.
An organizational emphasis on wellness and staff taking care of their health may also lead to staff taking preventative measures, such as having annual check-ups. It is unclear though to what degree that would contribute to increases in sick leave use, since such medical appointments are of short duration typically. Moreover, preventative measures may lead to diagnosing and treating health conditions early, or taking steps to prevent them altogether, leading to net reductions in sick leave use in the long run. If staff take sick leave for mental health days, these absences are typically limited to a day or so; they are not lengthy.
On the other hand, the data suggest that supportive supervisors (who presumably promote wellness principles) can help reduce sick leave use associated with work-related conditions. Additionally, the data suggest that the presence of serious mental health conditions significantly increases the number of sick days that staff report taking annually. A wellness culture with an emphasis on both prevention and intervention can be expected to lead to some reduction of these mental ill health conditions, and therefore to a reduction in sick leave use.
Question: Should a “mental health” day be considered a sick day or an annual leave day? Send us your thoughts on this at admin@desertwaters.com.
References
Denhof, M. D., and Spinaris, C.G. (2013). Depression, PTSD, and Comorbidity in United States Corrections Professionals. https://desertwaters.com/wp-content/uploads/2021/03/Comorbidity_Study_09-03-131.pdf
Kinman, G., Clements, A.J., and Hart J. (2019). When Are You Coming Back? Presenteeism in U.K. Prison Officers. The Prison Journal, 99, 363–383.
Milligan-Saville, J.S., Tan, L., Gayed, A., Barnes, C., Madan, I., Dobson, M., Bryant, R. A., Christensen, H., Mykletun, A., Harvey, S.B. (2017). Workplace mental health training for managers and its effect on sick leave in subordinates: a cluster randomised controlled trial. Lancet Psychiatry,http://dx.doi.org/10.1016/S2215-0366(17)30372-3
Obidoa, C., Reeves, D., Warren, N., Reisine, S., and Cherniack, M. (2011). Depression and Work- Family Conflict Among Corrections Officers. Journal of Occupational and Environmental Medicine, 53, 1294-1301.
Spinaris, C.G., and Brocato, N. (2019). Descriptive study of Michigan Department of Corrections staff well-being: Contributing factors, outcomes, and actionable solutions. https://www.michigan.gov/documents/corrections/MDOC_Staff_Well-being_Report_660565_7.pdf
Stadnyk, B.L. (2003). PTSD in corrections employees in Saskatchewan. Thesis for the Degree of Master of Arts in Psychology, University of Regina, Saskatchewan, Canada.
