Mine Health and Safety Act, 1996 (Act No. 29 of 1996)Notices, Guidance Notes, Compilation GuidelinesGuidance Note for the Prevention and Management of Non-Communicable Diseases and Mental Health Disorders in the South African Mining IndustryPart B: Aspect to be Addressed in the Guidance Note2. NCDS and mental health disorders programme |
| 2.1 | Establishment of a committee to run the programme |
| 2.1.1 | Based on the outcomes of the risk assessment, the employer shall establish a committee for the development, implementation and monitoring of the programme for the prevention and management of NCD and mental health disorder programme, after consultation with the employees in terms of the MHSA. The roles and responsibilities of the committee members shall be clearly outlined and documented (including those of outsourced professionals). |
| 2.1.2 | The committee shall as a minimum be comprised of the following persons: |
| 2.1.2.1 | The Occupational Medical Practitioner appointed in terms of Section 13(3)(a)(i) of the MHSA. |
| 2.1.2.3 | Occupational health nurses. |
| 2.1.2.4 | Health and wellness coaches. |
| 2.1.2.5 | Nutritionists. |
| 2.1.2.6 | The Health and Safety Committee or a representative. |
| 2.2 | Prevention strategies |
| 2.2.1 | The most common causes of NCDs are metabolic and behavioural risk factors and can be preventable by several available means. Many mental health disorders are also preventable. |
| 2.2.1.1 | Primordial prevention |
| 2.2.1.1.1 | Education and awareness: The employer to empower the employees with education relating to healthy living and positive social behaviour using relevant platforms for engagement with relevant stakeholder groups. This can take place during induction, various health and safety meetings, health campaigns and using peer educators. The following should be considered: |
| (a) | Education and awareness should include issues of discrimination in relation to race, gender, tribalism, organisational culture or inclusivity or multilingualism, culture and xenophobia. |
| (b) | It is vital to raise awareness of mental health and identify employees who may be at risk for mental health-related problems. |
| (c) | Improve awareness of available wellness services and reducing stigma should be addressed through health awareness campaigns. This will assist to normalise seeking help and motivate individuals to act when they need support. |
| (d) | Developing and implementing a specific education programme for the mental health of employees is very vital. |
| 2.2.1.1.2 | Programme and policy: Through the implementation of this programme for the prevention and management of NCDs and mental health disorders as well as alignment or synergies with other related mine policies including alcohol and substance abuse, employee wellness, workplace violence, sexual harassment, etc. |
| 2.2.1.1.3 | Environmental control: Control measures to prevent and manage environmental or occupational hygiene hazards e.g. airborne pollutants, radiation and hazards related to ergonomics. |
| 2.2.1.1.4 | Preventing and managing modifiable risk factors: Early identification and management of risk factors associated with NCDs and mental health disorders as part of primordial prevention. |
| 2.2.1.2 | Primary prevention |
| 2.2.1.2.1 | Nutrition: As mine employees spend a large proportion of their time at work, access to healthy food options and education about nutrition in the workplace can have a large impact on their diets and overall health. Implementing healthy nutrition policies in the workplaces (support the provision of healthy food options at canteens and mine hostels or residences, kitchens and hospitals) is crucial. This includes, but is not limited to lower sodium, lower sugar, lower carbonated, lower caffeine and lower saturated fatty foods and drinks options. Hydration and the consumption of fruits and vegetables is encouraged. |
| 2.2.1.2.2 | In developing and implementing the nutrition policy, nutritionist should be consulted. Employees should also be motivated about home or backyard or community gardening for access to organic food production. |
| 2.2.1.2.3 | Physical activity and social interactions: Depending on the tasks at a specific workplace, workers may be either sedentary for extended periods of time or physically active, while others work in solitude which may have an impact on the mental health of employees. Mines should implement a multi-component workplace activity programme aimed at promoting the holistic wellbeing of employees e.g. physical, mental and emotional wellbeing. These may include: |
| (a) | Gymnasiums at the mines or multi-purpose sport facilities. This would enable the possibility of mine employees practising different sporting disciplines within the same space. |
| (b) | Initiating and supporting employee participation in different sporting codes that will keep employees active. |
| (c) | Mind or board games (e.g. morabaraba, chess, crossword, etc.). |
| (d) | Encouraging the use of staircases and walking (where applicable). |
| (e) | Activities for physically challenged employees. |
| (f) | Various social interactions or events. |
| 2.2.1.2.4 | Environment: Promotion of environmental risk reduction and enhance public awareness of environmental, biological and occupational hazards (the use of a policy to control smoking areas and the monitoring of air quality). |
| 2.2.1.2.5 | Psychosocial support: Various factors can affect the mental health of employees at the mine. These include when workers experience an imbalance between perceived responsibilities and their abilities and resources, under-utilisation of talent, bullying, harassment, repetitive tasks, economic stress, precarious work and other factors and situations. In addition, mental health conditions can affect workers’ productivity and their ability to complete tasks safely. Mental health screening, the provision of wellness services and linkage to care are important. Mines should provide education and support for workers in mental health. Other interventions may include the promotion of a positive work culture, the modification of workstations, managing environmental factors, training, career progression and support groups (refer to Annexure E: WHO and ILO’s mental health policy brief provides in-depth strategies to address mental health at work). |
| 2.2.1.2.6 | Addressing violence and harassment: Violence and harassment in the workplace can be horizontal (between co-workers), vertical (between supervisor and worker) or external (between worker and the public, customers or vendors). Violence and harassment can affect the mental and physical health of workers as well as their productivity and safety on the job. Workplaces should have training, clear policies and procedures in place to protect workers. |
NOTE 5: The Mine Health and Safety Council website provides more information on measures to address violence and harassment in mines. |
| 2.2.1.2.7 | Alcohol and drug abuse: Alcohol and drug use, occurring both during working hours or outside of the workplace, can affect workers’ ability to safely complete tasks and can increase risks of diseases and injuries. Workplaces can provide cessation support and education about these substances as part of their health promotion strategies. Regulations concerning the consumption of alcohol and drugs in the workplace can also protect workers’ health and safety. |
| 2.2.1.2.8 | Harmful substance management: Harmful substances such as tobacco in the workplace can affect workers through primary exposure as well as second-hand smoke from other workers. Smoking breaks can also result in reduced productivity from workers. Smoking in the workplace also has the potential to cause fires or explosions, further posing a risk to safety and health. Providing workers with education, cessation support and regulations concerning smoking on workplace premises can protect workers from the harmful effects of smoking. |
| 2.2.1.2.9 | Promotion of healthy sleep: Working schedules, long hours, stress and other factors can impact healthy sleep, increasing the risk of workplace injury and NCDs. Promoting healthy sleep patterns will not only assist in reducing risk to NCDs and mental health disorders but also fatigue management. |
| 2.2.1.2.10 | Wellness programme: Many of the prevention strategies above may be undertaken under a wellness programme which will be part of the NCDs and mental health disorders programme. A wellness committee comprising of all relevant stakeholders including the trade unions is to be established. The committee will be responsible for the following as a minimum: |
| (a) | Wellness policy whether as a standalone or an integrated policy. |
| (b) | Wellness budget. |
| (c) | Annual health and wellness calendar aligned to the company statistics and trends and further aligned to the NDoH health calendar. |
| (d) | Health and wellness promotion materials from other stakeholders such the DMPR, the Mine Health and Safety Council, the Mineral Council of South Africa, etc. |
| (e) | Employee assistance programmes in place to address employees’ psychosocial issues. |
| (f) | The programme should cover initiatives such as a smoking cessation programme, fitness and weight loss, diet, discouraging the use of alcohol and drugs, mental health promotion, etc. |
| (g) | Adopt leading health and wellness practices and systems such as the SANS 1600, ISO 45003 etc. in order to have a structured approach to health and wellness in the workplace. |
| (h) | Collaborative efforts with the communities in which they operate to implement community health initiatives to empower the communities. This works well if the employers collaborate with the NDoH. |
| 2.2.1.3 | Secondary prevention |
| 2.2.1.3.1 | Screening: Integrate NCDs screening within the medical surveillance programme to screen high risk employees to increase the rate of early detection and diagnosis. |
| 2.2.1.3.2 | Diagnosis: Employees whose screening results indicate the need for further investigations are to be referred to PHC. Those employees with a positive diagnosis for NCDs or mental health disorders metabolic risk factors are to be linked to care to ensure that the risk factors are controlled and do not lead to the development of an NCD or mental health disorder. Employee assistance programme support is also crucial during these stages. |
| 2.2.1.3.3 | Treatment: If the mine offers PHC services on site, employees should be put on treatment and be placed on a chronic disease register for monitoring. If there are no PHC services on site, the mine should link the employees with their preferred treatment providers (general practitioners or the NDoH facilities) for the provision of treatment. |
| 2.2.1.3.4 | Linkage to care is crucial for employees diagnosed with NCDs and mental health disorders. Regular check-ups (blood test, reports from own general practitioner and the NDoH clinics) and continuous support is also important. Through the medical surveillance programme, the Occupational Medical Practitioner may deem it fit to conduct a fitness to work assessment and if the employee is no longer fit to perform work optimally, the medical incapacity process should be initiated. |
| 2.2.1.4 | Tertiary prevention |
| 2.2.1.5 | In the tertiary level of care, measures should be put in place to ensure that employees living with NCDs and mental health disorders receive care to prevent and manage related complications. This also includes rehabilitation and palliative care. |
