Safety Science 145 (2022) 105484 Available online 14 October 2021 0925-7535/© 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). “Mental health is not our core business”: A qualitative study of mental health supports in the Ghanaian mining industry Winifred Asare-Doku a,d,*, Carole James b,d, Jane Louise Rich a,d, Kwesi Amponsah-Tawiah c, Brian Kelly a,d a School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia b School of Health Sciences, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia c Department of Organisation & Human Resource Management, University of Ghana Business School, Legon-Accra, Ghana d Centre for Resources Health and Safety, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia A R T I C L E I N F O Keywords: Workplace mental health Mining Management support Mental health supports Workplace health promotion Health and safety A B S T R A C T Background: There is growing recognition of mental health aspects of workplace health and safety. Mining is a significant enterprise in the African continent; however, limited attention has been given to mental health in mining in this region. Ghana is the largest gold producer in Africa and mining contributes significantly to the economy. Mental health problems can have significant implications for the wellbeing and safety of mining employees, yet little is known about this in diverse geographic and cultural contexts. This study aims to explore mental health and available supports from the perspective of managers in mining companies in Ghana. Methods: A qualitative descriptive methodology was used to collect in-depth information from managers of in- ternational mining companies in Ghana. After receiving institutional ethics approval, all managers from the five mine sites were invited to participate in an interview. All interviews were audiotaped and transcribed verbatim for thematic analysis. Results: Three major themes were identified: Health Promotion, which explored health assessments and health promotion onsite activities; Onsite Support which included policy, human resources and medical supports; thirdly External Support, examined formal and informal supports such as family and social networks. Conclusion: Mental health was implied in various activities undertaken at the mine rather than being specific to targeting mental health directly. This study demonstrates the absence of mental health supports in mining in Ghana. Efforts should be made to incorporate mental health programs within the general health and safety policy, and an understanding of the local social norms and culture is vital. 1. Background Mental health is a state of well-being and the ability to cope with the normal stresses of life, work productively and contribute to the com- munity (WHO, 2018). The prevalence of mental health disorders in Sub- Saharan Africa is not well documented, although globally it is estimated that about 450 million people suffer from mental disorders making it one of the leading causes of ill health and disability worldwide (WHO, 2001). In Ghana, Oppong, Kretchy (Oppong et al., 2016) acknowledged the challenges in data gathering and access. They estimate about 13% of the adult population are affected by mental health disorders. The Biopsychosocial Model of Health and illness conceptualises human health and states that the interactions between biological, psy- chological, and social factors determine the cause, manifestation, and outcome of wellness and disease (Engel, 1978). These dynamic com- ponents affect the overall health and wellbeing. The Model allows for health to be viewed amongst its social and environmental backdrop, which includes the workplace and social networks (Mościcka-Teske et al., 2019). This approach to understanding health acknowledges the role of family and community, the availability of health resources, cul- tural norms, values, and health policies all have a dynamic influence on the well-being of mining employees. Discussions around mental health at the workplace has heightened among scholars and practitioners with the underlying cause largely Abbreviations: EAP, Employee Assistance Programs; WHO, World Health Organisation; PRIMA, Psychosocial Risk Management Model; MIM, Mates in Mining. * Corresponding author at: School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. E-mail address: Winifred.asaredoku@uon.edu.au (W. Asare-Doku). Contents lists available at ScienceDirect Safety Science journal homepage: www.elsevier.com/locate/safety https://doi.org/10.1016/j.ssci.2021.105484 Received 9 April 2021; Received in revised form 21 June 2021; Accepted 7 September 2021 mailto:Winifred.asaredoku@uon.edu.au www.sciencedirect.com/science/journal/09257535 https://www.elsevier.com/locate/safety https://doi.org/10.1016/j.ssci.2021.105484 https://doi.org/10.1016/j.ssci.2021.105484 https://doi.org/10.1016/j.ssci.2021.105484 http://crossmark.crossref.org/dialog/?doi=10.1016/j.ssci.2021.105484&domain=pdf http://creativecommons.org/licenses/by-nc-nd/4.0/ Safety Science 145 (2022) 105484 2 attributed to unhealthy work environment (WHO, 2017). Workplace stressors such as unrealistic deadlines, job insecurity, isolated working conditions, physical risks, and work overload may put a high strain on the mental health of employees (Harnois and Gabriel, 2000; Rajgopal, 2010). The mining environment is a pressured workplace with unique issues such as high psychological job demands, long working hours, shift work in remote locations, poor sleep habits, miner fatigue, living away from family and limited access to support services, all with the potential to influence the mental health of employees (McLean, 2012; Roche et al., 2016; Battams et al., 2014; Sadeghniiat-Haghighi and Yazdi, 2015). Shift work, heavy workload and low staffing especially have been noted to be one of the causes of employee fatigue and sleepiness at work (Magnavita, 2014). Late night working or a night without sleep, causes sleepiness while forceful physical exercise during the daytime causes fatigue as found in the mining population (Sadeghniiat-Haghighi and Yazdi, 2015; Bauerle et al., 2018). These unique issues more likely cause decreased alertness, slow response time, impaired judgement and decision-making ability which have safety-related consequences (Mag- navita, 2014). Common mental health problems that have been identi- fied in the mining industry in Australia and China are depression (Considine et al., 2017; Joyce et al., 2013; Molek-Winiarska and Żołnierczyk-Zreda, 2018); anxiety (Tynan et al., 2017; Velander et al., 2010; Liu et al., 2015), and stress (Joyce et al., 2013; Molek-Winiarska and Żołnierczyk-Zreda, 2018; Torkington et al., 2011). Whereas the importance of mental health in the mining industry is gaining recogni- tion in other parts of the world, there are very limited studies concerning psychosocial and mental health issues in the mining industry in Ghana (Amponsah-Tawiah et al., 2014). The mining sector is important and a major driving force to the economy of Ghana (Kim et al., 2015). Ghana has 23 large-scale mining companies producing bauxite, gold, manga- nese and diamonds, and about 300 registered small-scale mining groups and support services (Kim et al., 2015). Mental health problems can impact the wellbeing and safety of mining employees, yet little is known about this in Ghanaian mining companies. According to WHO estimates, only about 5–10% of the workers in developing countries and about 20–50% of workers in industrialized countries have access to adequate occupational health services such as occupational medicine and wellness promotion activities (WHO, 2003). Ghana does not have a national policy on occupational health and safety management yet although there are some regulations around health and safety such as the Factories, Offices and Shops Act 1970, (Act 328), the Mining Regulations 1970 (LI 665), and the Labour Act 2003 (Act 561) (Asumeng et al., 2015). The existing regulations do not have provisions for workplace psychosocial risk assessment (Chirico et al., 2019). There is however a policy and guideline on occupational health and safety for the health sector (Asumeng et al., 2015). With the limitation of non-existent national occupational health and safety policies, employers may not be obligated to ensure this at the workplace. However, this study brings attention to the necessity of ensuring encompassing health policy at the workplace including mental health. Like that of other jurisdictions, the Ghanaian mining industry has a focus on occupational health and safety with all the mining com- panies having health and safety departments as well as being equipped with medical facilities (Minerals and Mining, 2006). However, the in- dustry has been primarily focused on safety issues, most of which are engineering in nature. There has been less concentration on the psy- chosocial and mental wellbeing of the employees. Although mental illness is a serious psychological condition, it is often perceived as less legitimate than physical disorders or conditions hence little or no attention is given to it (Follmer and Jones, 2018). The provision of mental health services is left to the discretion of each mining company with many unprepared to support those with mental illness in a way reflected in industry polices. However the workplace is identified as an ideal place to promote the mental health of employees (Petrie et al., 2018). Health promotion and prevention are somewhat similar but different. Health promotion enhances healthy living and general wellbeing, empowering people to increase control over their health through health literacy efforts and activities (WHO, 2020). Health pre- vention minimizes the burden of diseases and associated risk factors (WHO, 2020). Similarly, mental health promotion involves a positive view of mental health rather than emphasizing mental illness (WHO 2004). Mental health promotion involves actions that improve psychologi- cal well-being by creating an environment that supports mental health (WHO, 2018). Employee assistance programs (EAP) are an example of a work-based program designed to identify “troubled employees”, moti- vating them to resolve personal issues, and providing access to coun- selling (Sonnenstuhl and Trice, 2018). Studies in Australia, Japan, and USA identify EAPs as a tool to assist in the management of mental illness of employees in diverse occupations (Torkington et al., 2011; Nakao et al., 2007; Richmond et al., 2016). Other mining studies in Australia and China have reported that creating a positive workplace culture is an investment in reducing work-related stress. Besides, management sup- port has been found to improve mental health (McLean, 2012; Liu et al., 2015). It is unclear the state of mental health supports available in the mining industry in Ghana. Furthermore, there is currently no published study about the type of mental health supports offered by the mining industry in Ghana, nor acknowledgement of cultural feasibility for such supports. This study aims to explore mental health and available sup- ports from the perspective of managers in mining companies in Ghana. To capture these views and perspectives, a qualitative in-depth inter- view study was used to understand supports available. 2. Methods 2.1. Research design This qualitative descriptive study used semi-structured interviews to gain an understanding of the mental health support systems available within mining companies for employees. Qualitative descriptive study seeks to discover and understand the perspectives and worldviews of the people (Caelli et al., 2003). It offers the opportunity to gather rich de- scriptions about the mental health supports available for employees. The focus of the study was exploratory; to gain an understanding of work- place based mental health supports from the perspective of managers in the mining industry and provide insight into this area. The Human Research Ethics Committee of the University of Newcastle (H- 2018–0194) and the Ghana Chamber of Mines research committee (074/M2/18C) approved the study 3. Research setting This study was conducted in five international gold mining com- panies in Ghana. All participating mining companies were international conglomerates. Interviews were conducted at each mine site with managers at a convenient time and location for the consenting participants. 3.1. Population/ sample recruitment The population for the study was managers of gold mining com- panies in Ghana. All managers were invited to participate in the study and the convenience sampling technique was used to recruit those interested. Inclusion criteria to participate were; being a manager, Ghanaian, and permanent or contract employee. All managers, including high level, middle level and lower-level managers were invited to participate and received an information statement describing the study that explained that participation was voluntary. Interested managers contacted the authors via email, phone or in-person to express interest, and a mutually convenient time was agreed upon for an inter- view. Consent forms were signed prior to the start of interview on the scheduled day. W. Asare-Doku et al. Safety Science 145 (2022) 105484 3 3.2. Instruments A semi-structured interview guide was developed based on relevant literature (see Additional file 1). This was peer-reviewed by authors for appropriateness. The guide included open ended questions to encourage discussion with probes used to expand on responses. Questions were modified based on the responses given by the participants to allow for further probes during the interview (Smith et al., 2003). The semi- structured interview allowed for flexibility and enhanced a deeper exploration of the topic under study. Some of the items on the interview guide included: “Do you think the workplace has a role in supporting mental health of its employees?”, “What forms of support systems are you aware of for workers who are having emotional problems/stress at the workplace?” and “What happens when a worker has a mental health issue? What if anything is done for the person”? 3.3. Data collection procedure The Ghana Chamber of Mines introduced and facilitated contact with the mining industries. The Chamber is the main minerals industry as- sociation in Ghana and oversees all mining companies in Ghana. The Chamber provided mining companies with information statement out- lining the study and inviting them to participate in the research via email. The Head Office of the mining companies provided contacts to individual mines at the various locations. Interested managers of the mines were requested to contact the researcher via phone or email for more information about the research, express interest, and to arrange appropriate time for participation of employees. Upon receiving consent for participation by each mine site, a mutually convenient time and location for the interview was arranged with participants. At the start of the interview, consent to record was re-confirmed and WAD explained their rights of confidentiality and informed participants they could request a copy of the recording after transcription. Interviews were recorded with a philips digital recorder and took approximately 30 min. Data collection spanned from December 2018 to March 2019. 3.4. Data analysis Recorded interviews were transcribed verbatim and imported into the NVivo version 12 software to help organize and analyse the data. NVivo (QSR International Pty Ltd, 2018) is a qualitative data analysis computer software package that is used to assist in classifying and sorting data, and is used to identify themes within data. Inductive the- matic analysis was conducted with interesting patterns being high- lighted in the text (Braun & Clarke, 2006). Mixed coding techniques were used; descriptive coding summarised the primary topic and in-vivo coding used direct language of participants (Saldaña, 2015). Each interview transcript was read several times to familiarise with the data, then potential emergent codes were noted. Data was coded line by line and recurring texts were identified and coded systematically. Initial codes were sorted into potential themes and superordinate themes, then re-categorised and redefined. Data saturation was reached prior to the end of coding and repetition of concepts became consistent. Several steps were undertaken to ensure the trustworthiness of the research. These included peer review via ongoing discussion with the research team on data coding and analysis processes and an audit trail involving examining the coding and analysis processes and interpretation of findings (Cohen and Crabtree, 2008). 4. Results Nineteen managers participated in the study, two females and seventeen males, from five international mining companies. Four par- ticipants were from site one, three from site two, three from site three, one from site four, and eight from site five. Job roles of participants included Human Resource Managers, Occupational Health and Safety/ Health professionals, Mining Managers, Public Relations Managers and Security Managers. These roles are further classified into operational and non-operational roles. The demographic profiles of participants are presented in Table 1. Three major themes were identified in the study: health promotion, onsite support, and external support. Sub-themes were developed for each major theme; health promotion (health promotion site activities and health assessments); onsite support (policy, supervisor support, management support, job accommodation/return to work (RTW) and onsite medical support); external support (formal support and informal support). Fig. 1 below presents a visual summary of identified themes and subthemes. 4.1. Health Promotion The mine organises activities, programs, and events for employees to promote health. Some of the health promotion activities reported were recreational activities, wellbeing programs, stress management pro- grams, financial literacy programs, social events, fatigue management programs, and drug and alcohol testing. Health assessments included medical assessments and tests organised for employees to monitor health. 4.1.1. Health promotion onsite activities Workplace wellness programs, seminars and workshops are organ- ised aiming to reduce the causes of stress and promote health of em- ployees. Some of the programs identified were indirectly related to mental health. Financial wellbeing has a significant impact on emotional and mental health, and sites organised financial literacy programs to assist employees. “So the company does trainings like financial literacy training, which tends to help employees manage their funds properly, and in my opinion, I think that it is a very good driver of mental health. Because if people finances are not good it will impact on their state of mental health” (Site 1) Fatigue is a state of physical and/or mental exertion that reduces the ability to work safely. It is caused by prolonged periods of not resting. Fatigue management programs were frequently organised whiles mod- ern and sophisticated technology is also used to monitor fatigue of employees in high-risk job roles. This was to enhance safety and pro- ductivity whiles managing fatigue in the workplace “What we do for the fatigue management training is we have inter- mittent breaks on the job. So that people will relax…. For instance, a dump truck operator who is just doing load and haul, will be driving for almost 12 hours and if you don’t regulate that, complacency sets in. So, you manage that fatigue management” (Site 3) Other initiatives included wellness programs to maintain or improve wellbeing through stress management, diet, exercise and illness Table 1 Demographic profile of groups (n = 19). Job roles Participants Gender • Operational managers (Engineering Manager, Health, Safety & Environment Manager, Underground Mine Manager, Mine Manager, Industrial Hygienist) • Non-operational managers (Human Resource Manager, Information Systems Manager, Occupational Health Doctor, Wellbeing Administrator, Security Manager, Communications and External Relations Manager, Project Manager, Learning and Development Superintendent) 8 11 8 males 9 males; 2 females W. Asare-Doku et al. Safety Science 145 (2022) 105484 4 prevention; “We do wellness programs. The wellness programs include walking, running all to create the awareness that as a human being you need to stay healthy” (Site 1) Although social events were reported as promoting health, a chal- lenge identified was the timing of the event which was not accessible to employees because they had to travel to see family on weekends. “…so on weekends that’s when you want to travel and see family… Then Friday will be travel days, then you have Saturday and Sunday and come to work on Monday” (Site 5) In contrast, at one mine site, one manager reported he had not attended any training or seminar on mental health awareness; “I haven’t seen any trainings or workshops before on site. I have seen blood donations and health walks, but I haven’t seen anything like mental health awareness” (Site 2) 4.1.2. Health assessments Health assessments may be considered a form of health prevention. Periodic health assessments were conducted at all mine sites by per- forming physical examinations which included HIV tests, cholesterol, substance use, blood pressure (BP), and diabetes test. These health as- sessments identified the specific needs of employees and how to address them. However, the annual medical review was basically only for physical health. “Everybody is monitored, and everybody goes through a compre- hensive medical review once a year, at least once a year” (Site 2) However, it was also recognised that attention should also be given to psychosocial risk assessments instead of only focusing on physical risks; “if you come to the mining industry, most of the risk assessment that we do are on physical hazards…noise, dust, vibration and all that but we also need to look at psychosocial risk assessment where you are looking at factors that influence peoples mental health, like what are the demands” (Site 1) In addition, at the entrance of each of the mine site, a breathalyser is placed to screen for alcohol and other drugs. This is a daily routine as part of health and safety measures on the mine site; “We do random drug test, and, on some occasions, we also get pos- itive drug test for cannabis (Site 4) 4.2. Onsite support Onsite support refers to the systems and processes available at the mine site for employees. This theme explored mental health support systems available on each mine site. The sub-themes identified were policy, supervisor support, management support, job accommodations/ RTW, and onsite health support. Mental health was referenced infre- quently and was implied through other activities and programs at the mine rather than being explicitly noted. 4.2.1. Workplace policy Each of the five mines reported having policies relating to the pro- vision of a safe working environment for employees, which included aspects of mental health. Safety was identified as critical to mining operations and various related policies were highlighted. Workplace policies supporting employee mental health were identified as fatigue policy, wellbeing policy, safety policy, alcohol, and other health pol- icies. No site specifically identified having a mental health policy. Two sites reported having a wellbeing policy that seemingly addressed mental health. “We have a policy on fatigue management. And we have told the guys “raise your hands up, be confident, that’s the kind of people we want”. If you are fatigued, we will not label you as lazy” (Site 1) “Yes we have a wellbeing policy and EAP is covered in it” (Site 3). Provisions for employees who have mental health problems were made at the mine site despite not having a mental health policy, how- ever the development of such was recommended; “…in providing support you need to have a clear-cut policy, the workplace can develop policies on mental health and that policy would guide practice. But unfortunately [the company] does not have any mental health policy…to the best of my knowledge I have not seen any policy on mental health. So that policy should incorporate accepting people with mental health problems, helping them rein- tegrate back to work. The company should if possible, contract the services of mental health specialist to support people with mental health problems.” (Site 1). In contrast although a participant felt a mental health policy for Workplace interventions Health promotion onsite activities Health assesssments Health promotion Onsite support Workplace policy Supervisor support Management support Job accomodation/RTW Onsite medical support Formal support Informal support External support Fig. 1. Major and subthemes identified. W. Asare-Doku et al. Safety Science 145 (2022) 105484 5 employees was not needed as the focus of the mine is production, there was support for reviewing health policies to include mental health. This sentiment is emphasized in this quote; “We don’t have a specific policy that addresses mental health… Mental health is not our core business. Our core business is mining gold”... I will support reviewing policies to ensure they support employees’ mental health (Site 2). All the participating mining companies are international companies and comply with international standards. Some mining companies had well-being departments in addition to the health service available at the mine site. Although occupational health and safety was unanimously viewed as important at the workplace, views differed relating to the need for a specific mental health policy and for others health policies included mental health. However, the attitude of the participants did not relate to tensions between the general approach and local approach but rather what was considered more important by the management at each mine site. All participants therefore embraced the idea of improving the mental health and well-being onsite, but that it had not been prioritised. 4.2.2. Supervisor support Direct supervisors provided support to employees at work regarding their general health and well-being. Referrals were part of the support provided, hence supervisors would refer employees to the human resource department or to the clinic when there was any health issue for further assistance if it was not in their capacity to assist. Supervisors also provided support with informal conversations about employees’ overall well-being; “Personally, what I do every morning is that if I don’t see or hear from my employees, I go to their offices to check how they are doing … so by chatting with them I can know if they have any challenge or problems… they are free to come to me when they have problems. So we have fun and eat together just to know and observe, then if something about them changes, I can identify it” (Site 5) “When you give that person a job and is unable to do it you just have to find out what his problem is…However if for one reason or the other you don’t feel fine, when you call your supervisor, he will give you time to rest” (Site 2) A barrier to employee seeking support that was identified included a culture of not discussing personal problems at work. Building commu- nication bridges to allow employees to freely engage with their super- visors was recommended; “the only way to know these things [mental health problems] is if you have constant communication with the employees whether it is formal or informal…if you actually set out time to have talks and chats with your employee to find out, what is actually going on in the person’s life, then those things come out [mental health problems]… We must put in structures to enable the person go to his boss, and tell him that, look I am not well in my mind, I don’t feel good” (Site 1) 4.2.3. Management support Managerial support has been identified as a key influence in employee mental health. Management in this context refers to the human resource department, managers, and heads of department at the mines. Management offer support by providing internal and external referrals to employees if employees are unwell. “I think that our management has gone beyond the stage where they see mental health problems as a recalcitrant behaviour or something, but we also view it as a form of illness that organisations need to appreciate and support people with such conditions” (Site 5) “[management] values the health of employees so if a mental health issue should crop up, it will be taken equally seriously as physical health” (Site 1) 4.2.4. Job accommodations/RTW Another form of onsite support provided for employees is job ac- commodations. This involves job adjustments and accommodations for employees who have recovered from either physical or mental health conditions and those returning from leave. Some employees work from home if needed and for others who return to work after an illness or injury, they complete light duties until they can perform their regular duties. “When they [employees] return, we do graded return to workplace. We just don’t reintroduce them to their usual routine…the shift is 12 hours but somebody returning from leave we can start him on 6 or 8 hours and then to do day shifts rather than night shifts” (Site 4) “For instance, we do 12 hour work but we give [employees] 8 hour work” (Site 1) “…We re-evaluate the job and check whether it’s realistic for one person to performing such work” (Site 2) Job accommodation is provided to employees on return from leave. For instance, employees working the shift system are scheduled to only day shift for a period before returning to night shift. This is to help employees adjust to the work routine and rhythm of shift work. 4.2.5. Onsite health support Onsite health facilities were located at each mine site to provide medical services to employees. These included onsite hospitals accessed by employees, their families and members of the community. The medical facilities are the first point of contact for employees who are unwell, with more serious cases referred to other general hospitals for care. “We have an onsite clinic with competent doctors who ensure that employees get the right treatment” (Site 2) “We have occupational health doctors’ onsite” (Site 3) “We have medical facility on site” (Site 5) In addition, two sites had well-being departments to support healthy behaviour and psychological well-being in the workplace. Psychological support was also recommended in addition to existing services; “We need counsellors in place who can counsel people who need it” (Site 5) 4.3. External support External support refers to receiving assistance outside of the mine site which was identified to be helpful. Participants explained that formal support included services provided by professionals who were not onsite or under the direct management of the mine. Informal support referred to the wider social network such as family. 4.3.1. Formal support Some mines provided EAPs, outsourced professionals and made external referrals to hospitals for their employees. “Yes, we have what we call EAP…there is an opportunity to get support and assistance from them and its confidential” (Site 5) “Sometimes we do bring in the clinical psychologist to attend to certain conditions” (Site 1) Unions were also identified as a formal external support as they are independent of the mine. Two of the sites had union groups and pro- vided support to its members; W. Asare-Doku et al. Safety Science 145 (2022) 105484 6 “If they [employees] actually find out that they are under stress or they have a condition that is not allowing them to perform at their best, they [employees] have their supervisor to talk to, if he [employee] is not comfortable to talk with supervisor, he can talk to the union leader, who then approaches the HR” (Site 1) 4.3.2. Informal support Informal support included the support provided by the family, social networks and the community of employees. In addition, the stress of the job was identified as being further compounded by domestic stressors. “Some people [employees] come and you see their stress is not because of the work but some situation in the house. If we [man- agement] find out that the situation is beyond us, we then try to get the family involved” (Site 1) In addition, a process of negotiating domestic roles of employees with their spouses to enable them to get the needed rest for work was noted; “In the course of operating a machine at work, and they start to doze, the fatigue tracker picks it up and sends the information to the control room. If that happens, employee’s supervisor will ask him what he did during his off-day to ensure he had enough rest…su- pervisor counsels him and sometimes [management] brings [em- ployees] family and wives to the mine for a tour. The family is informed of how stressful mining is so when [employees] finish work, wives should not give [employees] any stress or household chores to do… [management] informs them to allow their husbands to rest. The wives might think otherwise but from the job perspective, the worker needs rest” (Site 5). What this exploratory data indicates is that mining companies have instituted strong policies around health and safety to however mental health is implied rather than being explicit, with data suggesting that some of the activities and programs within the companies indirectly influence the mental health of employees. 5. Discussion The WHO recognises mental health promotion in the workplace as a global priority (WHO, 2002), and this study contributes valuable knowledge on supports available in mining in Ghana. This is the first study to explore and identify mental health supports available in the Ghanaian mining industry from the perspective of management. This is an important research as managers and higher-level staff can play a gate- keeper role to service access for employees with mental health issues. The identified themes were Health Promotion, Onsite Support and External Support. Each theme included subthemes addressing various aspects although mental health supports were not specifically identified. This finding is common among other companies worldwide (Dalsbø et al., 2013; Joyce et al., 2016). All the participating mining companies complied with the interna- tional occupational health and safety regulatory framework. This was evident in the fact that the various health and safety representatives, together with other managers interviewed, gave a positive account of the safety protocols which were consistent in all the sites visited and with what was set out by the regulator. The Ghana Minerals Commission regulations stipulates among other things a maximum of 8 working hours per day or 40 hours per week (7 days). However, through a petition to the regulator (Ghana Minerals Commission) by the Ghana Mine Workers Union, workers are permitted to work overtime to earn extra income. Ghana as a country does not have an overarching policy on occupational health and safety (Asumeng et al., 2015). However, the Mining and Minerals Act, which regulates the mining industry has sec- tions which cover occupational health and safety albeit focussing on physical safety issues to the almost neglect of the psychological and social issues. The Minerals Commission is empowered by the Act to regulate occupational health and safety related activities in the sector and has been firm in ensuring compliance. The results of this study demonstrate that while employers may be cognisant of the benefits of mentally healthy workers, they remain un- certain about the corporate responsibility to provide direct mental health care for employees (Pescud et al., 2015). A mental health policy for the workplace defines the vision for improving the mental health of the workforce and establishes a model for action (WHO, 2005). There are factors that may hinder the progression of mental health policy in the workplace although the mining companies may follow international standard operations. Generally, mental health is considered a low pri- ority for the government and a seldomly discussed topic in the Ghanaian culture and the workplace (Bird et al., 2011). Also the Ghanaian cultural context is deeply spiritually-oriented and cultural norms prioritise males as strong and tough, therefore admitting to mental ill-health can be seen as a sign of weakness and male impotence (Owusu-Ansah and Donnir, 2017). Further, masculine ideals such as the male-dominated culture in mining, reluctance to seek help and stoicism is an added factor (Seaton et al., 2018). In addition, spiritualisation of mental disorders in the Ghanaian context explains why it is not seen as a medical issue to be addressed through formal clinical structures, hence rely on the extensive psychosocial support within the Ghanaian society provided by imme- diate and extended family (Owusu-Ansah and Donnir, 2017). Most people do not consider mental illness as a physical health problem, but consider it as spiritual health and so often resort to faith or traditional healers for help (Ae-Ngibise et al., 2010). For the religious, their mental health needs might be met through their faith healers because most mental health issues are considered as spiritual breaches (Owusu-Ansah and Donnir, 2017; Idemudia, 2004). Moreover, faith healers sometimes serve dual roles; religious professionals and mental health professionals, especially in areas where there are insufficient mental health resources (Kehoe et al., 2018). Religion and cultural norms are important sociocultural components in the Biopsychosocial Model of Health and illness, these must be considered in identifying appropriate help-seeking approaches and mental health interventions in the Ghanaian mining context. In other industries, mental health policies aid implementation of strategies to improve mental well-being (Rajgopal, 2010). In the Australian coal mining industry for instance, there is the inclusion of mental health programs within the general health and safety policy (Kelly et al., 2012). In addition, adopting the Psychosocial Risk Man- agement Model (PRIMA), which is the management of psychosocial risks and the promotion of (mental) health, and safety at the workplace and beyond (Leka and Cox, 2008) is recommended to assist industry to include mental health as part of workplace policy and process. Supervisor and management support were considered a resource for employees; employees received support to help in their job roles from supervisors and colleagues. Management support and employee engagement were therefore positively identified, however other studies perceive management support negatively. In Australia, FIFO (Fly-In-Fly- Out) employees reported that although mental health support was available it was negatively viewed and not accessed by employees for fear of losing jobs (Gardner et al., 2018). This study identified that in Ghanaian mining, management attempts to break hierarchical barriers at work and relate more positively with employees. This is uncommon in other Ghanaian companies (including the public sector) where the workplace is very formalised and hierarchical with respect to authority (Williams and Innovation, 2019). Thus, although the mining industry is trying to incorporate this with the culture of an open-door policy to allow for more employee engagement, this social norm of reverence and respect for the elderly and persons in higher positions still exists. To break this sociocultural norm requires a deliberate effort from man- agement to implement a culture of informal relationships across the hierarchy. Though many Ghanaian mining companies have interna- tional standards for workplace health and safety, the company culture W. Asare-Doku et al. Safety Science 145 (2022) 105484 7 should reflect the values, beliefs and social norms of the Ghanaian people to influence the behaviour and attitudes of employees. However, this was not obvious from this study’s results, it became clear that little attention was given to cultural norms and practices regarding mental health support (Oppong et al., 2016). The workplace is an ideal setting for health promotion, and it is common across organisations and companies to organise physical ac- tivities, wellness programs, and other events in promoting wellbeing (Hutchinson and Wilson, 2012). Overall health promotion activities identified were well-being and stress-reduction events, financial literacy programs, social events and fatigue management programs. According to the Centre for Disease Control and Prevention, workplace health promotion programs become successful when mental and physical health interventions are combined (CDC, 2019). Companies that have incorporated mental health supports as part of the well-being programs have seen benefits such as positive workplace outcomes (Wagner et al., 2016). Indeed, as a culture in the mines, all the participating mining companies organise daily toolbox meetings where they receive health and safety briefings and discuss other occupational health and safety concerns before the commencement of work. Inclusion of mental health within the workplace health and safety policy, programs and toolbox meetings within the mining industry will help to addresses mental health. While there are limited in-house well-being programs and ser- vices on the mine site, the results showed that mining companies are supportive and provide both physical and mental health care for em- ployees when this is required. The mining companies that operated union groups advocate on behalf of employees by working with man- agement to help resolve workplace issues. Although in this study mental health was implied in occupational health and safety, fatigue management, and the well-being policies of the mining companies, there was no evidence of mental health supports at the mine. Although these policies are effective in maintaining health and wellbeing, in the absence of a direct or inclusive policy, there is no motivation to provide a workplace mental health strategy. This lack of motivation stems from the concern that mental health policy may reduce profits, insufficient resources of the organisation to tackle mental health and the belief that interventions for mental health problems may not be effective. Strategies to overcome these barriers may include demon- strating to stakeholders that addressing mental health issues can improve productivity leading to returns for the organisation; educative information sessions and consultation with stakeholders about the effectiveness of addressing mental health at work; developing low- resource mental health strategies and providing evidence that chal- lenges the myths of mental illness (WHO, 2005). Expanding the occu- pational health and safety policy to include a mental health policy provides the needed pragmatic step to improve the well-being of em- ployees. The workplace mental health policy needs to be based on a comprehensive needs analysis of the issues in mining. The needs analysis might include human resources data (e.g. absenteeism records or the number of resignations); occupational health and safety data (e.g. ac- cidents or risk assessments), financial data (e.g. the cost of replacing employees who are on long-term disability leave) and health data (e.g. common health and mental health problems among the employees) (WHO, 2005). 5.1. Conclusions This study explored mental health supports from the perspective of management and can assist with the establishment of mental health supports in mining companies. Creating awareness for employees through workplace health promotion, onsite support mechanisms, and external supports demonstrates a level of encouragement around mental health and well-being in the workplace. While the findings are most applicable to the Ghanaian context, they may have relevance for inter- national settings given the universal applicability of workplace mental health promotion and the growing trend towards the implementation of health and well-being programs in the workplace. 5.2. Recommendations All the mining companies that participated in the study are global and comply with international operational standards, this has resulted in a disconnect for local customs, and an internalisation or blanket approach to work, health and safety (Vignali, 2001). This means that, often nuanced approaches to mental health may be overlooked, for example local customs, appropriate language or social norms are neglected which may lead to increased barriers to access. Although an international standard is important, understanding the local context and social factors when addressing mental health and developing in- terventions should be considered. For instance, in Australia, the “mateship” cultural idiom has been harnessed and used to develop the Mates in Mining (MIM) program. MIM is an educational program that aims to help improve mining industry employees’ ability to recognise mental health problems (Tynan et al., 2018). Consequently, we need much deeper grassroots understanding of mental health in the Ghanaian context to best develop mental health supports and interventions. Working with managers is one of the first steps. An investment into mental health research across the resource in- dustry will help to build evidence, develop policies, and design appro- priately tailored interventions for employees (Deloitte, 2017). The industry can also partner with mining companies and other stakeholders to learn from best practises elsewhere. It is recommended that the Ghanaian mining companies combine both international and local ap- proaches in providing culturally sensitive mental health supports and interventions in mining. Culture, as identified in the Biopsychosocial Model influences mental health in various ways, from the formation of a disorder, its clinical manifestation and what is deemed as an appropriate coping response or help seeking behaviours (Owusu-Ansah and Donnir, 2017). Furthermore, primary and secondary prevention of mental health problems are recommended. Primary prevention includes measures that prevent the onset of mental health problems. This would enable mining companies to promote mental health and well-being as part of broader health and safety policy. Workplace health promotion should include mental health programs within the general health and safety processes and procedures to provide a healthy work environment. Moreover, as part of increasing mental health awareness, it is recommended that employees become actively engaged in their own mental health literacy, well-being and be encouraged to participate in workplace programs around mental health and strategies that promote mental well-being. A recommendation for future studies would be to follow an inte- grative approach to explore supports and interventions from the view- point of employees. Also, the PRIMA is recommended as a risk management framework to minimise psychosocial risks in the work- place. Future studies may build on this research to explore contextual supports and interventions that may work with this population. It would also be helpful to capture qualitatively the experiences and perspectives of employees regarding mental health supports that would be suitable. 6. Limitations Limitations of the study must be acknowledged. This study focused on the experience of management staff in the context of mental health supports. Participants (managers) were asked whether they thought the workplace had a role in supporting mental health of its employees and how it was done. They were also asked about preventative measures that minimise mental health problems and improve well-being. Managers were not directly asked about future intentions or anticipated problems with pursuing this, as this study was focused on current practice. In Ghana the field of mental health is under-developed with the Mental Health Act still in its nascent stage of implementation. It was not sur- prising that the mining companies did not have policies on mental health but referred any suspected cases to the few experts in the W. Asare-Doku et al. Safety Science 145 (2022) 105484 8 treatment centres dotted across the country. Consequently, the views on supports from the employees’ perspective remain under-researched. Acquiring a better understanding of the needs of employees would assist in the development of supports and interventions offered by the mining companies to employees. This would contribute to a more comprehensive understanding of this phenomenon. However, this research is a stepping stone to developing this knowledge base. The aim of this study was to explore available mental health supports, hence did not determine outcomes of these supports. Future studies are required to explore the success and effectiveness of supports. Declarations Ethics approval and consent to participate The Human Research Ethics Committee of the University of New- castle approved the study (H-2018-0194). Consent was sought from participants and information stated that the research is voluntary. Codes were given to each participant to preserve confidentiality and ano- nymity and all reporting of data used amalgamated or deidentified re- sponses. Signed consent forms and codes were separated to further ensure anonymity. Consent for publication Not applicable. Availability of data and materials For researchers who meet the criteria for access to confidential data, the data are available through the University of Newcastle Human research ethics committee giving the reference number (Approval Number H- 2018-0194). Requests for data access may be sent to human- ethics@newcastle.edu.au. Funding None. Authors’ contributions All authors conceptualized the study concept and design. WAD collected the data, WAD and CJ analysed the data. WAD drafted the manuscript and CJ, JLR, BK and KAT interpreted the results, edited, and approved the final manuscript. All authors critically and substantively revised the manuscript for important intellectual content. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Acknowledgements We are grateful to the Ghana Chamber of Mines, participating mining companies, and study participants. References Ae-Ngibise, K., Cooper, S., Adiibokah, E., Akpalu, B., Lund, C., Doku, V., et al., 2010. Whether you like it or not people with mental problems are going to go to them’: A qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana. Int. Rev. Psychiatry 22 (6), 558–567. Amponsah-Tawiah, K., Leka, S., Jain, A., Hollis, D., Cox, T., 2014. The impact of physical and psychosocial risks on employee well-being and quality of life: the case of the mining industry in Ghana. Saf. Sci. 65, 28–35. Asumeng, M., Asamani, L., Afful, J., Agyemang, C.B., 2015. Occupational safety and health issues in Ghana: strategies for improving employee safety and health at workplace. Int. J. Business Manage. Rev. 3 (9), 60–79. Battams, S., Roche, A.M., Fischer, J.A., Lee, N.K., Cameron, J., Kostadinov, V., 2014. Workplace risk factors for anxiety and depression in male-dominated industries: a systematic review. Health Psychol. 2 (1), 983–1008. Bauerle, T., Dugdale, Z., Poplin, G., 2018. Mineworker fatigue: a review of what we know and future decisions. Min. Eng. 70 (3). Bird, P., Omar, M., Doku, V., Lund, C., Nsereko, J.R., Mwanza, J., et al., 2011. Increasing the priority of mental health in Africa: findings from qualitative research in Ghana, South Africa, Uganda and Zambia. Health Pol. Plan. 26 (5), 357–365. Caelli, K., Ray, L., Mill, J., 2003. “Clear as mud”: Toward greater clarity in generic qualitative research. Int. J. Qualitat. Methods. 2 (2), 1–23. CDC. Mental Health in the Workplace 2019 [Available from: https://www.cdc.gov/ workplacehealthpromotion/tools-resources/workplace-health/mental-health/index. html. Chirico, F., Heponiemi, T., Pavlova, M., Zaffina, S., Magnavita, N., 2019. Psychosocial risk prevention in a global occupational health perspective. A descriptive analysis, Int. J. Environ. Res Public Health. 2019;16(14):2470. Cohen, D.J., Crabtree, B.F., 2008. Evaluative criteria for qualitative research in health care: controversies and recommendations. The Annals of Family Medicine. 6 (4), 331–339. Considine, R., Tynan, R., James, C., Wiggers, J., Lewin, T., Inder, K., et al., 2017. The contribution of individual, social and work characteristics to employee mental health in a coal mining industry population. PloS one 12 (1), e0168445. Dalsbø, T.K., Dahm, K.T., Austvoll-Dahlgren, A., Knapstad, M., Gundersen, M., Reinar, L. M., 2013. Workplace-based interventions for employees’ mental health. Norwegian Knowledge Centre for the Health Services, Oslo. Deloitte, 2017. At a tipping point? Workplace mental health and wellbeing. Deloitte. Engel, G.L., 1978. The biopsychosocial model and the education of health professionals. Ann. New York Acad. Sci. 310 (1), 169–181. Follmer, K.B., Jones, K.S., 2018. Mental illness in the workplace: an interdisciplinary review and organizational research agenda. J. Manage. 44 (1), 325–351. Gardner, B., Alfrey, K.L., Vandelanotte, C., Rebar, A.L., 2018. Mental health and well- being concerns of fly-in fly-out workers and their partners in Australia: a qualitative study. BMJ Open 8 (3). Harnois, G., Gabriel, P., 2000. WHO. Mental health and work: impact, issues and good practices. Hutchinson, A.D., Wilson, C., 2012. Improving nutrition and physical activity in the workplace: a meta-analysis of intervention studies. Health Promot. Int. 27 (2), 238–249. Idemudia, E.S., 2004,. Mental health and psychotherapy through the eyes of culture: lessons for African Psychotherapy. Unifying Aspects Cultures. 230–232. Joyce, S., Modini, M., Christensen, H., Mykletun, A., Bryant, R., Mitchell, P.B., et al., 2016. Workplace interventions for common mental disorders: a systematic meta- review. Psychol. Med. 46 (4), 683–697. Joyce, S.J., Tomlin, S.M., Somerford, P.J., Weeramanthri, T.S., 2013. Health behaviours and outcomes associated with fly-in fly-out and shift workers in Western Australia. Int. Med. J. 43 (4), 440–444. Kehoe, N.C., 2018. The role of religious professionals in ethocal descison making in mental health. In: Peteet, J., Dell, M.L., Fung, W.L.A. (Eds.), Ethical considerations at the intersection of psychiatry and religion. Oxford University Press. Kelly, B., Hazell, T., Considine, R., 2012. Mental health and the NSW minerals industry. NSW Minerals Council, Sydney. Kim, R., van Moorsel, T., Amoako-Tuffour, J., Danchie, S.J., 2015. Mining in Ghana - What future can we expect? London. International Council on Mining & Metals and Ghana Chamber of Mines, UK. Leka, S., Cox, T., 2008. The European Framework for Psychosocial Risk Management: PRIMA-EF. Institute of Work, Health and Organisations, UK. Liu, L., Wen, F., Xu, X., Wang, L., 2015. Effective resources for improving mental health among Chinese underground coal miners: Perceived organizational support and psychological capital. J. Occupat. Health 57, 58–68. Magnavita, N. (Ed.), 2014. Industrial Activities. Springer, Milano. McLean, K.N., 2012. Mental health and well-being in resident mine workers: out of the fly-in fly-out box. Aust. J. Rural Health. 20 (3), 126–130. Minerals And Mining (Health, Safety and Technical) Regulations, 2006. Molek-Winiarska, D., Żołnierczyk-Zreda, D., 2018. Application of mindfulness-based stress reduction to a stress management intervention in a study of a mining sector company. Int. J. Occup. Saf. Ergon. 24 (4), 546–556. Mościcka-Teske, A., Sadłowska-Wrzesińska, J., Najder, A., Butlewski, M., 2019. The relationship between psychosocial risks and occupational functioning among miners. Int. J. Occupat. Med. Environ. Health 32 (1), 87–98. Nakao, M., Nishikitani, M., Shima, S., Yano, E., 2007. A 2-year cohort study on the impact of an Employee Assistance Programme (EAP) on depression and suicidal thoughts in male Japanese workers. Int Archives of Occupational and Environmental Health. 81 (2), 151–157. Oppong, N.Y., 2016. National Managerial Talent Development in the Ghanaian Mining Industry. In: Bawole, J.N., Hossain, F., Ghalib, A.K., Rees, C.J., Mamman, A. (Eds.), Development Management: Theory and Practice. Taylor & Francis. Oppong, S., Kretchy, I.A., Imbeah, E.P., Afrane, B.A., 2016. Managing mental illness in Ghana: the state of commonly prescribed psychotropic medicines. Int. J. Ment Health Syst. 10 (1), 28. Owusu-Ansah, F.E., Donnir, G.M., 2017. Psychotherapy in indigenous context psychotherapy in indigenous context: A Ghanaian contribution towards provision of culturally competent care. In: Handbook of Research on Theoretical Perspectives on Indigenous Knowledge Systems in Developing Countries: IGI Global, pp. 395–410. Pescud, M., Teal, R., Shilton, T., Slevin, T., Ledger, M., Waterworth, P., et al., 2015. Employers’ views on the promotion of workplace health and wellbeing: a qualitative study. BMC Public Health. 15 (1), 642. Petrie, K., Joyce, S., Tan, L., Henderson, M., Johnson, A., Nguyen, H., et al., 2018. A framework to create more mentally healthy workplaces: a viewpoint. Australian New Zealand J. Psychiatry. 52 (2), 15–23. QSR International Pty Ltd. NVivo qualitative data analysis software. 12 ed2018. Rajgopal, T., 2010. Mental well-being at the workplace. Indian J. Occupat. Environ. Med. 14 (3). Richmond, M.K., Pampel, F.C., Wood, R.C., Nunes, A.P., 2016. Impact of employee assistance services on depression, anxiety, and risky alcohol use: a quasi- experimental study. J. Occup. Environ. Med. 58 (7), 641–650. W. Asare-Doku et al. http://refhub.elsevier.com/S0925-7535(21)00327-1/h0005 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0005 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0005 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0005 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0010 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0010 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0010 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0015 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0015 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0015 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0020 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0020 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0020 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0025 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0025 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0030 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0030 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0030 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0035 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0035 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0050 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0050 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0050 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0055 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0055 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0055 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0060 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0060 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0060 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0070 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0070 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0075 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0075 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0080 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0080 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0080 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0090 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0090 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0090 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0095 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0095 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0100 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0100 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0100 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0105 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0105 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0105 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0110 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0110 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0110 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0115 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0115 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0120 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0120 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0120 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0125 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0125 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0130 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0130 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0130 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0135 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0140 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0140 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0150 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0150 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0150 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0155 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0155 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0155 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0160 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0160 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0160 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0160 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0165 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0165 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0165 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0170 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0170 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0170 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0175 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0175 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0175 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0175 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0180 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0180 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0180 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0185 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0185 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0185 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0195 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0195 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0200 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0200 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0200 Safety Science 145 (2022) 105484 9 Roche, A.M., Pidd, K., Fischer, J.A., Lee, N., Scarfe, A., Kostadinov, V., 2016. Men, work, and mental health: a systematic review of depression in male-dominated industries and occupations. Saf Health Work. 7 (4), 268–283. Sadeghniiat-Haghighi, K., Yazdi, Z., 2015. Fatigue management in the workplace. Industrial Psychiat. J. 24 (1), 12–17. Saldaña, J., 2015. The coding manual for qualitative researchers. Third ed: Sage; 2015. Seaton, C.L., Bottorff, J.L., Oliffe, J.L., Medhurst, K., DeLeenheer, D., 2018. Mental health promotion in male-dominated workplaces: Perspectives of male employees and workplace representatives. Psychol. Men Masculinity. 20 (4), 541–552. Smith, J., Osborn, M., 2003. Interpretative phenomenological analysis. In: Smith, J.A. (Ed.), Qualitative psychology: a practical guide to methods. Sage. Sonnenstuhl, W.J., Trice, H.M., 2018. Strategies for employee assistance programs: The crucial balance. Cornell University Press. Torkington, A.M., Larkins, S., Gupta, T.S., 2011. The psychosocial impacts of fly-in fly- out and drive-in drive-out mining on mining employees: a qualitative study. Austral. J. Rural Health. 19 (3), 135–141. Tynan RJ, James C, Considine R, Skehan J, Gullestrup J, Lewin TJ, et al. Feasibility and acceptability of strategies to address mental health and mental ill-health in the Australian coal mining industry. Int J Ment Health Syst. 2018;12:66. Tynan, C.R., Wiggers, J., Lewin, T.J., James, C., Inder, K., et al., 2017. Alcohol consumption in the Australian coal mining industry. Occupat. Environ. Med. 74 (4), 259–267. Velander, F., Schineanu, A., Liang, W., Midford, R., 2010. Digging for gold and coming up blue: a health survey in the mining industry. J. Health Saf. Environ. 26 (5), 389–401. Vignali, C., 2001. McDonald’s:“think global, act local”–the marketing mix. Brit. Food J. 103 (2). Wagner, S.L., Koehn, C., White, M.I., Harder, H.G., Schultz, I.Z., Williams-Whitt, K., et al., 2016. Mental health interventions in the workplace and work outcomes: a best-evidence synthesis of systematic reviews. Int. J. Occupat. Environ. Med. 7 (1), 607–611. WHO, 2002. The World health report 2002: reducing risks, promoting healthy life. World Health Organization, Geneva, Switzerland. WHO, 2005. Mental Health Policies a nd Programmes in the Workplace. World Health Organisation, Geneva. WHO, 2001. Mental disorders affect one in four people. World Health Organization, Geneva. WHO, 2003. OCCUPATIONAL HEALTH - Ethically Correct, Economically Sound. World Health Organisation, Geneva. WHO. Promoting Mental Health Geneva World Health Organisation 2004. WHO, 2005. Mental health policies and programmes in the workplace. WHO Press: World Health Organisation. WHO, 2017. World Mental Health Day. World Health Organisation, Geneva. WHO, 2018. Mental health: strengthening our response. World Health Organisation. WHO. Health promotion and disease prevention through population-based interventions, including action to address social determinants and health inequity 2020 [Available from: http://www.emro.who.int/about-who/public-health-functions/health- promotion-disease-prevention.html. Williams, M.J., Innovation, Yecalo-Tecle L., 2019. Voice, and Hierarchy in the Public Sector: Evidence from Ghana’s Civil Service. University of Oxford. W. Asare-Doku et al. http://refhub.elsevier.com/S0925-7535(21)00327-1/h0205 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0205 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0205 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0210 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0210 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0220 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0220 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0220 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0225 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0225 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0230 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0230 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0235 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0235 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0235 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0245 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0245 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0245 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0250 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0250 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0250 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0255 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0255 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0260 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0260 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0260 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0260 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0265 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0265 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0270 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0270 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0310 http://refhub.elsevier.com/S0925-7535(21)00327-1/h0310 “Mental health is not our core business”: A qualitative study of mental health supports in the Ghanaian mining industry 1 Background 2 Methods 2.1 Research design 3 Research setting 3.1 Population/ sample recruitment 3.2 Instruments 3.3 Data collection procedure 3.4 Data analysis 4 Results 4.1 Health Promotion 4.1.1 Health promotion onsite activities 4.1.2 Health assessments 4.2 Onsite support 4.2.1 Workplace policy 4.2.2 Supervisor support 4.2.3 Management support 4.2.4 Job accommodations/RTW 4.2.5 Onsite health support 4.3 External support 4.3.1 Formal support 4.3.2 Informal support 5 Discussion 5.1 Conclusions 5.2 Recommendations 6 Limitations Declaration of Competing Interest Acknowledgements References