Mental Health at Work: In-depth
This topic provides practical tips on how to put in place workplace policies that support those struggling with their mental health.
Mental Health Awareness Week (14th-20th May) https://www.mentalhealth.org.uk/campaigns/mental-health-awareness-week
Mental health issues are important in the workplace: it is said that one in six people in employment are having mental health problems at any one time. Employers have a key role in managing working conditions that can affect mental health, ensuring that people with mental ill health have the support they need, and taking appropriate steps to combat discrimination and stigma.
- Employers have a general duty to ensure, so far as is reasonably practicable, the health and safety at work of all employees under the Health and Safety at Work, etc Act 1974.
- Under the Management of Health and Safety at Work Regulations 1999, employers must assess the risks to the health of their employees for all aspects of work. This includes psychological risks.
- The Equality Act 2010 requires employers to make to make “reasonable adjustments” to the workplace and to work tasks to accommodate the needs of a disabled employee, ie those who have a long-lasting physical or mental impairment that impacts substantially on their ability to carry out day-to-day activities.
- It is the duty of the employer under the Equality Act 2010 to prevent discrimination, bullying and harassment in the workplace.
- An employee is not generally obliged to tell an employer if he or she has a mental health condition or disability. However, although he or she may be wary of revealing the extent of any health condition, unless an employer is aware of the issues it may be handicapped in its ability to support the employee.
The Importance of Mental Health in the Workplace
The World Health Organisation defines mental health as “a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”.
Mental health issues are common and affect many employees and managers in workplaces. The Centre for Mental Health estimates that every year in the UK a total of 91 million days are lost to mental health problems and nearly half of all long-term sickness absences are caused by a mental health problem. The total annual cost is more than £30 billion.
Practical Action to Promote Positive Mental Health at Work
Happy, resilient employees mean less sickness absence and higher productivity — which is one of the reasons that increasing numbers of employers are looking at mental health as part of their wellbeing programmes. Obviously, mental ill health cannot be separated into separate boxes for work or personal life, but it is acknowledged that work can have a significant impact on mental health.
There are a number of practical actions that employers can take to promote positive mental health and resilience in their workplace. For example, the Health and Safety Executive’s Management Standards define the culture of an organisation where the risks from work-related stress are being effectively managed. Stress is not mental ill health, but stress can affect mental health.
Acas suggests a three-step approach to dealing with mental health problems at work.
- Train managers to spot the signs of employees who may be having psychological or emotional difficulties.
- Identify any work-related causes and make “reasonable adjustments” to support people.
- Promote awareness of mental health issues and create a culture where employees feel they can talk about their concerns.
Practically, this means:
- enabling someone to act as the “mental health champion” in the workplace to build an open culture and destigmatise mental health issues
- offering structured training to managers and other selected staff so people know what to do
- communicating the ways that people can ask for help
- giving managers and trained staff the information on how to respond (ie the options of where to refer staff, information on what is available in terms of time off, etc)
- offering a range of options, so different people can be supported in different ways.
The first step in enabling employees to come forward with problems may well be improving the work culture to eliminate the stigma attached to mental ill health.
Spotting the signs will often mean identifying the common symptoms of mental ill health, including:
- an increase in unexplained absences or sick leave
- poor performance
- poor timekeeping
- poor decision-making
- lack of energy
- uncommunicative or distressed behaviour.
Acas suggests that managers start by having a quiet and confidential word with an employee causing concern. If the employee is returning from sickness absence a return to work discussion could be held. If a more formal follow-up meeting is required it should be scheduled. Where stress or over-work is identified as a cause in exacerbating an existing mental health condition then suitable action should be taken to resolve the situation in compliance with the organisation’s stress management policy.
Where required an employer should provide access to an occupational health service where a member of staff with a mental health issue can obtain confidential help and support.
Promoting awareness will be aimed at encouraging the workforce to be more tolerant of mental health and more understanding of the stresses and strains staff are subjected to and how these can be lessened. A starting point for an awareness campaign may be to undertake a survey of the workforce to find out more about their attitudes to mental health. Mental health champions can be identified and given additional training. Awareness days could be arranged. Applying for accreditation as a mental health aware organisation is another good strategy.
An initiative that has been found to be useful in many workplace settings is to train “mental health first aiders” to help colleagues. Mental Health First Aid (MHFA) England is a charity that provides the equivalent of physical first-aid training.
Benefits of Positive Workplace Mental Health Policies
The benefits for an employer taking a positive approach to mental health at work include the following.
- It can help to retain valuable and experienced staff, reducing turnover, staffing and training costs.
- It can reduce sickness absence, particularly from stress related mental health conditions.
- It helps staff achieve their potential and sustain their careers.
- It enhances safety and increases productivity.
- It makes for a healthier, more tolerant workplace.
- It demonstrates that an employer is socially responsible.
In its report, Added Value: Mental Health as a Workplace Asset, the Mental Health Foundation quotes research which suggests that people living with mental health problems contributed an estimated £226 billion gross value to UK GDP, nine times the estimated cost to economic output arising from mental health problems at work. It states that improving and protecting mental health secures that value and should help reduce cost.
Employers can demonstrate their commitment to supporting mental health in the workplace by signing up to schemes such as:
- the Charter for Employers Who Are Positive About Mental Health established under the MINDFUL EMPLOYER campaign
- the Time to Change campaign.
Benefits to People with Mental Health Issues from Working
Work is a key factor in supporting people who are living with mental health issues and in keeping them well. Studies show that work is generally good for people’s mental health. It not only provides financial reward. It gives many people self-esteem, companionship and status, as well as a chance to use their skills and to feel fulfilled.
Being employed has a positive effect on mental health symptoms. Being unemployed, conversely, can make symptoms worse.
Key Role of Line Managers
Line managers play a crucial role in the promotion of positive mental health at work. They are well placed to detect mental health issues in an employee. They are also in a position to help a worker who has mental health difficulties to cope with their work by providing additional support and by reducing work pressures and stress. They can also introduce flexible working conditions and help people to return to work following sickness absence if it is required.
Some managers will be concerned that by addressing mental health issues they will be getting involved in areas that they feel ill-equipped to deal with. They need the right level of support and training in order to fulfil their potential in supporting mental health at work needs.
Managers are not counsellors. They should not try to give advice about a mental health problem but should be furnished with the appropriate procedures and information to direct colleagues to experts who can help. They should work within their capabilities and use their management skills to focus on the practical things they can do to help. They should remember that their role is not to “cure” people, but to help them to cope at work and fulfil their potential.
Work-Life Balance and Working Hours
The concept of work-life balance is important when considering working arrangements for people with mental health issues. Flexible working arrangements are generally supportive of people with mental health issues, especially approaches that offer:
- variable hours or start times
- part-time working
- paid or unpaid leave for appointments related to health
An advisory booklet by Acas, Flexible Working and Work-life Balance, includes examples of flexible working that may be useful when supporting staff with mental health issues, such as term time working, job shares and changes to shift and rota patterns
Mental Health Policies
Every employer should have a mental health in the workplace policy. The policy should be supported by senior management. It should support an approach which promotes positive mental health and challenges stigma and discrimination.
Occupational health services can be very effective in supporting people at work who have mental health issues. Any referral should be entirely confidential and should be discussed with the worker concerned.
Occupational health services can be particularly helpful if an employee is returning to work after illness and requires a rehabilitation programme. Such programmes may require a temporary period of reduced hours, an adjustment of roles and responsibilities, or additional support.
Some employers have Employee Assistance Programmes, designed to provide employees with counselling and advice for a wide range of personal and work problems.
Managers should keep all aspects of a member of staff’s condition confidential. Workers who have mental health issues have the same rights to confidentiality as any other employee.
Types of Mental Health Issues
Mental health issues are very common. The Department of Health estimates that one in four will suffer from a mental health problem at some point in their lives.
There are many different forms of mental health conditions which generally vary on a continuum from mild to severe. In addition, they will often fluctuate and people may have good days and bad days, just as everybody does. Most people with a defined diagnosis of mental illness will be able to perform normally at work.
The most common forms are:
- anxiety states
- bipolar illness.
Managers should beware the danger of “labelling” people with a mental illness. This can feed expectations and become self-fulfilling, or even encourage harassment. However, a general awareness of symptoms may assist managers in supporting people appropriately.
While most people sometimes feel low in mood from time to time, clinical depression is a serious health condition. In most cases it causes periods of intense low mood, hopelessness and helplessness. In severe cases, it can lead to a person losing their ability to cope with day-to-day living or even to attempt suicide.
Depression is probably the most common form of mental health issue, affecting one in 20 people.
- low mood
- low self-esteem and preoccupation with negative thoughts
- feeling tired and lacking energy
- loss of drive — often neglecting work, hobbies and interests
- withdrawing from social contact
- having suicidal thoughts or thoughts of self-harm
- smoking more, or using more alcohol
- change in appetite — not eating or overeating
- poor sleep — waking up early, having difficulty getting to sleep
- poor performance at work or difficulties in home and family life.
The causes of depression vary from person to person. Sometimes it will be a reaction to something that has happened, such as the loss of a loved one. Sometimes there is no discernible cause. Some people will have a history of bouts of depression that can last for weeks or months. Others may have a family history of depression. Depression is often linked to loneliness.
Depression is treatable and most people recover. It is usually diagnosed by a GP.
Mild to moderate depression can be helped by a range of methods including just helping someone to be more active, more socially engaged or to do more exercise. This helps to rebuild someone’s self-esteem and confidence. Those with a mild depression that fails to improve may be offered a form of talking therapy such as cognitive therapy or counselling.
Those with moderate to severe depression will often be prescribed anti-depressant medication, sometimes in addition to talking therapy.
Those with severe depression may be referred to specialist mental health services which could include seeing a psychologist, a psychiatrist, or a specialist mental health nurse.
Feeling anxiety from time to time is quite normal, particularly when nervous or apprehensive about something. However, someone suffering from an anxiety disorder may suffer excessive anxiety and worry relating to a range of situations and issues, rather than one specific event. Some may go on to develop more severe problems, such as panic attacks, a phobia or obsessive compulsive disorder.
The physical symptoms of generalised anxiety disorders can include dizziness, drowsiness, tiredness, palpitations, muscle aches and tension, dry mouth, shortness of breath and stomach ache.
An experience of panic is quite normal in dangerous or stressful situations where a person may feel threatened. When having a panic attack a person suffers the same fight or flight response but in situations where most people would not perceive any danger. They start to panic for no reason and experience an overwhelming sense of fear, apprehension and dread.
Attacks can be precipitated by any tension or stressful situation, or even by the fear of having an attack itself, especially in public places. They can lead people to avoid any situations where they feel anxious and to become withdrawn and isolated.
In the case of a phobia, a person develops an exaggerated fear about a specific situation or object. If confronted with the thing they fear they may suffer a full-blown panic attack.
Anxiety disorders are usually diagnosed by a GP or a psychiatrist and treated with a combination of medication and psychological therapies.
Some of the more severe forms of mental ill health can involve a general loss of contact with reality and may include hallucinations, delusions and an impaired level of insight. These symptoms are often referred to as psychosis.
A number of different conditions can give rise to psychotic symptoms but the most common diagnosis is probably that of schizophrenia. Symptoms when unwell may include confused or jumbled thoughts, hearing voices and seeing and believing things that other people do not share. Behaviour may become bizarre in nature and usually includes difficulty with social interaction and carrying out daily life activities. Insight may be lacking. Sufferers can become confused and withdrawn and there is a danger of them acting on destructive delusions and harming others or themselves.
People with schizophrenia are usually in contact with mental health services and under the care of a consultant psychiatrist. They may be taking regular medication which helps to control their condition. When well there may well be little sign of the underlying condition.
People whose moods swing rapidly from one of uncontrollable excitement and impulsiveness to intense despair and apathy could be suffering from what is now known as bipolar disorder, formerly called manic-depressive illness.
Each type of “mood episode” will contain its own defining features. For example, a pattern of little or no sleep might be typical in an “high” phase and sleeping most of the time in a “low” phase.
People can be incredibly productive when in a “high” phase, but may also be irresponsible and impulsive.
Those with bipolar illness will typically be under the care of a psychiatrist. They will usually be taking medication which help to even out their mood.
Alcohol Dependency and Mental Ill Health
Alcohol dependency is a problem for people of all ages, and many people use alcohol to deal with loss and loneliness. Alcohol use can mask underlying depression.
A variety of different eating disorders are recognised as mental health issues, the most common being anorexia and bulimia.
For people with eating disorders the subject of food, and how much they weigh, is likely to be a constant preoccupation. A person with anorexia will commonly deny themselves food, even when they are very hungry. Those with bulimia may binge.
Eating disorders usually develop as a result of deeper issues in a person’s life and will usually respond to professional counselling and psychotherapy.
Suicide and Self-harm
Suicide is the biggest killer of men aged 49 and under and the leading cause of death in people aged 15–24. Most vulnerable are men with mental illness and those who self-harm. Managers and work colleagues should encourage anyone who is expressing suicidal thoughts to seek help immediately.
The Mental Health System
The UK has a well-established mental healthcare system that is structured as local community services and specialist in-patient services.
Most people with mild to moderate mental health issues will be looked after by their GP. The GP may diagnose the problems and prescribe medication to help. They will usually try to encourage a person to self-help, often with the help of the numerous self-help groups and charities that exist in most areas. Some GP practices host or have access to counselling services where people can talk their problems through with a trained counsellor.
Each area is covered by established NHS mental health services. These consist mostly of acute in-patient facilities and community mental health teams.
In combination with GPs, community teams look after most people with moderate to severe mental health issues. They are comprised of staff such as psychiatrists (doctors who specialise in mental health) and specialist mental health nurses supported by psychologists, occupational therapists and mental health social workers.
Community teams will visit people in their own homes or see people in clinics.
There is a general movement in mental health away from treatments solely consisting of medication towards more psychological treatments and therapies.
Psychological treatments are often referred to as “talking therapies” by some. Usually provided by psychologists, psychotherapists, psychiatric nurses and counsellors, psychological treatments consist of sessions where a person is given an opportunity to talk about what is troubling them and develop new coping plans.
When acutely unwell, people with severe mental health illnesses may be admitted to a specialist unit for assessment and treatment. Sometimes they may be admitted against their will under the Mental Health Act 1983, a process known as sectioning. In some cases people who are acutely unwell may find their way into hospital through an A&E department, or through the police under a place of safety order. Both should have link mental health workers attached to facilitate liaison.
Time to Change
Time to Change is a mental health campaign movement that was set up in 2007 by the Department of Health with lottery funding and supported by a range of mental health charities.
The campaign aims to:
- improve public attitudes and behaviour towards people with mental health problems
- reduce the amount of discrimination that people with mental health problems report in their personal relationships, their social lives and at work
- make sure even more people with mental health problems can take action to challenge stigma and discrimination in their communities, in workplaces, in schools and online
- create a sustainable campaign that will continue long into the future.
The workplace campaign includes:
- organisations being able to sign-up and taking a Time to Change employer pledge
- establishing mental health workplace champions
- training for managers and employees
- tips on activities to get everyone in the workplace involved in supporting positive mental health changes
- opportunities to share information and collaborate with other organisations.
Resources can be downloaded from the campaign website.
Managers and supervisors should be trained how to provide appropriate support to people with mental health issues and how to create a healthy working environment. Training in mental health issues will help to fight the misconceptions some people have about mental illness.
Training in areas such as managing discipline and grievances at work and managing absence at work should include mental health aspects. Employment law training should cover the need to comply with the mental health requirements of the Equality Act 2010.
Many charities and organisations run training courses, including MIND, the Mental Health Foundation and Time to Change.
Acas provides a free eLearning module on Mental Health Awareness for Employers.
Mental health first-aid courses — the mental health equivalent of physical first-aid training — are becoming increasingly popular in some workplaces, particularly for staff identified as “champions” who are willing to offer counselling assistance to colleagues.
If you require further information, please contact us.
Brought to you by WHSS, HSE, Croner and time-to-change.org and Mental Health Foundation.