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December 21, 2011

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Mental health – Speak your mind

The Government believes that employers have a major role to play in safeguarding their employees’ mental health and well-being. Kevin Yip looks at the barriers businesses face in addressing these issues and suggests how they can be overcome.

There is a plethora of information available on the scale of mental-health issues in the UK, but the statistics are only the tip of the iceberg because most people who have a problem are either unaware of it, or too embarrassed to come forward and open up to someone about the challenges they are facing.
It is often cited that one in four people will experience a mental-health problem in a given year. This figure is based on a large-scale study conducted by the Mental Health Federation in 1980, which was updated in 1992.1 According to the research, around 300 people out of 1000 will experience mental-health problems every year in Britain. Of those, 230 will visit a GP, and 102 of these will be diagnosed as having a mental-health problem, six of whom will become inpatients in psychiatric hospitals. These figures are supported by results from three adult psychiatric morbidity surveys.2

It has also been suggested that by 2020, depression will be one of the most common types of mental-health problem and second only to chronic heart disease as a global health burden.3

But, despite such stark data, there is still a lack of awareness and understanding about mental-health issues, even at government level. This is illustrated by the criticism that the Department for Work and Pensions’ Work Capability Assessment (WCA) – the main means of assessment for Employment and Support Allowance claims – has attracted, especially when it comes to assessing the claims of those suffering mental-health problems.4   All in all, this would seem to paint an unhealthy picture of mental health in Britain.

Why should firms tackle this issue?
If the Government, in the form of the WCA, lacks sensitivity and struggles in dealing with mental-health issues, why should businesses see these as problems that they need to tackle? Quite simply, the statistics illustrate that virtually all workforces and all businesses will be affected. If you have a firm of just 100 staff, say, it’s likely that 25 of them will have some mental-health issue – whether it’s stress, or severe illness.

The costs – indirect and direct – to the business can be enormous. If you just take one form of mental-health issue – stress – it costs the industry around £4 billion a year in sickness absence.5 This figure doesn’t even take into account the other impacts outside of sickness absence – for example, employees who have mental-health problems can have a negative effect on both the morale at a firm and its productivity.

Overall, it has been estimated that the total cost of mental-health issues to the economy is £32 billion.5 When you bear these figures in mind, it is clear why firms should seek to protect the mental health of their employees as, in the long run, such action will benefit businesses and their bottom lines.

Obstacles to tackling mental health
So, there is a sound business reason for tackling mental health, but is it really that easy to deal with such a complex issue in the workplace? The simple answer, unfortunately, is no. However, that doesn’t mean that businesses should ignore it – with the right measures in place, firms can make a positive impact, particularly if a mental-health issue is identified early on before it becomes a major problem.

Two of the major stumbling blocks to tackling mental-health issues are the social stigma attached to them and the fact that they can also be related to deeply personal problems that the individual doesn’t want to discuss, especially with their employer. Both mean that employees are often disinclined to come forward if they have a problem for fear of how they will be judged, or because they are worried they might jeopardise the security of their job, or promotional opportunities.

Indeed, in our experience, we have seen employees who have obvious mental-health issues in complete denial for fear of how it reflects on them. This can lead to more manageable problems being overlooked until they become a serious illness, which is then much more difficult to handle.

Another major obstacle in tackling such issues is a lack of understanding from the employers, staff and managers. Managers are often unable to identify if an employee has a problem and also don’t know where to go to access the right support and information. Even if a line manager or business owner does notice a mental-health issue, they often don’t want to pry, or are unsure how to deal with it. There is also the fear that if they bring the issue up and it is work-related, they could be leaving the business open to legal action, or could lose an employee to long-term sick leave (see panel, p38). 

These barriers need to be overcome because the best way to tackle mental-health problems is to encourage open discussion. It’s not about prying into the lives of staff but about raising awareness of what constitutes a mental-health problem and making staff feel that if they do have an issue they can come forward in confidence and not be judged; after all, the statistics and research clearly illustrate just how common these problems can be.

Employee understanding
The key to de-stigmatising mental-health problems is to improve understanding among staff at all levels, so there is a culture and environment that accepts them as a common occurrence. All employees should undertake awareness training, which, to ensure complete transparency with the workforce, should incorporate an explanation of the organisation’s policy and procedures.

Training of line managers in mental-health issues is also key, as they are on the front line, dealing with staff every day. It is not simply that line managers need to understand the issues to enable them to know how to deal with a member of staff if they have a problem; they also need to be approachable and champion an atmosphere of open discussion.

Employees should also be informed of where mental health sits in a legal sense. For example, mental-health issues can come under the remit of the Equality Act 2010, which will require employers to implement reasonable adjustments to ensure that the individual is not put at a disadvantage.

The Act makes it illegal to discriminate either directly or indirectly against people with mental-health problems in public services and functions, access to premises, work, education, associations, and transport. If such adjustments are implemented appropriately, all employees need to be aware of their implications at the outset.

Robust policies
Firms need to develop a work culture where everyone is treated with respect and dignity. Vital to this is putting in place robust policies on equal opportunities, covering anti-discrimination reporting, bullying and whistle-blowing, and ensuring that all staff are aware of and understand them. That way, everyone in the business knows what the company line is and what might constitute overstepping it.

Working practices
Putting in place staff-friendly working practices are key to helping avoid mental-health issues, particularly work-related factors, such as stress. Firms can put in place a range of practices, such as: giving employees more control over their work, which helps combat stress; ensuring employees have the right skills for the job; making sure staff have manageable workloads; operating flexible working hours; and checking the physical work environment to eliminate stressors, such as flickering lights and excess noise.

However, confidentiality should still remain and supporting options should be available that do not overly affect the remaining workforce, placing unfair extra pressure on them. Ultimately, there is absolutely no reason why people suffering from mental-health problems cannot continue to work efficiently, providing adequate support is in place.

Identifying the problem
The earlier you pick up a problem the better. Whether the issue is low-level stress, or a major mental-health issue, acting early can stop it escalating.

There is a wealth of existing literature on the warning signs, but the key things to look out for are:

  • changes in a person’s usual behaviour and appearance;
  • poor performance;
  • over-performance;
  • rapid changes in mood;
  • increase in sickness absence; and
  • headaches.

Firms can use a range of mechanisms to spot things early on, from simple observations by other staff and line managers to carrying out staff surveys, workplace health assessments, or periodic reviews of staff to identify potential problems. 

Managing a mental-health problem
Once a problem is identified, businesses need to be careful how they then address this and engage with staff. The ‘Line Managers’ Resource’, from the Department of Health’s mindOUT for Mental Health, provides guidance on how to deal with staff who are reluctant to talk, or are distressed, in order to encourage open discussion of the issue and identify how to deal with it.6

In brief, there are three elements to managing a health problem:
Managing an illness in work
Most people who have mental-health problems can continue to work effectively; they just require a little support – from regular monitoring of their needs to helping them develop coping strategies to deal with an issue.
The firm can manage the work-practice aspects of employees, but when it comes to developing coping strategies it can often be helpful to bring in outside support, who can work with staff to help them deal with an issue.

Dealing with staff who are off sick
Managers often fear that if they contact someone who is off sick it could be seen as harassment. However, keeping in touch with the employee can act as a reassurance that the person’s job is safe and that the employer cares. While the person is recovering both parties can explore ways to improve the employee’s working practices to help them back into work. 

Returning to work
It’s important to realise that most people with mental-health problems can recover completely, but it is vital to plan their return to work so that they can be eased back into the workplace and the work routine.

Managers should liaise with the individual, and, where appropriate, GPs or occupational-health experts, to consider factors such as workload, putting in place achievable goals, discussing which colleagues will be told, and implementing mentoring schemes with other employees so that the person has someone to talk to, should they have an issue.

Mental health in the workplace is a complex issue, which is difficult to deal with in any setting, particularly a work environment, but employers have a very significant part to play.

By de-stigmatising mental-health problems, encouraging open discussion and having plans in place to identify and manage issues at an early stage, a mental-health problem can be tackled before it develops into a more severe condition.    


The elephant in the room: what would you do?
Earlier this year, mental-health charity Mind hosted a business summit to explore the mental-health challenges employers face and share experiences. Read through these two scenarios, edited from those given to delegates at the summit, and see if your solution tallies with the one recommended by Mind.

Scenario one
George works at a regional removals company. He has reportedly under-performed persistently since he joined the company but had been promoted way above his level of competence by his previous manager. The company often makes a loss on jobs that George costs, but performance management processes were not put in place by his previous manager.

Hannah, his new manager, feels she needs to take action after some serious costing mistakes by George, two customer complaints, a period of sickness absence, and the need for efficiency in the economic climate.

There have been some discussions between colleagues that, a few years ago, George had said he was diagnosed with bipolar disorder, but, more recently, he had mentioned that he has chronic fatigue syndrome.

The HR officer has obtained an occupational-health report that indicates George cannot manage the staff he has under him, but it is inconclusive as to his exact condition and whether George needs a change of management role, or can continue to undertake a customer-facing role.

Mind’s response:
George is under-performing, so this needs to be addressed instead of avoided. During this conversation, the manager needs to be able to say to George that his performance is unacceptable, but that they are worried that there is an undisclosed health condition that is having an impact.

The manager needs to make it clear that unless the firm knows what health condition George has, it cannot support him. If George maintains that he does not have a health issue then he must be dealt with as any other employee who is under-performing. Rumours do not substantiate George having bipolar disorder, but this should be explored with him, and then supporting medical information can be sought, with his permission. When the reality of the situation is explained to him and an offer of support is made by the company, then the solution should become clear.

Scenario two
Alex was made redundant from her role in the accounts department of a financial services company and redeployed into a new credit-control role at another office. Her new manager, Brenda, was unsympathetic to her need to adjust to her new role and has been alleging demonstrable – although, to a degree, understandable – under-performance.

In truth, Brenda was not keen on the redeployment, as Alex had a bit of a reputation for under-performance prior to the move. Consequently, Brenda handled the management and performance issues badly and this undermined her relationship with Alex. A written capability warning was issued by Brenda and, in response, Alex raised a grievance, in part against Brenda for bullying. The grievance claimed that Alex had experienced a lot of stress as a result of the treatment she had received since the move.

A grievance investigation by an independent manager upheld some of Alex’s allegations and the outcome included a limited apology for the poor handling of her job transfer and of the capability procedure. She was given assurances that steps had been taken to monitor the situation. The outcome also stated that the material findings of under-performance and the resulting objectives and performance monitoring were appropriate.

Soon after receiving the grievance outcome, Alex went off sick with GP-diagnosed ‘work-related stress and depression’. Alex has appealed against the grievance outcome in general terms via her solicitor, but will not attend a grievance appeal meeting, as she is said to be ‘too ill’.

Mind’s response:
Following the grievance investigation, the employer should have taken steps to address her health needs. The outcome focused solely on the behaviour of the manager and employee in terms of performance management, failing to recognise the links between performance and health. If, as seems likely, the employee’s under-performance is linked to ill health, the solution, at least in part, should be health-focused. There has also been a subsequent failure to assess the health impacts of the acknowledged poor management the employee received, all of which have culminated in this crisis.

It is clear that the battle lines have been drawn, which means that both Alex’s health and her employer relationship are being damaged. A third party – either from HR or from an external organisation – could help the two sides identify solutions to move forward, rather than focusing on blame and perceived past failings on either side.

See for more information about the summit.

1    Goldberg, D and Huxley, P (1992): ‘Common mental disorders? A bio-social model’, London: Routledge
2    Meltzer et al (1995): ‘Surveys of psychiatric morbidity in Great Britain: Report 1’, HMSO: London
5    Patel, A and Knapp, M (1998): The Cost of Mental Health in England, Mental Health Research Review 5, Centre for the Economics of Mental Health
6  See also Cooper, C and Cartwright, S (1996): ‘Mental Health and Stress in the Workplace, a Guide For Employers’, Department of Health: London

Kevin Yip is an advisor at Liverpool-based charity Health@Work

What makes us susceptible to burnout?

In this episode  of the Safety & Health Podcast, ‘Burnout, stress and being human’, Heather Beach is joined by Stacy Thomson to discuss burnout, perfectionism and how to deal with burnout as an individual, as management and as an organisation.

We provide an insight on how to tackle burnout and why mental health is such a taboo subject, particularly in the workplace.


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Oil spill clean up
8 years ago

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