Are employers equipped to manage mental ill health?

Author: Rachel Suff

There is growing recognition that employers need to be better equipped to manage mental ill health in the workplace. There are a number of steps that they can take, such as training and support for line managers and awareness-raising campaigns.

Key points

  • Mental ill health is one of the main causes of absence in the workplace, yet there is still widespread misunderstanding surrounding mental health problems.
  • Many people suffering from mental ill health are reluctant to disclose their condition because of the myths and stigma surrounding it.
  • Workplace mental health and wellbeing programmes aim to give employees the knowledge and confidence to care for themselves.
  • Line managers play a vital role in managing mental health at work, and recent research shows that their willingness to have a dialogue about the issue is increasing.
  • Maintaining a relationship with an individual who is absent due to mental ill health can help alleviate any feelings of isolation and, in the long term, aid their eventual return to the workplace.

A quarter of the population (on the Mind website) suffer from some form of mental ill health at any one time, yet it is still far from being accepted as a "normal" element of the human condition. Because of this stigma, it can be very much a hidden phenomenon, with many people reticent to disclose a mental health condition to their employer.

Exclusion of people with mental health problems from the workplace is a widespread problem. According to 2009 Department for Work and Pensions figures (on the Mind website), only 21% of people with mental health issues are in employment compared with 74% of the overall working-age population and 47% of the total number of people who declared themselves disabled.

The Chartered Institute of Personnel and Development's 2010 absence management survey (PDF format, 2MB) (external website) showed that more than one-third (38%) of employers noted an increase in reported mental health problems, such as anxiety and depression, among employees in the last 12 months, a significant increase on the one in five reported in its previous survey.

The same survey shows that mental ill health is the third most common cause of long-term absence among non-manual employees, after acute medical conditions and stress.

Putting mental health on the map

At a public-policy level, there is recognition that more needs to be done to manage mental health at work. To this end, the Government published the UK's first mental health strategy No health without mental health (PDF format, 705K) (on the Department of Health website) in February 2011. It aims to "transform the mental health and wellbeing of the nation and ensure that mental health is treated with the same importance as physical health".

There is a strong business, as well as a moral, argument as to why employers need to recognise and manage mental health problems: the Centre for Mental Health (PDF format, 290KB) (external website) estimates that the total cost of mental ill health at work is nearly £26 billion per year.

Employers also have a legal obligation to effectively manage mental ill health in the workplace. Disability is a protected characteristic under the Equality Act 2010 (which replaced the Disability Discrimination Act 1995) and mental impairment is one of the conditions covered. The term "mental impairment" covers a wide range of conditions including mental illness. An employer has a statutory duty to make reasonable adjustments where necessary under the legislation, and this duty applies equally to employees with a mental or physical impairment.

Mental health, stress and the workplace

It is important to distinguish between stress and mental health illnesses. As Clare Duggan, occupational health adviser at Leeds Metropolitan University, comments: "Although stress can act as a trigger for some mental health conditions such as anxiety or depression, they are not the same. There are different levels of mental distress, such as work-related stress, or distress caused by a loss or bereavement, or common mental health problems such as depression or anxiety. At the other end of the spectrum there are more severe and enduring psychiatric illnesses such as bipolar disorder. All of these require a different level of response on the part of the employer."

 
 

There are different levels of mental distress, such as work-related stress, or distress caused by a loss or bereavement, or common mental health problems such as depression or anxiety. At the other end of the spectrum there are more severe and enduring psychiatric illnesses such as bipolar disorder. All of these require a different level of response on the part of the employer.

Clare Duggan,
occupational health adviser,
Leeds Metropolitan University

 

According to Bob Grove, joint chief executive of the Centre for Mental Health (external website), it is not always easy for line managers to differentiate between someone suffering from stress and mental ill health, and it is often a judgment call.

As Grove explains: "If an employee's behaviour changes over an extended period, as the first point of contact the line manager needs to have a conversation with the individual and from that can hopefully determine what the problem is. According to self-report data, four in five people absent with mental health issues say their illness is not caused by work. This means that, however healthy the workplace, managing people showing signs of mental ill health should be part of every manager's repertoire."

Barriers to the effective management of mental health at work

Because of the widespread myths and stigma surrounding it, many people suffering from mental ill health are reluctant to disclose their condition. Research (PDF format, 2MB) (external website) commissioned by the Shaw Trust found that exactly four employers in 10 view workers with mental health issues as "a significant risk" to the business.

This can go some way to explaining employees' reluctance to disclose a mental health condition. The majority of organisations often become aware of an individual's mental health problem during or after a period of sickness absence rather than during the recruitment process. This means that employers have a tendency to underestimate the proportion of the workforce suffering mental ill health. It also means that an employer is not necessarily in a good position to gauge the level of corporate and individual support that they should be providing for staff.

Promoting mental wellbeing

According to the 2007 XpertHR survey on managing mental ill health in the workplace, two measures were ranked in joint-first position by employers as being the most effective means of promoting their employees' mental health:

  • access to an in-house occupational health service; and
  • the provision of an employee assistance programme.

Workplace mental health and wellbeing programmes aim to give employees the knowledge and confidence to care for their own mental health problems. This does not mean that an employer can prevent someone from developing a serious mental health condition. But it does mean that an employer can provide tools and support to improve employees' resilience to stress, and  their knowledge and understanding of mental health conditions. 

BT's Positive Mentality programme is a prime example of the steps an employer can take, as is Leeds Metropolitan University's Wellbeing Excellence Programme (see box 1).

Box 1: Promoting wellbeing at Leeds Metropolitan University

Leeds Metropolitan University (Leeds Met) has won several awards for its Wellbeing Excellence Programme that offers staff a wide range of resources designed to support their mental and physical health in the workplace.

At the heart of the programme is an online wellbeing resource (external website) covering more than 200 topics, designed by the health and wellbeing team and easily accessible to staff and students. The online resource has been so successful as a tool to promote employee wellbeing that Leeds Met now has around 10 external client organisations that have produced their own, customised versions.

The website is a simple, self-help tool where staff they can tap into basic advice and guidance and be signposted to more specialist internal or external sources of support if needed. The site is very user-friendly as a first point of contact. For example, someone who may feel low or depressed can click on a range of different icons to reflect how they are feeling such as faces depicting "ill", "sad", "stressed" or "confused", or on other icons such as "health" or "fears".

The image below provides an example of the different icons on the wellbeing website:

Wellbeing Excellence Image

From these icons it is then possible to drill down into areas such as "mental health", which will display a webpage containing six different categories of resources covering, for example, "relaxation", "negative thinking" and "happiness".

"As well as simple tools and techniques that people can try out on their own, there is advice on coping with anxiety and depression and knowing when to seek medical advice," says John Hamilton, head of safety, health and wellbeing. "It is not just used by those suffering mental distress but is a useful resource for colleagues or line managers wanting to support someone in their team."

The online portal also features one-off campaigns. For example, for January 2011 the campaign was "Beat the New Year Blues", which aimed to give people timely advice to help cope with seasonal pressures such as "money worries" and "coping with anxiety and depression". Under the latter resource, there is practical step-by-step guidance on how to promote mental wellbeing - for example, around alcohol consumption, exercise and sleep. The website also provides further sources of help designed to meet the different levels of anxiety that people may be feeling.

Line managers can make a difference

Despite the fact that line managers are the main point of contact between an employer and its employees, not all feel equipped to deal with mental ill health among their teams. Some may feel awkward dealing with such potentially sensitive issues and are unsure what approach is appropriate. The 2007 XpertHR mental health survey found that line managers did not receive enough support and advice to effectively manage employees with mental health issues in more than half (53%) of organisations.

But, says Grove, the proper skills and behaviours for managing people with mental ill health can be learnt. "Line managers cannot be experts in mental health issues but they play a crucial role in picking up early signs of stress and mental distress in their teams," Grove comments. "Being able to signpost individuals to the appropriate sources of support - be it services in the workplace such as occupational health or in their locality - is also important."

The Shaw Trust research (PDF format, 2MB) (external website) provides encouraging statistics: exactly nine managers in 10 say that they would feel comfortable talking with employees about mental health issues, an increase of nine percentage points compared with the 2006 research. The trust says that the rise in understanding of mental health issues has led to an increased willingness to engage in dialogue about the issue.

Guidance and support for line managers

According to an Acas policy paper (PDF format, 266K) (external website), line managers need the following to help them manage mental health problems effectively:

  • training - to raise their awareness of stress and mental health issues so that they know, for example, when a member of their team may be suffering from additional or excessive pressure;
  • good interpersonal skills - to help nurture trusting relationships with staff who may be understandably anxious about disclosing their mental health problems; and
  • an organisational infrastructure that supports and guides them by providing, among other things, clear policies and procedures for managing mental health.
 
 

Line managers cannot be experts in mental health issues but they play a crucial role in picking up early signs of stress and mental distress in their teams.

 Bob Grove,
joint chief executive,
Centre for Mental Health.

 

"In order to be effective, line managers need training and support so that they understand mental health issues and feel confident about talking to employees," Grove comments. "For example, how a line manager explains a referral to occupational health, so that the individual does not feel it is punitive, is very important."

The Centre for Mental Health has researched the most effective training approaches and piloted a programme based on "Beyondblue", the Australian national anti-depression programme. It now runs its own suite of line manager training courses called Impact on Depression (external website), including a three-hour module that is focused on practice. Delivered by expert facilitators with clinical experience, it covers three key areas: how to spot the signs of distress; how to respond well; and where to point people to additional support.

Managing sickness absence due to mental ill health

The longer someone is off sick, the less likely they are to return to work. The isolation and apprehension experienced by someone following long-term sick leave is likely to be even greater on the part of someone who has suffered mental ill health. Maintaining a relationship with the absent individual can help alleviate any feelings of isolation and, in the long term, aid their eventual return to the workplace.

"The evidence shows that it's good to keep in touch with employees who are off sick with mental health problems, but with an approach that eliminates any suggestion of discrimination or harassment," says Grove. "If a manager is nervous about what to say, a script can help. The main point is to reassure the employee about their continuing relationship with the workplace and set the expectation of them returning."

Once a person has been off work for four weeks or more they may need extra help and there is good evidence that a case-management approach is effective in aiding recovery and return to work, as Grove comments: "Often, a person suffering mental ill health does not feel able to negotiate workplace adjustments on their own behalf or devise a return-to-work plan. It can be very helpful to have a third party working with the individual, the line manager, union rep, HR, occupational health, etc making the return-to-work plan a team effort where everyone knows what is expected and has thought through difficult issues such as what to tell colleagues."

Duggan agrees: "We have a case-conference approach at Leeds Met, where the client determines what level of disclosure there is about their mental health condition. But there is always an open discussion with key people such as the line manager, with occupational health acting as the conduit and adviser, about what support is needed for the individual."

Royal Mail has a system in place to refer employees who have been off sick with mental ill health to occupational health as early as possible, in order that the right treatment strategies can be put in place at a very early stage (see box 2).

Box 2: Royal Mail's proactive and reactive steps for managing mental ill health

Royal Mail has taken a number of steps over the past few years to ensure that its occupational health approach is "genuinely holistic" when dealing with employees' physical, mental and emotional wellbeing, says Dr Steve Boorman, health and safety director and chief medical adviser. These steps reflect both a proactive and reactive strategy for managing mental health.

On the proactive front, Royal Mail raises awareness and educates both employees and managers about mental health issues. For example, it took part in the Centre for Mental Health's "Beyondblue" pilot, based on the Australian national anti-depression programme. Royal Mail has also built on its own internal mental health promotion interventions, including DVD- and web-based modules. Developed with experts in the field, these are interactive and train managers in basic skills such as how to raise potentially sensitive issues around mental health with their staff.

There are two main points of access to Royal Mail's occupational health support for mental health issues. The first is aimed at employees - a confidential helpline called HELP (health, employment, legal and practical). Through the telephone helpline, occupational health specialists provide an employee self-help service 24/7, 365 days a year that includes broad-ranging support, such as legal, financial and welfare advice. It is also linked to counselling services and acts as a gateway for employees who may be suffering mental distress.

The second is for managers and encourages early referral to occupational health if an employee has a mental health issue, so that treatment strategies can be put in place at a very early stage. Boorman says that, typically, the timescale for referral to occupational health for most sickness absence issues is about three weeks, but in the case of mental ill health it is much more immediate. There is then the opportunity for the employee to have a telephone-based session with a welfare counsellor.

"We have found that prompt discussion with a trained counsellor helps to surface the problem and bring to light any broader psychosocial issues such as domestic difficulties," Boorman says. "The medical term for this early intervention would be 'triage', which enables Royal Mail to get in place the right support for the individual."

Effective rehabilitation

The 2007 XpertHR mental health survey shows that the three measures most commonly used by employers to help individuals return to work after long-term absences on mental health grounds are:

  • considering reasonable adjustments, such as different hours of work;
  • keeping in regular contact with individuals on long-term absence; and
  • offering a phased return to work.

Leeds Met's case-management approach to dealing with long-term sickness absence helps facilitate an effective return to work, as Duggan explains: "The functionality of someone returning to the workplace having suffered mental ill health can be a real unknown, so it is important that the right communication channels are already in place to oversee their rehabilitation."

For example, the organisation has recently managed the return to work of an employee with a serious mental health disorder and liaising with the individual's clinician and line manager was a vital element of facilitating their successful rehabilitation. Duggan says that advising and supporting the returning employee's colleagues can be a key part of occupational health's role, as often team members are not sure how to deal with a situation involving mental ill health.

Continuing support is also an important feature of an employee's resettlement into the workplace and, at Leeds Met, the returning employee and their line manager meet regularly to track progress. For example, one employee who has returned to their original role following a serious mental health illness may now be redeployed to further protect them from potential stress.