How to support line managers in dealing with mental ill health

Managers require a certain level of knowledge when dealing with mental health. OH practitioners can provide the necessary support, says Dr Sally Wilson.

On this page:
Managing stress and other causes of mental illness
Tackling misconceptions
Managing absence and return to work
Working towards best practice
References.

Non-health professionals can lack the confidence to deal with mental health issues and so occupational health specialists have a vital role in providing line managers with the support and information that they need.

Despite increasing recognition of the importance of tackling mental health issues in the workplace, recent absence figures suggest that UK employers still have some way to go in improving employees' mental wellbeing. According to the annual absence survey from the Chartered Institute of Personnel Development (external website), published in October 2010, more than one-third of employers reported an increase in mental health conditions such as anxiety and depression over the past year. The survey also reported that there was a particularly marked rise in reported mental health problems in organisations where employers were planning to make redundancies. This suggests that work-related factors continue to play a major role in the development of mental ill health and, therefore, that efforts to address mental ill health at work should not be cut back at times when resources are tight.

Some line managers may find it a challenge to give these issues sufficient attention if they are under pressure to maintain staff productivity with reduced resources, especially if their own positions are at risk. However, it is vital that efforts to engage line managers with these issues continue and that tough economic conditions do not result in halting the progress that has been made in recent years.

A comprehensive review (external website) of this area conducted for the Department for Work and Pensions (DWP) by the Institute for Employment Studies (IES) and the Social Policy Research Unit (SPRU) showed that line managers play a key role in identifying and supporting people with mental health conditions, helping them to do their job. The review found that line managers were always involved at some level in the organisational response to the mental ill health of an employee, whether it be managing absence or spotting early signs of mental health conditions in their staff. However, the same report also drew attention to the limitations in the knowledge base of line managers and the fact that they frequently feel out of their depth.

OH specialists are well placed to provide line managers with accessible information but should be aware that a balance needs to be struck between informing them and overwhelming them. Line managers cannot and should not be expected to have in-depth knowledge of mental health issues but ideally they should:

• be clear about where their responsibilities lie with respect to managing and monitoring stress, and be aware of the link between stress and mental health;
• be sufficiently informed about mental health conditions to challenge misconceptions and prejudice among their staff; and
• be confident about having "difficult" conversations with employees who may be experiencing symptoms of a mental health condition or in the process of recovering.

Managing stress and other causes of mental illness

One area where line managers can have a real impact is managing workloads and providing support for staff who are experiencing work pressures. A report documenting employers' experiences of implementing the Health and Safety Executive's (HSE) management standards (on the Institute for Employment Studies website) highlights the critical role of the line manager in monitoring how work demands are affecting employees. Line managers need to be aware of their responsibility to manage workloads effectively and to provide sufficient support to all staff at times of high demand.

However, managers should not feel pressured into absorbing excessive workloads themselves. The IES's review shows that commitment is necessary at board level to support managers in dealing with work stresses effectively. In-house OH professionals are in a good position to be able to approach senior managers and underline the importance of the organisation taking a strategic approach to preventing stress-related illnesses. They can also direct them to available training and resources.

Not all instances of mental ill health are triggered by work causes and managers should be made aware that it will not always be apparent why a particular employee is experiencing symptoms of mental ill health. Even where an illness is purely non-work related, managers should know that employers still have a responsibility to make reasonable adjustments to support an employee in their role. The HSE website provides general information on mental health conditions (external website) as well as guidance on stress - it serves as an accessible resource for line managers and other non-specialist professionals.

Tackling misconceptions

It is difficult for line managers to identify a mental health condition unless the employee tells them, and employees can understandably be reluctant to disclose this. IES and SPRU researchers found that this was often the case for participants with a history of mental health issues who contributed to the DWP review. Among them there was a perception that employers viewed people with mental health conditions as a "risk", unreliable or incapable of coping in their job, and that many employers lacked a basic understanding of mental health issues. Consequently, many of these individuals had not disclosed their condition to their current employer.

It is important to foster a culture in which employees feel able to talk to their employer about any difficulties they experience and educating line managers is an important component of this. This also better equips line managers to recognise the signs of a mental health condition and broach the topic when a member of staff seems unwell. A well-informed line manager is less likely to discriminate against employees with mental health issues and is also in a better position to tackle discrimination from colleagues and challenge prejudicial views.

The need to increase knowledge and understanding of mental health conditions among employers, particularly those with line-management responsibilities, has already been recognised by national public and voluntary sector organisations, and initiatives such as Time to Change and Shift have gone some way to improving awareness and countering the stigma of mental illness. A number of providers now offer courses and seminars aimed at improving attitudes towards mental health in the workplace. OH professionals are well placed to advise employers on training and resources and could even consider offering awareness-raising events themselves.

Managing absence and return to work

In many cases a manager's first direct encounter with a particular mental health condition will be when an employee is off sick. Therefore, the prospect of keeping in contact with an employee who has a mental health condition can be intimidating. It can be particularly confusing for managers with no experience in health matters to understand conditions that fall outside the scope of "common mental health problems" such as anxiety and depression.

A successful experience of dealing with an employee who has had a one-off episode of mild depression won't enable a line manager to feel confident if, for example, another employee is absent from work following a psychotic episode. Likewise, adjustments that employees require when they return to work are likely to differ according to the nature and recovery path of their condition.

For some employees, offering a phased return may be sufficient, while others may require temporary adjustments to the content of their job, such as substituting a demanding project that requires teamwork for a smaller project that can be completed independently. In some cases, side-effects of prescribed drugs should be considered as well as the individual's underlying condition. Employees whose concentration is affected by medication may benefit from a less distracting work environment, for example, screening off desk space or providing other soundproofing or visual barriers.

Line managers will deal with mental-health-related absence more effectively if they do not approach the issue from a position of fixed expectations or stereotypical beliefs about mental ill health and its treatment. A basic awareness of mental health recovery routes can remove awkwardness and help avert the potentially awkward scenario of "saying the wrong thing" to the affected employee. For example, managers should be aware that recovery times can vary significantly, as can treatments. Some people recover without medical intervention, while others may require a course of medication and/or therapy such as counselling or cognitive behavioural therapy.

It is useful for managers to know that a range of health professionals can potentially be involved in the recovery of a person with a mental health condition so that they are able to understand if an employee or OH professional mentions these. For example, an employee may have been referred by their GP to a community psychiatric nurse or other secondary care specialists. They may also receive input from psychiatrists and clinical psychologists.

Knowledge of some basic facts about mental health can also help line managers contribute with more confidence to discussions about an employee's return to work and any adjustments that they require. An accessible summary of facts about diagnoses, treatment and recovery can be found online in the Mindful Employer information sheet (PDF format, 93K) (external website).

Working towards best practice

What constitutes best practice in the area of managing mental health at work is still a subject for debate, although the UK is well on the way to gaining a wide evidence base. A number of government initiatives are under way that address issues raised in the review by Dame Carol Black, "Working for a healthier tomorrow", which place a strong emphasis on mental health. These are likely to provide more insight into what works in relation to facilitating return to work following ill health (via the Fit for Work Service pilots) and into the benefits of provision of OH advice direct to employers (via the Occupational Health helpline). The results of these pilots (on the Institute of Employment Studies website) will be revealed before the end of 2011.

The IES is also involved in assessing the impact of the fit note. As reported in Occupational Health, December 2010, there are early indications from a separate study that the new Med 3 format is already leading to better return-to-work-focused discussions.

Nevertheless, while it is desirable that line managers are as informed as possible about mental health issues, a balance needs to be achieved in order to ensure that unrealistic expectations are not placed upon them in terms of understanding an area outside their own field of expertise. It is also essential to convey to line managers that their understanding of an individual's situation will always be restricted by medical confidentiality issues and what an employee has chosen to disclose to them. OH professionals who deal with these sensitivities on a routine basis are in an ideal position to educate and support line managers, as well as ensure that mental health remains a high priority in the workplace despite the pressures that employers currently face.

Dr Sally Wilson is a research fellow at the Institute for Employment Studies.

References

Sainsbury R, Irvine A, Aston J, Wilson S, Williams C, Sinclair A. "Mental health and employment", (prepared in association with Social Policy Research Unit); research report DWPRR 513, Department for Work and Pensions, July 2008.

Broughton A, Tyers C, Wilson S, O'Regan S. "Managing stress and sickness absence: progress of the sector implementation plan phase 2"; research report RR694, Health and Safety Executive, Mar 2009.

Paton J and Riches E. "Ticking boxes", Occupational Health, Dec 2010.