Mental Health in the Workplace
This article is inspired by the just-published Stevenson / Farmer ‘review of mental health and employers’ entitled Thriving at Work.
During the past couple of years we’ve seen a notable upsurge in attention to mental health, thanks in no small measure to the interventions of the Duke and Duchess of Cambridge and Prince Harry. We’ve also seen some hard-hitting analysis and statistics from multiple sources including medical experts, mental health charities, and politicians. Here’s one, from the report entitled The Five Year Forward View for Mental Health, issued back in Feb 2016 and referenced by David Cameron in a speech the same day:
"Mental health problems are widespread, at times disabling, yet often hidden. People who would go to their GP with chest pains will suffer depression or anxiety in silence. One in four adults experiences at least one diagnosable mental health problem in any given year. People in all walks of life can be affected and at any point in their lives, including new mothers, children, teenagers, adults and older people. Mental health problems represent the largest single cause of disability in the UK. The cost to the economy is estimated at £105 billion a year – roughly the cost of the entire NHS."
Stevenson / Farmer provide a lot more detail in this respect and it’s worth spending some time to take in the points they make.
- 300,000 people with a long term mental health problem lose their jobs each year.
- 15% of people at work have symptoms of an existing mental health condition.
- According to a study commissioned from Deloitte, the annual cost to employers due to absence and degraded productivity is £33BN - £42BN a year; the cost to the Government in terms of lost tax revenue and benefits plus NHS costs is between £24BN and £27BN a year; the cost to the economy as a whole due to lost output is between £74BN and £99BN pa.
- Mental health is one of the greatest causes of sickness absence – and whilst overall sickness absence has fallen 15% - 20% since 2009, mental health-related absence has actually risen by 5%. And people with a mental health condition are three times more likely to experience a long period of sickness.
- Employees believe that a mental health condition can seriously impede their job progression. More specifically, 35% think they are less likely to be promoted if they suffer from depression.
- The impact is far worse in some professions than others. Worst are finance, insurance and real estate sectors, with an average mental ill health cost of £2017 - £2564 pa; and professional services with an average of £1473 - £1998 pa. Men working in construction are 35% more likely to commit suicide than the national average and female nurses 24% more likely to do so.
- From Stevenson and Farmer’s own work, 11% of employees discussed a recent mental health problem with their manager and 50% said they would not discuss mental health with their manager. 80% of employers report no cases of employees disclosing a mental health condition.
The implications of all of the above, and the wealth of information published elsewhere, are unmistakeable: mental ill health is costing the Government, the economy, and businesses vast sums of money. Infinitely worse is the emotional cost borne by sufferers, their families, their friends, and their colleagues.
The option of doing nothing is completely unsupportable on both financial and moral grounds. So something has to be done. What, and by whom?
Well, the Stevenson / Farmer report was commissioned by the Prime Minister so it’s hardly surprising that it focuses a lot of attention on what Government can do – a top-down approach. And indeed Government are already taking action: earlier this year the Health Secretary announced that 21,000 new medical health staff would be in place by 2021. It’s not easy to establish total NHS mental health professional staffing levels but numbers from the Mental Health Confederation suggest it’s about 45,000 so that 21,000 implies a major increase. Sounds like a really big deal, doesn’t it. But that 1 in 4 number who will suffer from mental ill health in any one year suggests that up to 16 million people could be suffering right now – and to that we can add the impact on relatives, friends, and colleagues. That means the existing 45,000 are very thinly spread, at up to 355 sufferers per professional – and whilst a staffing increase to 66,000 looks impressive, it’s still a pretty shocking 242 sufferers per professional – or worse if population and / or illness levels increase.
On the other hand there are more than 32 million of us in work, employees and employers. What can we do to help each other – and meet the top-down Government initiatives half way with a potentially mighty bottom-up contribution?
Let’s talk first about what we could do – and then look at how we can make it happen.
Firstly it’s worth keeping in mind that there’s a powerful financial dimension to this issue as well as an overarching moral one. We’ve already looked at the costs to the State, the economy and business. There’s a very strong positive side too. Stevenson / Farmer quote a couple of examples:
- From Deloitte: a study of 23 investments in mental health in the workplace showed a return of £4.20 for every £1 spent, with a range £0.40 - £9.
- From The Lancet, an Australian Fire Service investment in manager mental health training showed a payback of £9.98 for every £1 spent.
So by now we should be fairly clear what’s in it for us, all of us. And that’s what underpins the time and money we’d need to spend on the what and how.
Stevenson / Farmer report lists a set of six “mental health core standards” and then expands on them. They all make good sense and anyone interested should take a look at pages 32 – 35 of the report. I would like to make the approach a little simpler and less top-down. So I’ll boil it down to a two-step approach.
A good, solid, essential first step is to create the right workplace culture. The subject of mental ill health has been taboo amongst too many people for far too long and each and every one of us can change that with a simple act of will. We need to get people talking. And we can all start to talk about it RIGHT NOW. We can publicise and share our own experiences in a myriad of ways, be they face-to-face or via social media and blogs. We can show relatives, friends and colleagues that we are willing to listen and to help. And those of us who are managers can take a lead, set an example, and help to create an atmosphere in which it’s seen to be right, necessary indeed, to be open about mental health issues and always ready to listen.
For those suffering from mental ill health, talking isn’t easy. In fact for most it is impossible. Sufferers feel ashamed, damaged, different. They try to deal with their illness by withdrawing into themselves, drinking too much, self-medicating with drugs, seeking release through self-harming. It doesn’t work. In fact it makes things worse. Hidden for years, often decades, an untreated condition will worsen and frequently metamorphose into a much more complex and harder-to-treat illness. So one of the most important things we can do is to spot a developing mental condition at the earliest possible opportunity – and get help as quickly as possible. The earlier it’s given, the less sophisticated and intensive it need be.
So, how can we make these things happen?
The most efficient and effective way to initiate a change in workplace culture is for the most senior manager in the organisation to set the tone. That is, to articulate both the need for change and the sort of change he or she envisages. And it doesn’t need to be done through some complicated programme. A simple announcement can start the ball rolling. It could look much like this article – describe the problem, underline why we need to do something about it, and show how we can all contribute.
Initiation is a whole lot quicker and easier if the rest of us are already well-disposed to listen, of course. That’s the main reason for writing and circulating this article. All / any of us can do something similar at any time and through any medium we choose. That way we all soften ourselves up, as it were, ready for something more structured and formal. We can – and should – start on this right now.
Initiation without some sort of follow-up may not achieve much and won’t give any assurance of sustainability, let alone the means to track successes. We’ll need a plan. More on that later.
How do we “spot a developing mental condition at the earliest possible opportunity” – and how do we get appropriate help? For both we need training. How / where do we get it? Well, for starters take a look at the MIND website and specifically the courses they offer. Here’s one, entitled Mental Health Awareness Training: “This course aims to raise awareness of mental health, and to understand and recognise the causes, symptoms and support options for arrange of common and less-common mental health problems”. And another, entitled Managing Mental Health at Work Training: “Learn to recognise when a staff member is struggling and how you can support them professionally”. Other organisations, both from commercial and charity sectors, have similar offerings and most will come to your workplace to give the courses if that’s what you want. You can take a “train the trainers” approach. Or you can select a handful of “mental health champions” and have them trained in some depth. Whatever suits you or your organisation.
That’s some ideas about what and how. Now we need a plan.
First off you need someone to champion the cause – someone who really cares and who can sell both the moral and financial imperatives and benefits. They don’t have to spend all their time doing it either. They just have to set the ball rolling – and keep it rolling. If it’s the CEO, that’s great. But it doesn’t have to be. It can be anyone in the organisation. But that said, it really does require the active and committed support of top management. Some practical ideas that your champion(s) can advocate, support and encourage include:
- Listening to employees with mental illnesses and giving them support and understanding; and managing any related absence sensitively
- Arranging training for managers regarding mental illness; the different illnesses and what to look out for, how to sign post people etc.
- Offering employee assistance helplines and other counselling services
- Implementing benefits that relate to wellbeing such as medical cover, gym discounts, cycle schemes and more.
- Ensuring wellbeing and stress management policies are in place
- Promoting work/life balance with flexitime schemes whether formal or informal
That done, there needs to be put in place some means to drive progress, monitor it, see where improvements can and should be made, and make sure they do get made. That’s a familiar process for anyone who has ever been involved in a quality drive.
Here’s an example of something that really works and demonstrates how any part of an organisation can contribute and create something of real value.
In March 2015 MIND launched what it called The Blue Light Programme. It was triggered by research that had indicated that members of the emergency services were even more at risk of experiencing a mental health problem than the general population, but were less likely to seek support.
That same year Sussex Police signed up to Blue Light, and in 2016 launched the Mental Health Advocacy scheme to coincide with Mental Health Awareness Week. The driving force behind this was Chief Constable Giles York, who takes the health and welfare of his staff really seriously.
By May 2016 Sussex and Surrey police had trained 110 volunteer advocates who would act as a point of contact for anyone who was struggling with mental health themselves, or were concerned about someone they knew.
Leading from the front, Giles York said at the launch "In many ways the stigma associated with mental health can actually be more disabling than the condition itself. I want our people to get the support and guidance they need. I am incredibly proud of our work, every day I ask our officers and staff to take on exceptional challenges to keep the public of Sussex safe. I believe our new advocates have volunteered to help others, in addition to their own day jobs, guiding and helping those who need them. We need to have the courage to start conversations about mental health, to give people the confidence that they will be heard and understood.”
This year something rather remarkable happened. A Sussex Police response sergeant, himself a Mental Health Advocate, working with a friend who has a strong interest in helping PTSD sufferers, came up with a really impactful idea. They felt that a mobile app would be a great way to allow officers and staff, in private and informally, to find out more about the most common mental health issues they or their colleagues might face. The app, launched in February this year, is ‘their’ resource to find out how to look after themselves, their friends and most importantly where to access help when it’s needed. Importantly the app also features stories of colleagues who themselves suffered with mental health issues, strongly enforcing the idea of “you are not alone”.
The way this Sussex Police programme has developed, and continues to develop, is a great example of leadership from the top, bottom-up meeting top-down, ongoing improvement, and substantial benefit to staff who work in a highly stressful environment and “were even more at risk of experiencing a mental health problem than the general population, but were less likely to seek support”.
So there we are. Now back to you and your organisation. Think about it, and ask yourself: what can I do?