In many workplaces, the time for cultural shifts about mental health is long gone and now it’s a cultural heave that’s needed to propel change.
Fifteen years have passed since Xerox CEO Anne Mulcahy first spoke the now well-worn phrase, “employees are a company’s greatest asset”. Despite all those years, can many employers honestly say that everything that can be done is being done to manage workers’ mental health?
In the twelve months captured by the HSE’s 2016/17 statistics, 12.5 million working days were lost in the UK due to stress, depression, anxiety and similar mental health conditions. Not only was it the category of work-related illness/non-fatal workplace injury that resulted in the most working days lost, it also topped the charts for the number of cases (more than half a million) and days lost per case (23.8).
Sickness absence, which increases the cost of getting a job done due to reduced output and/or the expense of getting someone in as cover, isn’t the only consequence of having workers suffering from unmanaged mental health problems. Efficiency and quality of work will run down while the probability of mistakes being made goes up. Additionally, an unhappy workplace will suffer from high staff turnover.
On the flipside, a business that actively combats the causes and contributing factors of mental health problems in the workplace and manages the needs of affected workers will reap the benefits of improved productivity and a reputation as a good employer that attracts and keeps talent.
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UNDERSTANDING MENTAL HEALTH PROBLEMS
There are various mental health problems that can present difficulties at work. Information on all of these conditions can be found on the websites of NHS UK and the charity Mind.
The mental health problems that employers are most likely to come across – and that work may exacerbate or is the cause for – are stress, clinical depression and generalised anxiety disorder.
There are a few common features between the illnesses, such as a tendency to irritableness, being less sociable, constant worrying and/or fearfulness, suffering from muscle aches and pains and sleep problems. However, there are symptoms and behaviours that also clearly define them.
– “the adverse reaction a person has to excessive pressure or other types of demand placed upon them”.
People who are stressed may often try to avoid the things or people that act as triggers. They can seem distracted and find it difficult to think clearly about other things as they become overwhelmed by racing thoughts and low self-esteem.
These emotions can cause individuals to eat, drink or smoke less or more than usual, and they may also get frequent headaches and suffer from dizzy spells. Stress can evolve into clinical depression or generalised anxiety disorder if left unmanaged.
– “[feeling] persistently sad for weeks or months, rather than just a few days”5.
Clinical depression is frequently described as a continuous low mood or feeling of sadness, which sometimes leads to it being confused with grief – “an entirely natural response to a loss, while depression is an illness”. People who are depressed find it difficult to think positively about the future and don’t enjoy anything – their feeling of sadness is constant, whereas with grief it can be intermittent.
In cases of depression, the person can be carrying around a variety of feelings that keep their mood down, such as hopelessness, guilt and tearfulness. In extreme cases, they may think of suicide and/or self-harm. Someone suffering from depression may appear to be moving or speaking more slowly than usual, struggling with their work, have difficulties maintaining their home and family life and neglect their hobbies and interests. For women, a physical symptom, in addition to aches and insomnia, can be changes to their menstrual cycle.
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– uncontrollable and distressing feelings of unease “about a wide range of situations and issues, rather than one specific event”6.
What sets apart generalised anxiety disorder (GAD) from stress and depression is how a constant feeling of worry, fear and/or dread can result in the manifestation of physical symptoms beyond aches and sleep problems. With GAD, signs can include trembling, stomach ache, nausea, dry mouth, excessive sweating, pins and needles, shortness of breath and heart palpitations (a noticeably strong, fast or irregular heartbeat).
Individuals with phobias or panic disorders will often know what can ‘set them off’, but those with GAD may not be able to identify the source of their anxiety, and this not knowing can cause it to intensify. They carry around a sense of dread which leads to a feeling of being ‘on edge’ and causes restlessness, irritability and difficulty concentrating.
AVOID STEREOTYPING – THERE’S NO ‘ONE SIZE FITS ALL’ SOLUTION
The effect a mental health problem can have on any individual will be unique to them. There are common characteristics that are used for diagnosis so that their condition can be treated and managed, but it doesn’t mean that the needs of one worker are the same as any other’s.
Time should be taken to consult with the worker and, if necessary, specialists to learn what adjustments they need to be able to do their job without worsening their mental health problem.
There is a general obligation for employers set out in UK law to manage and control, if not eliminate, health and safety hazards in the workplace, including environmental factors which can cause or worsen mental health problems. When it comes to the physical health of workers, there are regulations and standards that clearly, and in considerable detail, inform employers what they should be doing (as a minimum) to protect their people, but to many it can seem that with regards to mental health legislation and guidance is more ambiguous.
The top cause, by far, for work-related stress, depression or anxiety, is workload, this being the reason cited for 44% of recorded sickness absence cases in statistics produced by the Health and Safety Executive (HSE). The three other main causes are lack of support (14%), violence, threats or bullying (13%) and changes at work (8%).
All businesses should have an absence policy, as recommended by HSE guidance, that means the reasons for ‘sick days’ are recorded and individuals have an opportunity to report problems and get support. The records can be used to help identify patterns throughout the workforce so that widespread or common issues can be considered and tackled through risk assessments and a review of those control measures already being implemented.
EASING THE LOAD
On top of consideration of each worker’s health needs, the Chartered Institute of Personnel and Development (CIPD) recommends looking at a “number of factors that will help determine whether harm is foreseeable or not”, such as whether:
• their workload is much more than others doing the same jobs;
• more or greater burdens are put on a worker in comparison to others in similar roles;
• there are signs, such as extended or frequent incidences of absence, that a worker may be suffering from stress;
• there are influential non-work factors.
Workers need to feel like they won’t be looked down upon for admitting that their workload is more than they can reasonably handle.
A CUTLURE OF SUPPORT AND UNDERSTANDING
To address a perceived lack of support there needs to be commitment from all parties, but buy-in from senior management and employee representatives will really help get things moving.
Establishing or sourcing counselling services or helplines that workers can use to report and get help with mental health issues is no good without signposting. All workers should be made aware of how to get any support they might need on their first day, and they need to be reassured that they won’t be put at a disadvantage if they report issues they might be having or concerns about an emerging problem. Some workers often believe that by revealing a mental health problem they will be seen as ‘weak’ or ‘damaged goods’ and therefore might get overlooked for promotion or certain tasks.
Line managers need to be trained so that they can sympathetically manage the factors that can cause and/or worsen mental health problems, and awareness of policies about managing mental health in the workplace ought to be regularly promoted.
How often do you hear this phrase when someone’s come to work despite being visibly unwell?
Mental health problems might seem invisible, but in cases of presenteeism – when a worker comes to work despite not being in a fit state to do their job safely and/or effectively – the impact will manifest as loss of productivity and/or a poorer quality in the output of their work.
Workers may insist on being present due to a perceived stigma around mental health problems, or because they are insecure about their position or are more concerned about managing their workload.
There may also be a lack of knowledge about the impact that work, and not acknowledging and managing relevant issues, has on mental health. A consequence of presenteeism can be that a longer period of absence is eventually needed, compared to what might’ve been required if the issue was tackled when it first became apparent. Additionally, mental health can have significant and long-term effects on physical health.
DON’T TOLERATE BULLIES
It’s an unfortunate truth that bullying doesn’t get left behind in the playground and it can happen in the workplace. Bullying can cause mental health problems to start, recur or worsen and, in some cases, the illness itself might be what leads the bullies to target an individual.
An actively enforced policy for bullying and harassment that includes measures to prevent discrimination against workers with mental health problems needs to be in place before a situation arises so that it can be promptly dealt with. It should spell out the steps that will be taken if accusations of bullying, harassment or discrimination are made and be promoted internally so that it acts as a deterrent and not just a reference guide for the actions to take when it’s discovered.
What constitutes as bullying can vary from physical assaults and derogatory remarks to purposefully ignoring the individual, making jokes about them to others and generally making their life difficult, for instance by hiding their work equipment. When it comes to pranks that someone has made a complaint about, any excuses like it actually being ‘banter’ shouldn’t be accepted, although each situation needs to be handled carefully with appreciation for every side to the story.
After all this, it shouldn’t be forgotten that, as well as the victim of any harassment or bullying, the offender might have problems that need to be addressed considerately.
MANAGING AND COMMUNICATING CHANGE
However large or small, changes in the workplace can have a dramatic impact on a person’s mental wellbeing. Consider how the average full-time worker spends 40 hours a week, about a third of their conscious hours, at work, so it is a significant aspect in their life.
Change can take the form of physical moves or alterations to the work environment, movement of people, or they might be organisational (e.g. restructures).
MAKING REASONABLE ADJUSTMENTS
Employers have a duty set out by the Equality Act 2010 to not discriminate against people with disabilities and to make reasonable adjustments to try and support any worker (or job candidate) that is disabled and overcome resulting disadvantages. Mental health problems can amount to a disability if they cause challenges and have a noticeable impact on everyday life and have lasted at least a year, are expected to last more than a year, or are likely to recur following improvement.
In cases where a mental health problem is being managed with counselling or cognitive behavioural therapy (CBT) and/or by taking medication the law says that you should look at how an individual’s mental health problem would affect them if they weren’t undergoing treatment or taking the medication when deciding whether the impact is significant.
The individual(s) requiring the adjustments should never be asked to cover the costs for them – this duty lies with their employer.
Here are some examples of reasonable adjustments that might lessen any perceived disadvantage due to a mental health problem:
• Adjusted working hours, for instance to allow an employee to avoid the crowds during ‘rush hour’, or to enable extra breaks during the day.
• Flexibility on when hours are fulfilled or working from home.
• Reduced workload and/or re-allocation of duties.
• A change of role (only if they become unable to do their current job as a direct result of their disability).
• Time off for treatment or rehabilitation.
• Phased return to work following leave.
• Ignore periods of disability-related absence during redundancy procedures or from a previous job when selecting job candidates.
• Physical changes to the working environment and break areas that make it more accessible or will help with preventing or managing symptoms.
• Provision of aids, including support from internal or third-party workers.
WHAT CAN AND CAN’T BE ASKED BEFORE EMPLOYMENT?
Apart from in exceptional cases, any questions about health mustn’t be brought up until a job offer is made. Recruiters and employers are allowed ask about health if it’s in relation to whether the candidate will be able to undertake an assessment for the job and to find out if reasonable adjustments are required to ensure, as much as possible, they aren’t at a disadvantage at any point in the recruitment process and/or to perform the role.
If, after offering the job, a mental health problem is revealed and then the offer is taken back without there having been any further assessment or investigations then the recruiter or employer may be found guilty of discrimination. It’s okay for employers to be concerned that a mental health problem might affect a candidate’s ability to do the job, but before taking any action they must seek more information or advice from relevant and professional sources.
For some jobs, it may be the case that a disability is required, and in these situations employers are permitted to ask about health. For instance, a charity that supports people who suffer from anxiety may be looking for a blog writer who has first-hand experience of the condition. Other times, an employer may ask broadly about health to ensure that they’ve got a diverse range of job applicants.
Source: Allianz Insurance plc
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