Raising the profile of mental health at work

The profile of mental health issues has risen substantially in the last 18 months. From education to sport, there has been an increased focus on the prevalence of mental health problems and their impact. In the political arena, mental health was an issue in the 2015 general election, with a pledge from the Liberal Democrats to improve funding of services, and it has continued to be prominent, not least because of media attention to service failures, such as that at Southern Health. Steve Vale, HR Consultant, investigates what’s on the horizon for mental health issues in the workplace.

Mental health in the workplace has been an issue whose prominence has waxed and waned over the years. There was a strong focus on workplace stress at the end of the 1990s, with issues around the employer duty of care, under health and safety at work legislation, to those employees (such as social workers) who were most at risk. More recently there has been an increasing interest in, and focus on, health and wellbeing in the workplace, with a broader and more holistic approach being taken by employers to address a range of issues which affect and impact on this. It is not surprising, therefore, that, in the current climate, the issue of mental health in the workplace is again becoming prominent, with recent survey data on the prevalence of such problems, and a new report offering calls and recommendations for action.

Highlighting the problems

There have been a number of recent reports which draw attention to the extent of the problems of employees’ mental health.

The results of survey from Capita Employee Benefits, published in October 2016, showed that more than a third of employees (36%) said that a colleague had complained about stress but didn’t receive employer support. Only a third (33%) of the 3000 workers surveyed said they would feel comfortable talking to their employer if they had a mental health problem and more than half (56%) of workers surveyed said they wouldn’t feel comfortable talking to colleagues about taking time off work following mental ill health.

These findings were backed up by comments from the CIPD, which said: “Our key findings about stress in the workplace suggest workload and management style are some of the key causes of work related stress, but there are also non-work factors such as lifestyle, relationships and family issues. We don't lose ourselves walking through the door, and offering to support people with stress is not just about physically being in the office.” It drew attention to the fact that, despite the rise in awareness and concern around stress and mental illness, many businesses are failing to support robust mental health at work — for example, a survey from the Institute of Directors found that only 13% of businesses have created plans to support good mental health — despite 95% saying it was important for the performance of their business.

To mark World Mental Health Day, the World Health Organization (WHO) recently issued a reminder to employers of their responsibility to support the wellbeing of employees with “invisible” disabilities, such as depression, anxiety, dyslexia and dyspraxia. The WHO also reminded employers of their duties under the Equality Act 2010, which protects employees with long-term health conditions against discrimination because of their disability. Mental health conditions and other invisible conditions can amount to disabilities provided they have an impact on normal daily life. For example, depression can be a disability if it has lasted or is likely to last 12 months or more or if it is likely to recur. Dyslexia has similarly been held to amount to a disability. The Equality Act’s provisions around making reasonable adjustments for people with disabilities would also be applicable in these instances.

Stress remains a major issue

In a separate report released to coincide with World Mental Health Day (10 October), the TUC reported that health and safety representatives named stress as one of the UK’s top workplace hazards. It reported that stress stands out more than ever as the chief health and safety concern, identified as a top five hazard by 70% of safety representatives in the survey, and is still the most common concern in all sizes of workplaces and in every region/country of the UK.

2016 saw a higher proportion of respondents cite it as one of their top five concerns than in any previous TUC safety representatives’ survey. Concern over stress remained higher in the public sector than the private sector, but it has become more widespread in both sectors. In particular concern about stress is especially prevalent — and rising — in central government (with 93% citing it as a top five concern), education (89%) and health services (82%).

The report was the 11th biennial TUC survey of safety representatives, conducted to help TUC policy officials and union health and safety specialists to understand the changing experience of safety representatives at work and to help them provide more support, as well as to inform public policy debates and work undertaken with the Health and Safety Executive (HSE). A total of 1039 safety representatives responded to the questionnaire either on paper or online in the period March–July 2016.

It showed that:

  • while stress is the most widespread concern in both public and private sectors, it is more frequently cited as a top five concern in the public sector (78% of representatives citing it) than in the private sector (63%)

  • overwork is another concern that is more widespread in the public sector, with 46% citing it in their top five hazards compared with 33% in the private sector

  • the public sector uniformly has higher rates of concern than the private sector over “psycho-social hazards” — including stress but also bullying/harassment and violence and threats

  • in local government, concern over stress, bullying/harassment and violence have all increased considerably compared with 2014 — the sharpest rise was in the proportion of representatives citing violence in their top five list of concerns — up from 26% in 2014 to 47% in 2016

  • stress is the most common concern in all sizes of workplace, with around three-quarters citing it as the major concern in organisations with over 200 employees

  • there was a remarkable uniformity in the main five concerns of representatives in each UK region/country, with stress the most widespread concern everywhere.

The report concludes that the TUC is concerned with the increase in reports of stress, bullying/harassment and violence and threats in the workplace, and will continue its campaigning to ensure they are prevented.

The Mental Health at Work Report 2016

This report, produced by Business in the Community, and published in October 2016, covers the 2016 National Employee Mental Wellbeing Survey findings. It describes itself as a “landmark survey which gives us an extraordinary opportunity: by listening to the voices of employees and managers, employers are able to fundamentally change the way that businesses approach mental wellbeing in the workplace.”

It refers to the political developments mentioned above, with a quote from Norman Lamb MP on its contents page: “Considering the amount of time people spend in work, achieving a stronger focus on employee mental health must be an absolute priority. Health and safety at work has overwhelmingly focused on physical health in the past, but we should be looking to big employers and senior business people to lead the way in adopting a more enlightened approach to staff wellbeing.”

The report is based on a survey (the main survey) of 3036 full- and part-time employees in the UK representative of gender, age, industry sector, region and business size, excluding sole traders and those working alone, drawn from a YouGov panel of over 600,000 people. In addition, it highlights data drawn from a parallel public open survey of 16,246 responses that was promoted by Business in the Community, partners, supporting organisations, and through social media. It was conducted during May–July 2016, and aimed to explore mental health and wellbeing in the workplace with a focus on the role of the line manager.

Main survey findings

The headline findings from the survey are as follows.

  • A majority of employees have been affected by symptoms of poor mental health. Seventy-seven per cent of employees covered by the main survey said they had experienced symptoms of poor mental health at some point in their lives, and 29% had been diagnosed with a mental health condition. Sixty-two per cent of employees attributed their symptoms of poor mental health to work or said that work was a contributing factor. The results from the open survey are even starker, with 84% reporting having experienced physical, psychological or behavioural symptoms of poor mental health where work was a contributing factor (although it needs to be remembered that participants in the open survey were self-selecting).

  • There is a clear disconnect between employees’ experience in the workplace and what those running the organisation believe is taking place. Sixty per cent of board members and senior managers believed their organisation supports people with mental health issues. Despite this, only 11% of employees in the main survey reported that they had discussed a recent mental health problem with their line manager, and half of employees said they would not discuss mental health with their line manager.

  • Line managers are being required to respond to something they know little about. Seventy-six per cent of line managers believed that employee wellbeing is their responsibility, yet only 22% of managers had received some form of training on mental health at work. Forty-nine per cent of line managers said that they would find even basic training in common mental health conditions useful, and 38% said that they would find it useful to have training on how to talk to employees about wellbeing. The default responses to employees experiencing symptoms of poor mental health appear to be arranging time off or a job move, which do not necessarily align with what the employee wants or what good practice would dictate.

  • A pervasive culture of silence remains entrenched across workplaces. Employees appear to be uncomfortable talking about mental health at work and more than a third (35%) of employees covered by the main survey had not approached anyone for support on the most recent occasion they experienced poor mental health. Only 25% of employees had approached someone at work for support (rising to 26% when including those who had contacted an Employee Assistance Programme (EAP)). Despite believing that colleagues care about each other’s wellbeing (77% felt that their colleagues were very or fairly considerate), 86% said that they would think twice before offering to help a colleague whose mental health they were concerned about. Only 14% felt that nothing would stop them from approaching someone if they were concerned.

  • The threat of employees facing disciplinary action when experiencing mental ill health is very real. Results showed that 9% of employees who experienced symptoms of poor mental health also experienced disciplinary action, up to and including dismissal.

  • There are big differences between women and men in relation to workplace mental health. Women were more likely than men to talk about mental health with their line manager. Male managers are less confident than female managers in responding to poor mental health, yet are less enthusiastic about mental health training. In the case of a staff member with depression, 68% of female managers said that they would feel confident responding, compared to 58% of male managers.

  • The experience of mental health at work greatly differs between generations. Younger workers (18–29 years old) were more likely to experience symptoms of poor mental health but felt less confident about discussing it with their manager. They were also less trusting in their employer’s commitment to mental health and wellbeing. Older employees talked more freely about mental health and were more likely to feel that their employer is concerned with mental health and wellbeing.

  • Overall perceptions of how well organisations support those with mental health problems are not encouraging: only 40% of those surveyed thought that their organisation dealt with mental health issues very well (just 11% thought this) or fairly well.

More detailed findings

More detailed findings from the main survey show the following.

  • Over 10% of those surveyed would describe their current state of mental health as poor or very poor.

  • The most common symptoms of poor mental health in which work was a factor were:

    • psychological symptoms (eg depression, anxiety, panic attacks) — 42%

    • behavioural symptoms (eg changes to appetite, irritability, procrastination, mood swings) — 39%

    • physical symptoms (eg raised blood pressure, muscle tension, sweating, dizziness, headaches or migraines) — 36%.

  • A total of 29% of employees surveyed had been formally diagnosed with a mental health condition at some point, with the most common diagnoses being depression and anxiety.

  • As noted 76% of line managers believed that employee’s wellbeing is their responsibility. However, only 57% reported that senior management had been supportive or quite supportive when they made changes to support an employee; 63% felt that they are obliged to sometimes put corporate interests before the wellbeing of colleagues; and 29% said that they faced situations where they have to put the interests of the organisation above the wellbeing of their team members frequently, or even every day.

  • As a result, only just over half (55%) of employees believed their manager is genuinely concerned about their wellbeing.

  • Managers identified the main barriers to supporting the mental wellbeing of those they managed as:

    • not having had mental health training themselves

    • having insufficient time for one-to-one management

    • being required to achieve performance targets

    • having other priorities at the time.

  • Thirty-two per cent of managers reported that they lacked the confidence to recognise the symptoms of a mental health issue.

  • When a problem is presented, line managers themselves reported that they often sought advice or support in their decisions — 31% from their own manager, 23% from someone in HR. Other channels of support include speaking to another colleague (21%), a senior manager (18%) or someone in occupational health (18%). However, a quarter of managers (24%) say they did not talk to or receive support from anyone else in their organisation the last time an employee approached them about a mental health issue.

  • In contrast to managers, less than 4% of employees surveyed said that they would ask HR for help with a mental health issue, and only 2% had actually done so following a recent experience of such an issue. Most commonly, employees reported that they had turned to someone outside the organisation (eg their GP or a family member or friend) for help.

  • However, where employees had resorted to seeking help from colleagues, 75% reported that colleagues had been very supportive or quite supportive.

  • Generally, the survey showed that employees and managers were happier to talk about issues such as age and physical health than about mental health issues, although the survey distinguished between “mental health issues” and “stress” and showed that there was a greater willingness to talk about stress.

  • By the same token, stress was the symptom which managers felt most confident in responding to (77%). It appeared that more complex conditions might be less likely to be spotted. Experiences such as panic attacks, depression and mood swings are less familiar to managers and up to two-fifths of them feel not very or not at all confident in responding.

  • Those with more than one experience of mental health problems were less likely to report any subsequent episodes, which may indicate their previous experience when sharing the experience was poor.

  • More than half (56%) of employees said no action was taken when they last experienced symptoms of poor mental health; only 7% were offered help with their workload and just 4% of employees were allowed time to work from home.

  • A total of 7% of employees who disclosed symptoms of poor mental health were referred to some form of counselling and 5% said they were told where to get help or advice.

  • Access to workplace services and facilities, including EAPs, which are designed to help employees deal with personal problems that might adversely impact their work performance, health and wellbeing, is still limited: 37% of employees reported not having access to such facilities or services. Twenty-three per cent of employees had access to a specific EAP.

  • As well as a difference in confidence in talking about mental health issues between male and female managers, there was also a difference in the actions they took: male managers were less likely to signpost their staff for help and information (30% compared to 42% for females), but 12% of male managers had organised an internal job move for staff members with symptoms of poor mental health, compared to just 4% of female managers.

  • Younger managers were more likely than older managers to ask for support and advice in managing an employee’s mental health problem. They were also more likely to sign up for relevant training: 53% of managers aged 18–29 wanted training on how to talk to employees about wellbeing, compared to 34% of those in their 50s, while 47% of 18–29 year olds were interested in a Mental Health First Aid course compared to 34% of 50–59 year olds.

Conclusions from the survey

The report summarises the main conclusions from the survey.

  • Employers need to recognise the scale of poor mental health in work, and take significant steps to reduce the risk of their workplace being a contributor to poor mental health.

  • Employers have a duty of care to their employees to respond to mental ill health just as they would to a physical illness, such as cancer, diabetes or back pain.

  • Organisations should equip their managers with the tools, support and organisational culture they need to do their job well, which must include managing employees with mental health issues.

  • There is a disconnect between the stated aims of employers regarding workplace mental health and wellbeing and the experience of employees with symptoms of poor mental health.

  • Workplaces should be environments in which employees feel comfortable disclosing their current state of mental health. Employees need support at an early stage and line managers should agree and implement a personalised plan that works best for employees.

  • Better signposting to support mechanisms such as EAPs is vital.

  • It makes good business sense to foster a culture of openness that supports employees with a mental health issue to work and stay in work. While progress is being made with greater organisational awareness of the need to support better mental health at work, significant and potentially damaging disconnects exist that demand an urgent response from business.

Recommendations on the way forward

The report recommends actions on a number of fronts and at all levels within organisations.

Employers need to:

  • make a public commitment to tackle the culture of silence that surrounds mental health, and seek to embed wellbeing into organisational culture

  • take simple, positive actions to build a culture that champions good mental health — in this context Business in the Community and Public Health England’s Mental Health Toolkit for Employers is recommended

  • send a clear message of parity of esteem between mental and physical health to normalise conversations around mental health

  • appoint a mental health champion on to their senior team, with a remit to drive better mental health and encourage all leaders to act as role models, actively challenging myths and stigma both proactively and reactively

  • ensure skills-based learning is made available to leadership and management teams to develop awareness, confidence and capability in managing mental health.

Employees need to:

  • be provided with basic mental health literacy so they can spot the signs when they or a colleague may need help

  • know where to go for guidance and be equipped with the confidence to start a conversation about mental health with colleagues they are concerned about. (In this context, Business in the Community’s Listen Up: Let’s Talk Mental Health is recommended as a practical guide for all employees on how to start a conversation with someone they are concerned about and how to talk about their own mental health.)

To address the disconnect between the aims of employers and the experiences of their employees, organisations need to:

  • acknowledge that a gap may exist between their leadership’s perception of support for employee mental health, and reality of employees’ experience, and take action to identify the gaps, with a commitment to resolving them

  • gather employee feedback using a range of informal and formal mechanisms to understand where gaps exist, including annual surveys, focus groups and various employee forums

  • identify and remove any specific organisational barriers that restrict line managers from effectively managing and supporting individuals experiencing a mental health issue

  • identify the issues in the workplace that may be impacting on employee mental wellbeing and use this knowledge to inform changes to approach, policy and organisational design.

To support line managers and address their needs, organisations need to:

  • train as many line managers as possible in first-aid training in mental health and invest in improving their mental health literacy

  • regularly communicate to line managers the support they can draw on when supporting colleagues, and encourage them to seek support as needed, when managing a colleague with mental health concerns, eg from HR or other specialists, or their own line managers

  • ensure managers are supported to manage their own wellbeing, through their own managers and appropriate resources and training

  • ensure line managers understand what steps they can, or need to, take in order to agree reasonable adjustments with someone who is experiencing mental health issues

  • introduce the concept of “everyday wellbeing” as a core part of all one-to-one and/or personal development conversations, to help to normalise conversations around mental wellbeing between staff and their managers.

To tackle the culture of silence around mental health, organisations should:

  • instil an understanding in every employee that everyone has a state of mental health as they do physical health, and use awareness campaigns regularly to communicate this message, such as Time to Talk Day, Mental Health Awareness Week and World Mental Health Day

  • appoint volunteer wellbeing champions to be ambassadors, who can lead by example, raise awareness and share information to promote positive messaging about mental health

  • work with change-makers, including key leaders, HR and other specialists, and wellbeing champions, to equip them with the confidence and knowledge to promote an open climate where discussion of mental health becomes normalised.

To provide clear support to employees, organisations need to:

  • provide them with a clear wellbeing offering, starting at induction, and reinforced on a regular basis, including resources to support employee resilience and mental wellbeing

  • include employees in discussions to develop flexible, bespoke solutions to their mental health support needs, ie making reasonable adjustments and implementing Wellness Action Plans

  • ensure that reasonable adjustments to enable people to remain in work are made whenever possible and take a phased approach to employees returning to work after a period of ill health

  • ensure every employee has access to (and knows where to find) appropriate support to stay well and to help manage mental ill health, reinforcing this information regularly

  • clearly outline the role that HR and any additional specialist support functions can play in supporting all employees, so that employees feel they have a safe space to discuss mental health.

Overall conclusions

HR professionals reading The Mental Health at Work Report 2016 may feel daunted by the extent of the issues it highlights, and the range of recommended actions. They will probably see the report as critical of the role of HR in organisations, suggesting that it is not sufficiently supportive of, or trusted by, employees who are experiencing mental health problems. There appears to be a need for HR to improve its own effectiveness at constructive interventions, as well as seeking to improve understanding and good practice across the whole organisation.

It also underlines the importance of seeking to build and develop resilience within the workforce, enabling them to better manage and cope with the complexities and changing nature of their working and personal lives.

The report does not distinguish between the sectors, but, for the public sector, the scale of the actions recommended is bound to cause issues over how a better response to mental health concerns and improved support for managers and workforce alike can be resourced. However, against the background of the report from Capita and in particular that from the TUC, the findings from which emphasised the prevalence of issues in the public sector (which will almost certainly accord with the experience of those working in the sector), it will be difficult to justify taking no action at this time. To do so is to risk a downward spiral where the failure to address increasing mental health and stress issues leads to greater pressures on employees, continuing decline in employees’ confidence that their employer is properly concerned for their wellbeing, and more distrust in the employer’s ability to take practical measures to assist them. Ultimately, this can only mean that mental health issues will become ever more prevalent, in a way which can only damage organisational performance.