Mental health in the workplace as an issue has reached unprecedented levels in terms of discussion, but are we really taking it seriously enough? In this article, Tricia Palmer, HR consultant, considers the importance of good mental health, and the possible impacts of not giving it enough of the right attention.
The culture of mental health
Two years ago, in its report on Mental Health at Work, Business in the Community reported that 15% of people who declared a mental health issue faced a disciplinary, demotion or dismissal. In its national mental employee wellbeing survey, 84% of employers agreed that they had a responsibility for the wellbeing of their people, and 91% of managers agreed that what they did affected the wellbeing of their staff, but less than a quarter had received any mental health training. The report claims that there is still a pervasive culture of silence over mental health at work, and fears of prejudice and exclusion are limiting people in achieving their full potential at work. This is not only bad for individuals, but clearly affects the performance of the organisation.
Tribunal fees and disability claims
In addition, since the abolition of employment tribunal fees following a legal challenge in 2017, the number of disability claims has risen significantly, and have almost doubled in the last five years. There is evidence that mental ill-health is an increasing area of friction with workers being more willing to bring cases related to mental health to tribunals, with a particular emphasis on work-related stress and depression. The landmark Walker case is in the mind of every public sector HR professional, where a social worker claimed his employer was liable for his two nervous breakdowns. The Court held the Council liable for the second breakdown, as it had failed to adequately protect him and take notice of his concerns around work pressures. This case was heard back in 1994 when there was significant public scrutiny around child protection cases, and Mr Walker claimed that he was “shell-shocked by the pressure he was put under while the local authority sought to protect its back”. This case was notable as it was the first time that it was recognised that employers had a duty to protect employees from work-related stress.
However, have things really changed much since then? A lot of work is put into tertiary support (ie support for the individual after the event, once they are already stressed or depressed), but not many seem to be tackling the systemic issues which cause the stress in the first place. The main reason I am told is that a lot of the pressures are due to the constant reduction in resources, austerity and growing demands, and it is inevitable that people have to work harder to keep up. While this is true in itself, I still firmly believe it is possible to protect and support employees from an environment so pressurised that they go under. This article will draw on research and personal anecdotes to demonstrate this.
Cost of mental ill-health
The charity Centre of Mental Health estimates that mental ill-health costs the country £105 billion a year in economic and social costs. While the Department of Health says this is an uncertain estimate, it does highlight the range of factors associated with cost of mental ill-health both to the individual and society. The charity breaks down the costs in the following way:
£21.3 billion cost of health and social care — this includes not only the cost of providing NHS and local authority health and social care services, but the cost of welfare benefits, and the cost of informal care provided by family and friends.
£30.3 billion cost of the loss of output — this includes the cost of lost productivity due to sickness absence, lost productivity and working hours due to people with mental health problems not being in work, and lost productivity at home, such as housework.
£53.6 billion human cost — this provides a monetary value for the cost of the reduction in people’s quality of life caused by mental illness.
These are terrifying figures and demand that we take the issue seriously.
Mental health and unemployment
Other figures support the claim that mental illness is a huge drain on the country’s resources. The think tank OCED claims issues relating to mental ill-health are costing Britain £70bn a year. The Paris-based Organisation for Economic Co-operation and Development said “mental health was the cause of 40% of the 370,000 new claims for disability benefit each year — the highest recorded among the 34 nations that belong to the so-called ‘rich man's club’”. This study found that the bill to the UK from a failure to cope adequately with mental health issues was 4.5% of GDP each year, caused by productivity losses, higher benefit payments and the increased cost to the NHS. It added that around one million claimants on employment and support allowance (ESA), and as many on jobseeker's allowance (JSA) and other working-age benefits, had a mental disorder such as anxiety and depression that was hurting their prospects of finding work. The report goes on to say:
“People with a mental illness continue to fare badly compared to their counterparts without such illness: their unemployment rate is more than double the overall rate; and the risk of falling below the poverty threshold is almost double the overall risk. Indeed, the risk of poverty among people with mental health problems is the highest in a comparison of 10 OECD countries including seven other European countries, Australia and the US.”
This is a wake-up call for us in the UK to start to understand the factors which make our record on mental health issues poorer than our economic counterparts.
The independent review of mental health and employers by Lord Dennis Stevenson and Paul Farmer (Thriving at Work — 2017) found that the mental health cost to the UK could be around a £100 billion. They concluded that the stigma that surrounds mental health and prevents open discussion on the subject means that the UK faces a significant mental health challenge at work.
The report came to the following conclusions:
While there are more people at work with mental health conditions than ever before, 300,000 people with a long-term mental health problem lose their jobs each year, and at a much higher rate than those with physical health conditions.
Behind this, the analysis shows that around 15% of people at work have symptoms of an existing mental health condition.
There is a large annual cost to employers of between £33 billion and £42 billion (with over half of the cost coming from presenteeism — when individuals are less productive due to poor mental health in work) with additional costs from sickness absence and staff turnover.
The cost of poor mental health to Government is between £24 billion and £27 billion This includes costs in providing benefits, falls in tax revenue and costs to the NHS.
The cost of poor mental health to the economy as a whole is more than both of those together from lost output, at between £74 billion and £99 billion per year.
The report goes on to conclude that “The human cost is huge, with poor mental health having an impact on the lives of many individuals and those around them. This manifests itself in a variety of ways both at work and at home, and impacts a person’s ability to manage other elements of their personal life. Then there is the ultimate human cost of loss of life through suicide. We know that rates of poor mental health and suicide are higher for employees in certain industries”.
Mental health as an investment
In an independent study on the cost to employers commissioned from Deloitte, Stevenson and Farmer it was also found that those organisations which made investments in improving mental health showed a consistently positive return on investment. This is supported by a number of academic studies which demonstrate the importance of work environments which encourage good mental health. This was supported by an article in The Lancet (2017), where findings from a study in the Australian Fire Service found that a manager mental health training programme could lead to a significant reduction in work-related sickness absence, with an associated return on investment of £9.98 for each pound spent on such training.
Mental health statistics
As part of Mental Health Day 2018, sponsored by the World Health Organisation, 12 shocking statistics were published. They make salutary reading and it is vital for employers to note the incidence of mental illness and the groups it affects. A significant statistic is that half of all people with mental ill-health have considered resigning from their jobs. Given that estimates state that 1:4 people will suffer some form of mental ill-health during their life time this is a vast number of employees considering leaving their employment. The other statistics included:
1. The number of people experiencing mental illness in the UK is 16 million
Broken down this means one in four people experience a mental health problem every year; the most common mental health condition is anxiety, which affects 5.9 in every 100 people.
2. Those living in low income households are more likely to suffer with mental illness
A survey by the National Centre of Social Research found 27% of men and 42% of women in the lowest income bracket experienced mental illness. This was compared to 15% of men and 25% of women in the highest income bracket.
3. Men are three times as likely to take their own lives as women
Depression in men — especially young men — is higher than in women. In the Republic of Ireland, men are four times as likely to take their own life. Every year around 6000 people take their own life by suicide across the UK and Ireland. That is an average of 18 suicides a day — which is why prevention is key. Although, suicide affects both genders, three-quarters of all suicides in 2016 in Britain were male. However, there has been a significant decrease in male suicide in the UK over the last 30 years.
4. Women are more likely to have mental health issues
While men are more likely to take their own lives, women are more likely to suffer from a mental health condition. One in five women report having a mental illness, compared to one in eight men in England.
5. 11% of the NHS budget is spent on mental health
At present mental health problems account for 23% of the burden of disease in the UK. However, only 11% of the money given to the NHS by the government is currently spent on dealing with mental health issues.
6. Half of all mental illness begins by the age of 14
Depression is the third leading cause of mental illness in young people. Meanwhile, 1 in 10 children aged 5–16 have a diagnosable condition.
7. Suicide is the biggest killer of young people in the UK
Suicide is the leading cause of death among men and women aged 20–34. In addition, suicide is the second leading cause of death among 15-year-olds. In fact, statistics from the Office for National Statistics show the number of young suicides is increasing. In 2015, 1660 young people under the age of 35 took their own lives, which was 103 more than in 2014.
8. 75% of young people with a mental health problem are not receiving treatment
Despite mental health problems being so prominent in young people, most are not receiving treatment. In fact, there has been a rise in the time children have to wait before they are given treatment. In addition, children with depression and anxiety are the most likely to be left undiagnosed.
9. Drugs are the most common form of treatment
Drugs are the most common form of mental health treatment. The number of medicines dispensed for anxiety, depression, obsessive-compulsive disorder and panic attacks have more than doubled in the past 10 years.
10. The average waiting time for effective treatment is 10 years
Despite aims to cut waiting times, it can take a decade for many young people to receive help. Young people are often not helped until they reach the “crisis” stage.
11. Up to 300,000 people with mental health problems lose their jobs each year
The Government-commissioned Thriving at Work report found people with mental health problems feel stigmatised at work. They are not getting the support they need and employers are unsure how to provide it.
12. 89% of employees with mental health problems report an impact on their working life
In a survey by CV Library, of the respondents who identified having a mental health problem, 89% said it impacts their life. In fact, nearly half of the respondents said they have considered resigning the job because of the impact it has on their mental wellbeing.
The reasons why these statistics are important for employers to note is that it helps to understand why mental health is such a significant issue and which groups it is most likely to affect. Many issues relate to systematic societal factors, which makes it difficult for employers to provide useful interventions, particularly in the area of prevention. It is interesting to note that much of the commentary I hear in organisations is around stressed middle and senior executives and professionals and there is little regard to the lower paid, who many believe have less stressful roles. However, the incidence of ill-health is almost double in the lower-income households.
Life is hard, work is hard
In his book 12 Rules for Life, the controversial writer and clinical psychologist Jordan Perterson touches on the need to be tough to survive and thrive in life. Whether you support his views or not, there is something compelling about his approach. He states that life is hard, work is hard and we do our children and ourselves no service by pretending its not.
He questions “Do you want your children to be safe or strong?”. While our jobs are to keep our children are as safe as possible, building resilience is essential in order for them to thrive in our complex world. All too often we try and protect people from the pain of living. I see this at work where managers try to hide the reality of the situation, and consequently come across as weak and disingenuous. People are astute and will discover the truth, leaving them feeling both betrayed and shocked by the changes ahead. They are not prepared and feel out of control; couple this with not having learnt resilience earlier in life and disaster awaits.
The problem with most of our organisational approaches are that they are too little, too late. We attempt to put a sticking plaster on a broken leg, when what we should be doing is helping people to develop stronger legs! I am acutely aware that I now delving into a complex area fraught with difficulty, but I am prepared to challenge my HR colleagues and managers/leaders to rethink how we approach mental health at work.
Over the years, I have carefully studied the reports from the EAP services, providing counselling for employees and in every organisation (local authorities, charities, health) the pattern is the same. Over two thirds of the issues causing stress and depression relate to life in general, with less than a third emanating from work issues. I am not referring to serious mental illness, which requires specialist clinical support, but what I know Occupational Health professionals refer to as “the worried well”. People who are finding life hard, and have had just one too many knocks to be able to cope. This means that employers only have control over at best a third of the issues causing concern, and are often questioning how they can make a difference overall. This is why tackling mental health at work is so difficult and complex, but a co-ordinated approach which tackles all aspects of work can make a difference.
Many of us spend eight hours and more a day at work, and our environment will have a huge impact on our wellbeing. I am not going to delve into the physical environment here, but suffice it to say a pleasant physical environment clearly has a positive effect on how we feel (Maslows’ hierarchy of needs springs to mind).
As well as being comfortable and well-fed (that’s why the arguments about canteens and air conditioning are so common) we need to feel safe. If we do not feel safe, we cannot achieve our full potential, because we are concentrating on our lower order needs. Safety is not just about the physical, but also covers safety from threat. We are hard wired to see threats everywhere — it is our survival instinct. You will all be familiar with fight or flight, and the serious issues the released cortisol can cause to our health and wellbeing if we are not able to respond in a physical way. This is why the threat of a bully in the workplace or a change which may affect our livelihood is so stressful, especially if individuals feel they have no control over the outcome.
Civility and toxic environments
There is currently a lot of debate about “workplace civility” and toxic environments affecting employees’ mental health. According to Mckinsey and Company, workplace incivility is “the accumulation of thoughtless actions that leave employees feeling disrespected — intentionally ignored, undermined by colleagues, or publicly belittled by an insensitive manager”. It also includes “low-intensity deviant behaviour with ambiguous intent to harm the target, in violation of workplace norms for mutual respect.” Research over the last 20 years (Torkelson et al 2016) has shown that toxic work environments are associated with increased depression, substance misuse, and health issues among employees. Further research has shown that organisations are suffering as well. Some of these adverse effects include decreased productivity, lower levels of employee commitment and increased turnover. The article in the Harvard Business Review (2013) The cost of incivility makes this point in a powerful way. From a sample of 800 employees and managers in 17 industries they found that of those who had been on the receiving end on incivility:
48% intentionally decreased their work effort.
47% intentionally decreased the time spent at work.
38% intentionally decreased the quality of their work.
80% lost work time worrying about the incident.
63% lost work time avoiding the offender.
66% said that their performance declined.
78% said that their commitment to the organisation declined.
12% said that they left their job because of the uncivil treatment.
25% admitted to taking their frustration out on customers.
Effect on creativity
In addition, it has been found that creativity suffers in toxic environments. This was demonstrated in an experiment by Amir Erez, a professor of management at the University of Florida, where participants who were treated rudely by other subjects were 30% less creative than others in the study. They produced 25% fewer ideas, and the ones they did come up with were less original.
What can employers do to set the tone and prevent a toxic environment, and keep constant vigilance on workplace civility? The Harvard Business Review gives the following suggestions:
Manage yourself. Leaders set the tone, so you need to be aware of your actions and of how you come across to others.
Model good behaviour. Managers at Fortune 1000 firms spend the equivalent of seven weeks a year dealing with the aftermath of incivility. In one of Harvard’s surveys, 25% of managers who admitted to having behaved badly said they were uncivil because their leaders — their own role models — were rude. If employees see that those who have climbed the corporate ladder tolerate or embrace uncivil behaviour, they’re likely to follow suit. So turn off your iPhone during meetings, pay attention to questions, and follow up on promises.
Express your appreciation — this helps to create a culture of respect and bring out your employees’ best. Personal notes are particularly effective, especially if they emphasise being a role model, treating people well, and living the organisation’s values. Doug Conant, a former CEO of Campbell Soup, is well aware of the power of personal recognition. During his tenure as president and CEO, he sent more than 30,000 handwritten notes of thanks to employees.
Ask for feedback. You may need a reality check from the people who work for you. A manager at Hanover Insurance decided to ask his employees what they liked and didn’t like about his leadership style. He learned that it really bothered them when he glanced at his phone or responded to emails during meetings. He now refrains from those activities, and his team appreciates the change.
Pay attention to your progress. Be aware of any negative role modelling, including gossiping, ignoring junior colleagues or being overly critical.
Manage for civility — recognise good behaviour and pick up immediately on unacceptable ones
Recruit for attitude and teach civility if necessary — this is particularly important when group norms appear to support rude and disrespectful behaviour.
I have concentrated particularly here on civility because it is all-pervasive, and sets the tone for the whole organisation. This does not detract from the importance of setting priorities, managing performance and making changes, all of which can be carried out from a place of respect and understanding. Employees need leaders who are honest and genuine. In my experience, people usually accept the need for change, especially if it is well-thought out and clearly articulated, but find the process more stressful when it is carried out in a “disrespectful” way. I have seen managers take refuge in their offices rather than face employees and fail to communicate vital messages because they are fearful of the reaction. This kind of avoidance is rude and uncivil and leaves room for rumour, leaving employees feeling out of control and unworthy.
The best support we can give our employees is to teach them resilience, the ability to bounce back in the face of adversity, be it at home or at work; but can resilience be taught or is it genetic? Neuroscientists suggest that differences in the brain explain differences in how we respond to stress. One difference is how we produce serotonin.
Serotonin is a neurotransmitter that is associated with feelings of tranquillity, calm and wellbeing. Some individuals have a variant gene, the 5HTT, which produces more serotonin than is the case for the rest of us. These individuals are generally more optimistic, regardless of the situation they are in. In contrast, someone with a variant of the 2-adrenoreceptor gene, which is responsible for the production of the stress hormone adrenaline, will respond strongly to any stress in their environment; likewise, their stress levels will take longer to settle. Furthermore, there is the amygdala, the central part of the brain that is key to our emotional responses. It fuels our “flight or fight” response to stressful situations. To add further complexity, neuroscience has now established that we are neurally plastic and capable of learning throughout our lives and that some of us have greater neuroplasticity than others. This is positive because it shows that although some of our responses to stress are hereditary it is possible to learn and grow in the area of resilience, but it takes practice.
Early years development
New research in this field indicates that protection in early years, or reassurance from a parent or any other close adult (teacher, grandparent, priest, etc.), regardless of economic circumstances, plays a key role in resilience. In the world of adults, this protection will translate into someone trying to look for protection in a very pressurised and stressful work environment, ie someone who reaches out, communicates, uses their network efficiently, etc. The other key factor in the building up of resilience is purpose. It is problematic when individuals experience a lack of purpose. When they have purpose, individuals have the ability to direct their goals and keep them on track when they are faced with difficulty. This has a direct effect on determination and energy. When purpose goes, individuals are more vulnerable to the loss. A study by the Association of Psychological Science, published in 2014, found that having a purpose in life consistently predicted a lower mortality risk across an individual’s lifespan, whether for younger, middle-aged or older participants.
Finally, there is the learning part of the building up of resilience. Individuals who view difficulties as opportunities and learn from them can move forward, reinforced and re-energised by this learning. (Natalia Martinez — Executive Coaching Company)
To translate this into the work environment managers should be mindful of the following.
Employees need a sense of purpose — they need to see their work adds value and gives them meaning. It is as important for new recruits to feel they are aligned to the organisations’ values, as it is for the recruiter to believe they are.
Provide opportunities for networking and feedback — individuals need ways of reaching out and asking for help.
Treat problems as learning opportunities and engage employees in finding the solutions.
Train managers to be aware of mental health issues and know how and where to refer people with significant difficulties — help is the key.
Publicly celebrate success involving as many people as possible, including clients and customers.
Create an optimistic climate — downtrodden managers who prophecy doom and gloom bring everyone down. Leaders should role model realistic optimism.
Interestingly the General Medical Council has recently determined that resilience is an essential part of being a doctor, and all medical students are now required to have mandatory training in resilience.
It is evident, both from the academic research and my own personal experience of workplace issues, that the incidence of mental health issues is on the rise. It is difficult to tell whether this is due to increasing pressure (workloads, technology, different ways of working) or the fact it is more acceptable to openly discuss mental health issues.
In the recent past individuals resisted having stress identified on their medical certificates, opting for backache or migraine as the reason for being off, for fear that it would affect their prospects. Now stress, anxiety and depression are the number one reason for sickness in the public sector. The reasons for this are complex, as many of the presenting issues are unrelated to work. It is not possible for employers to deal with all the ills of society, but it is possible to provide environments which are supportive and feel safe, and enable people to give of their best.
Leaders and managers need to be self-aware and ever vigilant of their impact on their teams. As well as drive and determination, managers need to be compassionate and empathetic towards their people. Employers can build resilient workplaces by providing the right environment of trust, direction and empathy. They can support their employees to become more resilient through training and providing good mechanisms for support and feedback, as well as ensuring they have meaningful work, over which they have some control. In times of change and uncertainty leaders need to be visible and strong, showing determination, clear direction and support.
It is not enough to provide the support after the event, outsourcing our problems to the EAP or occupational health services. We need to look very closely sat the systemic issues within our organisations and tackle them head on. Leadership training must start with self-awareness and the impact of behaviours. Bullying or “absent” managers should not be tolerated and the disruptive employee should be robustly managed. It may seem strange to say that to reduce stress and mental health issues in the workplace we must be tough; tough on the stressors that affect the majority. Life is hard, work is hard — we can’t always be safe, but we can be strong.
Mental Health at Work 2017 — Business in the Community
Walker v Northumberland Council (1994 and 1995)
Centre for Mental Health Research (2010), updated by Department of Health 2016
OCED study into mental health (2014)
12 Rules for Life — Jordan Peterson (2018)
The Price of Civility — Harvard Business Review (2013)
The Hidden Toll of Workplace Incivility — Mckinsey and Company (2016)
Factors contributing to the perpetration of workplace incivility: the importance of organisational aspects and experiencing incivility from others — Eva Torkelson, Kristoffer Holm, Martin Bäckström & Elinor Schad (2016)
Resilience — Genetic or Learnt? — Natalia Martinez, Executive Coaching Company (2016)
For professional advice on wellbeing issues, contact Health Assured, the UK’s leading employee assistance programme and wellbeing services provider on 0844 891 0350.
Last reviewed 13 June 2019