Mind over matter

One
in four people suffer mental health problems, yet the subject remains taboo –
especially in the workplace. Stephen Overell looks at the issues involved for
employee and employer in overcoming the stigma and moving towards integration
of the mentally vulnerable

A week after Andrew Webster joined Dairy Crest in 1989 as a food production manager
looking after a unit with a £100m turnover, a form landed on his desk, asking
for details of his medical records. He felt he couldn’t lie, so he went to his
director and told him that before being hired, he had spent a period in a
psychiatric hospital, when a lifelong tendency to depression and a chronic lack
of self-confidence ran out of control. His boss told him, "Join the
club".

With mental illness rising fast across nearly all classifications (see box),
the issue will require more critical attention over the next 10 years.
According to mental health charity Mind, a survey of 778 people questioned
about their experience of suffering mental illness while working, found 34 per
cent had either been sacked or forced to resign due to their condition.
Meanwhile, fellow charity the Mental Health Foundation claims 47 per cent of
people who have suffered mental health problems have been discriminated
against.

For Webster, as for many, coping alone with the stress of a management
position proved too much. "The work initially went well – I have always
been a competitive person, always driven to achieve. Just because the
management will to turn this plant around had not been there before, that was
not going to stop me, I thought. But the pressure finally got to me."

He denies it was the job that made him unwell, but rather "the stress
that came from within". He began to notice changes in the illness – the
anxiety, despair and anguish were still there, but also that he was beginning
to lose touch with reality, spouting ideas which his colleagues simply could
not comprehend.

On the last day Webster worked in industry, he sat down at his desk one
morning and was unable to read – the words were just "a grey mess". A
severance package he describes as "generous" was negotiated. He was
35 years old.

During the period that followed, Webster went into a three-month psychotic
state, involving episodes of mania alternating with depression – bi-polar manic
depression in the psychiatrist’s language. After repeated attempts, he finally
succeeded in getting admitted to psychiatric hospital. "You try not to
become a full-time patient," he says, "but manic depression is
something that you have to learn to manage in whatever way you can."

With the illness controlled once more, Webster found himself full of energy,
but facing a bind. He was unwilling to lie his way through the gap on his CV,
but desperate to work. No one was hiring.

In response, he set up his own charity, Talent to Work, which between July
1995 and February 2001 fought for employment for people with mental health
problems.

He predicts that the "fear culture" surrounding employing people
with mental health troubles will have to diminish for demographic and labour
market reasons. "With one in four people likely to suffer and the rates
continuing to rise, employers will have to change their attitudes," he
says. "They probably don’t realise it, but they are almost certainly
unwittingly employing people with poor mental health already."

The issue of how to manage mental health issues in the workplace raises some
difficult issues for HR practitioners. Line managers, under pressure to
perform, perceive that any risk-taking in recruitment will be a fast-track to
career disaster. For understandable reasons, they would rather play safe. But
for equally understandable reasons, employees feel compelled to falsify their
conditions to stand any chance of getting work or staying in work.

Research by the Industrial Society earlier this year confirmed what most of
us intuitively know to be the case. If a person is suffering from poor mental
health, there is a tendency to think them a liability – incapable of doing
difficult, challenging work, immune from constructive criticism, and needing to
be closely monitored.

Mental illness, when it is "recognised by a respected body of medical
opinion", comes under the Disability Discrimination Act. So in theory
there is a requirement not to discriminate and an obligation to make
"reasonable adjustments" where necessary.

Among employers, there has been little will to take mental health issues
seriously until very recently. The Health and Safety Executive recommends that
mental health should come within an occupational health strategy. Yet just one
in 10 employers has a policy. Andrew Kinder, principal welfare coordinator of
employee health services at Consignia, says, "The myths of mental illness
prevalent in our society permeate through to all our workplaces."

Before considering what good HR policy on mental health looks like, it is
necessary to be clear about what we are talking about. Mental health is not
just about stress. True, extreme, prolonged stress can lead to mental health
problems. And, yes, the term "stress" is often used as an acceptable
label for psychological conditions which themselves carry a profound stigma.

But mental health problems in this context, while including stress, also
mean diagnosable, psychological disturbances such as acute agitation,
melancholia, depression, nervous breakdown, anxiety disorders, mid-life crisis
and so on. Mental ill-health comes in a vast and varied array of forms,
affecting different people in very different ways. The American writer William
Styron, who chronicled his own descent in his book Darkness Visible, portrayed
the illness as being like "a rhythmic anxiety…an agitation and unfocused
dread. I felt a kind of numbness, an enervation but more particularly an odd
fragility as if my body had actually become frail and hypersensitive and
somehow disjointed and clumsy, lacking normal co-ordination."

The first thing to be said is that while the stigma attached to mental
health conditions is real enough, it is largely unreasonable. Poor mental
health is no sign of being weak, flaky or not-up-to-the-job. And that is not
just wishful thinking, it is cold, hard fact.

Modern scholarship has tended to confirm the ancient intuition of a close
link between psychological disturbance and genius. In The Price of Greatness,
author Arnold Ludwig collated biological details of 1,004 "eminent men and
women". People who reached the top in business careers had a rate of
psychiatric disorders of 49 per cent – slight in comparison to poets (87 per
cent), but arresting none the less. For his paper, Organizational Sleepwalkers:
Emotional Distress at Midlife, Manfred Kets de Vries, a professor at Insead,
the France-based business school, interviewed 200 senior executives. He found
that 20 per cent had identifiable mental health issues such as depressive
illness.

Elsewhere, there has been a noticeable trend in management literature to
re-evaluate psychological problems among business leaders. Sol Davidson, a
coach with Penna Executive Coaching, says, "Individual breakthroughs often
involve some kind of emotional disturbance or crisis."

Obviously, for the most part, HR professionals are not interested in genius,
but in competency. But it does make the point that the desire to manage people
who suffer mental health problems out of the workforce is very short-sighted.
Most psychological problems – some claim 75 per cent of all conditions – are
treatable. The vast majority of people recover, though some illnesses recur
episodically. Therefore it is not surprising that companies which have a policy
of attempting to retain people in work testify to its effectiveness.

Dr Anne Price, head of occupational health at Marks & Spencer, says work
is often critical to coming back from an illness. "There is little logic
in treating mental health problems any differently from physical ones – a bad
back, say," she argues.

Companies such as Marks & Spencer include mental health problems within
the scope of their Employee Assistance Programme (EAP). EAPs have never really
caught on in the UK – just 10 per cent of the workforce is covered by them. Yet
the field of mental health is one where some claim EAPs are important.

Astra Zeneca, the pharmaceutical company, which has had an EAP for about
eight years, says its service, known as the Counselling and Life Management
Programme (Calm) is an important part of the well-being of its 12,000-strong UK
workforce. Calm is used by 7 per cent of its employees in any one year, split
between a third who use it for mental health problems caused by work, a third
for troubles in home life and a third for a mixture of reasons. Dr Eric
Teasdale, the company’s chief medical officer, argues the programme reflects a
growing awareness that health and safety needs to be seen in increasingly broad
terms. "Companies have a direct interest in keeping people physically,
mentally, socially and spiritually well," he says.

However, a formal EAP is, perhaps, a big company luxury. So what should
others do? Charities, employers, doctors and service users all agree the best
response for an organisation to an employee who is suffering from mental health
problems is simple good management.

A supportive culture in a workplace might include emphasising the value of
an individual to an employer and, where possible, being willing to restructure
their job or re-allocate certain duties while ensuring confidentiality.

Yet Mind argues that people with mental health problems should not be
treated as especially vulnerable. "A person who happens to have mental
health problems can also be legitimately angry, have off-days like everyone
else," the charity says.

Best practice – in addition to the DDA – emphasises that the employer’s
response must be "reasonable". In practice this means not making
assumptions about an illness or confusing a person with a diagnosis while
consulting the employee on the best course of action. The CIPD notes that a
process of rehabilitation after a mental health problem "will usually be
more cost-effective" than early retirement.

However, Liz Aram, programme manager for Working Minds, the government
campaign to tackle mental health at work, acknowledges that part of the
difficulty in confronting the myths surrounding mental health and employment is
the lack of rigorous academic research. There is ample anecdote, but no serious
UK studies on the links between well-being and productivity. Proving a
"business case" for positive attitudes to mental health problems
would involve evaluating different interventions and that would be costly and
slow.

Aside from the usual preconceptions about weakness and unreliability, there
is also an entrenched perception among employers that anyone with a mental
health problem will be off sick more often than a "normal" employee.
It is certainly true that many chronic conditions are recurrent. But then many
people are able to manage their illnesses with drugs, plan for any relapses and
soldier on.

South West London and St George’s Mental Health Trust has been running a
programme encouraging the recruitment of people who have experience of mental
ill-health problems since 1995. It found that absence rates for service users were
less than for all care staff. Aram says, "There are going to be some
people who are just not capable of being in mainstream employment. But the
point is not to make assumptions about people on the basis of a label. Mental
health is different for everyone."

Perhaps paradoxically, Dr Sayeed Khan, head of occupational health at
Rolls-Royce, says that serious, chronic psychiatric problems are not the most
difficult for employers to deal with. With modern medication they can be
controlled, and good liaison between healthcare professionals and managers can
ensure illness episodes among employees can be pre-empted and handled smoothly.
Absence levels and performance of the Rolls-Royce workers who suffer these
serious conditions are not significantly different from other workers.

Khan argues that it is the lower level nervous disorders – stress, anxiety
and so on – that pose the real problem and add most to sickness absence.
"These are the conditions that can be unpredictable and where occupational
health intervention at an early stage can make the most difference," he
says.

Rolls-Royce has found that training managers to minimise the pressures of
work can reduce absence rates for stress, anxiety and minor depression by 21
per cent. "Teaching workers how to cope with more stress is not always the
best approach," says Khan.

The economic logic of employers seeking to protect their workers’ mental
well-being is easy to understand – it fits neatly with their legal "duty
of care" as well. But if we accept there is both an economic case and a
legal duty to promote good practice on mental health, it suggests that many
employers’ strategies have gone badly wrong. Mental ill-health is rising fast.
We also know that work can cause psychological harm; the series of six figure
payouts for injury resulting from stress since 1996 has served to prove the
point. Meanwhile, studies have found that complaints of both stress and
increasing workloads are rising too. Some might say that work itself could be
partially culpable for declining social well-being.

Dr Chris Manning, a government adviser on mental health, argues that instead
of seeking to "marginalise and medicalise" people who have mental
health problems, it would be better to treat them "like the canaries who
were sent down the mines"; as an early warning system for "noxious
attitudes" in the workplace.

"If mental health problems are caused by work, it makes sense to fix
them at work, rather than bundle the burden onto the NHS," he says.
"It has always seemed to me to be fatuous to send unwell people back into
a psycho-toxic environment."

Reforming the workplace culture that gives rise to stress is now one of the
priorities of the Health and Safety Executive. Such a project in the current
economic climate will inevitably take time.

In the shorter term, campaigners such as Andrew Webster say that getting rid
of the "fear culture" surrounding mental health issues at work has to
be fundamental.

"Business is not in a position to know what mental health problems are
costing them," he says. "Unless you can start from the position of
honesty, no one is in a position to do anything about it."

Mental health and employment – The facts  

– One in four people will experience some form of mental health
problem in a year, according to the World Health Organisation

– By 2020, the WHO says depression
will become the second leading cause of disability worldwide after heart disease

– In the UK, three in 10 employees
will have mental health problems in a year, which lead to some 91 million working
days being lost per year at a cost estimated at £32bn

– Britain has the highest rates of
depression in Europe. Urban Britain has a prevalence of depressive illness of
17.1 per cent, compared to 10.5 per cent across the whole of Europe. Spain has
the lowest rates at 2.6 per cent

– In the US, one in five of the
population suffers from a diagnosable mental disorder in any one year – 44.3
million people – a disease burden that exceeds the cost of all cancers put
together. Depression alone, which affects 19 million annually, costs US
businesses $44bn each year, according to the National Foundation for Brain
Research

– In the UK a third of GP
consultations are for social and mental health problems

– A quarter of drugs prescribed on
the NHS are for mental health issues

– Between 1990 and 1995, the number
of UKprescriptions for antidepressant drugs rose by 116 per cent

– An Institute of Management survey
found 16 per cent of managers had taken time off work in the last year due to
stress and mental health problems

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