One in four people will experience some kind of mental
health problem in the course of a year and they are likely to face prejudice
and discrimination at work. It is time to lift the lid on one of society’s last
taboos, by Greta Thornbory
The first conclusions from the document Working Minds: Attitudes on Mental
Health in the Workplace1 state: "There is very low awareness and
understanding of mental health, its symptoms and causes, and how it can or
should be handled in workplace situations." One presumes it means mental
The Mental Health Foundation2 says that one in four people will experience
some kind of mental health problem in the course of a year, and according to
the Department of Health3 a quarter of all the drugs prescribed in the NHS are
for mental health problems.
It goes without saying, therefore, that if the workforce of the UK
represents half the population, then the state of the mental health of the
workforce must have some impact in the workplace.
Common mental health problems include anxiety, depression, schizophrenia,
dementia, alcohol and drug misuse and eating disorders1. This article
endeavours to explore how mental ill health is regarded in the workplace, how
it is dealt with and how mental well- being can be improved through workplace
When disability is mentioned what does it conjure up in your mind? Generally
one sees a wheelchair and a physical disability, yet the Disability
Discrimination Act 19954 covers mental disability and is quite clear in its
definitions of what constitutes mental disability: "mental impairment
including learning disabilities and mental illness (if it is recognised by a
respected body of medical opinion)".
The DDA seeks to end unfair discrimination against disabled people and that
includes those with a history of mental illness, yet there are endless stories
from employees and prospective employees who have experienced discrimination
because of mental health problems.
The Department of Health’s Mind Out for Mental Health campaign is working with
partners across all sectors to combat this stigma and discrimination. Working
Minds is the employer programme for this campaign and the Industrial Society –
now known as The Work Foundation, undertook the research as part of the Mind
Out for Mental Health initiative.
The Working Minds research
In its research, Working Minds1 says that it aims to lift the lid on one of
society’s last taboos – the attitudes, practices and prejudices that lead to
widespread discrimination in the workplace on the grounds of mental health.
This research, undertaken in early 2001, included quantitative and
qualitative studies. The qualitative study took the form of focus groups with
employees and, separately, with managers. The quantitative survey sent
questionnaires to 500 human resources and personnel managers and had a 13.8 per
cent response rate, and to 1,000 opinion-formers and received an 8.5 per cent
response rate. The researchers admit that this methodology is neither
comprehensive nor scientific, but they were confident that the approach was
"robust and fair". Unfortunately, the research has not been
sufficiently widely promulgated to have had any great impact on employers, let
alone the workforce.
Working Minds is working in partnership with employers to help bring about
positive changes in workplace policy and practice on mental health. More
information on this initiative is available at www.mindout.net. Here, and in
the Working Minds research document1 you can read about the employment
experiences of, and discrimination against, many people suffering from, or with
a history of mental illness.
Examples of attitudes towards people with mental health problems include the
– They will be dangerous and unpredictable
– They will never recover
– They will never be able to contribute fully
– They have problems communicating
– Some mental health problems are self-inflicted
The way in which the media presents and reports on issues compounds these
The Working Minds initiative and the Mind Out for Mental Health campaign
encourage partnerships with employers. Their website lists partnerships with a
number of mainly mental health-related, charities. However, there appear to be
only four companies that have signed up to this initiative, one of which is
Marks & Spencer – the only organisation to mention the involvement of its
occupational health service.
The Working Minds research1 concludes that employees appear to lack
confidence in the ability and specialist expertise of their human resources,
personnel or OH services to handle mental health problems. It seems that there
is a great deal to be done by these departments in developing knowledge, skills
and competence in handling mental health issues.
The HSE has addressed this problem by producing a resource pack for
management training and development on mental wellbeing in the workplace5. The
resource pack emphasises that the "mental health spectrum" is an
important concept to comprehend. At one end of the spectrum exists mental
wellbeing; a mental health dimension conducive to growth and development. The
spectrum moves across into the mental ill-health bracket, through social,
behavioural and biomedical conditions and then ultimately at the opposite end
into the more rare severe mental illnesses, such as psychosis, which, it says,
affects only about 1 per cent to 2 per cent of the population. Hence the
majority of mental ill health problems to be found in the workplace will be
those at the centre of the spectrum and therefore generally of a moderate
nature. Even so, they may have a disastrous effect on the individual, as well
as the workplace.
The most common mental health problem encountered in the workplace is
anxiety, which causes distress and is known as ‘stress’. The HSE6 defines
"The reaction that people have to excessive pressure or other types of
demand placed upon them. It arises when people worry that they cannot
Stress manifests itself in both physical and behavioural effects that may
result in sickness absence. Once the stress is relieved or reduced, the
physical and behavioural effects disappear.
It is only when stress continues for a long period without relief that there
may be long-term and long-lasting damage to health. The main problem with
stress is that there is no way of knowing what level each individual can
tolerate. See Figure 1.
What is known1, 5-7 is what causes the physical and behavioural changes
associated with stress. Fingret and Smith7 suggest that individual characteristics
such as genetic factors, poor parental models, personality, quality of social
support, past experiences and lastly, the amount of control one has over life,
all influence the likelihood of suffering from a stress-related condition.
However, along with the HSE5 and Arnold et al7 they also suggest a number of
workplace factors that affect the individual.
Figure 2 shows that there are a number of organisational symptoms that cause
companies a huge financial loss. A CBI/DOH survey in 19917 estimated that 30
per cent of sickness absence was due to stress, anxiety and depression, and in
1995 it estimated that the cost of mental health absences from work was in the
region of £3.7bn for 100 million days lost per year9. However, the HSE reports
an estimated 6.5 million days lost due to stress, depression or anxiety, or a
physical condition ascribed to work-related stress. In the same document it
does admit that there are difficulties in measuring stress and the occupational
contribution to it.
Tackling the problem
It is therefore sensible to address the source of stress in order to prevent
stress-related conditions developing.
As can be seen from the work being done on mental health and mental
well-being in the workplace, this is not a new initiative. Epidemiological
studies have been undertaken for some years, yet there does not seem to be any
specific relief for the majority of the workforce.
As stated earlier, there is a lack of confidence in the knowledge and
understanding of those responsible for the health and wellbeing of the
workforce. Some larger organisations have undertaken and put in place
strategies to deal with mental wellbeing at work and examples of those
strategies from The Post Office, Kings Healthcare NHS Trust, The Boots Company
and Zeneca Pharmaceuticals are included in the HSE resource pack5. Also
included in the pack are four strategies from SMEs.
Occupational health nurses have been taught about mental health and
well-being for some years but there appears to be a theory-practice gap, not
only for OHNs, but also for those in personnel and human resources management5.
It is interesting to note that the HSE states that the highest rates of
stress, depression or anxiety occur among nurses and teachers, with other care
workers, managers and professionals coming next. This indicates that the
highest work stress rates occur among social class II, and they tend to be in
public sector workers. For teachers, who have little access to occupational
health services, this is not surprising. There is usually one small OH service
serving a whole county of public servants and in Oxfordshire, for example, the
service has to provide OH for more than 300 schools, as well as a number of
The way forward
So how can occupational health services help to promote mental wellbeing at
work? Working Minds recommends that employers develop specific mental health
policies to promote awareness and understanding of mental health and wellbeing,
and that this should be done in collaboration with unions as the employees’
representatives. There is also a need to ensure that organisations have
managers who are well trained in all aspects of personnel matters and are able
to manage human resources as well as other resources.
It has been said in the past, reputably by the Chairman of NatWest Bank,
that human resources are the most valuable resources a company has. To this end
it is worth considering the work of Luthans and Kreitner (cited by Arnold et
al8) of "organisational behaviour modification". They suggest five
– Identify critical behaviour
– Measure critical behaviour
– Carry out functional analysis of the behaviour
– Develop an intervention strategy
The purpose of this is to strengthen desirable behaviour and weaken
undesirable behaviour, thereby presumably creating a happier and more
productive workforce who will not suffer from the stresses usually associated
with the workplace.
In an effort to encourage such practices the RCN, as a trade union, has
carried out a survey10, the findings of which show that "employers’
employee-friendly attitudes and practice can strongly influence nurses’
wellbeing and job satisfaction". The survey involved a sample of 6,000
nurses, who received a postal questionnaire for which there was a 68.5 per cent
response rate – exceptionally good for a postal questionnaire.
These results are supported by the DOH who says in its document, Making it
Happen – a Guide to Delivering Mental Health Promotion11, that
organisation-wide approaches are most effective and should include support for
staff. They continue by reinforcing the need for enhanced job control,
increased staff involvement, workload assessment and role clarification.
The RCN survey identifies a good employer as one that:
– Provides well-designed employee- friendly services
– Values and consults staff
– Provides a safe environment
– Protects and supports staff
All these points are relevant to any working environment, not only for
nurses and healthcare workers. OH nurses would do well to read the RCN document
and use it as a basis from which to encourage their own human resources and
personnel departments to reconsider their own practices – as part of quality
assurance and audit practices, and in order to improve the mental wellbeing of
people at work. It is also important to study the DOH’s strategy for mental
health11 to understand how the workplace fits into the overall health promotion
OH can do a lot and take a lead in promoting mental wellbeing at work, but
it cannot do it in isolation. OH needs to work with all the stakeholders to
promote mental wellbeing, as well as to bring about a greater understanding and
acceptance of mental ill health. Making it Happen says that mental health
promotion involves any action to enhance the mental wellbeing of individuals,
families, organisations or communities. If half the population is at work for
half of their lives then the workplace has a strategically important role to
play in mental health.
1. Blackwell T, Burns P, Hardy S (2001) Working Minds; Attitudes on Mental
Health in the Workplace with Proposals for Change. A report by the Industrial Society
for the Mind Out for Mental Health campaign.
2. Goldberg D, Huxley P (1980) Mental Illness in the Community, cited in
Blackwell et al (2001).
3. Department of Health (1996) Statistics of Prescriptions Dispensed in
FHSAs: England 1985-1995. Stationery Office: London.
4. Minister for Disability (2001) The Disability Discrimination Act
Definition of Disability, HMSO: London.
5. Doherty N, Tyson S, (2001) Mental Well- being in the Workplace: a
Resource Pack for Management Training and Development, HSE.
6. HSE (1995) Stress at Work: a Guide for Employers, HSE.
7. Fingret A, Smith A, (1995) Occupational Health: a Practical Guide for
8. Arnold J, Robertson I T, Cooper CL, (1991) Workplace Psychology, Pitman
(Revised version due Nov 2002).
9. HSE (2002) Occupational Stress Statistics Information sheet: 1/02/EMSU,
10. Royal College of Nursing (2002) Working Well: a Call to Employers, RCN.
11. Department of Health (2001) Making it Happen: a Guide to Delivering
Mental Health Promotion, Stationery Office: London.