Evidence shows that mental health issues at work are a growing problem. Dr Nick Summerton sets out a suggested framework for what HR, occupational health and wellbeing professionals can do proactively to help their employees.
As a GP, when I see people in the surgery on long-term sick leave, I’ll always encourage them to go back to work if they can. Work is a central building block to good mental health, providing a positive routine, sense of purpose and achievement as well as a social environment, and makes it easier to be in better physical health. So there’s the paradox for anyone working in wellbeing, that the cure can be the same as the cause of ill-health.
In an age of more desk-bound working, the health risks are primarily around stress. At low levels it’s a typical, and, it could be argued, useful part of modern working life. Over time, though, it also has the potential to set off a chain reaction of psychological and physical damage.
There is now evidence of the suspected link between ongoing high levels of stress and heart-related conditions and deaths with research (Tawakol A et al, 2017). A study by Harvard Medical School, published in The Lancet, suggests that higher levels of activity in the amygdala part of the brain, processing emotions associated with stress, encourages the production of more white blood cells and inflammation of the arteries – leading to heart attacks, angina and strokes. The researchers concluded that long-term stress should be seen as being as significant a risk factor in diagnosing heart problems as smoking and high blood pressure.
More on managing mental health issues at work
Mental wellbeing at work isn’t just about the character of the individual employee, but the product of interactions between the working environment, the nature of the work and the individual. The impact of poor employee mental health on organisations is well-documented. Ninety-one million working days are lost to mental health problems every year, including half of all long-term sickness absences.
In 2014 the Centre for Mental Health estimated that the annual costs of mental health problems at work is over £30 billion. Half of this figure was believed to be the result of presenteeism, where employees continue working when they are ill. This is an issue affecting the great majority of employees. According to a report by Business in the Community (BITC, 2016), 77% of employees have experienced symptoms of poor mental health at some point in their lives and 29% of those have been diagnosed with a mental health condition.
The problem is increasingly high-profile and more openly discussed, but it’s a moot point whether it’s become any easier for employees to admit they have a mental illness that’s affecting their ability to perform at work. In this article I’m going to set out a suggested framework for what HR and wellbeing professionals can do proactively to help their employees.
A framework for managing mental health issues at work
It’s useful to look at activity for all three phases: primary prevention (creating an environment which removes some of the risk factors relating to increased workplace stress); secondary prevention (ways to catch mental health issues at an early stage and when they can be more straightforward to address); and tertiary prevention (working with employees with psychological problems to ensure they have the right support and the impact on their life can be mitigated).
Tactics for encouraging a positive mental health culture should be based around awareness of simple, but also unappreciated, causes of stress in the workplace. Studies on wellbeing in UK police forces have shown that the threat of conflict and physical harm is only a minor cause of stress among officers. Administration and issues with IT actually have more of a negative effect on perceived levels of wellbeing.
Stress and anxiety form a negative cycle, where negative impressions and experiences reinforce and encourage each other. Here are some tips on mitigating stress levels in the workplace:
- Pay attention to the character of work roles. Review workloads and work variety, ensuring employees are in a position to feel in control of their daily routines, and supported when the pressure rises.
- Keep in touch with what’s happening in the working environment: personal relationships, any potential bullying, the state of management processes (do they encourage participation, empowerment, the opportunity to give constructive feedback?), as well as the physical factors (like noise, dust, dirt, natural light).
- Promote mental wellbeing within the organisation. Improve awareness and understanding, and provide training for managers and staff around mental illness in order to reduce stigma and discrimination, making it easier for employees to admit to issues as early as possible.
- Provide opportunities for flexible working (including home working, part-time working and job-shares). Small adjustments to work routines can be a release valve for growing pressures and any sense of a lack of control.
- Be aware of those individuals most at risk of mental health problems. Conditions like anxiety and depression are more likely to occur among those employees with existing long-term health problems such as diabetes or health issues involving pain. They are more prevalent among people who are experiencing relationship problems or been through a recent bereavement as well as those who misuse drugs or alcohol. And also – probably due to the disturbance of healthy sleep patterns – the conditions are common among shift-workers.
Being alert to the working environment is essential. In my own large general practice I’ve seen personally the enormous benefits of replacing unsupportive line managers, improving workloads and empowering staff in enhancing the overall wellbeing of the practice.
At the level of secondary prevention comes the provision of different types of screening, linked to the importance of spotting problems early. Just as with physical conditions, early interventions make it more likely that an employee will recover more quickly. Here are examples of screening for mental health problems:
- Annual health checks can be used as the opportunity to include simple, short and reliable screening tests for anxiety (the Generalised Anxiety Disorder test, known as the GAD-7, and commonly used in primary care situations, among outpatients in hospitals for example) and depression (the Patient Health Questionnaire-9, or PHQ-9).
- Consider screening for eating disorders if there’s a low BMI at health check using the five question SCOFF test (Morgan JF et al, 2000).
- Alcohol misuse can be an indicator of wider problems, so organisations should also consider blood testing (GGT/MCV) and audit questionnaire screening as part of a health check.
- There are also a number of non-medical indicators that HR and line managers should be conscious of as early warning signs: increases in unexplained use of sick leave, uncharacteristically poor decision-making, time keeping or performance in general, complaints of a lack of sleep, lack of energy and feeling tired all of the time; withdrawn and moody behaviour.
A less well-understood area is tertiary prevention, what can be done to reduce serious effects on employee’s lives and to mitigate ongoing, long-term issues. That means playing a part in helping employees access the best healthcare services. Here are tips on tertiary prevention:
- Take into account that NHS mental health provision is very variable across the country in terms of quality and quantity. Also, that NHS services are often too slow to be able to provide the all-important early interventions needed to improve outcomes. In this context, any support offered by an employer is of real value.
- Provide good quality information and advice to all employees on mental health, coping strategies, stress and self-help services, signposting sources (such as, for example, the Royal College of Psychiatrists’ website).
- Consider providing appropriate and easy access to private Cognitive Behavioural Therapy services by accredited therapists (on-line, telephone and face-to-face).
- Keep in touch with employees if they have been away from work with mental health problems – in line with legal regulations – and provide ongoing support that can continue when they return to work.
- Appreciate the interrelationship there can be between physical and psychological problems. Chronic back pain is a good example of where there’s evidence of how support on mental health can help improve long-term physical health conditions. The Orebro questionnaire can be used as part of a health screening programme to explore attitudes to physical pain in relation to mental health.
Improving mental wellbeing across a workplace has the potential to increase productivity, lower costs associated with temporary recruitment and covering absence, improve staff retention (reducing costs incurred due to staff turnover) and improving staff morale.
The bigger issue, over time, may well be one of employer brand and employer reputation. In Japan, a string of work-related suicides has led to resignations by senior business bosses and greater scrutiny of employers by government.
Mental health has become one of the biggest challenges faced by industrialised nations as levels of global competition ratchet upwards, and organisations have the opportunity to demonstrate their credentials as employers of choice, aware of the issues, and ready to provide an environment where mental as much as physical safety is taken seriously.
Dr Nick Summerton is a GP and medical director at Bluecrest Wellness. http://www.bluecrestwellness.com
Business in the Community (BITC). Mental Health at Work Report. October 2016.
Tawakol A, Ishai A Takx RAP, L Figueroa AL, Ali A, Kaiser Y, Truong QA, Solomon CJE, Calcagno C, Mani V, Tang CY, M Mulder WJM, Murrough JW, Hoffmann U, Nahrendorf M, Shin LM, Fayad ZA, Pitman RK (2017) Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study. The Lancet, 25 February 2017, vol 389, no 10071, p834–845.
Morgan JF, Reid F, Lacey JH. (2000). The SCOFF questionnaire – a new screening tool for eating disorders. Western Journal of Medicine, March 2000, 172(3), p164-165.