Record NHS waiting lists mean the one in four people who now have clinical levels of anxiety or depression face months waiting to access support and, by then, a longer recovery. Rehabilitating people while they’re still in work will usually more than pay for itself, argues Malcolm Smith.
The cost-of-living crisis has worsened an existing mental health crisis, with one in four employees (26%) saying they now have clinical levels of anxiety or depression, according to research carried out for our PAM Wellbeing Health at Work report.
Three-quarters (75%) of employees say stress has undermined their mental health, seven out of ten (72%) are affected by anxiety and three-quarters by depression (64%). Just one in four (25%) has access to mental health counselling through work and, even then, just 14% make use of this.
A major reason for all this is that less than half of employees are given proactive support to stay healthy and more than one in four (27%) are given little or no support or don’t know how to access support.
For example, despite the value of an employee assistance programme (EAP) for helping employees to recover from acute mental health issues before this can spiral into something worse, less than one in six (16%) employees have access to this form of support. Even then, only one in ten (9%) actually use it.
As a result, employees are waiting far too long to reach out for help. By the time they do finally reach out to their GP, NHS waiting lists mean they typically have to wait between two to five months to access counselling and six to 12 months to access specialist trauma therapy or cognitive behavioural therapy (CBT).
This means that, by the time an employee finally gets the support they need, they will be struggling to attend or perform at work.
Instead, a far better approach is to rehabilitate them in as few as six to 12 sessions, while they’re still in work, with the following proactive steps:
1. Identify those in need of support
Whether the employee is on a long waiting list to access counselling or realises all is not well with them, but hopes they can recover unsupported, the chances are they will be struggling in silence for fear of recrimination, stigma or discrimination.
One key to getting them to come forward for support is to make it clear that you understand we all have a state of mental health that can become compromised for numerous reasons.
Make it clear that you don’t want them to suffer in silence, that you have support processes in place and that they will not be penalised for utilising these as you want to help them recover.
To this end, it is also important to encourage managers to look out for people who might be struggling with their mental health. This could be employees who have become noticeably distracted, error-prone, unproductive or sporadically absent.
Encourage managers to talk to the individual in confidence by saying: “I’ve noticed you’re not yourself lately, is there anything going on that you need support with?”. This may help both sides to explore the subject and see if they’re happy to be referred for support if appropriate.
Make it clear that you don’t want them to suffer in silence, that you have support processes in place and that they will not be penalised for utilising these as you want to help them recover.”
2. Refer the employee for support
The type of mental health support an employee might need can differ greatly from one individual to another, and even for the same individual depending on what’s going on in their home life or at work.
Healthcare practitioners use mental health assessments (such as GAD7 for anxiety or PHQ-9 for depression) to help to work out what support they might need.
Changes in mood are natural responses to some of the pressures we’re under and represent warning signs to take steps to look after ourselves.
Sleep problems and panic attacks, for example, or obsessively and compulsively checking things are indicative of more serious anxiety issues. Continuous feelings of hopelessness or tearfulness may be signs of depression.
Once referred, the employee can be confidentially assessed within as little as one to two weeks and a report written that will only be shared with their employer if the employee gives their consent.
The aim of the report is to explain how the person is feeling, what the issues are, how their manager can support them to stay in work and what further treatment they might benefit from. Most employees are keen to share this information to help progress their recovery.
3. Invest in treatment
The treatment needed by the employee could vary from providing access to self-help education and other support services, or from debt advice to a chat with a counsellor via the EAP to more in-depth psychological services.
These in-depth psychological services might include Eye Movement Desensitisation and Reprocessing (EMDR) to help people process trauma and overcome their fear response. They might need counselling to talk through problems or develop coping strategies. Or it might be helpful for them to access cognitive behavioural therapy (CBT) to help them manage problems by changing the way they think or behave.
Psychological health providers that offer a stepped-care model can often provide the most appropriate treatment at each stage of the individual’s recovery. The intensiveness of the care may be stepped down as the individual recovers, or up if they experience a setback during their recovery.
4. Facilitate recovery
The health provider should keep the employee’s manager, and the HR contact, updated on the individual’s progress throughout their recovery. They should provide a report with practical and actionable recommendations on how the employer can support them to stay in work.
The intensiveness of the care may be stepped down as the individual recovers, or up if they experience a setback during their recovery.”
For example, this could be by allowing them to reduce the pressure they’re under at work for a while or start work at a later time if they have sleep issues.
If the individual has been traumatised at work, perhaps because of an aggressive customer or accident for example, part of their therapy might involve making them feel safe in the environment where the incident happened.
If they are struggling with a bereavement, complex grief or feelings of low self-esteem while they go through a divorce, they might need to work more flexibly for a time so they can attend their weekly counselling session or work from home when feeling tearful.
Throughout the individual’s recovery, every effort should be made to keep them in work, as work can be a power for good, helping the individual to have a sense of purpose and achievement.
Our experience of rehabilitating employees with moderate to severe anxiety and depression also shows that quicker referrals, made while the employee is still in work, require fewer sessions and cost less than once the employee has already gone on sick leave.
5. Calculate the return on investment
Once the employee has been helped to recover, which typically takes just six to 12 weeks while they’re helped to stay in work, it is important to calculate the return on your investment.
This will help you to justify the initiative to the board or chief financial officer, so that you can help more people in future.
When calculating the business benefits, it’s important to consider both direct costs, such as sickness absence, and indirect costs, such as the cost of replacement staff.
Research by Deloitte has shown that employers typically save £5 for every £1 invested in mental health services.
Also, try to calculate less tangible human capital savings, for example increased loyalty, productivity and engagement from the employee and reduced staff turnover costs.
If the employee is happy to share their experience, this can be captured in writing to create a testimonial that can be shared with other employees to encourage more people to come forward for support.