Lol (not his real name) was the sort of person who prided himself on never taking a day’s sick leave. For 25 years, he worked as a mental health nurse, holding down a stressful job at a psychiatric hospital. But in September 2004, he experienced mental health problems himself, and took two months off work.
“I had the idea that I was indispensable,” he says. “I was acting second manager and had a heavy case load. It was a demanding role.” Depression struck, and Lol had to take time out to recover.
His employer, the Tees, Esk and Wear Valleys NHS Foundation Trust, was supportive and his return to work went smoothly. “My manager came to see me for a chat, kept in touch, and made me feel much better about returning to work,” says Lol. “Other members of the team also sent cards and chocolates. There was no sense that people were getting in touch to check up on me. I felt very reassured.”
After two months, he had a gradual return to work, but after a short time he felt so much better and so much a part of his old team that he returned to work full time, and has been in good health ever since. “I was also offered counselling when I went back to work, and I took that up – it’s been really helpful.”
Lol was one of the lucky ones – other organisations would do well to learn from best practice examples like that set by his employer.
Challenge
With mental health problems experienced by one in six people, the health and wellbeing of people of working age is of fundamental importance to employers.
Mental illness can be a daunting issue for occupational health (OH) professionals, both because of the wide variety of conditions and issues that fall under this category, and because of the ignorance and prejudice which surrounds the issue of mental health.
But two campaigns are now tackling the issue and raising public awareness about mental illness. And the fact that many people who have a mental health problem are more than capable of holding down a job is central to both initiatives.
Campaigns
The Time to Change campaign aims to tackle prejudice against mental illness. The team behind it includes Mental Health Media, Mind and Rethink. Funded with £16m from the Big Lottery Fund, and £2m from Comic Relief, it is being evaluated by the Institute of Psychiatry at King’s College, London.
Time to Change’s initiatives include a mass participation physical activity week, legal test cases, training for student doctors and teachers, and a network of grassroots activists who are combating discrimination.
Shift is a similar initiative which is working to overcome the stigma and discrimination surrounding mental health issues. The organisation’s goal is “to create a society where people who experience mental health problems enjoy the same rights and opportunities as other people”. Shift was established in 2004 following a plan called ‘From Here to Equality’. It is part of the National Institute for Mental Health in England (NIMHE), a government-funded organisation that works to improve the quality of life of people of all ages who experience mental health problems.
“Fear is at the root of the problem,” says Gary Hogman, programme leader at Shift. “People fear mental health problems because this is the unknown. And there is also the perception that a mental health issue is special, different, a separate entity to physical health, and that therefore a different set of skills is needed to deal with it.”
This is not the way that Shift sees the problem. “For instance, if someone suffers from a musculoskeletal disorder (MSD), and they can’t do their job properly, or fulfil their function at home, then it’s not surprising that they will also suffer from anxiety and panic.”
Conversely, exercise can be as effective at combating depression as medication. A 2006 study carried out at Duke University in North Carolina looked at 156 patients diagnosed with major depressive disorder (MDD). They were assigned to three groups: exercise, medication, or a combination of the two. After 16 weeks, all three groups showed similar – and significant – improvements in measurements of depression.
But misconceptions about mental health are hard to shift. The idea that mental illness marks someone out as ‘different’ – and even threatening – persists. According to a recent Time to Change report, UK workers are more reluctant to discuss their mental illness than any other issue.
Of the 2,331 people surveyed, nearly 30% said they would find it difficult to admit to having a mental health problem, while 10% less said they would find it difficult to come out as gay, emphasising the campaign organisers’ view that mental illness is the last great taboo.
Aims
The campaign aims to create a 5% reduction in discrimination by 2012, to increase the ability of 100,000 people with mental health problems to address discrimination, and to engage more than 250,000 people in physical activity. Its report, A World Without, also points out that such luminaries as Winston Churchill, Abraham Lincoln, Charles Darwin, Florence Nightingale and Marie Curie might all have been prevented from working if they had come up against the kind of prejudice against mental illness that we have today.
These campaigns may be able to help make up some of the shortfall in the government’s policy on incapacity benefit. Ministers are committed to getting most of the 2.6 million people currently claiming incapacity benefit into work. By the end of 2008, the Pathways to Work had been expected to deliver 73,200 jobs. However, only 20,100 people returned to work.
Gabriela Rea, team manager at the Forwards Employment Support team, funded by Middlesbrough Borough Council, says that overcoming the taboos which surround mental health is essential if real inroads are to be made. “Eighty per cent of people on incapacity benefit are suffering from mental health problems,” she says. “They may have begun their sick leave for some other reason – bad backs being the most common one. But after a prolonged period off work, they will feel isolated and are likely to suffer from anxiety and depression, as well as their original illness.”
Andrew Kinder, chartered psychologist at mental health care provider Atos, agrees that this is a deeply entrenched problem, and stresses that there is much more work to be done. “There is an improvement in employers’ awareness,” he says. “Shift is running an excellent campaign. The workforce is a captive audience, and we spend more time at work than anywhere else. So it’s a huge opportunity to push out messages about good mental health.”
Triggers
Stress can be a trigger for mental health issues, and Kinder warns that the recession is an added burden on employees. Though it is impossible to be precise about the effect this will have, it’s clear that it is likely to exacerbate existing problems. “Stress is poorly defined, but it is generally caused by an imbalance between demands on an individual and their ability to cope,” he says.
Atos has seen an “astonishing” increase in calls to its helplines since the beginning of the recession. “Between 2007 and 2008, these increased by 37%,” says Kinder. “The calls cover everything from debt to people’s ability to concentrate at work.”
Another factor which is likely to boost stress and therefore mental health problems is so-called ‘survivors’ guilt’ – the negative emotions of those who are still holding on to their jobs at the end of a period of redundancy.
“Counselling can help alleviate the high degree of anxiety people feel when they are in this position,” says Kinder. “This can be very paralysing, and people often need help to focus on the job at hand.
“Occupational health has a vital role to play in this. The casualties come to them. But they could be proactive in promoting mental health, as well as picking up the casualties. And it is up to OH to make the business case.”
OH role
Williams Johnson, commercial manager at the Great Place to Work Institute UK, sees a central role for OH as an impartial source of information on mental health, as well as support. But he believes that many OH professionals feel less than confident about handling mental health issues.
“The reality is that OH staff may have to seek advice from mental health specialists when it comes to dealing with these issues,” he says. “OH staff are in a similar position to GPs, in that they have a good general overview, rather than a detailed knowledge of specific areas.
“People with mental health problems are afraid of the stigma just as much as anything – and this can be a big problem when getting them back. So keep the lines of communication open.”
The employee’s story
Liz is a personal assistant at a credit ratings company in London. Her mental health problems began in 2002, when she had depression and was prescribed Prozac. A year later, a series of events led her to become “manic and psychotic”. These included the ending of her relationship, a house move, and bullying at work.
The drugs she was prescribed for her ‘high’ periods caused her to feel very depressed, and she was hospitalised for six weeks. At this stage, bi-polar disorder was diagnosed.
When Liz returned to her job as an office manager at an internet publishing company, she found that her colleagues’ attitude towards her had changed.
“They didn’t know how to respond,” she says. “They seemed to be walking on egg shells around me, and were unsure about the kind of work that they should give me. My boss started to scrutinise my work and undermine me.”
As a result, Liz left the company, and moved to her present job. She experienced further manic episodes, and then had a serious relapse last year. Liz was signed off work from November 2008 to January 2009.
“My boss has been very supportive. I wanted to go back earlier but he said it was important for me to fully recover.”
Although Liz was confident enough to tell her current employer the truth, only her close friends and family are aware of her history.
“If you have a mental health condition, you are judged,” she says. “People are scared of you, mainly because of a lack of understanding. I’m a normal person and people like me deserve more respect.”
The attitude of her colleagues has made all the difference. “My new work colleagues were fantastic and my boss reassured me, saying: ‘Take as long as you want.’ Their attitude definitely helped me recover more quickly than I would have done.
“It’s hard to say what triggers you off. But stress does play a big part – I was quite stressed and busy at work. How I would describe it is that it’s as if you are powered by an unseen entity. You are not the same person.”
So what advice would she give to employers? “To support people with mental health issues, you should have policies that apply to everyone, rather than singling them out. For instance, you should monitor the workload of all your staff.
“Being over-stressed is bad for all employees, not just those with a mental health problem.”
The employer’s story
Lincolnshire Partnership NHS Foundation Trust employs David, a community support worker who experienced physical and sexual abuse in his childhood. He now has obsessive compulsive disorder, severe depression and anxiety, and has self-harmed. He has previously lost a job on the grounds of “incapability”.
The trust employs 2,000 staff and serves about 7,000 people. Although it is committed to championing the needs of people with mental health issues, it has only recently updated its policy on diversity.
This year, the trust ran an anonymous staff survey to see how many of its employees had suffered from mental illness. It has recently updated its training on diversity awareness, which is now mandatory for all staff and includes training specific to mental health. Training on recruitment and selection is also being reviewed. Employees are briefed on the Disability Discrimination Act (DDA) and mental health issues through this training.
“In addition, the trust has appointed a service user and carer champion,” says Jane Tuxworth, lead occupational therapist at the trust. “Her role will also be to provide advice, guidance and support to managers to ensure that people (including staff) who have experienced mental health issues can and will be involved in the delivery of trust services.”
A new working arrangement with the OH service is also in place. The service has recently undertaken a case note audit on staff referred to their service who require reasonable adjustments and have needs under the DDA.
“The audit showed a high incidence of managers identifying staff who require advice on how to make reasonable adjustments due to mental health conditions,” says Tuxworth. “This information is to be presented to senior managers for further discussion.”
The trust also has two relevant policies available on its intranet: ‘Mental Health in the Workplace’, which has been developed to provide guidelines to staff in supporting employees with a mental illness; and a ‘Stress in the Workplace’ policy, which recognises that workplace stress is a health and safety issue.
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The trust’s annual health survey asks questions on employee stress. If high levels of stress are recorded in a particular area, managers are expected to put an action plan in place which aims to reduce stress levels in their area.
Last year, the chief executive promoted the National Stress Awareness Day, and the previous year a staff stress audit was undertaken.
