OH professionals have a vital part to play in tackling the problem of stress and mental health in the workplace.
But this is a complex and multi-faceted issue, which involves a collaboration with other professional groups, including HR and GPs. And while recent government initiatives suggest a welcome shift towards ‘joined-up thinking’ about mental health at work, it is too early to say how successful this will be, and how the role of OH professionals will develop.
So what are the key points to bear in mind in terms of public policy?
A report by the Royal College of Psychiatrists (RCP) in March 2008 – commissioned by Dame Carol Black to support her review – found that sickness absence caused by mental health problems is likely to last longer than that caused by physical illness, and accounts for 47% of long-term absence from work.
This has added to the mounting evidence that tackling mental ill health will reap financial rewards, and is not a ‘soft’ area of people management.
As well as emphasising the role of OH, line managers and employers in tackling stress, Black’s report also highlights the problem that GPs and NHS staff are not equipped to deal with staff who are absent from work with mental health problems. Black proposes new ‘fit for work’ teams, including OH professionals, job advisers and other specialists, who will work with GPs to identify stress at an early stage, and rehabilitate employees so they can return to work, on restricted hours and/or duties if necessary.
The government is due to respond to the recommendations of this report in the summer. But ministers have made it clear that they are keen to increase access to psychological therapies, such as cognitive behaviour therapy (CBT) as a way to get people with mental health problems back to work.
Another important step forward is the report Improving Access to Psychological Therapies, and the announcement by health secretary Alan Johnson that 3,600 extra therapists are to be trained in a £170m NHS project. But there is some disagreement about the effectiveness of CBT. The Royal College of Psychiatrists report found that the evidence for the benefits of CBT is scanty, although the report recommends improving access to such therapies.
It also points out that the factors affecting returning to work after mental health problems are highly complex and many are unrelated to the workplace. CBT alone is unlikely to be effective in such a situation.
The complexity of mental health issues in the workplace is perhaps better understood by experts in the field than by the government. While there is a generally positive response to the report, the lack of detail in some areas – how access to OH services can be improved in smaller organisations, for instance – has been criticised.
Fundamentally, the way forward is to address the issue of mental health in a more holistic way, suggests Philip Dewe, professor of organisational behaviour at Birkbeck College, London.
“It’s important for organisations to recognise that stress is not the fault of the individual, or the organisation, but of the interaction between the two,” he says. “And line managers have an important responsibility in recognising this, even though it may not be one of their priorities.”
There is no shortage of evidence on what employers find effective in managing stress. A survey of employers in IRS Employment Review in October 2007, for example, identified the four most effective ways to tackle stress as:
implementing work-life balance initiatives
training managers in stress awareness
conducting regular staff appraisals where stress is discussed
ensuring that health and safety risk assessments take account of stress-related factors.
The Health and Safety Executive (HSE) defines the role of HR as “understanding what stress is and what constitutes a healthy workplace” and knowing “what skills, abilities and behaviours are needed to manage employees in a way that minimises work-related stress”. Much stress-related absence is caused by the behaviour of line managers towards their subordinates and their refusal or inability to identify when employees are suffering from stress.
But although the evidence is there, the rise of stress-related absence suggests many organisations are not applying good practice. The official guide is the HSE’s Stress Management Standards, launched in 2004.
The standards advise employers on how to develop a company culture, communications and management practices that help prevent stress, and give advice on risk assessments and a partnership approach with employees and unions. Among the competencies outlined by the standards are managing workload, planning, empowering staff, handling conflict, and training and development.
Employee assistance programmes (EAPs) are an effective way of co-ordinating responses to stress management and ensuring the right kind of intervention is made as early as possible, believes Wolfgang Seidl, executive director of support services supplier The Validium Group. Not only can EAPs help maintain contact with staff who are off work with depression or similar mental health issues, they can also help identify staff who are managing to come to work, but who are underperforming because of their mental state.
“Presenteeism costs twice as much as absenteeism,” he points out. “OH and HR work in isolation and they need to work better. And OH is still sometimes brought in only for compliance purposes and doesn’t get enough status from colleagues. An EAP system can link these groups together, as well as producing earlier interventions.”
Interventions are made earlier partly because an EAP can act as a focal point for HR and OH, and also because when there is an EAP in place, managers are more likely to be involved in managing absence and to notice tell-tale changes in performance.
“For example, managers should look out for people who lose or gain a considerable amount of weight, have erratic absence patterns, are more accident prone, or show sudden emotional changes,” says Seidl.
“Any change in behaviour can be an early warning sign of stress. Managers should not be amateur psychologists, but they should look out for staff and talk to people about how they are feeling without being intrusive.”
Without the clear structure provided by an EAP, managers can be afraid to raise the issue of depression or other mental health issues, Seidl warns.
“Left to themselves, line managers worry about transgressing boundaries, or phoning someone who is off sick and staying in touch in a nice, respectful manner. They think this is an intrusion, or that they might be accused of harassment. If there is a clear policy, they are more confident about picking up the phone.”
Employment relations service Acas says managers are underestimating the extent to which colleagues are suffering from stress, anxiety and depression, and has included guidance on spotting the tell-tale signs and how to act on them in its new booklet on health, work and wellbeing.
“A clear policy enables a manager to have a difficult conversation without making assumptions and labelling colleagues as depressed,” says Gill Trevelyan, head of training and equality services.
At the same time, she sees a need for greater clarity about the role of OH in this field. “Not only is there patchy provision across the board, as Black’s review pointed out, even where provision exists there may be the assumption that OH will deal mainly with poor attendance or pre-employment questionnaires,” she says.
“There should be an understanding that where there is a potential problem with a member of staff, OH is called in.”
But although these are both recognisable trends, more fundamental change is needed, according to some commentators. “Saying ‘I’m depressed’ is still seen as a career-limiting move – and for good reasons,” says Andrew Kinder, chairman of the Association for Counselling at Work, and one of the editors of Employee Wellbeing Support: A Workplace Resource, which was published in March.
“The government needs to address how to tackle the stigma of mental health problems,” he adds. “Men in particular assume they can’t say anything to colleagues about how they are feeling.”
The good news is that when the workplace can offer staff total anonymity and confidentiality, it can then be seen as the safest and easiest place to address concerns about anxiety, depression or other forms of mental distress, says Kinder. “We have found that where there is access to counselling from the workplace, which is free of charge, men are more likely to access this than to visit their GP.”
Some employers have tried to reduce stress and mental health problems among staff by building resilience or the ability to cope with challenge and adversity, recognising that change, heavy workload and stress are all endemic to the workplace, and staff need tools to deal with this. But some OH specialists and psychologists believe that to reduce stress and mental ill health a new leadership paradigm is needed in which employees develop their self-knowledge and focus on four areas of wellbeing: physical, mental, emotional and spiritual.
This is a strategy that is being put into practice by global pharmaceutical company GlaxoSmithKline (GSK) and rolled out across its international businesses (see case study, page 23). Adrian Chojnacki, vice-president of employee health, says: “We all have the ability to perform better in every area of our lives – and we are saying to staff that we can give them the means to go home at the end of the working day still full of energy.”
For GSK, the message that managing mental health should not focus on helping employees to hold it all together, but on enabling them to aim high, and develop their emotional strength by using their energy productively.
“This is not just about getting more out of people at work this is about how to develop an optimistic mental response to all areas of your life, and learning how to be more energised and productive.” says Chojnacki. “And the first step is to ask: what is the meaning and purpose of what I do?”
IRS Events is running a one-day conference on Managing Stress on 18 June. For information on how to book a place, call Aileen Cremins on 020 8652 4669 8403 or go to www.irsevents.com/managingstress
Case Study: Nationwide
Financial services company Nationwide has 680 branches in the UK and employs about 19,000 staff. In 2007, it merged with Portman Building Society creating a mutual body with assets of more than £160bn.
Since then, a shift to a more customer-focused way of working has been introduced. This has put additional pressure on staff and the company wanted to help them deal with the resulting stress. The aim was to help them ask for help when they felt stressed rather than allowing the situation to deteriorate, potentially to the point of illness and absence. Changing attitudes to stress was a priority.
Nationwide’s 80 top managers and HR staff attended a ‘Managing Troubled Employees’ workshop run by The Validium Group. The course acted as a reminder of what existing support services could offer, including the company employee assistance programme (EAP). The intention was to encourage more managers to refer staff to the EAP when they were stressed.
“We recognised from the outset that making fundamental changes to the way employees worked was going to result in increased pressure,” says Harvie Hughes, occupational health and safety consultant.
“It was essential to find a way of enabling people to deal with stress, so it wouldn’t translate into increased absence or make people want to leave the organisation.
“Getting support mechanisms in place wasn’t enough – we wanted people to recognise when they needed support and, more importantly, to realise getting help was the right thing to do, not a sign of weakness.”
Critical to the success of the workshops was the effort Validium put into changing attitudes to stress, and helping managers recognise their own role in creating stress and depression, says Hughes.
“Managers were taught to recognise the early signs, including irritability, reduced eye contact and inconsistent work output. Case studies were used to devise new ways of supporting individuals and groups.”
Feedback from managers was positive, and EAPs are now more widely used across the company. “Everyone has found the insight into how to tackle stress in themselves and others very useful,” he says.
The positive effect on staff attendance is reflected in the company’s financial performance: at the end of 2007, Nationwide’s half-yearly figures showed that the lender’s pre-tax profit was £394m, an increase from £306m in September 2006. Validium is still working with Nationwide, providing an EAP, legal and debt helplines, face-to-face counselling and critical illness support.
Case Study: Glaxosmithkline
Global pharmaceutical company GlaxoSmithKline (GSK) has operations in 116 countries and employs more than 100,000 people worldwide. Survey data showed employees were perceiving work demands as “excessive” and that only 22% of the workforce were “engaged, energised and resilient”. And while 38% of senior staff were engaged, they were “compromised in terms of energy and resilience” – in other words, they could not continue at the level they were working at without the risk of burning out.
With this in mind, GSK developed a set of management tools to promote the personal resilience of staff so that they are better able to cope with change and work-related stress. Key features include a corporate culture that supports employee health, the re-engineering of business processes to minimise pressure, a health risk appraisal for all staff, and an early intervention case management approach to attendance management.
For the past two years, all managers have focused on ensuring that health is a fundamental part of the leadership framework. Resilience has been built at all levels, both for teams and individuals.
The key is to keep it simple, says GSK employee health management vice-president Dr Adrian Chojnacki. “You should focus on daily practices – behaviour that will create a more supportive work environment quick wins that will relieve pressure quickly, and one or two more challenging issues that are within your team’s control,” he asserts.
The essential point here is that staff are learning to reframe their responses to what they do, and to pace themselves throughout the working day. And, perhaps most important of all, to try and align what they do with what they want to achieve in life, rather than just going through the motions at work.
And though this may sound like a tall order, Chojnacki says that unlearning one habit and learning a new one is not impossible. Just like giving up cigarettes or taking up physical exercise, some initial effort and sustained self-discipline can pay off. “It takes between 30 and 90 days for a new habit to be learned,” he says. “Once you have gone through that process, the new habit becomes automatic.”
More than 22,000 employees have been through this training scheme since 2003, and since the introduction of the programme, dramatic improvements have been recorded. Work-related mental ill health cases have decreased by 60%, and mental ill health absence has fallen by 20%.