The term ‘stress’, as any occupational health (OH) professional will know, is widely abused and frequently misunderstood in the workplace. More often than not it is used by employers and managers as an easy excuse for ignoring bad management practices or wider environmental or cultural failings. Yet mental ill health at work, in all its shapes and forms, is nevertheless an all too real problem that costs the economy, as well as individuals, dear.
According to the government’s mental health at work strategy – New Horizons, – which was unveiled in December 2009, at any one time, just over 20% of working-age women and 17% of working-age men are affected by stress and anxiety. One in six adults will suffer from a mental health problem at some point in their lives. Mental ill health is also the most common reason for claiming health-related benefits, costing the economy between £30bn and £40bn a year through lost productivity, sick pay and NHS treatment.
The new document comprises a UK-wide national mental health and employment strategy, a cross-governmental delivery plan, and commitments to action (see box below) that span 11 departments.
New horizons mental health strategy: Key recommendations
Alongside the strategy document, the government also published a Department for Work and Pensions-commissioned review of employment support for people with mental health conditions, entitled Realising Ambitions (see box below).orizo
‘Realising Ambitions’: Key recommendations
ns mental health strategy: Key recommendations
Both documents are a central part of the government’s response to national director for health and work Dame Carol Black’s vision for the future of workplace health, with the government’s over-arching aim being to have radically narrowed the gap between the employment rate of people in contact with secondary mental health services and those of people with disabilities in general by 2025.
The strategy therefore needs to be seen as another piece of the puzzle ministers have been putting together to tackle workplace ill health in the wake of the Black recommendations, including the launch of a new ‘fit note’ to replace the current GP sick note, a Fit for Work service, the reform of incapacity benefits, and a dedicated workplace health helpline for small and medium-sized enterprises (SMEs). In fact, the unveiling of the NHS Plus-run helpline was even bundled into the launch of the strategy, such is the way ministers see all the different elements meshing together to create a larger whole.
The strategy also needs to be seen in the context of guidance from the National Institute for Health and Clinical Excellence (Nice) published in November promoting mental health and wellbeing in the workplace.
As Nice made clear, tackling mental ill health in the workplace effectively is all too often simply about careful, sensible, common-sense management and intervention, including the promotion of a culture of participation, equality and fairness based on open communication and inclusion, creating better awareness and understanding of mental wellbeing, plus reducing the potential for discrimination and stigma. Nice also urged employers to put in place better systems for assessing and monitoring mental wellbeing, including employee attitude surveys, information on absence rates, staff turnover and investment in training and development. Finally, it called for more flexible working (if practicable) and for line managers to be given more freedom to promote the mental wellbeing of employees through supportive leadership style and management practices.
The New Horizons strategy document builds on these recommendations, suggesting a range of responses, including the dissemination of good OH practice in recruiting and retaining people with mental health conditions; that public sector employers review their OH arrangements in relation to the recruitment of people with mental health conditions; and that the “inappropriate” use of pre-employment health checks be outlawed.
Mental ill health is one of the major reasons why people are not able to be at work, Black tells Occupational Health, which is why making this strategy work is so important.
“Mental ill health makes a huge contribution to people not being there,” she says. “But it is not just about what we do to help when people have already got into difficulty, but what we should be doing to help maintain people and keep them well.”
And while OH professionals will have an important role to play as champions and educators, ultimately, it is the attitudes and effectiveness of line managers in managing people and mental ill health that will make the difference, adds Eugene Farrell, business manager at Axa ICAS.
“Line managers are very much the key because they are on the front line, and they need to be being trained to identify conditions and issues and act on them in a sensible way. You are not going to get very far if you do not train your line managers. It is also a good idea to keep it simple, keep it relevant to your business or sector, and keep it common sense,” he says.”It is about first having the right policies in place, and then deploying the right products and services.”
It all comes down to line manager capability, agrees Ben Willmott, adviser at the Chartered Institute of Personnel and Development. “Managers can be part of the problem or part of the solution when it comes to tackling mental health in the workplace,” he says. “And it is not just about managing stress, but about encouraging people to become better people managers.”
There is also growing recognition that often it is not the workplace per se that may be the stressor, but family life or financial concerns – but a badly managed workplace can in such circumstances be an exacerbator or a “tipping point”.
“If you are managed well at work, you are more likely to be able to manage, say, a debt burden or family issue,” says Willmott. “It is when you are struggling at home and come into work and put under yet more pressure that it can have the effect of pushing people over the edge.”
The test now for the government is whether it can pull together to deliver the important promises made in the strategy, particularly in a climate of very tight public finances, said Steve Shrubb, director of the Mental Health Network, in the wake of the launch.
The Sainsbury Centre for Mental Health also welcomed the new strategy, with chief executive Dr Bob Grove saying: “The challenge now is to keep up the pace of reform and to enable people with mental health problems a fair chance in life and the opportunity to make better lives for themselves.”
Future governments, of whatever hue, will need to use the strategy as “a baseline for developing better mental health services and creating a healthier, more productive society”, suggested Paul Farmer, chief executive of the charity Mind.
And the emphasis on the relationship between work, the workplace and mental health was also welcomed, argued Dr Andrew McCulloch, chief executive of the Mental Health Foundation. “Without good mental health, our relationships, jobs, and physical health all suffer. We need to get to grips with the financial and social burden that poor mental health places on the NHS and society as a whole, and the way to do this is by promoting the mental health of everyone,” he said.
Role of OH
For OH professionals, work still needs to be done to get employers, GPs and even other health professionals to recognise that mental ill health needn’t be a barrier to returning to work, argues Sandra Neylon, director of OH and vocational rehabilitation provider Neylon Occupational Health.
“When I speak at conferences I am sometimes shocked at the number of health professionals who still do not think they should do anything until they have had the note through from the GP saying an employee can come back to work,” she says.
“OH needs to be helping to spread the word, but I am worried that OH has still not fully got its own house in order. Students, for example, need to be given practical advice on how to do rehabilitation and how to bring people back to work early, but I do not know how much they get on this in their degree.
“OH professionals have to embrace it and they have to help managers to embrace it. It is about allowing people to come back to work and supporting them back into work. It is about helping managers to recognise that mental health is every bit as important as physical health, and not necessarily any more difficult to deal with. Someone with, say, bipolar disorder should not be more difficult to deal with than someone who has a broken leg,” she adds.
In practical terms, OH can play a central role in showing managers and HR departments how to speak to employees, and show them what questions to ask and how to ask them, she recommends.
“This is not going to convert everybody, but I do think it is going to have a positive impact, particularly on how managers and employers perceive and deal with mental ill health. And it is not just about health issues per se – it may also be important in helping employers recognise the need to deal with physical health issues so they don’t then lead into mental health issues,” Neylon says.