Mental health at work – how can line managers have a positive impact?

Line managers are often best placed to identify problems with mental health at work, and have a major influence on managing the problem. Clare Price, strategy and development manager at CBT Clinics, advises on how organisations can develop line managers for this sensitive role.

The Centre for Mental Health Charity estimates employers should be able to cut the cost of mental health by about one-third by improving their management of mental health at work. However, a study by Willis OMI Group in February found 14% of workers are sceptical about colleagues who take time off for mental health issues. Given this, what can employers do to create a culture of disclosure and support?

More line manager resources for managing mental health at work

Line manager briefing: stress

Line manager briefing: short-term sickness

Line managers are often the most well-placed individuals within an organisation to notice changes in a colleague’s behaviour that may be caused by mental health difficulties. Most will readily identify that they have had to manage a colleague who has been experiencing a mental health problem.

The question most often overlooked by organisations in relation to managing mental health in the workplace is whether or not line managers believe they have the skills to manage colleagues with mental health problems. The overwhelming response to this question when asked in line manager mental health training is “no”, so what needs to happen to improve competency in this area and change organisational culture?

The National Institute for Clinical Excellence (NICE) Workplace Health management practices guidelines, published in July 2015, make specific recommendations regarding the prioritisation of health and wellbeing for organisations. Part of the advice is related to the development of policies to support mental wellbeing in the workplace, with further direction to ensure line managers receive training to improve their awareness of mental health and wellbeing issues.

According to the recommendations, managers should be equipped to identify when a colleague has a mental health problem, recognising signs and symptoms, how this translates into changes in behaviour and performance within the workplace, and how to advise colleagues on where they can access further support.

Returning from sickness does not necessarily indicate that health and wellbeing has improved, and increased awareness is required regarding the impact of aggressive return-to-work procedures on presenteeism to the detriment of the organisation.

Dispelling the myths and reducing stigma

When people think about mental health, negative images often come to mind more readily than positive ones: for example, movies such as “One flew over the cuckoo’s nest”, “Silence of the lambs” or “Psycho”. The media rarely reports on positive outcomes in mental health care, with headlines focusing instead on failings of services, perpetuating those negative perceptions.

Mental health rarely conforms to stereotypes. Common mental health problems are mostly short lived but may become more problematic if not recognised. Likewise, more serious problems are not necessarily lifelong, especially where people engage with effective treatments. Having a mental health problem does not mean someone is unable or unfit to work. It is likely that we are all working with someone who is experiencing a mental health problem, we just do not know it, and, in many cases, we would not need to know.

Organisations and line managers need to be proactive in challenging negative perceptions of mental health, and improving the general understanding of mental health problems and their effects.

What signs and symptoms can indicate a mental health issue?

Common mental health problems such as anxiety and depression can have some similar symptoms and it can be difficult to distinguish one condition from another. It is not a line manager’s job to diagnose, but to look out for symptoms, respond to them and manage the impacts within the work environment.




Sense of dread Low mood
Overly worried or concerned Feeling sad, empty or numb
Catastrophising Loss of interest and pleasure
Restlessness Tearfulness
Difficulty concentrating Inability to make decisions
Irritability and impatience Irritability or intolerance
Tense or on edge Low motivation
Sleep disturbance Sleep disturbance
Altered appetite Altered appetite
Fatigue Fatigue, loss of energy
Easily distracted Agitated or slowed down body movements or responses


The key is to remember that colleagues are often unwilling to disclose that they are experiencing these issues and keep them hidden due to fear of the unknown, uncertainty about responses and worries about future prospects at work. Changes to behaviour and productivity may provide the first clues to a line manager that a colleague is experiencing difficulties.

Taking notice how colleagues are performing and behaving can give an indication of whether or not something is wrong. The symptoms of common mental health problems disrupt abilities and functioning, and this is expressed in behaviour that is easy to recognise and can frequently be seen within the workplace, including:

  • absence from work;
  • issues with timekeeping and punctuality;
  • difficulties following instructions or completing tasks;
  • procrastination or putting off work;
  • neglecting responsibilities;
  • inability to meet targets;
  • increased sensitivity to perceived criticism;
  • negative evaluation of self, colleagues or work;
  • conflict or misunderstandings with others;
  • withdrawal and isolating oneself; and
  • a reluctance to pursue career goals, such as promotions or extra duties.

In many instances these issues are picked up by line managers, but unfortunately they are often managed as performance-related difficulties, when in reality they are related to a health condition. One of the main reasons for this appears to be a lack of two-way communication between an individual and a line manager, and there are a number of reasons why this may be the case.

Broaching the subject of mental health at work

Mental health symptoms themselves can be a barrier to effective communication, and making assumptions can lead to misunderstandings. The quicker steps are taken to understand what is happening, the quicker sources of help can be identified. The longer it is left, the greater the risk that a colleague’s symptoms and related problems will worsen.

A line manager has to be prepared to make the first move in starting a conversation about mental health. This means inviting colleagues to talk about their concerns or using general management procedures, such as appraisals or review meetings, to provide an opportunity to talk in a supportive, non-threatening way.

Sometimes all the line manager needs to do is help colleagues to help themselves. They may already have coping strategies or medical advice that they can follow, but listening and showing empathy always helps. When a colleague does make the decision to share, it is important for line managers to understand what else they could do to offer support and help.

Focus on practical support

Some of the factors that influence mental health, such as childhood experiences or family relationships, cannot be addressed by general work practices and the temptation to become a pseudo-counsellor should be resisted. However, help can be provided by signposting colleagues to available help, such as employee assistance programmes, psychological therapy services or occupational health where offered, or encouraging the employee to contact their GP or local NHS services.

If there are performance issues, these should be acknowledge in a non-blaming way and related to the symptoms being experienced. A plan can then be developed together with a colleague to support them in overcoming these in both the short and longer term.

A line manager can be proactive in moni­toring workloads, engagement and involvement, the physical work environment and relationships at work. It is advisable to consider short-term adjustments to help manage symptoms.

The simple step of moving focus from disability to capability can prevent the need for time-consuming performance management procedures, reduce the likelihood of absence and make colleagues feel valued by the organisation.

Any adjustments need to be planned collaboratively and there should be regular planned reviews, with long-term adjustments made in consultation with HR.

When a colleague does go off work, line managers can continue to offer support by maintaining regular contact. Offering a choice of contact method, for example, telephone, e-mail or letter, and time frames preferable to the employee, can help to keep lines of communication open.

Putting pressure on the employee to meet a return-to-work date can be counter-productive. However, keeping return to work on the agenda can facilitate an earlier return and enables the development of a support plan, which improves the probability of successful outcomes and the sustainability of a return to work.


There is no doubt that positive outcomes can be gained by improving line manager competency and confidence in managing colleagues with mental health problems in the workplace. Confronting stigma and providing signposting and effective practical support reduces the costs of mental health at work. Line managers should be equipped with the knowledge and information required to implement best practice for managing mental health at work.

Clare Price Cert Mental Health Nursing, PG Cert CBT, PG Dip CT is strategy and development manager at CBT Clinics.  

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