New foundations – getting back to work after mental illness

There is much debate within the occupational health profession about the government’s plans to encourage or, as critics might have it, cajole more people off incapacity benefit and back into work. One OH nurse who is better qualified than most to take a view on these plans, and their likely impact on occupational health practitioners, is 37-year-old Nichola Elvy.

Elvy is founder and managing director of Building Health, a consultancy that specialises in providing OH and health and safety advice and services to the demolition and construction industries.

In March, the one-year-old South East London-based consultancy was named ‘Best new company’, ‘Winner of winners’ and ‘Company of the year’ at the Lewisham Business Awards. What makes this achievement all the more remarkable is that two years ago, Elvy was on Incapacity Benefit following a six-month admission to London’s Bethlem Hospital after being diagnosed with the mental illness bipolar type two disorder.

Overcoming the odds

“I first suffered severe depression in 1999 and was off sick for about six months. I had to move in with my parents and felt suicidal,” she recalls.
That episode successfully treated, Elvy returned to her job as a health and safety inspector at the Health and Safety Executive (HSE), got married and had a child, only to suffer a recurrence of her illness at the start of 2004.

“I was admitted in January and discharged in June. I was on incapacity benefit and applied for ill-health retirement, but didn’t get it,” she says. “It took until December 2004 to come out of it. I just remember being very tired and wanting to sleep all day.”

Looking back, her failure to get ill-health retirement was probably a blessing in disguise, Elvy admits, because it forced her back into the workplace. “I could easily have still been on incapacity benefit now,” she says. “But we needed money to pay the mortgage, and that was what motivated me. If I had been given ill-health retirement, perhaps I might never have gone back.”

At one level, starting your own business – a risky and potentially stressful venture – seems an odd way of coming back into the workplace after mental illness. But one thing it did allow Elvy to do was to set small goals and slowly work her way up.

Starting from scratch

“Initially I said to myself I wanted to try to earn £4,000 a year. I started ringing around demolition companies and was surprised to earn £4,000 for my first job alone – it’s just gone from there,” she says. “Running my own business has allowed me to take more control of my work.”

In her previous job, the HSE had proved to be a model employer when it came to rehabilitating Elvy into the workplace, taking an approach from which OH professionals could learn useful lessons.

“When I came back the first time, I was given a greatly reduced workload. I was working part-time and then gradually increased it back to full-time. Because of my illness I could not, for instance, go up ladders, so the HSE only sent me to flat sites,” says Elvy. “The targets they gave me were almost ridiculously low, but there was still a lot of positive feedback when I achieved them,” she adds.

One of the keys to success was that her immediate manager and team were hugely supportive throughout – Elvy estimates 80% of the support she got came from her manager – showing the importance in OH of securing buy-in and acceptance of the rehabilitation process at a local level.

For people returning to work, it is their desire not to be defined by their condition or illness. Elvy is keen to emphasise her work in helping to bring OH to the construction sector – the industry with the highest fatal injury rate in the UK, and where 115,000 people are estimated to be absent because of work-related illness every day.

At the HSE, Elvy was part of the team that worked on the Constructing Better Health pilot project, which aimed to test how an OH and health and safety advice and support service for the construction industry might work in practice.

Challenges for construction

Key OH challenges facing this particular industry include slips, trips and falls from height, occupational asthma and dermatitis, working with unstable roofs, use of on-site vehicles, lifting, exposure to asbestos, musculoskeletal disorders, noise and hand-arm vibration.

Elvy’s Building Health consultancy provides a range of services, many of them relatively basic in OH terms, but still vital.

Common services asked for by clients include pre-employment health screening, taking blood pressure, urine and vision screening, audiometry, ear irrigation, spirometry, health surveillance for occupational skin disease, biological monitoring, hand-arm vibration screening, asbestos medicals and blood lead medicals.

As far as Elvy is concerned, there is a lot of willingness in the construction industry to improve its record on health, safety and wellbeing, but there is still little understanding of what services are available, their cost and how to access them. In what has the potential to be a vicious circle, there are also still remarkably few OH consultancies that specialise in working with the construction sector.

Much of the workforce is transient and casual and for many workers, English will not be their first language. “I have a lot of sympathy for my clients because a lot of their workers cannot read or speak English, so it is not as straightforward as it might be,” she explains.

“A lot of companies have good intentions, but they cannot get the services they need because there is a lack of nurses within the field,” she adds.
Construction would certainly be one sector where the increased use of OH technicians, under the supervision of a properly qualified OH nurse (OHN), could have a positive impact, she believes.

“Particularly in this sort of industry, where companies might only employ 50 to 200 people, they do not have the resources to employ a full-time OHN, so using consultancies is often less expensive and works very well for them,” she adds.

Elvy’s experience has inevitably given her an insight into the difficulties people face when returning to the workplace after a long absence and the challenges faced by both sides, employee and manager, when dealing with severe mental health conditions.

“It has certainly made a difference to how I view mental illness in terms of employing people. One thing you realise is that the chemical lows you experience are completely unrelated to what is going on in the rest of your life,” she says.

She also recognises much more clearly that for some people, coming back to work may be the best course of action possible, but not for others.
“For someone who is depressed, getting back to work may help if they are fit enough to do so and if they have the right sort of support,” she says.

In this situation, occupational health can have an important role to play as a workplace advocate, helping to break down the stigma or ignorance about mental illness and its impact, she argues.

Elvy self-medicates for her condition and is regularly visited by her community psychiatric social worker – yet is perfectly able to function normally and run a successful business, and has been assessed as fit to practice by the Nursing and Midwifery Council. Similarly, while she may occasionally have to take time off work because of her condition, it is generally no more than a ‘healthy’ worker might have to if they went down with flu. So there are preconceptions to be challenged.

“If people are well managed there is no reason why they cannot provide a service, even though they may have a few periods off sick,” she explains.

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Nichola Elvy’s CV

Age: 37


  • 2005 – present: Occupational health and safety consultant, Building Health
  • 1995 – 2004: HM inspector of health and safety, Health and Safety Executive
  • 1993 – 1995: Assistant safety adviser, Royal Free Hospital
  • 1987 – 1993: Student nurse and staff nurse, University
    College Hospital


  • Diploma in OH nursing, South Bank University
  • Postgraduate diploma in health and safety, Aston University
  • Nebosh diploma
  • BSc occupational hygiene, South Bank University
  • RGN, University College Hospital

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