Understanding some of the variables in mental health and return to work

The challenges of effectively managing mental ill health post pandemic were firmly in the spotlight at a recent virtual workplace health conference, including research examining the role, and limits, of mental first aiders and the effect individual variability can have on the return-to-work process. Nic Paton listened in.

Covid-19, as we all know only too well, has introduced new and potentially long-term stresses and strains into the working world. Mental ill health and emotional wellbeing were already significant and worsening workplace health issues even before the pandemic hit last year.

In fact, as the Office for National Statistics reported just before the pandemic, 17.5 million working days were lost in 2018/19 because of mental health-related sickness absence, and stress, depression or anxiety accounting for 44% of all work-related ill health cases and 54% of all working days lost due to ill health.

But then, as Duncan Spencer, head of advice and practice at the Institution of Occupational Safety and Health has highlighted, along came coronavirus and our year, for many of us, of home working, masks, sanitiser, hand-washing and lockdowns. “Illness, loss of family members, caring for children, trying to work while you’re home-schooling, working from a bedsit, lack of interaction; people are now talking of Covid bringing along a new pandemic, and that is the pandemic of mental health.”

Spencer was speaking at a two-day wellbeing webinar held at the tail-end of last year and run by recruitment company Endeavour Search & Selection. In two presentations over the two days, Spencer addressed how employers – and occupational health – can best support and facilitate return to work after common mental health disorders, a challenge that is likely to become only more pressing this year as we work through the long-term fallout from the pandemic.

Spencer highlighted two intriguing research projects IOSH had carried out with Tilburg University in the Netherlands to gain a better understanding of how individual variability can affect the return-to-work process for employees on sick leave because of poor mental health.

Five key return-to-work considerations

The first study outlined five key things that workplaces – leaders, managers, line managers but also HR and occupational health – need to be thinking about and putting in place to facilitate effective return to work in this context.

“First, if you understand your people and what makes them tick, then you will be able to manage them better. Understanding the motivation of the employee in their return to work is a fundamental point that everybody needs to think about how you’re going to do that,” Spencer highlighted.

“Secondly, work adjustments are necessary. If we don’t do any adjustments, what the study showed is that it leads to new sick leave. If a person has gone off sick there are reasons why. If there is no adjustment when they return, they will return to sickness.

“What we need to do, and as quickly as possible, in any return-to-work process is that we need to progress them into small successes as rapidly as we possibly can. Because that helps to re-establish their self-confidence and it helps them to engage once more and to feel they have got purpose,” Spencer advised.

“The third point is a safe, stigma-free working environment. The employer is not always motivated to have the sick worker return to work, because they are worried about their productivity; they feel this person needs to go away and come back when they’re 100% fit rather than accepting the fact that they might not be. But they might gather than 100% fitness through a phased return or something of that nature.

“Fourthly, [recognise that] there is no standard for a return to work. Everybody is different. So a personalised approach for each returnee is absolutely essential. Our study made it very clear that a supervisor, for example, staying in regular contact with a worker is very beneficial. But it is a balance. Sometimes a supervisor can be in touch too often, and sometimes not often enough. Our study demonstrated that you need to this by agreement with the employee and feel your way forward with this.

“The fifth area is collaboration between all stakeholders. There are lots of stakeholders in this. The study made it really clear that the most effective return-to-work programmes for individuals included all of the stakeholders; primarily the worker themselves of course, but also line management.

“You might have an occupational health and safety professional who is looking at some of the risk assessments as a result of an occupational health professional doing a capability study for that individual in terms of what they can or can’t do, which may affect the risks they are associated with. There might also be external case workers, perhaps a psychologist or other healthcare professionals involved, and of course there might be their GP,” advised Spencer.

“One of the things I think is really important to note here is that, in four out of five of these themes, line management plays an absolutely key role. It underlines the fact, as with most systems, if you don’t have educated managers who understand this and can facilitate it within their role, then you will have a system that doesn’t operate as effectively as it might,” he added.

This therefore emphasised how important it was for organisations to improve managers’ knowledge and skills in guiding workers with common mental disorders. “We need to support workers in gaining self-awareness and regaining control. Personalise workers’ return-to-work support. And we need to make sure we get that collaboration,” said Spencer.

“Another key thing is being able to decrease the perceived workload in the mind of the individual who is suffering from the common mental disorder, and increasing their self-reflection in terms of where they are in their response and in their development and their health is absolutely crucial, and must be included in the strategy. We need to address the perceptions and we need to increase the self-reflection; these are very important aspects of any return-to-work process for that individual,” he added.

Individual variability and return to work

The second study examined five different models that looked at how people return to work so as to gain a better understanding of individual variability in the return-to-work process for employees on sick leave because of poor mental health.

This research identified a range of trajectories that workers with mental health problems go through as part of their return to work – with some able to return quicker than others – and highlighted the need for more tailored approaches.

Individuals benefited from more frequent communication with their employer and more joined-up support from employers, co-workers, stakeholders and the wider community. Crucially, this needed to include tackling the stigma that can often be attached to mental health problems.

Nearly half of those missing from the workplace because of their mental health returned to work relatively quickly (within four to five months on average), with only a small chance of relapse during the return-to-work process, the study found.

Faster return-to-work trajectories were found to include more employees with stress complaints and adjustment disorders, while slower trajectories featured more employees with burnout. These findings suggested timely interventions could prevent the development of more severe mental health problems and long return to work trajectories.

Relapse in workers who had returned to the workplace from a mental health problem was more likely to be influenced by work or psychosocial factors since trajectories, with or without relapse, did not vary with the type of mental health problem, the size of the organisation or demographical factors, it also concluded.

“We need to think about who can help us to be able to form the best programme possible for each and every individual and getting a return-to-work programme in place for them,” highlighted Spencer. This needed to include collaboration with people internally and externally to the organisation.

And, again, it meant the competency of the line manager and leader was really important. “Leadership is needed to promote the good practice and ensure that people are engaged and act to destigmatise the subject. Policy is needed so that managers can be held accountable for complying with the management and control systems. If you can see whatever you deliver as being a programme for managing mental wellness, it needs to be quite comprehensive; you need to think about all things in each of those areas,” emphasised Spencer.

Role of ‘good’ work

Spencer cited the landmark 2017 Stevenson/Farmer Thriving at Work review into mental health at work and the importance of employees having “good” work. “Employees should be provided with the knowledge, tools and confidence to keep themselves mentally healthy; self-help and mutual help need to be part of that; all organisations regardless of size need to address their arrangements to support, and know where else to get that support from, to dramatically reduce proportion of people with long-term mental health conditions,” Spencer added.

After the year we’ve just had and where, for many, the barriers between home and work blurred significantly, it was also important for employers to recognise the overlap between the two from a mental health perspective.

“You can’t really divorce what is work related and what is domestic related when it comes to mental health. It will be influenced by factors in both cases,” said Spencer.

“So any sensible organisation really needs to address the whole aspect of this and start to think about, ‘if we’re going to develop systems and raise awareness, we’re going to need to give people tools to be able to improve on their resilience’ and those things need to be operable in both those circumstances, not only the workspace but also at home. It is the person, the being, we’re trying to address.”

The consequences of not getting this right could be dire, he warned, including the risk of staff turnover, burnout, exhaustion, presenteeism, failure to attract and keep talent. Issues such as pressure and, especially now, loneliness also needed to be on employers’ radars.

However, on perhaps a more positive concluding note, Spencer ended by highlighting how the pandemic had focused all of us on mental and physical health, both inside and outside work. “I think this decade is going to be decade of wellbeing; of health in the workplace, not just the physical safety side of things. And if you get it right you can really start to reap the benefits,” he said.

Need for proper training of mental health first aiders

In his other presentation at the virtual conference, Duncan Spencer focused on the role of mental health first aiders (MHFAs) and how important it is for MHFAs to be both properly trained and proactively supported within their organisation.

As he highlighted, becoming an MHFA was not something an employee should take on lightly. “Balancing a paid job role with being an MHFA requires some guidance. These people are often then contacted by lots of employees requesting help. And of course they have a day job to do as well.

“When they are called away to deal with somebody who has a particular mental health issue and is not feeling well, you cannot predict how long they’re going to be away for. They can’t just go for a quick 10 minutes; sometimes it may be quarter of an hour but other occasions it might be an hour or even longer. So who you choose to be a mental health first aider within the organisation is really key,” he said.

It was also imperative their own mental health and wellbeing was supported and managed, he emphasised. “The kinds of people who volunteer themselves as mental health first aiders might not necessarily be the right kind of psychology, if you will, to be able to deal with these kind of stressful situation; dealing with other people’s stresses.

“So who you select is not just important from a job perspective but also from the perspective of their own mental resilience; do they have resilience from emotional strain. You have to have some kind of selection criteria arranged around who you are going to pick for that.

“Measuring the impact and success of the programme is problematic because of the informal nature of mental health first aid conversations. They are held in confidence, so how do you actually measure the performance; how do you measure there has been an effect by that person being involved, and then by the systems kicking in accordingly? It is a really key aspect of the whole process if we are going to demonstrate that the investment of time and effort is actually producing what we want it to produce.”

Spencer also made the point that, while MHFAs do of course work to support and mitigate individual mental ill health within a workplace, they need to be seen as part of a wider, whole-system or whole-organisation approach. Employers need to be working to prevent people deteriorating to the point where they are failing to cope, requiring help or getting ill in the first place.

“Yes, mental health first aiders can help [to prevent stress] to some degree. But it is much more about how do you control the stresses in the first place; how do you engage people in a way that enables them to be able to come forward much earlier or even to be able to identify them before they perhaps recognise it in themselves?” he explains.

Worryingly, in a study of more than 130 MHFAs across 81 employers carried out by IOSH and the University of Nottingham, there had been a considerable degree of cynicism among the first aiders about their role. “They were very cynical about the organisation’s intention and motivation in getting them to attend that training and to be a mental health first aider first of all. That demonstrates that there is a disconnect in communication somewhere,” said Spencer.

“Most attendees understood the limitations of their role, but across the organisation there were variations in expectations of others towards that trained person; some people saw the mental health first aider as being somebody who could diagnose and give a prognosis of their condition, which is absolutely not the case, of course,” he added.

Sickness absence in the UK labour market: 2018, Office for National Statistics, November 2019, https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2018

“Return-to-work trajectories among employees with mental health problems”, Institution of Occupational Safety and Health, November 2020, https://iosh.com/resources-and-research/resources/return-to-work-after-common-mental-disorders/

“Thriving at work: The Stevenson/Farmer review of mental health and employers”, October 2017, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/658145/thriving-at-work-stevenson-farmer-review.pdf

“MENtal health first aid in The wORkplace (MENTOR): A feasibility study”, Institution of Occupational Safety and Health, November 2018, https://iosh.com/MHFAworkplace

One Response to Understanding some of the variables in mental health and return to work

  1. Avatar
    Harold A Maio 1 Apr 2021 at 7:25 pm #

    I am not at all sure what you mean by a “stigma-free” workplace. If you mean free of negative innuendo, please express it that way. If you mean open antagonism, please express it that way.

    Harold A Maio

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