A new website offers guidance for those involved with issues relating to work and mental health. Sarah Silcox reports.
Work is good for mental health. This is the main message of the online Work and Mental Health resource developed by the Royal College of Psychiatrists (RCP). The website is divided into four parts focusing on advice and guidance for workers, employers, clinicians and carers. So, how might occupational health professionals and managers use it to aid the work retention and rehabilitation of employees with mental health problems?
The business and personal case for keeping people with mental health problems in work is well established. Compelling evidence exists showing that paid work is generally good for both the physical and mental health of most people, and for the argument that work should form part of therapy. Yet mental ill health is still stigmatised, with myths abounding as to its effect on a worker’s ability to do the job. For example, it is still a commonly held view that work does more harm than good to somebody with mental health problems.
Mental ill health is a very difficult issue for people to talk about at work, including line managers and their teams. Many recruiters, managers and employees believe they lack the tools to recruit, retain and support those with mental illness at work, and it is for this reason that the RCP has launched its Work and Mental Health website.
The resource explores how work can play a positive part in people’s recovery, how employers can support those with mental ill health, and how clinicians – including occupational health professionals – can help get people back to work, and stay in work, by using work as part of therapy. The website was developed by a group comprising psychiatrists, occupational health clinicians, GPs, nurses, HR professionals and service users.
Funding and development
The project received £35,000 in funding from the Department for Work and Pensions (DWP) as part of Dame Carol Black’s programme of work. “The DWP is keen to get clinicians on board with the work and health agenda and has asked a number of different colleges to put information on their websites, including the RCP,” according to Dr Jed Boardman, chair of the working group that developed the RCP site.
Moves by a number of Royal Colleges and other professionals, including GPs and occupational therapists, to build workplace information into their online offerings are part of the drive to encourage clinicians and others to see work as part of treatment. “Social outcomes are an important part of therapy,” adds Boardman.
We are trying to push the basic message about work being good for mental health, which can apply to any clinician, including OH professionals.”
Dr Jed Boardman,
“We are trying to push the basic message about work being good for mental health, which can apply to any clinician, including OH professionals,” he argues.
If an employee is off work with a mental health issue, it is hard to predict how long they will be absent, but neither is it feasible or desirable that the employer or manager waits until all treatment finishes before starting rehabilitation. “The key is to do the treatment and rehabilitation in parallel,” Boardman stresses. It is important to encourage all parties away from the traditional view that if a person is not 100% ready to come back to work, they should stay off, as this approach is largely responsible for the long periods of sick leave associated with many mental health cases.
The website took around a year to develop and has been rigorously tested by potential users. A working group advised on what to include within the four sections, but also, crucially, on what links to make to external sources of guidance. “We were wary of overloading each page, so use links to other sites and within our own site where relevant,” Boardman explains.
The website was tested during development using a series of case scenarios, which were presented to particular constituencies, for example, the case of a 30-year-old worker recently diagnosed with schizophrenia. Evaluation questions included: how would a line manager use the website to get information on suitable workplace adjustments?; how easy was it to find the information?; and did the manager get lost in the system?
An RCP service user group also looked at a mock-up of the website to check it for ease of navigation and visual impact, as did clinicians, who checked whether or not the advice given would lead to better case management. The website will be evaluated after around six to 12 months, using standard tools such as the number of hits and comments from users.
Occupational health interface
Boardman argues that the interface between OH and other medical professionals, including psychiatrists and GPs, is crucial in supporting workers with mental health problems. He emphasises that employers, workers and clinicians need to work together, something that underlies the new RCP resource. “This triangle needs to work together and communicate properly – hence the section of the website about what to put in a medical report, and what questions different clinicians should ask and answer. There was very little until now to tell us how to do this,” he adds.
Supporting good communications features in a specific part of the website for clinicians; it is directed primarily at GPs and psychiatrists working with OH teams on work retention. It suggests that GPs and others provide the information requested by the employer’s OH practitioner, plus the following information if relevant:
- an outline of the clinical condition, but not a detailed psychiatric report as this is not normally required;
- the treatment plan, including details of any medication;
- an estimate of the clinical prognosis;
- details of any perceived barriers to return to work or progress;
- suggested ways of overcoming any such barriers; and
- flag up any significant risk of harm to the patient.
It also advises GPs and psychiatrists in their reports to the employer or OH team:
- not to repeat unsubstantiated allegations by the patient as fact;
- not to suggest a causal link between work and health without firm evidence;
- not to make employment recommendations unless qualified to do so;
- not to comment on financial matters, including sick pay or retirement benefits;
- to ensure that opinion is justified by rational argument and that it is not reported as fact;
- to remember that clinical risk aversion often results in job loss;
- to remember that keeping a job is much easier than finding a new one; and
- to remember that unemployment is a potent cause of mental ill health.
Line managers and making simple adjustments
Dr Steve Boorman, former director of corporate responsibility and chief medical adviser to the Royal Mail Group, was also involved in developing the new RCP resource. He believes it is a “pragmatic and practical” response to the need for better advice and guidance for all four groups targeted by the website’s different sections.
Clinicians, including OH professionals, will be able to use the website to present work as part of therapy, Boorman argues. Employers should be able to use it to raise the issue in the workplace and, in particular, to develop some simple adjustments to keep people in work, or get them back after an absence related to mental health. There is also information for patients on how to raise issues at work and where to seek help beyond the workplace.
Employers should be able to use the website to raise the issue in the workplace and to develop some simple adjustments to keep people in work, or get them back after an absence related to mental health.”
Line managers often find it particularly difficult to raise mental health issues among their teams and many still do not see this as part of their job. The RCP website, therefore, contains practical suggestions for managers on how to find information and ask relevant questions of employees. “Provided the question is raised in the right way, it is always better to ask it than avoid the issue,” Boorman suggests.
Making adjustments to keep people in work is not always easy, and some line managers argue that there is so little slack in their operations that it is often not possible. However, Boorman points out: “There will be even less slack if the person with mental ill health problems goes absent from work for an extended period.” Managers need to see work retention in a positive light over the medium to long term and, in particular, as a way of avoiding the additional costs of recruitment or early ill-health retirement if an employee exits the workforce, he adds.
Professor Sayeed Khan, chief medical adviser at the manufacturers’ organisation EEF, and also a member of the RCP website working group, says that absence related to mental health is “one of the hardest types of sickness absence most managers have to deal with”. He believes that the guidance provided by the website will make it easier for line managers to have difficult conversations with team members, and will also help dispel some commonly held myths and fears they have about making things worse for the employee. “We’ve been waiting a long time for decent guidance on mental health at work,” he adds.
Khan recognises that some managers are still reluctant to accept their role in employee retention, and find the concept of making simple adjustments hard. “We need to continue challenging the belief systems of line managers, particularly around not being able to make adjustments,” he argues, adding that the RCP tool should help in this process. In the majority of cases, adjustments are possible and, in some cases, these encourage behaviours that improve the effectiveness of the organisation as a whole, for example, rotating people around a production line. The RCP website, and its advice for managers, is all part of “chipping away” at some managers’ entrenched views about mental illness, he believes.
Work is part of therapy
The Royal Mail Group believes that mental ill health potentially affects many employees, so is worth taking seriously. The group works with mental health charity Mind and other organisations on raising awareness of the issue. Its in-house learning programmes include elements on supporting colleagues who may be going through difficult times, or have mental health issues. Royal Mail also actively recruits people with mental health problems with the help of mentors and buddying support systems, as well as advice from organisations such as Mind.
A web-based training resource has been developed for line managers, featuring writer and comedian Jo Brand, on how to identify possible mental ill health among teams and how to ask the right questions with empathy; for example, by choosing the appropriate environment and offering help and support, rather than criticism.
Royal Mail also provides access to a 24/7 telephone helpline called HELP, which covers health, employment, legal and practical issues. The organisation has used trained counsellors for around 75 years, but the current system of support emerged in the 1980s and 1990s, providing face-to-face help and liaison with other healthcare providers for those needing it.
Employees at Royal Mail also have access to comprehensive occupational health support for mental health problems. “Our OH team works with primary and secondary healthcare providers to get people back [to work],” Boorman adds. “You need the right person involved at the right time, and the interface between OH and our counselling team is crucial,” he explains.
For example, at Royal Mail the welfare team will help set up a dialogue between the OH physician and NHS psychiatrist if needed, and will also stress to external health professionals the support available within the organisation “so that they see work with Royal Mail as part of the therapy”, Boorman concludes.
Mental health referrals: what occupational health professionals should include in a report to an employer
1. Background to report
2. Current position
3. Specific questions
4. Future plans
5. Procedural issues
Source: RCP Work and Mental Health.