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For the first time, the 1999 WHO Report recognisedthat morbidity (illness), not just mortality (death),should be considered when establishingpriorities for health related action targets. Untilthen, neuropsychiatric conditions had beenignored as they did not feature in mortality lists.

However, when taking time lived with a disability intoaccount, several of the neuropsychiatric disorders becomeleading causes of disease burden worldwide.

In England, the Mental Health and Social ExclusionReport 2004 from the Office of the Deputy Prime Ministermakes the following observations. Although people withmental health needs want to work, only around a quarteractually do. With over 900,000 adults in England claimingsickness and disability benefits for mental healthconditions, this group is larger than those claimingJobseekers’ Allowance. The cost to the country is estimatedat over £77bn a year. Keeping people in work andmaintaining social contacts can significantly reduce thesecosts and is particularly important, as once a person hasreached crisis point, it is much more difficult to restorethem to employment and social status.

Accommodating people who have mental health needsin the workplace is now a requirement by law through theSpecial Educational Needs and Disability Act 2002. It is alsowritten in the Act that disabilities or difficulties should beanticipated, rather than simply waiting until they presentthemselves. This requires employers to make reasonableprovision ahead of the event for foreseeable cases ofdifficulty or disability. Mental ill health is such a case.

ORGANISATIONAL CULTUREAccording to the Department of Health, with one in six ofthe population likely to experience some form of mental illhealth problem in any one year, mental ill health is ascommon as asthma. This might range from being treatedfor a short-term stress problem or a health breakdownresulting in a long-term diagnosis of clinical depression,which means that all of us are likely to come into contact

with someone we know who has been affected.Mental ill health can affect anyone regardless of

background, intelligence or status. Naturally, it is necessaryto have company polices in place covering areas such ashealth and safety, equal opportunities, anti-discrimination/harassment etc. These statements help to shape thecompanies’ culture, but do not create it in practice.Therefore, a first important step is to raise awareness ofthe issues involved in order to change the negativeperceptions that can be so damaging and stigmatising.Unhelpful perceptions are often due to misunderstandingthe issues involved and the misconceptions andapprehension that this can bring. Developing an accepting

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Dr Ian Morrison andStephen Clift explainwhat employersshould be doing toaccommodate peoplewith mental healthneeds at work

36 IEE Engineering Management | April/May 2005

Human resources

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and knowledgeable culture within an organisation can domuch to create an open and fertile atmosphere in theworkplace, and create a supportive environment for thebenefit of all.

SOCIAL SUPPORT MODELA community setting, be it college or workplace, is not ahospital – neither is it a restraining organisation or aprison. The medical model is therefore inappropriate in theworkplace and not very helpful. This is because we are nottrying to ‘treat’ colleagues, but rather we are supportingthem in the task of rediscovering their role. This is a socialmodel of health and is more akin to the process ofmentoring or coaching colleagues. However, part of thismentoring role would be to maintain appropriate linkswith someone in contact with those responsible for themedical care of colleagues.

From a background of an accepting and supportiveorganisational culture, fostered by awareness training andleadership style, the preventative aim is to manage stressand prevent mental illness. In a supportive environment,existing employees should feel able to discuss their mentalhealth needs and feel supported before serious illnessensues.

Prospective employees, or those returning to work,should be referred to employers by a health professionalsuch as a GP or psychiatrist as ready to return, with anindication of a phased take up of duties. Ideally, employees’care workers (occupational therapists, communitypsychiatric nurses) should be party to the arrangementsand can form the co-ordination link with mentors, asmentioned above. The establishment of this co-ordinationlink between the medical and social models is important inthe process and can give support both to employees and toorganisations in the event of difficulties arising.

PROGRAMME SUCCESS A supportive programme enabling people with severe andenduring mental health needs to access further education

and employment has been evaluated by the author’sresearch using Antonovsky’s health model. This healthmodel is not a pathogenic model but represents health interms of ‘managing stress and staying well’. The associatedquestionnaire devised by Antonovsky, provides a healthscore for the individual. This model is suitable for supportiveinitiatives and concentrates on the degree of meaningfulness(a motivating sense of purpose), comprehensibility (anunderstandable structured programme), and manageability(the resources are available, or can be obtained).

The one-year programme undertaken in a furthereducation college assisted 70% of students starting in thepoorest health to move their scores a statistically significant

36% in a positive direction towards that of the generalpopulation. A medical intervention would be consideredvery successful if it attained such improvements.

A statistical operational model of the processes involvedwithin the programme showed that the support of otherstudents was a key-contributing factor to the success of theprogramme and to the uptake of staff support by thestudents. This highlights the need for a positive culturewithin an organisation if stigmatisation is to be overcome.

The model showed that the process of the learningactivity produced health improvements by reducing thesymptoms of loss of confidence, anxiety, and socialisolation. This in turn raised a positive effect (e.g. havinga future), which was the key contributor to the raisedhealth score. As an individual’s positive effect improved,his or her need for staff support reduced, which indicatedthe progression of the individual towards independence.

Many of the students passing through the programmesuccessfully completed their qualifications and some movedon to university or employment. Some of those moving toemployment did so with the assistance of the charity, ShawTrust. The further education college employed some of itsstudents in a variety of posts such as learning supportassistant, library assistant and catering assistant. The localNHS employed a student in their administration and anotherwas employed as a photographer for a local council aftercompleting his photography course. These appointmentswere graded as regards working hours. If the job was morethan 12 hours per week, the employee started at 12 hours andgradually built up the remaining hours. This allowed theemployee to acclimatise to work and the flexibility of makingup any hours lost due to feeling anxious or unwell.

POINTERS FOR EMPLOYERSStaff training to create an accepting, supportive culturewithin the workplace including a mentoring or coachingscheme will do much to:� Reduce the onset of mental illness amongst employees,

and if it does occur, make the return-to-work process

more likely to be successful;� Provide the possibility to employ people with mental

health needs;� Provide evidence that the organisation takes issues of

discrimination and health and safety seriously. �

Dr Ian Morrison MIEE left the electricity supply industry atits privatisation and trains staff in mental health awareness.Stephen Clift is professor of health education at CanterburyChrist Church University College

References and more information available inOnline Features at www.iee.org/mgt

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