Welcome to Managing Mental Health at Work

For the CIPD South London Branch

14 November 2012, 12.00-14.00

With Stephen Brogan

Structure of the Session

Introduction to mental health The causes, signs and symptoms of stress Supporting and treating stress Stress and anxiety Why manage mental health at work? The

Equality Act (2010) Reasonable adjustments Q and A, discussion

Learning Contract• Conditional confidentiality• Equal Opps• Timekeeping• Phones switched off and put away, and only used during

breaks• Monitor output• Avoid interruptions• No private conversations when someone is addressing the

group• Stick to the subject• Look after yourself• No such thing as a stupid question

The World Health Organisation (1999) defines mental health as:

• A positive sense of well being

• A belief in one’s own worth and the dignity and worth of others

• The ability to deal with the inner world of thinking, feeling, managing life and taking risks

• The ability to initiate and sustain mutually satisfying personal relationships

• The ability of the mind to recover from shock and trauma

• Someone with a mental illness can experience problems in the way they think, feel or behave. This can significantly affect their relationships, their work, and their quality of life. Having a mental illness is difficult, not only for the person concerned, but also for their family and friends and anyone else who is around them, such as work colleagues

• Mental illnesses are some of the least understood conditions in society. Because of this, many people face prejudice and discrimination in their everyday lives

• Mental illnesses do not relate to intelligence

Some Statistics• Findings vary, but approximately 1 in 4 of us will

have some sort of mental distress at any one time • Around 300 people out of 1,000 will experience

mental health problems every year in Britain • 230 of these will visit a GP • 102 of these will be diagnosed as having a mental

health problem • 24 of these will be referred to a specialist psychiatric

service • 6 will become inpatients in psychiatric hospitals Reference: Mind http://www.mind.org.uk/help/research

The Most Common Mental Health Problems in Britain

• The Office of National Statistics says 9.2 % of adults in Britain have a combination of anxiety and depression

• The most common symptoms are sleep problems, fatigue, irritability and worrying

• Mental health exists along a spectrum

• Explanatory models include medical and psychological perspectives

• Recovery

• Language

• Stigma and discrimination

The Psychiatric Classification of Mental Illnesses

• The neuroses or common mental health problems: stress, anxiety, phobias, obsessive compulsive disorder (OCD), depression

• The psychoses or severe mental health problems: schizophrenia, bi-polar disorder, psychotic episodes

• Post traumatic stress disorder (PTSD)

• Personality disorders

Stress

Right now, 1 in 6 workers is experiencing depression, anxiety or stress and costing the UK economy £26 billion each year.

Work-Related Stress

‘The adverse reaction people have to excessive pressure or other types of demand placed upon them’

Health and Safety Executive, 2004

The Effects of Stress at Work

• Reduced Productivity

Employees who remain in work without the support they need cost UK businesses up to £15.1 billion a year

• Lost Working Days

70 million working days are lost every year due to mental ill health, with 10 million working days directly caused by work-related problems

• Recruitment

Staff turnover as a result of employees leaving their jobs due to mental ill health costs £2.4 billion.

Understanding Stress

Stress, however, means different things to different people. Our life experiences and personality partly determine how we appraise and interpret events and whether a situation is seen as stimulating or intolerable varies greatly from person to person.

Causes of Stress

There are many sources of stress, both inside and outside work. Life changes, bereavement, negative social conditions, poor housing, noisy neighbours, relationship problems and conflict can all affect our wellbeing and cause stress.

Research shows that prolonged stress is linked to psychological conditions such as anxiety and depression, as well as physical conditions such as heart disease, back pain and headache.

What is Anxiety?

• ‘A state of uneasiness or tension caused by apprehension of possible future misfortune, danger etc’

• Anxiety is the what we feel when we are faced with stressful, difficult or threatening situations

• We often use words like fear, stress and worry to describe anxiety

• People usually feel anxious when faced with new or challenging tasks, when going through changes especially those over which we don’t have much control, and generally when we face any kind of physically or psychologically threatening experience

• Short-term anxiety can be useful. Feeling nervous before an exam can make you feel more alert, and enhance your performance. However, if the feelings of anxiety overwhelm you, your ability to concentrate and do well may suffer

Types of Anxiety

• Generalised Anxiety Disorder (GAD)

• Phobias

• OCD

Physical Symptoms of GAD

• Feeling restless and being on edge• Rapid breathing• Rising blood pressure and pounding heart• Tense muscles which can cause pain and

headaches• Sleep disturbance• Nausea , sickness and urgent need to use the

toilet• Tiredness

Psychological Symptoms of GAD

• Feeling worried all the time• Difficulties with motivation, concentration and

decision making

• Feeling low or weepy

• Heightened alertness

• Needing lots of reassurance

Panic DisorderThis involves recurring and unexpected panic

attacks – an exaggerated stress reaction that happens very quickly. The person may also feel:

• That they are going to die• Frightened of ‘going mad’ or losing control• Short of breath• That they are choking• That they must avoid situations/places/people in

case a panic attack happens

In addition, the person experiences:

• Persistent worries about further attacks

• Worries about the consequences of the attacks such as having a heart attack

• Significant change in their behaviour, such as avoiding situations in case a panic attack is triggered

Supporting an anxious person

• Learn about anxiety• Talking, informally or counselling• Structure the day, week, or month• Exercise• Healthy diet• Not too much alcohol• Physical relaxation techniques (deep breathing,

meditation, yoga, soothing music, complimentary therapies etc)

• You may want to see your GP• The National Institute for Health and Clinical

Excellence (NICE) suggests that for particular kinds of anxiety, such as panic, social phobia and obsessions, GPs should prescribe antidepressants, especially certain SSRIs (selective serotonin reuptake inhibitors)

• Doctors may also suggest beta-blockers to deal with symptoms such as palpitations, although the success of this treatment is variable

Anxiety is usually chronic, whereas stress is usually acute

• This means when we are stressed we usually need short term intervention to remove the stressor(s)

• But when we are anxious, we need longer term help too, such as confidence building, help with being assertive, and being around good role models

The Equality Act (2010)

• The Act requires employers to make reasonable adjustments in order not to discriminate against someone with a disability. Most mental health conditions are covered by discrimination law

• The Act applies to everyone who provides a service to the public, whether or not a charge is made for that service. It covers statutory, private, voluntary and community sector organisations. It also covers employment.

The Act asserts that everyone has the right to be treated with dignity and respect. It prohibits discrimination on named grounds, or nine ‘protected characteristics’. These are:

• Age• Disability (physical and mental)• Gender reassignment• Marriage and civil partnership• Pregnancy and maternity• Race• Religion or belief• Sex (or gender)• Sexual orientation

Disability• Disability is defined as impairment that has long term effect

on the person’s ability to carry out day to day activities

• It says that long term means it has lasted, or is likely to last, at least 12 months

• This means that even if a person is well at the moment, they may still be covered if adverse effects are likely to recur

• If someone takes medication or has treatment that keeps them well, they are still to be treated as having a disability if there is evidence that adverse effects would recur if they stop medication or if their treatment has ended

• The Act states that you no longer have to show that a particular capacity is effected e.g. memory, concentration, only that you have a condition that qualifies as a disability

Forms of Discrimination

• Direct discrimination • Indirect discrimination• Discrimination by association• Discrimination by perception• Harassment• Victimisation• Disability discrimination

– Discrimination arising from disability

– Failure to make reasonable adjustments

Reasonable Adjustments

• Adjustments to the work area• Flexible working hours• Allowing absence during working hours to attend medical or

therapeutic appointments• Providing additional supervision and support• Transferring the employee to fill an existing vacancy• The employee does not have to come up with suggestions, but it

will help if they do; the employer must consider any suggestions made

What do we mean by ‘reasonable’?

• The extent to which the adjustment will prevent the problem• How practical it is for the employer to make the adjustment• The financial and other costs• The disruption it would cause to the employer’s activities• The extent of the employer’s financial and other resources• The availability to the employer of financial or other assistance

e.g. grants to make the proposed adjustment

The SHIFT Holistic Model for Managing Mental Health at Work

There are 5 important stages:

• Recruitment

• At Work

• Getting Distressed

• Off Sick

• Returning to Work

The HSE Management Standards

• The Management Standards define the characteristics, or culture, of an organisation where the risks from work related stress are being effectively managed and controlled

• The Management Standards cover six key areas of work that, if not properly managed, are associated with poor health and well-being, lower productivity and increased sickness absence

• Demands – this includes issues such as workload, work patterns and the work environment

• Control – how much say the person has in the way they do their work

• Support – this includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues

• Relationships – this includes promoting positive working to avoid conflict and dealing with unacceptable behaviour

• Role – whether people understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles

• Change – how organisational change (large or small) is managed and communicated in the organisation

The Principles of Managing Mental Health

• Identify signs of distress early and act on them as soon as possible

• Use the usual management procedures to identify problems and needs and act on them

• Make talks positive and supportive• What can we do to help?• What has helped in the past?• Agree plans of action and review on a regular basis

• Is someone reluctant to talk? Think about why this is and offer reassure regarding confidentiality; highlight the benefits of disclosure but be realistic

• Suggest an advocate or friend or another manager attends the meeting

• Liaise with HR• If someone is reluctant to disclose anything to colleagues –

consider the pros and cons• Support other colleagues and manage their reactions• Performance issues? Act as soon as possible• Take a twin track approach: disciplinary and usual mechanisms

PLUS adjustments and support

Resources

• Mind www.mind.org.uk

• Mind Workplace www.mind.org.uk/workplace

• The Health and Safety Executive www.hse.gov.uk

• SHIFT www.shift.org.uk

• Time to Change www.time-to-change.org.uk