Workplace Report November 2009

Features

Negotiating better mental health

The government is planning a new strategy for mental health at work. With workers under pressure
from the recession, widespread poor management techniques, and increasing workloads, what can union
reps do to support workers with mental health difficulties?

A number of recent reports have highlighted the mental health of workers as a workplace issue requiring
a sympathetic approach from employers, not least because of the billions of pounds in lost productivity it
is causing. Some studies have shown that the recession is contributing to a growth in this area and that
significant numbers of people are affected at any one time.

For example, a recent discussion paper by employment relations service Acas, From stress to distress:
the impact of the economic recession on mental health at work, demonstrates this. It quotes an
Occupational Health magazine report that “studies of previous downturns suggest there will be an
increase in GP and hospital appointments, particularly among men, and higher rates of smoking,
drinking and drug use, as well as separation and divorce.”

Acas acknowledges that mental disorders can be hereditary, but argues that “there are obvious links
between the economic climate and mental disorders. An economic recession can provide many potential
stumbling blocks — tipping individuals from ‘coping well’ into stress, or from stress into anxiety or
depression.”

What is more, productivity across the UK is being significantly affected by people coming to work with
poor mental health as a result of stress and conditions such as anxiety and depression, according to a
survey by the Chartered Institute of Personnel and Development (CIPD) published in November 2009
(see also news story on p.6). The survey of over 2,000 employees found more than a quarter describing
their mental health as moderate or poor, with more than 90% of those suffering from poor mental
health saying it affected their performance at work.

This is particularly worrying for employers, argues the CIPD, as the majority of people with poor mental
health continue to attend work – although more than half (56%) say they have taken time off sick as a
result, almost all (98%) continue to attend work regularly. The survey also highlights the need for
employers to focus more efforts on managing this “challenging issue”, as only a third (37%) of workers
said their organisation supported people with mental health problems well.

The costs to the economy of this struggle to cope with mental health issues at work is huge. The
Sainsbury Centre for Mental Health report, Mental health at work (2007), estimates that the total cost of
mental health problems at work is nearly £26 billion each year. The majority of this cost (nearly 60%) is
due to the adverse impact mental health has on the way employees do their jobs, for example,
individuals may typically be less productive, often suffering loss of concentration, fatigue and memory
problems. Another third is accounted for by absenteeism and over £2 billion by staff turnover.

Acas is encouraging employers to prepare for the longer term effects of the recession and implement
policies and procedures to help cope with mental health issues in the workplace. In From stress to
distress, Acas looks at some of the lessons that can be learnt from tackling workplace stress and advises
employers to look at how they can anticipate and identify mental health problems at work and what
steps should be taken to respond.

Chair of Acas, Ed Sweeney, said that the impact of the recession on workplaces is likely to be felt long
after the worst of it has passed and that: “Acas is urging organisations and managers to implement
effective policies and procedures to help managers deal with the long term impacts of the downturn and
safeguard the health and wellbeing of employees, including workplace training to raise awareness of
stress and mental health.”
And government health advisers are also urging employers to pay closer attention to the levels of stress
and anxiety in the workplace as the cost of work-related mental illness soars. The National Institute for
Health and Clinical Excellence (NICE), an independent organisation responsible for providing national
guidance on promoting good health and preventing and treating ill health, has just issued guidance for
employers aimed at promoting mental wellbeing at work through the development of productive and
healthy working conditions.

The guidance recommends ways in which employers can help reduce the estimated 13.7 million working
days lost each year due to work-related mental health conditions including stress, depression and
anxiety. Highlighting that bad managers were the single biggest cause of the problem, NICE outlines
some simple steps that it says could help reduce the scale of problems by a third. These include giving
feedback, allowing flexible working and giving extra days off as a reward as well as better training for
managers and mentoring for staff to help career development.

Commenting on the NICE guidance, Dave Prentis, general secretary of UNISON, said: “While the
recession inevitably takes a toll on public health, employers need to act on the NICE guidelines, instead
of burying their heads in the sand. We know that many employers are failing to tackle workplace
bullying, impossible workloads, long hours and job insecurity, all of which take a toll on workers’ health
and their families. There is no room for complacency – taking action to protect workers’ health is not
only morally and legally right, it makes sound financial and business sense.”

The NICE guidelines are mandatory for the NHS, the largest single employer in Britain with 1.5 million
staff, which is already taking action on these concerns. At its annual conference in November, NHS
Employers announced that it will be launching a campaign this winter to help NHS organisations support
staff with mental health problems and encourage trusts to employ more staff from this group. The Open
Your Mind campaign on mental health and employment aims to reduce mental health stigma and help
employers to create a better working environment for staff with mental health problems. It will also
identify and share best practice among NHS organisations.

At national level, the government has just concluded its consultation on a new ten-year mental health
strategy called New Horizons: Towards a shared vision of mental health and has promised a final
document before the end of 2009. Central to its aims is to tackle the stigma around mental health and
inequality and discrimination issues.

Trade unions are already taking the issue of mental health on board, recognising that people with
mental health problems “experience some of the most severe disability discrimination in the workplace”.
TUC general secretary Brendan Barber said that hundreds of thousands of employees “face ignorance,
prejudice and stigma because of mental health problems” and that even more cannot get a job “because
of employer discrimination, despite being able and willing to work.”

This is backed up by the results of a survey of 2,000 adults commissioned for the anti-stigma campaign
Time to Change (led by the Mind and Rethink charities) and carried out in August 2009, which found
56% stating that they would not employ someone with a history of depression, even if they deemed
them the best candidate, because they assumed they would be unreliable.

In 2008, the TUC and consultants Disability Forward published Representing and supporting members
with mental health problems at work. The guidance recommends that unions work with employers to
encourage job applicants with mental health issues, as well as encouraging individuals to disclose any
mental health problems. It states that knowing how to make adjustments in the workplace for staff with
such problems can not only benefit a wide range of union members, but also help employers retain
valuable and skilled staff.

The TUC also recommends ensuring that reps have had training on mental health at work and training
“mental health champions” who would have a more thorough knowledge of the issues. These reps would
also network with other unions to share good practice, review policies and procedures to ensure they are
non-discriminatory and encourage employers to set up a programme where individuals can receive
counselling and advice.
Other things unions can do will not only support people who already have a mental health problem, but
may also help prevent others from developing such conditions in the first place. The following TUC list
indicates what union reps can do:

• Ensure that as many reps as possible have had some training on mental health at work issues. Try to
involve members with mental health problems in this training.

• Train one or two people in each branch or area to be mental health champions. These people can have
a more thorough understanding of mental health problems and how people can be better supported in
the working environment.

• Network with other unions to share knowledge and good practice.

• Review policies and procedures to ensure they are not discriminating against members with mental
health problems.

• Develop a union position statement about being positive and supportive of members with mental
health problems, and back this up with events and networking.

• Support employers to set up internal or external support meetings with people with mental health
problems reporting concerns and recommendations to managers.

• Encourage employers to set up a formal Employee Assistance Programme (EAP).

Some unions have instigated their own campaigns to tackle the issues around depression at work. For
example, the CWU communication workers’ union used Depression Awareness Week, held annually in
April, to urge its safety reps to take up the issues around depression using meetings, inspections and
local awareness campaigns. It circulated materials from the Depression Alliance to help safety reps,
including the detailed report Inside Story. And the union wants the 10-point Acas guidance (see box) to
be implemented in workplaces as a step towards tackling the issue collectively.

Acas guidance on mental health

Acas has produced guidance on stress and depression in the workplace and estimates almost three in 10
employees will have a mental health problem in any given year. Its 10-point plan says employers
should:

• be aware of changes in day-to-day behaviour, such as not coping at work, seeming distracted, loss of
motivation or absenteeism;

• not make assumptions, since inconsistent behaviour may well be a “blip”, rather than the signs of a
more serious problem;

• get to the root of the problem by approaching the individual privately, and informally asking if they are
feeling all right;

• take responsibility if the cause of the problem is work-related, such as work overload or poor working
practices, and remedy it;

• consult the safety representative;

• talk to the employee about changes which may be possible, such as flexible working, if the issue is a
domestic one;

• if the employee has not already found support, direct them to help from their GP or a counsellor;
• create a culture which eradicates the stigma mental health can carry by introducing key policies and
making support options available, like employment assistance programmes or access to occupational
health;

• ensure stress and Occupational Health Service policies are implemented in practice by means of the
training of management and staff; and

• ask the company to provide advice regarding exercise, a balanced diet and a healthy work pattern,
since evidence suggests these can be useful in treating mild depression.

Source: From stress to distress: the impact of the economic recession on mental health at work (2009),
www.acas.org.uk

Dave Joyce, national safety officer at the CWU, said: “Our advice is to raise the issue on safety
inspections and at health and safety committee meetings with senior managers so it’s on the record.” He
added that “in the current climate the problems will certainly increase and it’s important to raise
members’ concerns proactively around work related stress and depression.”

Key mental health conditions

In 2008, some education unions published a mental health guide for headteachers detailing key mental
health conditions. Although this list is not exhaustive, it indicates the wide range of conditions and the
connections between them:

Stress

Pressure is an essential motivating force but may become stress, when a person feels they don’t have
the resources to cope with the demands placed upon them. Symptoms may be emotional (e.g.
irritability, tearfulness) and physical (aches and pains, high blood pressure, etc). The person may find it
difficult to make decisions or perform tasks and may be unable to attend work. Stress is also often the
result of poor relationships at work.

Depression

Depression is on a spectrum from mild to severe. Depression is common in the general and working
population. Symptoms include low mood and lack of energy. Motivation can be affected and people may
experience thoughts of life not being worth living, which in extreme cases can lead to suicidal behaviour.

Anxiety

Anxiety becomes a problem when feelings of tension and fear prevent a person from carrying out
everyday tasks. In extreme cases people may suffer panic attacks or phobias.

Obsessive Compulsive Disorder (OCD) is a form of anxiety where people have recurrent, intrusive
thoughts they may feel “forced” to act on (e.g. fears of contamination leading to repetitive hand
washing).

Psychotic conditions/schizophrenia

In contrast to depression and anxiety, psychosis is very uncommon. Psychosis is a term used when a
person appears to lose touch with reality. People may hear, see or believe things that aren’t real to
others (e.g. hearing voices, thinking that others are “out to get them”). If the illness becomes chronic
(long term) the person may withdraw from the outside world and neglect themselves. In these
circumstances a psychiatrist may diagnose schizophrenia.

Bi-Polar disorder/manic depressive illness

Source: UNISON, GMB, Unite, NUT, Preventing work-related mental health conditions by tackling stress:
Guidance for head teachers (2008).