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Employment Today, HR Solutions - Thomson Reuters

Employment Today, HR Solutions - Thomson Reuters



Employment Today Magazine

Mental health issues at work—What can be done?

Research suggests one in four adults report medium or high levels of psychological distress, yet only a small proportion of workers feel able to disclose a mental health issue at work. Dr Mike Causer looks at what can be done to help.

Mental health problems caused by work are increasingly in the spotlight. Legislation requires organisations to pay due attention to psychological hazards. The business case supports organisations investing proportionate effort into preventing psychological health risks.

But, workplace mental health is not all about workplace hazards. It needs to be kept in mind that most mental health problems are multifactorial and not caused by work. UK research shows around 6/7ths of mental health-related sick leave is not work related. The picture is likely to be similar in this country.

The high prevalence of poor mental health in the general population will be reflected in the workplace, regardless of how well workplace hazards are managed. This article will focus on what can be done, when a worker has developed poor mental health.

SIZE OF THE PROBLEM

New Zealand research suggests that one in four adults report medium or high levels of psychological distress. These symptoms can impair work performance and increase the risk of sickness absence. Only a small proportion of workers feel able to disclose mental health issues to their manager or to human resources.

Unfortunately, the identification and effective treatment of poor mental health is less than ideal in primary care. Research indicates that general practitioners recognise only 30 percent of anxiety cases and 55-75 percent of depression cases. Clinical management commonly falls short of evidence-based guidance. It is common for occupational physicians to see workers who have been struggling due to mental health issues, and where earlier intervention may have resulted in a better outcome.

WHAT MENTAL HEALTH PROBLEMS?

Depression and anxiety disorders together account for the vast majority of poor mental health. About one to two percent of the population have a severe mental health illness such as schizophrenia, bipolar disorder or severe depression which require more intensive and ongoing treatment.

Stress is not a medical condition, but can result when there is a mismatch between the demands and pressures on a worker, and their ability and knowledge. Short-term stress can be motivating, but long-term stress is one factor that can lead to poor mental health.

Signs to look out for are noted in the table above. Persistent, frequent presence of these signs or a number of these signs in combination are more alarming than individual signs on any particular day in isolation.

IMPAIRMENT

The degree of impairment associated with poor mental health is variable between individuals and can fluctuate from day to day. An insidious onset means that some individuals are not aware they are impaired.

Many individuals with long-term mental health problems can be successful employees—with the right support. For these reasons, each case should be managed according to how that particular individual is affected.

SICKNESS ABSENCE

There is ample evidence that work is protective for mental health in general. Work brings about improvements in self-esteem, confidence, social connectedness, motivation and a sense of purpose. Absence from work may be required from time to time, but prolonged sickness absence is erosive to mental health and can further worsen the situation. Sickness absence does not treat the underlying problem.

Sometimes, health care providers aim to “protect” their patient by providing certification. With the current understanding of just how important work is in maintaining and restoring good mental health, this approach is outdated. As the focus shifts towards supporting workers in the workplace, employers need to develop flexible working arrangements and offer adjustments to facilitate return to good mental health.

Once a worker is absent, then there is some urgency to act. Individuals can very quickly adopt a disabled mindset, their availability for work can reduce, they can establish beliefs that they can’t work and this can be endorsed by those around them including medical providers.

This can be difficult to reverse and by 12 weeks of absence the chances of a return to work falls by 50 percent. Keeping workplace relationships intact and maintaining the worker’s purpose and routine may be the most important part of their recovery.

The worker has a right to confidentiality, but when the employer receives no information beyond a sick note, it can lead to incorrect assumptions. The worker has a role to play in engaging with their employer if the employer is to be expected to help.

WHAT STEPS CAN AN ORGANISATION TAKE TO PREPARE?

In order to help a worker with a mental health problem, it is going to be necessary for this to be identified in the first place. Voluntary disclosure may occur, and is more likely to occur where the workplace is seen as accepting and supportive of staff with mental health problems. With this in mind:

  • • 
    Train supervisors such that they are more likely to identify staff in difficulty, willing and able to have conversations about mental health with their staff.
  • • 
    Establish a process to facilitate support for staff. This will assist action being taken and early support being provided, as well as helping to normalise the process. Many organisations have a well-established process for managing workplace injuries yet struggle with non-injury health conditions such as mental health problems. Can supervisors rapidly access HR support? Who will coordinate return to work? Who will communicate with health care providers? Is there a consent process? Is there an attendance management process to follow?
  • • 
    Consider whether your organisation can provide support that may be difficult to access otherwise, such as psychological assessment and intervention. The mental health services of the public health system are focused on managing patients at risk of harm. Often their resources do not stretch to meeting the needs of your workforce. Spending money up front to support a worker pays off when considering how much it costs the organisation to have an unwell or absent worker, or to re-hire and train a new worker.

WHAT CAN AN ORGANISATION DO IN INDIVIDUAL CASES?

Supervisor or front-line management support:

Supervisors have a pivotal role as the connection between the worker and the organisation. The worker’s perception of whether the organisation is supportive will be modelled through communications with their supervisor. The supervisor’s response to the worker is possibly more important in successful rehabilitation than anything that healthcare workers do.

It is common for supervisors to worry about saying the wrong thing. Research shows that it is better to attempt to have a conversation than to ignore the issue and hope it will disappear.

Supervisors understand the worker’s role and are in the position to be able to make adjustments. They are able to reduce long-term disability through providing support. They can cause harm through inaction or inappropriate responses.

Early and regular contact from supervisors during absence improves the chance of a return to work. Employees prefer supportive contact versus no contact. No contact can lead to assumptions about the employer not caring or that their job is at risk.

It is useful to encourage absent staff to come into work informally—for example, for a cup of tea—to maintain their relationships with colleagues and work connection. As a clinician, when I see workers have been absent from work without contact with their workplace, I get concerned.

Supervisors do not need to be concerned about the exact diagnosis. It is more important to discuss how the worker’s problem affects them at work and what may be done to help. It can be difficult for a supervisor to support a worker if the organisation doesn’t allow them to, due to competing business priorities.

Consider how this may be overcome. Empower supervisors with the authority to act, give them the training to support. This is where an organisation needs to translate words of support into actions.

On return to work following absence, there is a need to help the worker reintegrate and re-establish relationships and confidence at work. The attitude of colleagues and the supervisor is key. Evidence suggests that colleagues are less likely to be understanding where absence has been due to mental health problems as compared to physical health problems, especially if colleagues were required to cover their work. A return-to-work plan should support the worker, but not disadvantage others.

Workplace factors:

Supervisors should have a discussion with the worker about workplace stressors that may be contributory, or are problematic for the worker affected by a non-work related mental health problem. This should occur as soon as possible.

Unless that discussion is completed, it is not possible to know what the worker may perceive as problematic. It may not be feasible to alter the specific factors of concern, but just having listened and understood can be valuable. Again, this is a conversation that supervisors can have difficulty with. Human resources can help facilitate such a discussion, but ultimately the supervisor is the one who needs to take responsibility.

Workplace adjustments:

Offer adjustments to assist the worker staying at work or returning to work (see table).

EAP:

Employee assistance programmes can help workers deal with certain problems. They are not a panacea for mental health problems. Depending on the programme, it may not provide access to the type of psychological interventions which are most likely to make a sustained difference to the employee, although a good programme will be able to screen and refer accordingly.

Clinical support:

Although many organisations look to the worker’s doctor for advice, the general practitioner is there to support and advocate for their patient. There are disadvantages in relying on the general practitioner to assist with workplace decisions. Very few general practitioners have training in occupational health.

Certification in the presence of a mental health issue is often “fully unfit” rather than alternative duties being considered (as would be the case with a physical injury). General practitioners do not usually have established methods of communicating with employers and confidentiality issues can arise when communication is attempted.

Occupational health providers specialise in the link between health and work. They are able to provide independent advice on how an employer can support the worker, suggest further clinical management and provide information on which to base employment decisions. There is strong evidence that work disability duration is significantly reduced by contact between healthcare providers and the workplace.

Psychological interventions such as cognitive behavioural therapy are effective in reducing symptoms of poor mental health. Ideally these therapies are combined with work-focused problem solving skills. Access to this type of intervention can be difficult through the public health system.

Consider early referral to occupational health and psychology support. The earlier you have the information you require to help the worker, the earlier the intervention, the better the outcome.

SIGNS OF POOR MENTAL HEALTH

  • • 
    Behaviour different from normal or erratic changes in mood
  • • 
    Emotional—tearful, sensitive or aggressive
  • • 
    Anxious or twitchy behaviour
  • • 
    Loss of confidence, motivation
  • • 
    Withdrawing from social interaction or difficulty with relationships at work
  • • 
    Loss of sense of humour
  • • 
    Poor performance, poor judgement, poor timekeeping
  • • 
    Complaints, grievances
  • • 
    Errors/accidents
  • • 
    Tardiness, increased absence or overworking, not taking breaks
  • • 
    Increased smoking/drinking/ substance abuse
  • • 
    Headaches
  • • 
    Loss of attention to appearance

WORKPLACE ADJUSTMENTS TO CONSIDER

  • • 
    Support with workload or changing duties
  • • 
    Flexible hours
  • • 
    Time off work
  • • 
    Performing some work from home
  • • 
    Time off to attend appointments
  • • 
    Regular planned catch-ups with supervisor
  • • 
    Signposting to sources of advice
  • • 
    Offering coaching/mentoring
  • • 
    Extra training
  • • 
    Help with time management/prioritisation of work tasks
  • • 
    Redeployment temporarily/permanently.

DR MIKE CAUSER is an occupational medicine specialist.

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