As mental health problems rise employers must improve their staff support infrastructure to ensure issues are addressed and employees kept in work. Dr Les Smith investigates
While mental health problems are common, most are relatively mild in their effects and are dealt with by family doctors and primary healthcare services without the need for professional psychiatric help. However, 15% to 20% of UK workers may have a mental health problem of some kind and while it is usually not associated with work, employers can play an important role in helping staff cope with psychological-wellbeing issues which will, in turn, enable them to stay in the workplace.
There are several important strategies that can be implemented to reduce presenteeism and absenteeism associated with people suffering from mental health problems. This should be welcome news for employers.
The Office of National Statistics (ONS) states that mixed anxiety and depression are experienced by 9.2% of adults in Britain. This is followed by general anxiety at 4.7% and depression without anxiety at 2.8%. Common mental health problems affect between one in four and one in six of the working population, whereas severe mental health problems only affect between 1% to 3% of workers, according to the ONS. Therefore, most employers will have very limited exposure to the issue, but this does not make it any less important.
Although stress frequently hits the headlines, it cannot be defined using the medical model for diagnosis. This is because it is a mixture of symptoms, feelings, emotions and behaviours and why it can be such a challenge for employers and staff to find the best ways to cope with mental health problems.
Disturbed sleep and fatigue are the most commonly reported symptoms of mental distress. Almost a quarter of the population frequently experience sleeping difficulties, and it becomes more common with increasing age. Not far behind sleep problems comes fatigue, at 29%, with irritability and worry being common symptoms at 22% and 20% respectively, according to figures from mental health charity, Mind.
It is, therefore, easy to see how even mild mental distress could impact on a person's ability to maintain performance at work.
A report from the Mental Health Policy group revealed that mental illness is Britain's biggest social problem. As a result of this research, the Government has announced plans to invest in talking therapies to help cope with rising levels of depression and anxiety disorders. The new initiative proposes the development of 250 new therapy teams by 2013, to help people with depression and anxiety.
Of all the people affected by mental illness, only a quarter receive treatment and in most cases that is in the form of medication. However, therapies like cognitive behavioural therapy (CBT) are as effective as medication and preferred by most patients.
Government help
The new Government investment aims to create a psychological-therapy service, for depression and anxiety disorders, to be commissioned in every part of the country, with a focus on CBT experts. But this may not be soon enough for the individuals already suffering from mental illness - and their employers.
For many employees their GP or occupational health (OH) practitioner at work is the first point of contact when faced with mental health problems. But with just six to 10 minutes on average being given for an appointment with a GP, it can still be hard for people to get the support they need. Moreover, many GPs have limited access to talking therapies or there are long waiting lists, which becomes a barrier to treatment. These delays increase the chance of conditions worsening.
This is where employers could play a crucial role, by helping staff gain access to counselling and psychology services at the earliest opportunity, and thereby reducing the costs associated with long-term ill health.
Cost awareness
The costs should not be under-estimated. Output losses due to mental health issues amount to £23bn, and social care footing a bill of £12.5bn.
The costs are clear and can hit businesses hard. Yet, by adopting best practice in the workplace, employers can prevent the loss of skilled employees, as well as increase productivity. The key is early, active and positive intervention.
Employers need to take heed to the old adage 'prevention is better than cure'. The aim should be to prevent mental health problems by creating a healthy working culture and line managers should be educated and trained to understand these types of problems.
Once treatment is necessary it should be given as early as possible. Psychotherapy or CBT and other methods can help prevent minor conditions worsening. This is crucial because if common problems like anxiety and depression are left without treatment, they will become more serious and pose a major challenge to all concerned.
Research shows that regular contact as well as CBT facilitate an early return to work. Employers should, therefore, ensure line managers keep in touch with staff who are off work due to sickness caused by mental ill health, at least once every two weeks. In addition, pressure-management techniques can improve people's resilience and ability to cope with stress and avoid stressful situations at work. Techniques including teaching problem solving skills, exercise and relaxation have also been proven to be useful aides.
However, many minor mental health conditions can be effectively managed with the help of counselling that is usually supportive and reflective rather than diagnostic. Indeed, the increasing demand for counselling services mirrors the need to address issues that affect everyone in their day-to-day lives, from the general demands and pressures of modern living to more significant issues like divorce, debt and bereavement. The pressures of getting to grips with a new job and increased responsibility also should not be ignored.
Many employers who recognise that performance and wellbeing go hand-in-hand, are also embracing wellbeing audits, early intervention absence management services and 24/7-access to expert medical counselling and lifestyle advice through employee assistance programmes.
The culture of an organisation and managers' behaviour are also important to identify interpersonal conflict, bullying and harassment. These issues can be addressed through line manager education and the setting of positive health-performance targets around levels of attendance, stress-related absence and employee satisfaction reward and recognition. Effective recording and monitoring of sickness absence levels means businesses can operate active case management. Combined with timely intervention from OH advisers, this can create a health and wellbeing model that addresses the causes not just the symptoms of sickness absence.
The result is that through effective management of sickness absence, employers can support their staff with access to advice, counselling, CBT, rehabilitation and physiotherapy.
At the moment, mental health problems seem to be increasing in the UK, affecting more people each year. People seem to be more dissatisfied with their lives as they become more complex. Big issues such as technology creating a 24-hour society, means people are under increasing pressure in and out of work. The result is that society needs to adjust.
A normal day includes outside stresses and strains such as commuting in rush-hour. Add to that working pressures and the demands of family life, managing day-to-day finances and balancing all of that with a healthy social life and it is easy to see how common mental illnesses will continue to increase.
Research suggests that implement-ing solutions on an individual basis, rather than a sweeping organisational level is the most effective way to manage common mental health problems, helping people stay at work. However, there are clearly ways that employers can integrate solutions into their organisation's human resources policy, helping to identify causes of ill health in order to reduce them, as well as providing the support once ill health becomes an issue. OH solutions can provide hands-on support and expertise to address specific health and wellbeing issues.
Employers cannot afford to ignore the mental health of their staff, but with the right strategy and support structure in place, they can do a lot to catch it early and minimise the need for time off work to recuperate.
Businesses who believe that investing in wellbeing improves productivity and profits will also find it pays off even more as the average age of the workforce increases. It is time to think about health promotion, active management of absence and return to work rehabilitation schemes as one integrated approach.
Dr Les Smith is group medical director at FirstAssist
