It has become the chief cause of long-term absence in the UK, but appropriate provision for mental health problems at work lags way behind. Keith Bushnell assesses how employers can limit absenteeism and reduce the strain on their insurance policies.
Any policy for tackling mental health should include the employer and aim to keep staff at work, or facilitate their return to work as quickly as possible, recognising that activity and work can be part of the recovery process. Early action is the key to this.
Immediate medical assessments (IMAs) are a well-developed approach to tackling common injury, and are based on quickly establishing the cause of symptoms with the opinion of medical experts.
While IMAs are potentially useful for all types of injury or illness, they are especially applicable to those with less predictable outcomes and recurrent symptoms such as mental health problems.
IMAs rely on an initial evidence-based clinical triage to determine conditions, using the diagnosis as a basis for an appropriate action plan. Evidence based diagnostic criteria are available for mood disorders (including various types of depression), and several anxiety disorders.
There is strong evidence that various medical and psychological treatments for anxiety and depression can improve symptoms, clinical outcomes and quality of life, but this may not lead to improved work outcomes.
It is clear that people do not have to be entirely symptom-free to remain in or return to work successfully. Several effective interventions focus on how to stay at work with common mental health problems rather than stopping work and then managing the health problems to be fit to return to work.
Crucially for employers, an IMA could determine that treatment or rehabilitation is not the most appropriate course of action.In the management of staff illness it is essential that employers avoid ‘over-medicalising’ common health problems and minor injuries.
The majority of problems improve without intervention and do not require extended rest, time off work or health treatment. In many cases, self-help advice including web-based support can be sufficient, which saves employers substantial costs associated with unnecessary medical treatment and absence.
An immediate medical assessment should help to provide:
- Clarity on specific symptoms and level of function;
- Potential assessment and treatment options, and resources likely to be required;
- Assessment of an individual’s motivation to participate in activity and work;
- Identification of obstacles to improving function and work;
- An individual rehabilitation plan and recommendations for action;
- Provision of self-help advice or self-management orientation;
- Analysis of other pertinentfactors affecting performance, such as lack of motivation, alcohol and drug use and any pre-existing conditions;
- An outline of specific recommendations, restrictions and limitations.
Before any intervention can take place, employers must be ready to quickly spot the signs of mental health issues in staff.
Naturally, in identifying people who are struggling with symptoms at work, it is very important to distinguish between genuine concerns and informal ‘grumbles’ that employees make from time to time.
The responsibility for making this distinction lies with line managers, who must be ready to quickly identify symptoms that could escalate if not dealt with rapidly.
Crucially, anyone without a medical qualification cannot and should not attempt to diagnose mental health problems. However, they should note and discuss changes in areas such as performance and productivity, and listen to other colleagues’ concerns.
When workplace adjustments or special arrangements are required these should be planned for as temporary (that is, the employee, their line manager and colleagues should be expecting recovery.) Psychologically, open-ended or long-term workplace changes do not set the right expectations, and create a mindset that can encourage unnecessary absence.
The real imperative for employers, however, is to choose policies that provide sufficient mental health support. Too many UK companies are making claims against general policies for staff absenteeism because problems have been allowed to escalate.
As the mental health issue deepens, employers will increasingly be on the look-out for policies that focus on keeping their staff in employment and using work as a tool for recovery.
Keith Bushnell is chief executive of Health & Case Management Ltd
