Jane Braithwaite considers how to manage mental health issues in the workplace.
From the start of the Covid pandemic, we have been very aware of concerns relating to mental health and the increased number of people suffering from mental health problems.
This has largely been due to lockdown and the impact that has had, and we have heard how it has affected everybody, both young and old. More lately, we are hearing about the enormous toll on healthcare workers and some very concerning discussions relating to this.
As people who work in healthcare, we need to be very aware of the mental health issues employees – and we ourselves – may be experiencing.
It is important that we gain the best understanding so that as leaders, managers and role models, we can help and support our people – and to know what support is available for those who need it.
Before Covid, we knew mental health-related issues were the most common cause of long-term sickness in UK workplaces.
Surveys performed by the Chartered Institute of Personnel and Development (CIPD) in 2019 reported that the impact of stress in particular had increased, with 37% of respondents saying that stress-related absence had increased in the last year. They concluded: ‘Work-related stress, depression or anxiety accounts for 44% of work-related ill health and 54% of working days lost in 2018-19.’
As well as sickness absence, poor mental health at work can lead to increased staff turnover, reduced engagement and high absenteeism.
Mental health problems affect around one-in-four people in in the UK in any given year.
As we recover from Covid, there is much evidence to suggest that the pandemic and measures taken to manage it, such as lockdown and social distancing, will have a significant impact upon the mental health of employees and the impact maybe felt for months or even years.
How will Covid-19 affect our mental health?
We do not yet know what the exact impacts of the pandemic on our mental health will be. People have been affected in different ways: many feeling isolated, others are fearful about catching the virus themselves and also anxious about their family and friends.
Employees in healthcare have been working long hours with few rest periods in very difficult circumstances throughout the pandemic and have possibly not had the time or opportunity to reflect on their own well-being.
The workload in the healthcare sector is destined to remain high. As Covid numbers have decreased, many individuals have been involved in the vaccine roll-out and are now facing the pressure of addressing long waiting lists of patients requiring non-Covid treatment.
This long-term stress has taken a toll and continues to do so. Our best defence against mental health is resilience, but, to maintain resilience, individuals need time to recuperate and this has not been possible in healthcare and is unlikely to be possible in the near future.
Mind, the mental health charity, reported that over half of adults and over two-thirds of young people said their mental health declined during lockdown. Young people and those with pre-existing mental health conditions were particularly affected.
The health impacts of lockdown include findings of fatigue, musculoskeletal conditions, poor work-life balance, reduced exercise and increased alcohol consumption. In relation to workplace mental health specifically, employees were reporting reduced motivation, loss of purpose, anxiety and isolation.
Evidence from previous quarantine situations also suggest that there are long-lasting effects on mental health.
Independent Practitioner Today is currently serialising parts of the book called Beneath the White Coat – Doctors, their minds and mental health, edited by Dr Clare Gerada, first published in 2020 (see page 42). In the book, the stress experienced by doctors is examined using supporting evidence and real-life case studies and offers practical steps for doctors to recover and thrive in their roles.
The book also demands policy-makers, government and hospital management ensure doctors are looked after and have access to the resources needed to ensure they remain healthy.
Working from home
Many people have been working from home during the pandemic and while most have found this to be more productive, still one-in-three people have found the opposite, according to research by MetLife UK.
Almost one-in-three (32%) workers admit that their productivity has declined as a result of the shift to home working. Of these employees, two in five (41%) believe that their mental well-being has impacted their productivity levels. The impact is understood to have been more apparent for younger groups aged below 30 and also older women aged 50 plus.
There is also a marked difference between the statistics reported by employees and those reported by employers. Employers believe there has been a greater decline in productivity, with 56% of employers reporting that they perceive their employees’ personal well-being has impacted their productivity levels. This is significantly higher than the 32% of workers who reported their productivity has declined.
Productivity is absolutely key in any business, including healthcare, and therefore it follows that we should be concerned about our employees’ mental health and how this affects the productivity of our teams.
We need to do our best to understand the issues that our teams are facing and support them by implementing management strategies to reduce the impact in the workplace.
Understanding the issue
As mentioned previously, there seems to be a huge amount of information stating the enormity of the mental health problem caused by Covid, but there does not appear to be much research yet giving us useful data to understand the specifics of the issues and indeed how to address them.
One of the greatest challenges is that individuals are often unlikely to ask for help when they need it, and this is perhaps more extreme for those working in healthcare, who feel they should be able to manage their own well-being.
As managers and leaders, we need to work hard to encourage openness and make it easier and more comfortable for people to ask for help.
Most larger healthcare companies will have in-house HR departments providing expert support and who will be defining organisational strategies to help their managers and leaders deal with mental health issues in the workplace.
For smaller organisations, there is less support available and managers will need to address these issues themselves.
In an attempt to provide a useful guide, our HR managers have provided some input that I hope will be of value.
What is workplace mental health?
Obviously, healthcare professionals have a much greater awareness of mental health illness, but it is still useful to define what we are dealing with in relation to the workplace.
Mental health, like physical health, fluctuates over time and there are degrees of severity. Symptoms include struggling with low mood, anxiety and stress, and we know stress can contribute to other illnesses.
Conditions include depression, anxiety, phobias and bipolar, which tend to continue over a prolonged period.
As employers, one of our objectives should be to help individuals feel comfortable in talking about how they feel. In doing so, we must avoid attempting to diagnose and instead focus on discussing how the issues impact the employee’s work and their work life with a view to agreeing a plan to provide additional support.
A range of measures will need to be introduced and a good starting point for any manager developing their strategy is to understand our legal responsibilities as an employer.
These legal duties set the minimum requirements and must be adhered to, but there is a wealth of evidence arguing that employers who go above and beyond will benefit from improvements in employee engagement, reduced absence, reduction in staff turn-over and improved organisational culture.
Employers have a duty to protect the health, safety and welfare of their employees, including mental health and well-being.
The UK Health and Safety Executive defines work-related stress as a reaction to excessive pressure or other type of demand placed on an individual at work. It is the employer’s duty to assess the risk of stress-related mental health issues arising from work and to take measures to control the risk.
Employees who have a mental health condition may be disabled and will therefore be protected from discrimination during employment as defined by the Equality Act 2010.
Employers are required to make reasonable adjustments for employees with disabilities, which may include amendments to working hours, location of work, changes to duties and the provision of additional equipment.
Prevention is always better than cure, but obviously in the case of mental health issues, prevention is not necessarily within the employer’s control; however, there are early actions that can be taken.
Supporting the mental health of employees in healthcare, many of whom continue to work under significantly increased pressure making them more vulnerable to stress and other mental health conditions, is vital and it is warranted to take a pro-active approach.
Preventative measures largely relate to improving organisational culture by increased communication so that mental health issues can be more easily addressed and supporting managers by ensuring they are well informed, as they will play a pivotal role in the handling of any issues. (See box below).
Managers need to know the typical signs and symptoms of poor or declining mental health exhibited in the working environment.
These can include the following:
Workaholic tendencies: Working long hours without breaks;
Increased absence due to sickness;
Any uncharacteristic behaviour: Emotional responses to situations which could include tearfulness or anger;
Withdrawing from others on the team.
Any of these behaviours in isolation clearly do not imply that an individual has a mental health issue, but they do provide an opportunity for a manager to discuss well-being with an individual, which could prove to be valuable in preventing a potential issue.
When a manager holds a one-to-one discussion with an individual, it is important they do not jump to any conclusions. Ideally, the conversation will start with an open discussion about how the employee is feeling, although we know that people are often reluctant to talk openly.
Within an organisation where mental health and well-being are discussed regularly, hopefully the employee will feel more able to be open and honest.
When an individual asks for help, it is important that help and support is made available in a timely manner.
In a large organisation, the HR department may become involved to provide support and potentially the occupational health team, if needed.
In a smaller organisation, it may be relevant to seek advice from outside organisations and there are many suitable providers.
Throughout any discussion of this nature, the manager must be non-judgemental. It is very clear that all people managers have a serious responsibility in their employees’ well-being, and they will also need to be supported and guided through this process.
The Chartered Institute of Personnel Directors provides a wealth of information on its website and while it is not specific to healthcare, it is a valuable resource for all managers dealing with HR issues.
Specific to Covid, it is valuable to access the most up-to-date information and Cochrane produced a report, which was updated in January 2021, entitled ‘Supporting resilience and mental well-being in frontline healthcare professionals during and after a pandemic’.
The International Labour Organisation has also recently produced a report entitled ‘Protect the mental health of health and care workers in the Covid-19 pandemic’.
Finally, the Academy of Medical Royal Colleges has a page on its website summarising all of the organisations available to provide support in relation to mental health matters for those working in the healthcare sector.
Over the coming months, we will have access to much more data regarding the long-term impacts of the Covid-19 pandemic. As leaders, we will need to learn and evolve to ensure we provide the best support possible so that we can continue to lead successful, high-performing companies and teams.
If you would like any further information in relation to this article, please do get in touch. I am always very happy to help and I am sure that my team of HR professionals will also be able to help with most workplace well-being questions.
Jane Braithwaite (right) is managing director of Designated Medical