Monitoring mental health in the workplace
Nick Martindale, September 04, 2015
There is growing interest among businesses in monitoring employees' mental health
The tragic case of Germanwings flight 9525 has brought into focus the issue of mental illness in the workplace. This case, where co-pilot Andreas Lubitz deliberately crashed into the French Alps after hiding a history of mental health issues from his employer, puts into sharp relief just how devastating the consequences of failing to treat ill health can be.
Events such as this are fortunately very rare. But they provide an extreme example of how important it is to tackle mental health problems in the workplace before they develop into something more serious. A report by UK chief medical officer Sally Davies found 70 million working days are lost each year due to stress, depression and other mental health conditions. This costs the UK economy between £70 and £100 billion a year. A separate study by Aon Employee Benefits put mental health as one of the four main risks affecting insurance claims, along with cancer, heart problems and musculoskeletal conditions.
There is, says Louise Aston, wellbeing campaign director at Business in The Community (BITC), a growing interest in evaluating and monitoring the mental health of employees. This was revealed in a one-year-on report following the launch of the Time to Change initiative, spearheaded by BITC, Mind and Rethink Mental Illness.
“Evaluation is critically important,” she says. “People are using a combination of things: it could be scores for specific questions in employee engagement surveys, sickness absence data, lost time, injury rates, work-related ill health incidences, the number of line managers receiving mental health and resilience training, or information on flexible working arrangements. But a really easy one is data from employee assistance programmes.”
A more formal way to keep track of employees’ mental health is through assessment. These are similar to physical medicals, with results compared against previous scores to identify any changes, for example to stress levels or general satisfaction.
This is not as simple as it sounds though, warns Dr Nick Summerton, a GP and medical advisor at Bluecrest Wellness. “It’s important that the tools used are very carefully selected to ensure they provide hard evidence – in other words they can be relied on to reflect the truth that an individual has got, for example, mild or moderate anxiety or depression – and that the tool is reproducible across groups of employees.”
His organisation uses a number of tools, including the PHQ-9 tool for depression and GAD7 for anxiety, as part of a broader health screening programme. “That way there can be a holistic understanding of wellbeing and the ways in which physical and mental health are closely interlinked, not just looking at that difficult issue of ‘stress’,” he says.
Other tests, such as MyCQPro, seek to measure cognitive health on a regular basis, perhaps every three or six months. “Cognitive health can serve as a proxy for mental health, with deficits in certain cognitive domains contributing to conditions such as depression and anxiety,” says Dr Raj Kumar, chief medical officer at MyCognition, the company behind MyCQPro. “This will then signal if the employee has a sudden drop in cognition, whether across the board or in one specific domain. At the heart of it, these are preventative solutions that put you in a position to act as early as possible, and avoid issues spiralling until they push employees to leave work. It’s waiting too long that sometimes makes this inevitable.”
For many people, it will be their line manager who is best placed to notice any changes in behaviour or performance. “This could be any kind of behaviour that is out of sorts, so someone who is usually quite measured becoming irritable, or someone taking a lot more time off work or turning up late just because they couldn’t get out of bed, which is associated with depression,” says Jill Miller, research adviser at the CIPD.
Training is essential though, to help managers identify the symptoms of mental illness. “There are plenty of interventions available to help managers recognise the signs of particular stress-related mental health issues, such as depression and anxiety, because the symptoms are relatively common,” says former Deloitte partner John Binns, who has suffered from depression himself in the past and now works as an independent adviser on mental health.
“There’s also a lot organisations can do to help those in leadership positions to recognise the signs in themselves, and in the people that they lead,” he says. Such training should be standard for all managers, he believes.
HR can work alongside line managers to help keep track of potential issues. This is the approach Meridian Business Support has taken, monitoring a number of metrics such as absence data and individuals’ key performance indicators to spot any warning signs that something may not be quite right.
“If something dips and someone has not been off sick or on annual leave, then we explore it a bit further,” says Steve Jeffers, the company’s HR director. “We’ll have an exploratory conversation with the manager to see what’s wrong. It might just be a bad month, and that’s absolutely fine, but when you unpick it there’s often another influencing factor that is external to work.”
Where there is cause for concern, individuals can be pointed to occupational health providers or charities. HR will even help them draw up an action plan, sometimes with the help of their families. “If we have to sit there for a couple of hours, then that’s what we’ll do,” says Jeffers. “If we don’t intervene at the right time then anything put in at a later date might not work, and the individual becomes disengaged and disenfranchised.”
Deciding what action to take and when is another issue HR must face up to, particularly if the employee doesn’t accept there is a problem. This can be common in industries like the emergency services, where individuals will have developed coping strategies and feel unable to ask for help, says Mandy Rutter, head of resilience and trauma management services at psychological wellbeing firm Validium.
“Police officers, pilots, oil platform workers and CEOs are all subject to the same distressing events as other people, whether it be divorce, illness, financial pressures, addiction, disruptive children, or bereavement,” she says.
Though deciding where the line lies between taking care of employees and intruding into personal territory can be difficult, action should still be taken where there is justifiable concern about the safety of that individual or others around them. “There are health and safety issues surrounding this, especially if the employees work in a factory or with machinery and are feeling stressed or tired,” points out Matthew Howse, a partner in the London office of law firm Morgan Lewis.
“Employers have a duty to undertake risk assessments and manage activities to reduce the incidence of hazards. Where problems are identified, the business must take action to eliminate or reduce them. As part of this employees should be encouraged to tell their employer if they are on any medication, as it could have an effect on the way they work and might be too dangerous for themselves and their colleagues.”
However, some question just how much HR should be tasked with such issues. “HR teams have to operate with a bias toward the interests of the employer, so allowing them to make mental health diagnoses would not be in the employee’s interests,” says Gabrielle Ramsay-Smith, a partner at people risk firm Ramsay Smith Consulting. “Counsellors, psychologists and medical professionals work in the best interests of the individual and society. If employers are concerned about a staff member’s mental health they should seek advice from qualified experts.”
One area where HR can certainly help, though, is in facilitating the type of culture where it is OK for employees to speak up if they are struggling. “People need to know they’re not going to have a black mark painted above their door if they are identified as having a mental health problem,” says Martyn Anwyl, head of operations, corporate solutions, at Buck Consultants (a Xerox company). “If organisations can get that culture right, it’s easier to make decisions based on what’s right for the individual, their colleagues and customers.”