Shedding light on mental health
Arvind Hickman, February 24, 2014
When it comes to wellbeing, the extent to which we ignore mental health is startling. What can be done to end a taboo that costs business – and people – dearly?
How’s this for absurd: one in four people will be affected by it at some point in their lifetime, it is responsible for four in 10 absence days, and it is the leading cause of disability for people aged above 15 – yet very few want to talk about it, and a third of us refuse to work with someone suffering it.
That mental illness is still a taboo subject in 2014 is truly depressing. Those who have experienced it (including this journalist) understand the debilitating effect it can have on work and personal life.
As staff resilience and wellbeing gains prominence in the corporate world, it is high time for mental health to come out of the shadows and be treated on a similar plane to physical wellbeing.
In January, a gathering of mental health experts converged on the ORTUS learning and events centre in London to discuss why mental health matters. The event was hosted by Maudsley Learning, a not-for-profit organisation that provides education for people with mental-health conditions. Managing director Genevieve Glover describes mental health as a “silent illness”.
“People aren’t talking about mental health when they talk about health and wellbeing,” Glover said in her opening address to the event. “Combine that with assumptions, stereotypes, discrimination and stigma, and it seems there are real and perceived barriers to taking action in this area.”
She added: “The way individuals and organisations respond to mental health issues seems to be based on their personal experiences or knowledge, whether they are ?a line manager or HR professional, rather than having a framework for proactive and reactive support.”
Although the prevalence of severe conditions such as schizophrenia and bipolar disorder has remained stable, the number of people suffering depression and anxiety has trebled in the past 30 years. And experts agree recent economic conditions and demographic shifts are exacerbating the problem.
A pressing issue
Stephen Bevan, director of The Work Foundation’s Centre for Workforce Effectiveness, told the event that an ageing workforce, later retirement and a higher incidence of chronic illness are causing poor health, leading to reduced productivity, increased absenteeism, higher healthcare and welfare costs, and a greater burden on families and carers.
The problem is being compounded by high unemployment and job insecurity. A good example of the latter is the growing use of zero-hours contracts, now believed to apply to well over a million people, according to CIPD estimates.
There has been an undeniable squeeze on living standards as the Government has implemented its austerity measures, while years of pay freezes have shifted a larger proportion of the country closer to poverty, placing pressure on household income earners.
Bevan said a challenge for employers is to know where to draw the line between a legal duty of care and the responsibility of individuals to deal with their mental health.
“If a member of staff is in debt, for example, [employers] have to deal with the consequences if it leads to anxiety, depression, poor performance and a long period of sickness absence, but [employers] have no responsibility for the cause of that debt,” he said. “We shouldn’t think that people living with mental illness are passive recipients of support and treatment – they need to be encouraged to play an active role.”
Presenteeism is another major issue. Bevan said people with a mental health illness are slightly more likely to attend work than people with physical illnesses. “There’s a challenge ?to spot people who are at work but underperforming because of a mental health problem,” he added.
The business case
Physical health conditions such as cancer and cardiovascular disease are given a priority in healthcare funding and treatment. However, mental health is responsible for about 40% of working days lost to ill-health, said Amy Iversen, a consultant liaison psychiatrist at the South London and Maudsley NHS Foundation Trust.
The problem isn’t unique to this country. Les Smith, MD of wellbeing consultancy Health and Wellbeing UK, who spoke at the event about his experience of running employee wellbeing programmes at a multinational pharmaceutical company, said mental illness accounts for almost 20% of the burden of disease in Europe.
During the course of any year, 18.4 million people in Europe aged between 18 and 65 are estimated to suffer from major depression. In fact, nine of the 10 countries with the highest rates of suicide in the world are in the European Region, and 60,000 EU citizens commit suicide each year – more than the annual deaths from road traffic accidents or HIV/AIDS. Furthermore, the economic cost to society is estimated to be between 3% and 4% of EU GDP, and most of this is through lost productivity. With such a high toll on society, it is alarming more isn’t done to tackle the issue. One of the major reasons is the stigma attached to mental health conditions.
Research shows that a vast majority of people who suffer mental health problems do not disclose it due to a fear that doing so could affect their career prospects and how they are perceived by colleagues.
“Why would you tell your co-workers or line manager or HR that you have a mental illness,” Bevan asked.
It is often severe conditions such as schizophrenia and bipolar disorder that carry the greatest stigma, despite affecting only a small segment of society. Bevan said one in a hundred people in the UK has schizophrenia, but only 8% of those are in employment, compared to 71% of the wider population. The major cost to society isn’t in treatment or healthcare, but in lost productivity.
Bevan said a Work Foundation study, Working with schizophrenia: Pathways to employment, recovery and inclusion, found 30% of people would refuse to work with someone who suffered a mental illness.
“People with schizophrenia suffer more from their diagnosis than from the symptoms. If they get good care early enough, their condition can be stable and they can play an active part in managing the condition,” he said. Bevan described a schizophrenia diagnosis as “a killer” because it greatly reduces the chance of getting a job or being accepted by co-workers.
Geoff McDonald, Unilever’s global VP of HR for marketing, communications and sustainability, said the stigma attached to mental illness of all types is “very real”. “People feel that if they talk about it, they will be seen to be weak. And I still think there are a lot of people out there in society who believe that if somebody suffers form depression and anxiety, they can’t take the heat in the kitchen,” he told HR magazine.
This stigma is a major barrier to discovering and treating mental illnesses in the workplace.
Iversen, who presented a session at the Maudsley Learning event on managing common mental health disorders, said a challenge for organisations is to create a culture where it is OK to discuss the issue.
How to spot it
Experts agree that early intervention in mental illness helps improve the outcomes of treatment, but a major challenge is identifying the problem in the first place, particularly as sufferers are less likely to ‘come out’.
CIPD head of public policy Ben Wilmott said some typical symptoms of mental illness are a lack of engagement, inability to concentrate, a loss of enthusiasm and irrational behaviour.
Iversen said it is important to be honest with staff if you suspect they are having a mental health issue. “Don’t be frightened [to name symptoms],” she said. “If you saw someone limping or bleeding, you would point it out. The same applies for mental health. You then want to assess their insight, because the golden moment comes when you make them feel comfortable enough that they self-disclose.
“Try to put the employee in the driving seat – they may feel disempowered, but you can make them feel empowered by trying to get them to think of their own solutions.”
Iversen added it is important to hold discussions in a private space and ask questions such as: What do you think might help you? How can we help you? What changes can we make to help you get through this period?
Managers should be upfront about disclosure and who will be privy to the information. The ultimate aim is to establish ?a mutually agreed plan to treat the problem and next steps, which may include reasonable adjustments to the employee’s current work pattern.
“The other thing I have noticed, and we are all guilty of this, is amateur diagnosis,” she said. “For example, ‘I’ve noticed your desk is overly tidy, do you have OCD?’. You must try not to be an amateur diagnostician, even if you’re right – it isn’t helpful.”
How to tackle it
Once a problem has been identified, experts recommend involving occupational health and safety as soon as possible.
Businesses have a legal requirement to make reasonable adjustments for workers suffering mental illnesses, but Bevan urged employers to “go way beyond that”.
“You need to think about the nature of the work people are doing,” he said. “If you look at companies such as BT, EDF Energy and some of the larger organisations, they are doing a lot to make sure their line managers can spot the early warning signs of people with depression and anxiety.”
Medical advice should be sought prior to making decisions on reasonable adjustments. For example, working in isolation at home may not be in the best interest of someone suffering depression, even if that is what an employee wants.
There are many ways to treat mental illness, including the use of medication and psychotherapy, but one effective method employers and doctors should consider is individual placement support, where employment services are integrated with mental health treatment.
Iversen said work is good for mental health because it gives people a sense of identity, fulfilment, self-esteem and routine, as well as an income.
“The paradox is that work itself can both promote and impair mental health,” she said. “Our challenge is that, if we create a healthy work environment, we can promote good mental health and reduce the risk of a relapse in people with established and recurring mental health problems.”
The benefits of employment have only recently been recognised by policy makers. Just before Christmas, it became mandatory that employment was an outcome of mental illness treatment. But while this is a positive step forward, it is clear that much more needs to be done in government and in businesses.
A worrying aspect of mental health is the lack of framework and ownership of its management. “Who is ultimately responsible for the health and productive capacity of the workforce in your organisation?,” asked Bevan. “It is very rarely anyone’s primary responsibility at senior level. If the UK is ?going to escape with velocity from the recession, it needs a healthy workforce – and that’s not a priority.”
Bevan believes employers can do a lot more by adjusting performance management processes, helping build resilience in the workplace and providing psychologically healthy environments where people can thrive even if they are not well. “It can be the place where you go to be normal and well,” he said.
McDonald believes it is about raising awareness, training managers on the importance of a healthy mind, and leadership role modelling. “More and more leaders should talk about this issue as an illness, rather than as a weakness,” he says.
By 2030, it is estimated that seven million Britons will suffer from a mental health condition. Although there is no quick fix, smart employers will value mental health in a similar light to physical health, from a moral and business performance standpoint.
One thing is clear: mental illnesses are not going away, and silence is no longer acceptable.