· Features

Mental health special 1/2: The onus is on employers to take care of stress issues

The economic downturn has exacerbated workplace stress and mental health problems – but they should be seen as part of a much longer term trend that has grown hand-in-hand with modern working practices.

Multi-tasking has a lot to answer for, according to Richard Perry, consultant neurologist at independent cognitive centre, Recognition Health. He reports 85% of those whom he sees perceive their job to be stressful - double the proportion of 20 years ago.

According to mental health charity Mind, one in six workers will experience a mental health problem at some time, including unmanageable stress, depression and anxiety. This means virtually every business is vulnerable, but employers should realise that absenteeism and indeed presenteeism costs can be greatly reduced by taking a proactive stance.

Employers should also appreciate they need to become much more involved with managing mental health issues generally, because the Equality Act 2010 prohibits them from asking about a candidate's health before offering them work, other than in limited circumstances.

Naeema Choudry, partner at law firm Eversheds, warns: "Employers who ask job candidates about their health are likely to find it hard to defend themselves against a disability discrimination claim. If an individual is turned down for a job and claims this was discriminatory, the onus is on the employer to disprove discrimination, where the individual claims the employer asked questions about their health."

Pamela Gellatly, CEO of Healthcare Risk Management, says: "This law is tough on employers, because employees can sometimes create problems by exaggerating their conditions if they don't like their job or boss. If you identity that someone has a problem, you must make reasonable adjustments, but can dismiss them over a period of time on capability, after looking at things such as modified duties, alternative duties or treatment options."

But capability does not have to be an issue if conditions are managed well. Independent healthcare management consultant Peter Marno highlights that people with mental health problems can actually have better than average sickness absence rates, because they want to prove themselves and to look after themselves more, and that even many of those suffering from schizophrenia or bipolar disorders are quite capable of working.

But Marno acknowledges problems can arise if they start feeling confident enough to stop taking their medication. He advocates that employers come to an agreement with staff at the outset, about how an episode of the illness should be handled, if it crops up.

Hilary Bright, head of HR services at City College Norwich, adds: "We don't find those with mental problems ever underperform consistently in the longer term. We have some who are bipolar, but we don't find it a problem as we can arrange for them to have time off or to take annual leave when they are feeling very down. Or they can start later in the morning if they are tired because they are changing drugs. It is no more inconvenient than dealing with employees who have bad backs and I think employers that find it a problem are scared and haven't had sufficient practical experience."

But experts acknowledge there is still evidence of a fair amount of prejudice against mental ill-health. They believe employers should do more to try to get the subject out into the open by talking about health issues generally or instigating specific initiatives. For example, the Mental Health Champions scheme started at Deloitte in 2009 involves eight senior managers, named as mental health champions, offering confidential counselling outside the line for any employee who feels they or someone in the team might be suffering from mental health problems.

Mental health charities and consultancies emphasise the importance of employers paying sufficient attention to work-life balance, encouraging healthy diets and regular and varied exercise, and having suitable absence management systems and regular wellbeing audits.

According to Mind, investing in wellbeing can save employers one-third of the cost of sickness absence and presenteeism due to mental health issues. Even if employers cannot afford to employ external help, useful free tools and information can be found on the CIPD, Work Foundation, Health and Safety Executive (HSE) and Mind websites.

Most importantly, line managers must be able to spot the telltale signs of stress, make appropriate work adjustments and offer protected time for one-to-one discussions.

Gillian Dixon, HR director at Carlisle-based media company, CN Group, explains: "It is increasingly important for line managers to make people aware what their roles are and to give them feedback on their performance, as this reduces unnecessary concern. Effective people management can suffer when organisations have limited resources and this can lead to increased anxiety among employees."

Eugene Farrell, key account director at AXA PPP Healthcare, emphasises managers need to understand how to make referrals to employee assistance programmes (EAPs) and should work alongside these to case-manage the more serious instances. He is encouraged that the Government's review of sickness absence published in November 2011 noted the value of EAPs and advocated retaining the current HMRC tax exemption for workplace counselling.

Other aspects of this review widely welcomed as having positive implications for workplace mental health include its proposals for granting tax relief for early intervention and for having those off sick for four weeks examined by an independent panel, rather than by their GP. But many experts are concerned about whether enough suitably qualified personnel can be found for such panels.

Cary Cooper, distinguished professor of organisational psychology and health at Lancaster University Management School, says: "I don't think most GPs understand mental health or the working environment very well. I like the idea of an independent service, but my worry is whether it will actually be truly independent. I would be wary if it were employer-led, as that could result in people being put back to work before being ready."

The secret is to keep close to staff

Since HR director Carol Johnson joined The Royal Brompton and Harefield NHS Foundation Trust in 2008, the proportion of its 2,700 staff absent due to sickness at any one time has fallen from 6.5% to 2.6%. Achieving a marked reduction in stress-related problems, which account for over half of all absenteeism cases, has proved crucial in realising the improvement.

A working partnership with a neighbouring healthcare trust makes cognative behavioural therepy available when necessary. Great emphasis is placed on staff who have overcome stress-related conditions being able to make a phased return to work, or receiving appropriate redeployment, mentoring or coaching.

A lot of team-building events are run to reduce stress, and psychometric profiling is widely used to help alleviate the symptoms of stress. Staff discussion groups, facilitating confidential and blame-free conversations about stressful situations, have also played a valuable role since being introduced a year ago.

Johnson explains: "The secret is for managers to keep close to staff to identify early on any indications they are not working as well as they should be. Recruiting the right staff who are able to handle the environment is essential. You also need good-quality front-line managers."

Stress at work: the statistics

  • 41% of employees are 'stressed' or 'very stressed' in their jobs - making work more burdensome than money worries, marriage and relationships or health issues
  •  Two in three staff have been put under more pressure by management since the start of the downturn
  •  A third feel stressed by a reduction to budgets in their workplace
  •  48% are scared to take time off sick
  •  28% are stressed by the threat of redundancy
  • One in five fears mentioning stress would put them in line for redundancy
  • Seven in 10 said their boss would not help them cope with stress

Causes of work-related stress

  • Workloads/volume of work 48%
  • Management style 40%
  • Non-work factors - relationships/family 37%
  • Relationships at work 31%
  • Considerable organisational change/restructuring 31%
  • Poorly managed organisational change/restructuring 18%
  • Pressure to meet targets 17%
  • Job insecurity 17%
  • Lack of employee support from line managers 16%
  • Long hours 12%
  • Non-work factors - financial concerns 11%
  • Lack of control over how work is carried out 7%
  • Poorly designed jobs/roles 5%
  • Lack of training 4%
  • Lack of consultation 4%