SUPPORTING MENTAL HEALTH IN THE WORKPLACE
INFORMATION FOR MANAGERS
Introduction
One in six workers is dealing with a mental health problem such as anxiety or
depression. This can prevent people from performing at their best. The right
kind of attitude, help and support in the workplace can minimise the cost to
individuals, services and our Trust. Organisations perform better when their
staff are healthy, motivated and focused and the support people receive from
employers is key in determining how well and how quickly they are able to get
back to peak performance. Staff who feel well supported and valued, provide
better patient care and enjoy higher levels of emotional and physical wellbeing
than those who don’t (West & Dawson, 2012).
This leaflet has been designed to complement the Trust Policy on ‘Sickness
Absence’ and provides advice for managers on spotting signs of distress in
employees, taking early action to prevent problems escalating, supporting an
employee who is off sick, and planning a successful return to work. This
information has been adapted from the Line Managers’ Resource (2013)
published by Mental Health First Aid England and How to support staff who are
experiencing a mental health problem published by the mental health charity,
Mind.
What are mental health problems?
Around one in four people in Britain experience mental health problems. Mental
health problems can affect the way people think, feel and behave. Various
mental health diagnoses are used to describe how people express emotional
distress for example, ‘anxiety’, ‘depression’, ‘obsessive compulsive disorder’ or
‘psychosis’ are labels you might have heard before.
Mental health problems can affect people in different ways – some people may
struggle with public speaking while others feel unable to leave their house. A
mental health problem can be just as painful as a physical illness or injury
although it cannot be seen. This sometimes means that people can underestimate
how serious things are. Mental health problems are different from stress
although they may share similar characteristics such as sleepless nights, loss of
appetite or feeling overwhelmed. The key differences are the severity and
duration of the experiences and the impact they have on someone’s everyday
life.
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If you would like to find out more about the different diagnoses and treatment
options you might find the following document helpful: Understanding Mental
Health Problems from the mental health charity, Mind.
http://www.mind.org.uk/information-support/types-of-mental-healthproblems/mental-health-problems-(general)/
Recruitment
There is no way of predicting who will have a mental health problem that will
interfere with their work. Therefore, issues around recruitment usually arise
when a person has experienced a problem during their previous employment or
has an ongoing problem. It is important to emphasise that the vast majority of
people who have experienced a mental health problem continue to work
successfully. If a person has an employment history with periods of absence you
are entitled as a manager to enquire about these. However, you must not use this
information to discriminate against a candidate. Under The Equality Act 2010,
employers may not discriminate against current or prospective employees on the
basis of their disability. ‘Disability’ is defined as a physical or mental impairment
that has a substantial and long-term adverse effect on a person’s ability to
carry out normal, day-to-day activities. If a mental illness is clinically well
recognised, it will count as a mental impairment under the act.
Managers should avoid:
 Asking for information about treatment, the history of the illness or any
information that is not relevant to the work situation
 Assuming that a person with a mental health problem will be more
vulnerable to workplace stress than any other employee. However, as with
any other candidate, it is good practice to ensure that they understand
the demands of the job and the working culture of the organisation
Talking at an early stage
The earlier you pick up on a problem, the better. Action taken at an early stage
can help to prevent difficulties escalating.
Spotting when an individual has a problem
Some
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of the key things to look out for are:
Changes in a person’s usual behaviour
Poor performance
Fatigue or irritability
Increased sickness absence
Increased use of alcohol, drugs or smoking
Poor timekeeping
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Difficulties with relationships at work
Tearfulness
Loss of sense of humour
Over performance – driving themselves to excess
While it is useful to know that the above signs may be linked to emotional
distress it is not appropriate to diagnose mental health problems in employees.
Using ordinary management tools to identify problems and needs
Regular work planning sessions, appraisals or discussions about progress are all
ordinary management processes which provide neutral and non-stigmatising
opportunities to find out about any problems your employee may be having.
It is helpful to use open questions that allow the employee maximum opportunity
to express concerns in his or her own way. For example: “How are you doing at
the moment?”, “Is there anything we can do to help?” If you have specific
grounds for concern it is important to address these before the situation
escalates. For example: “I’ve noticed that you’ve sometimes been arriving late
recently and wondered if there was a problem.”
Work-related stress
Stress can exacerbate underlying mental health issues. If the source of
distress is difficulties at work, then it is essential to find out what these are so
that they can be addressed. They may be affecting others too. Remember that,
in law, it is an employers’ duty to ensure that people are not made ill by their
work. As a manager you must assess the risk of stress at work and take steps to
manage it. The Trust has developed a 'stress' checklist and risk assessment to
review staff perceptions of workplace stress. It can be found at:
http://intranet.glos.nhs.uk/en/Your-Division/Corporate-Services/Safety/StaffSafety/Stress/Stress-Assessment/
In many cases, sources of stress can be identified and tackled by managers and
staff working together to address workplace problems. If necessary, seek
advice from Human Resources, Occupational Health or the Staff Support
Service. Employees who are absent from work due to stress should be managed
in accordance with the ‘Sickness Management Policy’, which includes relevant
forms and guidance.
Engaging with someone who is reluctant to talk
First, make it clear that the discussion will be confidential. Then consider why
they are reluctant. Is it really safe for them to be open? Will any disclosures
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be treated sympathetically and positively? Are they fearful of being
stigmatised? Some of the following tips may be helpful:
 Confidentiality is key.
 Meet the person in a private and possibly neutral setting.
 Be clear about confidentiality and who will be told what. You cannot offer
100% confidentiality but can clearly explain the limits of your
confidentiality (e.g. personal information is confidential but issues that
may have a health and safety risk will need to be discussed further).
 Agree how problems will be monitored.
 If adjustments are being made, ask the person how they wish this to be
communicated to other staff.
 Ensure that any hurtful gossip or bullying is dealt with promptly and
effectively.
Issues to raise with an employee who is distressed
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Ask open questions about what is happening, how they are feeling, and
what they think might be helpful.
Is this an individual problem or is it something that may affect others
too? If the problem seems widespread then a stress risk assessment
followed by team-based problem solving may be helpful.
Are there any problems outside work that it would be helpful for you to
know about? (You should not put pressure on the person to reveal the
details of external problems).
Check they are aware of support that the Trust provides e.g.
Occupational Health, Health and Safety representatives, Staff Support
Service etc.
Encourage them to also seek support outside of the Trust by talking to
friends and family or contacting counselling charities such as the
Samaritans (08457 909090) or the ‘Let’s Talk’ Service (0800 073 2200).
Employees may prefer to discuss their health with someone of the same
gender.
Is there any aspect of their medical care that it would be helpful for you
to know about? (e.g. medication, side effects, likely impact on their work).
Whilst you have no right to this information, the employee should be
aware that you cannot be expected to make ‘reasonable adjustments’ if
you are not informed about the problem.
Do they have ideas about any adjustments to their work that may be
helpful?
Establish what, if anything, they wish colleagues to be told and who will
say what.
Agree what will happen next and who will take what action.
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It is important that all conversations are accurately recorded not just to
protect the organisation but also to show that the actions have been
carried out fully. Make sure both you and the employee have a copy.
Managing an employee who becomes tearful and upset
It can be distressing for people to discuss mental health problems. If your
employee becomes upset or tearful stay calm and reassure them that it is ok to
be upset and that you are listening. Give them time to compose themselves by
offering tissues, a glass of water or a break to go to the toilet.
Be sensitive to the level of information and support the individual can cope with
at a given time. In the midst of a crisis they may not be able to think clearly and
take on board complex information. The important points are to:
 Establish a dialogue.
 State positively that all possible help, assistance and support will be
offered.
 Affirm that discussions can continue at a pace that is right for them.
 Bear in mind that it is important that you, the manager, should respond as
calmly as possible. While problems can escalate over time and you may feel
the pressure to do something immediately, it may be better to take some
time to pace yourself, seek advice if needed and consider the options. Try
to distinguish, with the employee, between what is urgent and what is
important. Also, be aware that you may have support needs of your own.
Communicating with colleagues
You should agree with the individual what they wish colleagues to be told. In
general it is best to deal with mental health problems in an honest, matter-offact way. Remember that the person’s requests may change over time. If they
initially request little contact, this may change as their situation improves. As
far as possible, a mental health problem should be treated in the same way as
any other sickness absence – with sensitivity and support.
Managing absence
Line managers are expected to undertake most of the management processes
associated with employee sick leave as outlined in the Sickness Management
Policy, drawing on support from HR and Occupational Health as necessary. If
more formal action is being taken to manage sickness absence, HR and support
for the employee (trade union rep or colleague) would need to be involved.
If a line manager has concerns they are required to make their own referral to
Occupational Health rather than suggesting self-referral to the employee (staff
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members may also self-refer if they wish to). Occupational Health may provide
guidance in relation to an appropriate return to work programme or an opinion on
the employee’s treatment and/or prognosis. Refer to Occupational Health if you
notice a pattern of short term absences; if there is an underlying physical or
mental health problem which will result in long periods of time off work; or if an
employee remains in work but raises concerns regarding their ability to continue.
Each case will be considered on an individual basis and if you have doubts about
whether you should refer to Occupation Health please seek advice from
Occupational health or HR.
Actions taken to manage sickness absence are intended to:
 Support the employee and ensure they are given medical help and where
appropriate
 Ensure that employees’ confidentiality is maintained
 Provide reasonable adjustments to employees who fall under the remit of
the Equalities Act 2010
 Assist with improved attendance in cases of repeated short-term sickness
absence
 Assist with rehabilitation and return to work in cases of long-term
sickness
 Monitor and observe trends in sickness to ensure that issues are picked
up promptly and adequately managed
 Ensure that employees are aware that further action may be taken in
cases of repeated short-term absence without good cause or sickness
which causes capability issues. It may be helpful to refer them to the
Trust ‘Sickness Absence’ Policy.
Keeping in touch during sickness absence
Managers often fear that contact with someone who is off sick will be seen as
harassment. However, the overwhelming view from people who have experienced
mental distress is that appropriate contact is essential. If there is little or no
communication, misunderstanding and barriers can quickly arise.
 It is good practice to contact someone early, e.g. within a week of
sickness absence. If the source of the problem is work-related, you will
need to know as soon as possible. If Occupational Health are also involved
it can be helpful to co-ordinate your approach.
 Reassure them about practical issues
 Give the employee the chance to explain the problem and what is
happening by asking open questions.
 Ask if there is anything you can do to help.
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Avoid
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Reassure them that you understand medical and personal boundaries and
will respect them.
It is helpful to think about the support you would offer to someone with a
physical problem. Do you have a different approach for mental distress,
and if so – why? Visiting at home, cards, flowers etc. can be appreciated –
but ask first and agree what it is appropriate for colleagues to know. The
bottom line is to let people know they have not been forgotten. Don’t make
them feel their problem is shameful.
Agree how best to keep in touch in the future – either by telephone call
or by email and perhaps arrange dates and times to catch up.
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Putting pressure on the person to divulge personal or medical information
Putting pressure on them to name a return date. Whilst they are in crisis,
it may be impossible for them to know how long recovery will take.
What to do if the person requests no contact
Bear in mind that their reluctance may be an initial instinctive reaction. You will
need to reassure the person that the contact is intended to be supportive. You
may wish to revisit this tactfully. As the person begins to recover, contact may
seem less daunting. An approach of ‘light touch’ regular contact for all people off
sick is a neutral, non-stigmatising way to engage with all employees.
Returning to work
Most people with mental health problems recover completely and resume work
successfully. Our Trust has made an investment in that individual and in most
cases, a planned return to work will be the best option. Managers with a clinical
background are reminded that when conducting return to work meetings they
are acting as a manager and not a clinician. It is NOT appropriate for managers
to ask for detailed health information or to advise on treatment.
It is recognised that when employees are off sick for long periods, this can
affect their confidence and therefore their ability to return to work. Effective
planning – between the individual and the line manager and, where appropriate,
the GP, Occupational Health or HR – will maximise the chances of success. As
will support and monitoring at the early stages of return.
Factors to consider in planning the return
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Consider with the employee any factors that contributed to their absence
that could realistically be changed.
Discuss whether any adjustments need to be made to ease their return
Agree how their progress will be monitored.
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Ensure that they don’t return to an impossible in-tray and thousands of
emails.
Brief them on what’s been happening – social as well as work developments.
Be realistic about workloads – be aware that some people will wish to
prove themselves and may offer to take on too much.
Have frequent informal chats to discuss progress
Discuss honestly the things you can change and those you can’t. Some
organisational factors are out of your control. Can they be mitigated?
Discuss what colleagues will be told.
Avoid making the person feel they are a special case – this can cause
resentment both with the individual and with peers.
Some adjustments to consider
You are legally bound to consider making ‘reasonable adjustments’ for employees
who have a disability. Well-recognised mental health problems are included in
this.
Some examples of adjustments are:
 A phased return to work – starting with part-time working and building up.
 Adjusting the content of the job, where possible.
 Review of training, development or support needs.
 Time off for attending therapeutic sessions.
 Changing shift patterns.
 Flexible working around agreed outputs.
 A later or earlier start to avoid rush hour travel.
 Extra support.
 Increased supervision or support from the manager. For example, some
people can take on too much so may need their manager to monitor their
workload to prevent this and ensure they’re working sensible hours.
 More positive and constructive feedback.
 Debriefing sessions after difficult patients or tasks.
 Mentor or ‘buddy’ systems (formal or informal).
 Mediation can help if there are difficulties between colleagues.
 Signposting to mental health support groups.
 Self-referral to internal support available.
 Identifying a ‘safe space’ in the workplace where the person can have
some time out, contact their buddy or other sources of support and
access self-help.
 Provision of self-help information and sharing approaches and adjustments
that have proven effective at supporting others.
 Provide regular opportunities to discuss, review and reflect on people’s
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esteem and develop skills to better manage their triggers for poor mental
health.
Review if any provisions are necessary regarding physical health. If
unsure, seek advice from Occupational Health.
Phased returns to work
Line managers are responsible for implementing medical guidance on Fit Notes
(where these are reasonable/feasible) where an employee is fit to return to
work with adjustments (reduced hours or duties; phased return), usually after
long term sickness. The following will apply:
 Seek further advice from Occupational Health Department or HR if
recommendations cannot easily be accommodated.
 Phased returns should ensure the employee is able to achieve an
effective, sustained return to work, taking into account advice from the
employee’s GP and/or Occupational Health.
 On phased returns, the employee will receive full pay for the hours
worked and sick pay (subject to entitlement) for the remaining hours.
 On phased returns, the employee may opt to use annual leave for the
hours not worked. Accrued annual leave from the previous year may be
used for this purpose.
 Ensure that phased returns to work are appropriately recorded on the
salary card associated with the ‘Sickness Absence Policy’.
 Ensure that fit notes detail that a phased return to work is
appropriate/safe.
 In exceptional circumstances, it may be appropriate to conduct the
phased return to work in another area, or where the employee can be a
supernumerary.
Managing reactions from colleagues and clients
Fear, ignorance and hostility from colleagues and clients can be a source of
great distress although rarely arising from ill will. People are often unsure of
what to say and find it easier to avoid the individual or not to mention the issue.
 Talk to the employee and agree who will be told what, by whom and when.
 Think about the language that will be used.
 Be clear about confidentiality and boundaries.
 Be guided by the employee’s wishes.
 Treat people returning from absence due to mental health problems in the
same way as those with physical ill health.
 Watch out for hostile reactions – stamp out any hurtful gossip or bullying
promptly.
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Treat mental health issues in a matter-of-fact way –
they are common and should not be a source of gossip or
conjecture.
FAQs
Q. What are mental health problems?
A. Mental health problems are often defined in relation to specific diagnoses,
for example depression or obsessive compulsive disorder. However, a mental
health problem can refer to any problem that disrupts the way we think, feel
and perform, either temporarily, or on a more severe and enduring basis.
Q. I get the feeling one of my staff has a mental health problem. What
should I do?
A. Don’t attempt to diagnose them, but talk to them about your concerns in an
open way. Seek specialist help, but be vigilant about confidentiality issues- don't
discuss colleagues' mental health with others without their permission.
Q. What should I do if one of my staff comes to me in obvious mental
distress?
A. Ask the person how you can help. Try to make private space; ask the person
if they need someone else; stay calm yourself. Ask whether there is a work
factor in their distress which you may need to address.
Q. One of my staff has told me s/he has a particular mental health
problem. What should my first step be?
A. Stay sensitive and open, respect confidentiality, and seek specialist help and
information.
Q. What is stress at work?
A. Feeling “stressed” and unwell is people’s natural reaction to excessive
pressure. It is not an illness, but if it is excessive or prolonged, it can lead to
mental or physical ill health. As an employer or manager, it is your duty to ensure
that staff are not made ill by their work.
Q. What can I do to help reduce stress and safeguard mental health?
A. Try to give your staff greater control over how, and at what pace, they do
their work. Do not make unreasonable demands in relation to working patterns or
hours. Consult staff are about their working conditions and changes that affect
them. Aim for clarity about roles and responsibilities. Ensure levels of
authority are clear and that lines of accountability are simple and understood.
Q. Is it reasonable to expect people with mental health problems take on
new challenges?
A. Misplaced sympathy or defensive management practices can result in
discrimination and suppression of potential. Open discussion about the prospect
of new and/or changing responsibilities is needed.
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Further help and information is available from:
Occupational Health
Working Well Staff Health and Wellbeing 2gether NHS Foundation Trust
Gloucestershire Royal Hospital
Great Western Road
Gloucester
Gloucestershire
GL1 3NN
Tel: 0300 422 5165
http://www.workingwell2gether.nhs.uk/
Human Resources
Beacon House
Gloucestershire Royal Hospital
Great Western Road
Gloucester
Gloucestershire
GL1 3NN
Tel: 0300 422 5360
http://intranet/en/Your-Division/Corporate-Services/Welcome-to-HR/
Staff Support Service
Health Psychology Department
Beacon House
Gloucestershire Royal Hospital
Great Western Road
Gloucester
Gloucestershire
GL1 3NN
http://intranet/en/Your-Division/Diagnostic-Specialties-Division/HealthPsychology/Staff-Support/
Further Reading
Challis, S. (2014). Understanding Mental Health Problems. London: Mind.
Available at www.mind.org.uk/media/619080/understanding-mental-healthproblems-2014.pdf
How to support staff who are experiencing a mental health problem. Available at
www.mind.org.uk/work
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Line Managers’ Resource: A practical guide to managing and supporting people
with mental health problems in the workplace (2013). Available at
http://www.hse.gov.uk/stress/pdfs/manage-mental-health.pdf
Mental Health at Work Chartered Institute of Personnel and Development
(CIPD). Available online at www.cipd.co.uk
The Equality Act 2010. Available at www.legislation.gov.uk
West, M. & Dawson, J. (2012) Employee engagement and
NHS performance. London: The Kings Fund
http://www.kingsfund.org.uk/sites/files/kf/employee-engagement-nhsperformance-west-dawson-leadership-review2012-paper.pdf
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