Managing staff with Mental Health Problems Sophie Gask Occupational Health Adviser

Session outline Spotting that someone is/may be struggling How (& when) to have the conversation Managing sickness absence due to mental ill health Supporting someone back to work

Mental Health – an introduction What is it? Why is it an issue? What can I do about it? What is it? We all have mental health, but we are on a spectrum which we all move up and down, some of us have poorer mental health than others, some have better. The factors that influence where we are on this spectrum include physiological factors (which can lead to diagnoses such as bipolar disorder, schizophrenia for example), and our experiences whether these are within home or work life. Why is it an issue? Mental ill health is common. 1 in 6 people at any one time will be dealing with a mental health problem such as stress, anxiety or depression. MIND, a mental health charity, has some worrying statistics for employers and managers of staff. If staff don’t talk about issues they are having then these issues can spiral often ultimately impacting on them, their colleagues, manager and the organisation. What can I do about it? Create an open culture within your team to encourage and enable staff to realise it’s okay to talk about mental health, support staff experiencing mental health problems to cope at work and recover. Less than half the people with a diagnosed mental health problem had told their line manager about it when surveyed.

MIND - research More than one in five (21 per cent) agreed that they had called in sick to avoid work when asked how workplace stress had affected them 14 per cent agreed that they had resigned and 42 per cent had considered resigning when asked how workplace stress had affected them 30 per cent of staff disagreed with the statement ‘I would feel able to talk openly with my line manager if I was feeling stressed’

Spotting someone is or may be struggling Changes in mood or behaviour or how they interact with colleagues Changes in work output, motivation or focus Changes to decision-making, organisation or problem-solving Appearing tired, anxious or withdrawn Losing interest in tasks or activities previously enjoyed Changes in eating, appetite and increased smoking or drinking These are clues and not everyone will display these or any of these changes when they are struggling, which is why it’s important to encourage openness. A model to explain the impact of stress

How & when to have the conversation Take the lead – initiate the conversation Ask them: “How are you doing?” Establish open conversation Routinely – as part of regular one to one meetings As soon as you become aware something has changed We’ve already covered that staff are likely to feel uncomfortable at coming forward. They may feel that they are letting you down as a Manager by having problems, they may feel ashamed or embarrassed that they are struggling, previous experience of negative responses to them or others being open regarding their health, their perception of organisational fairness or justice. Approach this in the same way you would a physical health problem, many of the early symptoms can also be experienced with physical health problems and stress can manifest as a physical problem – back, head or neck aches or tension, gastric upset, palpitations. If you are asking staff regularly about how they are doing and create an open culture then this will make it easier for them to broach the subject themselves or reply to your question when asked. With trust and integrity between you and your direct reports people are less nervous about sharing this information. Referring them to OH to have the conversation is formalising the situation. You already know your staff and can approach the conversation sensitively and keep the situation low key and non-threathening.

What to say Ask simple, non-judgemental, open questions Let them explain their mental health problems to you in their own way, using their words Ask how this affects them, any triggers you should be aware of and what support they need at work

What to do Don’t make assumptions Listen to what they tell you & respond flexibly Be clear, open and honest Ensure confidentiality – limit to as few people who need to know as possible Develop an action plan Encourage them to seek advice & support Reassure them Seek advice & support for yourself

What to do when… They say it’s you that’s causing the problem Stay calm Ask open questions: about how you are causing the problem how they would like to work differently with you remain honest about what can change agree actions planned

What to do when… They say they are having thoughts of suicide or self harm Stay calm Encourage them to talk about how they are feeling Ask what help and support they are getting Signpost them to their GP/existing services If you think there is immediate danger, do not leave them on their own, arrange for them to see their GP or care team immediately or contact A&E for details of the nearest Crisis Resolution Team Ensure you continue to reassure them – that they are okay to talk – show them respect and support. Talking can be enough to support them at that time, explore whether they are in contact with their GP and whether they have been referred onto specialist services – local mental health teams etc. If not Rethink Mental Illness and Birmingham Healthy Minds have crisis support in addition to signposting them to the Samaritans

Role of Occupational Health To advise staff and managers about health impacting on work and work on health Accessed via management referral An advisory report is prepared with the staff members consent, which they can choose to view prior to the report’s release As a manager you can ask advice of OH if you are concerned or require some support about managing one of your team. Whilst OH have no knowledge of the case/person we are able to advise in general terms based on our knowledge of health problems and accessing NHS and other support. If you require specific information relating to how an individual’s health is impacting on them in work and what actions you may consider taking to manage them then a referral is appropriate. However, a referral to OH is formalising the situation and should not be taken as the first step unless this is unavoidable. The person being referred needs to understand why they are being referred and what you are seeking to gain from this. The best way to do this is be open in your discussion and share or compose the referral paperwork with them. Staff often view a referral to OH as a punitive measure – this is view is pretty universal, not specific to the University. And staff can feel that they are becoming a problem to you and / or suspect you have an ulterior motive to remove them from the organisation – using HR.

Managing sickness absence due to mental ill health Keep in touch Agree frequency and mode of contact Keep the conversation social and ask open questions about them Reassure them that you are interested in their welfare and recovery Agree what information should be shared with colleagues

Refer to Occupational Health Act on their recommendations Be clear with the team about expectations on them in the absence of their colleague Document all actions agreed – at every stage Remain supportive to the absent employee The University’s position for absence due to stress, anxiety and depression is referral to OH is appropriate immediately. OH provides advice, as managers you will be in a position to assess the impact of their recommendations and what it is possible to put in place – but act on the report and arrange to discuss this with the staff member at an appropriate time.

Supporting someone back to work Arrange a return to work interview This may be at their home (with their consent) A neutral place On their return to work Prepare the team for their return Meet the individual on their first day back

Return to Work Interview Tell people they were missed Explain return to work process Reassure them they are not expected to walk back in to their usual workload / hours Ask how they are feeling Ask whether there are any problems at work causing them stress or home contributing to their absence Discuss any concerns they have and agree a strategy Understand that despite looking well, they may still be unwell

Maintaining them at work Agree a schedule of regular one to one meetings with them at a frequency that works for both of you Ask them how they are doing Discuss with them how their mental health problem is impacting on them Revise the return to work plan and strategy Source further adjustments or support if required

Sources of support Remploy Mental Health Service https://www.remploy.co.uk/ Rethink Mental illness https://www.rethink.org/ Birmingham Healthy Minds http://www.bsmhft.nhs.uk/our-services/birmingham-healthy-minds/ Remploy Mental Health Service – delivered in partnership with the Access to Work scheme, supports individuals with common mental health conditions, such as depression, anxiety, stress or other mental health issues affecting their work. Rethink Mental Illness – a charity that provides services across England from advice helplines through to support groups and crisis support Birmingham Healthy Minds – NHS Service available to residents of Birmingham. Provides talking therapies, crisis support 24/7 and the Recovery College – courses in Mindfulness, Mental Health First Aid in addition to condition and recovery specific courses

Further resources and information MIND - www.mind.org.uk/work How to support staff who are experiencing a mental health problem How to promote wellbeing and tackle the causes of work-related mental health problems Managing and supporting mental health at work How to be mentally healthy at work

NHS - www.nhs.uk/conditions Suicide – getting help: www.nhs.uk/Conditions/Suicide/Pages/Getting-help.aspx Helping others: http://www.nhs.uk/Conditions/Suicide/Pages/helping-others.aspx Samaritans – 116 123

Any questions