1. MENTAL HEALTH AT WORK Department of Occupational Health Tracy Bluestone Deputy Head of Occupational Health tracy.bluestone@btuh.nhs.ukracy.bluestone@btuh.nhs.uk Extn 3591 or 3982

2. Aims of this presentation Briefly discuss Mental Health problems Legislation and Government Guidance Management of MH at work – role of manager, OH and employee Stigma and reactions from colleagues Useful links Please email me if you would like a copy of the presentation Department of Occupational Health

3. STATISTICS Between 15 and 30% of employees will experience mental health problems in any year and virtually any one is susceptible to psychiatric illness One in six women and one in nine men are likely to require treatment in a psychiatric unit during their lifetime, yet only a minority of these will suffer long term or permanent disability. Department of Occupational Health

4. People with mental health problems frequently suffer discrimination in the workplace Professor L Appleby, National Director of Mental Health NHS employers can tackle discrimination, promote equality and opportunity in their staff and provide the opportunities that people with mental health problems are now entitled to expect. Professor L Appleby, National Director of Mental Health The Chartered Institute for Personnel & Development Absence Management Survey 2008 suggests that Mental Health is the second largest cause of time lost due to sickness absence. Department of Occupational Health

5. For most people work is good for mental health and well being Most people recover or are successfully treated without specific employment intervention Waiting for people to become 100% fit for their return to work before allowing them back is unrealistic – it lengthens absences unnecessarily and may ultimately even compromise their future employability. Department of Occupational Health

6. In some cases applying reasonable adjustments will be required to discharge duties under the DDA but in all cases it will make business sense. The decision on what is “reasonable” rests squarely with management, though it is always preferable if the individual concerned agrees. Department of Occupational Health

7. LEGISLATION & GOVERNMENT GUIDANCE Health, Work and Wellbeing – Caring for our Future: A Strategy for the Health and Well- being of Working Age People (DWP/DH/HSE, 2005) The Management of Health and Safety at Work Regulations (1999) The Health and Safety at Work Act (1974) Improving Working Lives – first introduced as part of the NHS Plan (2000) Department of Occupational Health

8. LEGISLATION AND GOVERNMENT GUIDANCE The 1995 Disability Discrimination Act (DDA) (amended 2005) Part 2 of the DDA requires employers not to directly discriminate against disabled people, to make reasonable adjustments for disabled people, not to practice disability related discrimination, and to protect disabled people from harassment in the field of employment. Department of Occupational Health

9. MANAGEMENT OF MENTAL HEALTH PROBLEMS IN THE WORKPLACE When an employee displays behaviour in the workplace that causes the employer concern, the question of whether or not this is health related often arises Triggers to referral of an employee by their manager might include any of the following: Sickness absencePoor performance Unusual behaviourComplaints Untoward incidentsEmployee asking for help Department of Occupational Health

10. In law, it is your duty to ensure that your employees are not made ill by their work In most cases, reasonable adjustments can be made easily and inexpensively You should 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. health and safety risks will need to be discussed further) Department of Occupational Health

11. Agree with the employee how problems will be monitored If adjustments are being made, ask them how they wish this to be communicated to other staff You need to ensure that any hurtful gossip or bullying is dealt with promptly and effectively You have a responsibility under the DDA to ensure that staff are not being bullied or harassed on account of a disability. It is important that you record ALL conversations accurately – not just to protect the organisation and the employee, but also to show that the actions have been carried out fully.

12. Be aware of the impact one employee’s mental health problems could have on the rest of the team, whether as a result of reasonable adjustments that have been made or because of a person’s particular symptoms or behaviour while unwell. Department of Occupational Health

13. RETURNING TO WORK Most people with mental health problems recover completely and have the capability to return to work successfully. Effective communication and collaboration – between the individual, line manger and Occupational Health – will maximise the chances of success You should consider with the employee any factors that contributed to their absence that could be realistically changed or accommodated. You can then agree how their progress will be monitored Department of Occupational Health

14. When they return, brief them on what’s been happening – socially 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. Set achievable goals that make them feel they are making progress Give positive and constructive feedback You will also need to discuss honestly the things you can change and those you can’t. Department of Occupational Health

15. Be aware that if an employee is on medication they may experience distressing side effects In some cases the employee may not know immediately if medication will affect their ability to do the job. You need to ensure that any side effects are considered against their job requirements. Department of Occupational Health

16. OCCUPATIONAL HEALTH ADVICE Having collected all the relevant information the OH department will be able to advise the employer in non-medical terms and without breaching the confidentiality of the individual’s medical information:  Whether or not the individual has a health condition  How this will impact on their ability to do their job in both the short and longer term Department of Occupational Health

17. OCCUPATIONAL HEALTH ADVICE Where a treatable long term condition is identified  Any workplace adjustments that would enable the person to do the job.  Where the employers OH advisors know that a person has a disability, as defined by the DDA, the employer is obliged to comply with the act. This places a requirement on the OH service to advise management of any adjustments, even where the employee wishes the disability to remain confidential. Department of Occupational Health

18. Managing reactions from colleagues and clients: Fear, ignorance and hostility from colleagues and clients can be a great source of distress. Many people who have experienced mental ill health describe this as an area of stigma and discrimination. Managers need to think about how communications will be managed. Department of Occupational Health

19. People are not sure what to say and find it easier to avoid the individual or not to mention mental health. Try to talk to the employee and agree who will be told what, by whom and when. Think about the language you use, be clear about confidentiality and boundaries. Be guided by the employee’s wishes. Encourage them to talk if they wish, but do not pressurise them to do so. Department of Occupational Health

20. Treat people returning from absence due to mental ill health in the same way as those with physical ill health. Watch out for hostile reactions – stamp out any hurtful gossip or bullying promptly. Treat mental health issue in a matter of fact way – they are common and should not be a source of gossip or conjecture Avoid shrouding the issue in secrecy Avoid making assumptions about workloads and capacity to cope. Department of Occupational Health

21. BARRIERS TO RECOVERY Where people do not recover and return as expected the barriers cited include:  Stigma and fear of discrimination  Leaving it too long to ask for help  Pressure or lack of support outside work  Poor advice or lack of advice from GP or mental health worker  Loss of confidence  Loss of the work habit  Returning to the same pressures that triggered the episode Thomas, T.,Secker, J. & Grove, B “Getting Back For Christmas” (2002) IAHSP London Department of Occupational Health

22. What happens if the return to work is not successful? If all reasonable adjustments have been made for their role, it may be necessary to consider re- deployment Use normal procedures if it is a performance, attendance or conduct issue rather than on relating primarily to health or disability. If matters cannot be resolved you may have to move to termination. You should help the individual to move on with dignity. Department of Occupational Health

23. Summary Mental health problems can affect anyone Early referral to Occupational Health is essential in effective management Discourage secrecy about Mental Health problems Be consistent with you management of physical and mental health problems Stigma is the biggest barrier to recovery Department of Occupational Health

24. USEFUL LINKS Workplace interventions for people with common mental health problems. Evidence review and recommendations: www.bohrf.org.uk www.bohrf.org.uk www.mentalhealth.org.uk www.mindfulemployer.net www.shift.org.uk/employers Line Managers Resource www.shift.org.uk/employers www.dwp.gov.uk Department of Work and Pensions www.dwp.gov.uk Sainsbury Centre for Mental Health - mental health charity working to improve the quality of life for people with mental health problems http://www.scmh.org.uk/ http://www.scmh.org.uk/ Mind - mental health charity to create a better life for everyone with experience of mental distress http://www.mind.org.uk/ Mental Health Foundation - mental health charity to help people survive and recover from mental health problems. http://www.mentalhealth.org.uk/ http://www.mind.org.uk/ http://www.mentalhealth.org.uk/ Royal College of Psychiatrists - the professional and educational body for psychiatrists in the United Kingdom and the Republic of Ireland http://www.rcpsych.ac.uk/ http://www.rcpsych.ac.uk/ National Institute for Mental Health in England - responsible for supporting the implementation of positive change in mental health and mental health services. http://www.nimhe.org.uk/ http://www.nimhe.org.uk/