1. Managing staff with Mental Health Problems
Sophie Gask Occupational Health Adviser

2. 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

3. 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.

4. 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’

5. 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Appearing tired, anxious or withdrawn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

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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.

12. 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

13. 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.

14. 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

15. 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

16. 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

17. Sources of support Remploy Mental Health Service
Rethink Mental illness
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

18. Further resources and information
MIND -
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

19. NHS - www.nhs.uk/conditions
Suicide – getting help:
Helping others:
Samaritans –

20. Any questions