first_img Comments are closed. Working mindsOn 1 Jul 2002 in Personnel Today One in four people will experience some kind of mentalhealth problem in the course of a year and they are likely to face prejudiceand discrimination at work. It is time to lift the lid on one of society’s lasttaboos, by Greta Thornbory The first conclusions from the document Working Minds: Attitudes on MentalHealth in the Workplace1 state: “There is very low awareness andunderstanding of mental health, its symptoms and causes, and how it can orshould be handled in workplace situations.” One presumes it means mentalill health! The Mental Health Foundation2 says that one in four people will experiencesome kind of mental health problem in the course of a year, and according tothe Department of Health3 a quarter of all the drugs prescribed in the NHS arefor mental health problems. It goes without saying, therefore, that if the workforce of the UKrepresents half the population, then the state of the mental health of theworkforce must have some impact in the workplace. Common mental health problems include anxiety, depression, schizophrenia,dementia, alcohol and drug misuse and eating disorders1. This articleendeavours to explore how mental ill health is regarded in the workplace, howit is dealt with and how mental well- being can be improved through workplacehealth promotion. Mental disability When disability is mentioned what does it conjure up in your mind? Generallyone sees a wheelchair and a physical disability, yet the DisabilityDiscrimination Act 19954 covers mental disability and is quite clear in itsdefinitions of what constitutes mental disability: “mental impairmentincluding learning disabilities and mental illness (if it is recognised by arespected body of medical opinion)”. The DDA seeks to end unfair discrimination against disabled people and thatincludes those with a history of mental illness, yet there are endless storiesfrom employees and prospective employees who have experienced discriminationbecause of mental health problems. The Department of Health’s Mind Out for Mental Health campaign is working withpartners across all sectors to combat this stigma and discrimination. WorkingMinds is the employer programme for this campaign and the Industrial Society –now known as The Work Foundation, undertook the research as part of the MindOut for Mental Health initiative. The Working Minds research In its research, Working Minds1 says that it aims to lift the lid on one ofsociety’s last taboos – the attitudes, practices and prejudices that lead towidespread discrimination in the workplace on the grounds of mental health. This research, undertaken in early 2001, included quantitative andqualitative studies. The qualitative study took the form of focus groups withemployees and, separately, with managers. The quantitative survey sentquestionnaires to 500 human resources and personnel managers and had a 13.8 percent response rate, and to 1,000 opinion-formers and received an 8.5 per centresponse rate. The researchers admit that this methodology is neithercomprehensive nor scientific, but they were confident that the approach was”robust and fair”. Unfortunately, the research has not beensufficiently widely promulgated to have had any great impact on employers, letalone the workforce. Working Minds is working in partnership with employers to help bring aboutpositive changes in workplace policy and practice on mental health. Moreinformation on this initiative is available at Here, and inthe Working Minds research document1 you can read about the employmentexperiences of, and discrimination against, many people suffering from, or witha history of mental illness. Examples of attitudes towards people with mental health problems include thebelief that – They will be dangerous and unpredictable – They will never recover – They will never be able to contribute fully – They have problems communicating – Some mental health problems are self-inflicted The way in which the media presents and reports on issues compounds thesemisconceptions. Employer partnerships The Working Minds initiative and the Mind Out for Mental Health campaignencourage partnerships with employers. Their website lists partnerships with anumber of mainly mental health-related, charities. However, there appear to beonly four companies that have signed up to this initiative, one of which isMarks & Spencer – the only organisation to mention the involvement of itsoccupational health service. The Working Minds research1 concludes that employees appear to lackconfidence in the ability and specialist expertise of their human resources,personnel or OH services to handle mental health problems. It seems that thereis a great deal to be done by these departments in developing knowledge, skillsand competence in handling mental health issues. The HSE has addressed this problem by producing a resource pack formanagement training and development on mental wellbeing in the workplace5. Theresource pack emphasises that the “mental health spectrum” is animportant concept to comprehend. At one end of the spectrum exists mentalwellbeing; a mental health dimension conducive to growth and development. Thespectrum moves across into the mental ill-health bracket, through social,behavioural and biomedical conditions and then ultimately at the opposite endinto the more rare severe mental illnesses, such as psychosis, which, it says,affects only about 1 per cent to 2 per cent of the population. Hence themajority of mental ill health problems to be found in the workplace will bethose at the centre of the spectrum and therefore generally of a moderatenature. Even so, they may have a disastrous effect on the individual, as wellas the workplace. Workplace stress The most common mental health problem encountered in the workplace isanxiety, which causes distress and is known as ‘stress’. The HSE6 definesstress as: “The reaction that people have to excessive pressure or other types ofdemand placed upon them. It arises when people worry that they cannotcope.” Stress manifests itself in both physical and behavioural effects that mayresult in sickness absence. Once the stress is relieved or reduced, thephysical and behavioural effects disappear. It is only when stress continues for a long period without relief that theremay be long-term and long-lasting damage to health. The main problem withstress is that there is no way of knowing what level each individual cantolerate. See Figure 1. What is known1, 5-7 is what causes the physical and behavioural changesassociated with stress. Fingret and Smith7 suggest that individual characteristicssuch as genetic factors, poor parental models, personality, quality of socialsupport, past experiences and lastly, the amount of control one has over life,all influence the likelihood of suffering from a stress-related condition.However, along with the HSE5 and Arnold et al7 they also suggest a number ofworkplace factors that affect the individual. Financial consequences Figure 2 shows that there are a number of organisational symptoms that causecompanies a huge financial loss. A CBI/DOH survey in 19917 estimated that 30per cent of sickness absence was due to stress, anxiety and depression, and in1995 it estimated that the cost of mental health absences from work was in theregion of £3.7bn for 100 million days lost per year9. However, the HSE reportsan estimated 6.5 million days lost due to stress, depression or anxiety, or aphysical condition ascribed to work-related stress. In the same document itdoes admit that there are difficulties in measuring stress and the occupationalcontribution to it. Tackling the problem It is therefore sensible to address the source of stress in order to preventstress-related conditions developing. As can be seen from the work being done on mental health and mentalwell-being in the workplace, this is not a new initiative. Epidemiologicalstudies have been undertaken for some years, yet there does not seem to be anyspecific relief for the majority of the workforce. As stated earlier, there is a lack of confidence in the knowledge andunderstanding of those responsible for the health and wellbeing of theworkforce. Some larger organisations have undertaken and put in placestrategies to deal with mental wellbeing at work and examples of thosestrategies from The Post Office, Kings Healthcare NHS Trust, The Boots Companyand Zeneca Pharmaceuticals are included in the HSE resource pack5. Alsoincluded in the pack are four strategies from SMEs. Occupational health nurses have been taught about mental health andwell-being for some years but there appears to be a theory-practice gap, notonly for OHNs, but also for those in personnel and human resources management5.It is interesting to note that the HSE states that the highest rates ofstress, depression or anxiety occur among nurses and teachers, with other careworkers, managers and professionals coming next. This indicates that thehighest work stress rates occur among social class II, and they tend to be inpublic sector workers. For teachers, who have little access to occupationalhealth services, this is not surprising. There is usually one small OH serviceserving a whole county of public servants and in Oxfordshire, for example, theservice has to provide OH for more than 300 schools, as well as a number ofother departments. The way forward So how can occupational health services help to promote mental wellbeing atwork? Working Minds recommends that employers develop specific mental healthpolicies to promote awareness and understanding of mental health and wellbeing,and that this should be done in collaboration with unions as the employees’representatives. There is also a need to ensure that organisations havemanagers who are well trained in all aspects of personnel matters and are ableto manage human resources as well as other resources. It has been said in the past, reputably by the Chairman of NatWest Bank,that human resources are the most valuable resources a company has. To this endit is worth considering the work of Luthans and Kreitner (cited by Arnold etal8) of “organisational behaviour modification”. They suggest fivesteps: – Identify critical behaviour – Measure critical behaviour – Carry out functional analysis of the behaviour – Develop an intervention strategy – Evaluate The purpose of this is to strengthen desirable behaviour and weakenundesirable behaviour, thereby presumably creating a happier and moreproductive workforce who will not suffer from the stresses usually associatedwith the workplace. In an effort to encourage such practices the RCN, as a trade union, hascarried out a survey10, the findings of which show that “employers’employee-friendly attitudes and practice can strongly influence nurses’wellbeing and job satisfaction”. The survey involved a sample of 6,000nurses, who received a postal questionnaire for which there was a 68.5 per centresponse rate – exceptionally good for a postal questionnaire. These results are supported by the DOH who says in its document, Making itHappen – a Guide to Delivering Mental Health Promotion11, thatorganisation-wide approaches are most effective and should include support forstaff. They continue by reinforcing the need for enhanced job control,increased staff involvement, workload assessment and role clarification. The RCN survey identifies a good employer as one that: – Provides well-designed employee- friendly services – Values and consults staff – Provides a safe environment – Protects and supports staff All these points are relevant to any working environment, not only fornurses and healthcare workers. OH nurses would do well to read the RCN documentand use it as a basis from which to encourage their own human resources andpersonnel departments to reconsider their own practices – as part of qualityassurance and audit practices, and in order to improve the mental wellbeing ofpeople at work. It is also important to study the DOH’s strategy for mentalhealth11 to understand how the workplace fits into the overall health promotionstrategy. OH can do a lot and take a lead in promoting mental wellbeing at work, butit cannot do it in isolation. OH needs to work with all the stakeholders topromote mental wellbeing, as well as to bring about a greater understanding andacceptance of mental ill health. Making it Happen says that mental healthpromotion involves any action to enhance the mental wellbeing of individuals,families, organisations or communities. If half the population is at work forhalf of their lives then the workplace has a strategically important role toplay in mental health. References: 1. Blackwell T, Burns P, Hardy S (2001) Working Minds; Attitudes on MentalHealth in the Workplace with Proposals for Change. A report by the Industrial Societyfor the Mind Out for Mental Health campaign. 2. Goldberg D, Huxley P (1980) Mental Illness in the Community, cited inBlackwell et al (2001). 3. Department of Health (1996) Statistics of Prescriptions Dispensed inFHSAs: England 1985-1995. Stationery Office: London. 4. Minister for Disability (2001) The Disability Discrimination ActDefinition of Disability, HMSO: London. 5. Doherty N, Tyson S, (2001) Mental Well- being in the Workplace: aResource Pack for Management Training and Development, HSE. 6. HSE (1995) Stress at Work: a Guide for Employers, HSE. 7. Fingret A, Smith A, (1995) Occupational Health: a Practical Guide forManagers, Routledge. 8. Arnold J, Robertson I T, Cooper CL, (1991) Workplace Psychology, Pitman(Revised version due Nov 2002). 9. HSE (2002) Occupational Stress Statistics Information sheet: 1/02/EMSU,HSE. 10. Royal College of Nursing (2002) Working Well: a Call to Employers, RCN. 11. Department of Health (2001) Making it Happen: a Guide to DeliveringMental Health Promotion, Stationery Office: London. 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