Paul Avis from Employ-Mend discusses what is needed to ensure that the workplace is a healthy one when it comes to stress and mental health management.
I am getting just a bit bored of all this talk about stress. Yes we know that it exists and that it does not, that it is subjective (and also therefore is hard to gain objective medical evidence) and we know that the HSE are doing all they can to support us with surveys, policies and measures to tell us whether we as employees and employers are stressed.
As with any specific condition there is a lot of analysis at the beginning or identification of the condition and then services come out to remedy this. However unlike many physical conditions, stress prevention needs a synergy of activity to achieve a corporate remedy.
Stress is not new and there are lots of services supporting it already but as it is often more complex than back pain to remedy there are no tick box answers to its prevention and management.
So is there any point in looking at stress as a subject? In short the answer is yes: in April 2005 a King’s College research team concluded that depression and anxiety had become the most common reason for people becoming long term sick.
Unumprovident (an insurer with about 700,000 employees under management) has had almost a three times increase in mental health claims since 1995 as opposed to a 50% increase in musculoskeletal claims.
Obviously concerned by this they assessed US mental health claims (which on average lasted 14 months), Canadian claims (four years) and were horrified to find that the average duration of a UK mental health claim was 10 years (after a deferred/waiting period of 28 weeks, during which time the GP had signed repeat sick notes without onward referral).
In simple terms stress is the biggest issue facing employers and one of the worst resourced. With only one in five people with mental health problems in economic activity compared to 50% of all disabilities, not only is it the biggest but also the most misunderstood of all health conditions: if you shut your eyes and think of a disability a wheelchair and a guide dog/stick may be what you see but that does not represent the volume of subjective illness sufferers that exist in the UK. Almost 900,000 of the 2.7 million people on State Incapacity Benefit are suffering from mental health conditions.
The physical manifestations of stress and mental health problems is an article in its own right and an area that I think warrants ongoing scrutiny. The purpose of this article is to highlight what could be needed by an employer to remedy stress and mental health issues in the organisation?
Non clinical issues:
There is a world of difference between a management and a clinical issue. Much stress is caused by interpersonal conflict in the workplace and as there is no underlying medical reason for this it should have to be viewed as a management issue. However what tends to happen is that the GP will sign the employee off with work based stress and then the Occupational Health assessor will say that there is nothing wrong with the employee.
What should the employer do? One remedy is to have numerous policies and procedures-bullying/harassment, acceptable behaviour and whistleblowing policies in place. Good words but many employees, especially those with generous occupational sick pay schemes, prefer to just take the easy option and see the GP.
Communication and employee understanding of such policies is key to their successful and beneficial use in such situations. Encouraging utilisation of such policies is another employer challenge and training and proactive communication can help in this.
But then the employer hits a flaw-if an employee genuinely feels that they cannot cope because of a work based personal conflict who is the person that they call-often the line manager who could be the cause of such a situation.
Having an independent third party taking such calls with the ability to de-select the line manager from the process would be the paradigm. We had one case where an employee reported that they were being bullied and once HR went to the department they found that the employee had been stalking a colleague and that the line manager was doing their best to control the situation.
The employee was sacked on the spot for gross misconduct (despite the De Cerembault DDA and ‘Protection from Harassment Act’(1997) implications!) and the colleague never had a day off sick either.
A further area where there is no clinical reason for stress is where over promotion or a capability issue exists. Specifically someone who may be excellent in their role but then is asked to manage a team, possibly including former colleagues.
The issues here are that they simply do not like managing people and they often feel ill equipped to do so. For example a brilliant and technically sound architect or Doctor is too valuable a commodity to lose but may not like their new role.
However what tends to happen is that they plough on in the management role as the stigma and loss of earning associated with demotion is too bad to contemplate.
Finally they cannot cope and go off sick or have persistent short term absences and in some cases the management issue can become a clinical one as long periods away from work can lead to mental health issues, such as depression, emerging.
They then begin to dislike the employer and the friction grows. In such cases a redeployment register for larger organisations and a pay and benefit protection (sometimes for a year or until pre-redeployment salary and benefit levels have been reached) for all organisations is recommended.
After all the employee was good at their former role and it is simply that they do not like the management aspect. This has to inevitably be backed by a consistent and supportive communication between employer and employee and will also cope with the employee who has been promoted beyond their level of competence and is struggling.
Non work related stress:
Employers often feel justifiably aggrieved where an employee is complaining of home/domestic based stress as the reason for absence from work. The first challenge an employer should ask is ‘What has brought that on’, ‘Why do you feel like that’ – in simple terms anything but ‘Is the absence work related?’ This should happen in the first call into the line manager and then should be recorded as non work based and the reason recorded.
Whilst this does not guarantee absolute protection from no win no fee solicitors it is a good starting point. We had one case where the employee was suing the employer for work based stress as his wife left him and the car and house were repossessed. In actual fact the organisation withdrew overtime and he did not adapt his lifestyle and as the debts mounted he began to get depressed!
With debt, matrimonial breakdown, elder/childcare, aspirational lifestyles and so forth a quick remedy to stress is the use of an Employee Assistance Programme.
Only 30-40% of all calls result in face to face counselling and hence a lot of additional information (approximately 20% for legal support for instance) is provided to help people.
Good EAPs will ‘unpeel the onion’ and look to case management. An employee who rings in with a debt issue would be questioned as to why they are in debt and if divorce or drug/alcohol addiction was denoted then other support will be forthcoming. With prices starting at £6 + VAT per employee for a six session EAP model, this short term, solution focused approach, covering all family members would be a good investment.
Where there is non work based stress relating to family issues, employers have embraced compassionate leave, voluntarily reduced working hours and authorised absence without pay policies but the best ones time limit these ordinarily to seven days per annum. Whilst this may seem harsh, absence from work, disruption from the normal routine and the loss of a key support network (the workplace) can compound the issue and so restriction is recommended.
Employees can then take holiday as the next level of absence and at least this is paid. Furthermore the effect on colleagues, the loss of operational input and the lack of visibility of a long term absentee, all imply that limitation of such leave will be beneficial to the employer.
In one case an employee’s fit husband died of a heart attack at the age of 35 on a Sunday morning. The employer did nothing apart from to pay occupational sick pay and she has not worked since.
Sometimes in adverse and stressful personal situations, the employer has to take the lead and deal with emotive situations for their benefit and the employees, even if this may not seem anything to do with work. We are not advocating the employer as a welfare agency, but having invested in policies, benefits and services, they should implement them, even when it may feel difficult to do so.
Non work based stress is too easily abdicated as non relevant-in fact employers should want all employees back at work when they are able to do so and phased returns, sheltered convalescence and really good ongoing contact management should be undertaken, whatever the reason for absence.
Support if genuinely in trouble:
A whole range of services exist to support employees that are clinically recognised to be suffering from mental health but what are the boundaries of where an employer can stop supporting the employee?
The first area of scrutiny must be the employee benefits package. Does the Private Medical Insurance or Cash Plan cover have mental health support/funding within them? For employers who use Group Income Protection, for long term absence, are claim forms being considered at six weeks absence, despite there often being a 13, 26 or 52 week waiting period?
If the insurers get in early they will do all they can to mitigate the financial cost of a claim by trying to prevent an employee from becoming a claimant. For longer term absentees there are multi-disciplined teams of cognitive behavioural therapists, physios, psychologists etc. who can address the complexity of fear of returning to work, the physical dimensions and structuring a case focused plan of goal setting.
These can be paid for either by the Group Income Protection insurer or employer and do prevent the loss of an employee, the cost of an ill health retirement or increased Group Income Protection premiums going forward.
As a final thought on employee benefits and mental health management, a new breed of online and questionnaire based ‘wellness’ services are emerging which empower employees to know what their current state of physical and mental health is.
Once the employee has put data in on stress, sleep, nutrition, height/weight and alcohol consumption a report is provided with recommendations as to what is needed to become healthier. Employees return to the web site or action plan and can monitor how they are performing against the criteria needed on a regular basis thereafter.
Another avenue for employers to explore is in the form of the services available. Health & Safety (or often the line manager) should have proactive approach to risk assessments and be able to prevent an employee from becoming too stressed through work surveillance.
At a corporate level the HSE six stressor assessment can be made using the free stress survey available from the website. It is often best to ‘hide’ these questions in an employee satisfaction survey if the organisation does one as any scrutiny on stress and mental health in the workplace can raise expectations as to change/reduced workloads and in some cases even litigation!
Occupational Health can act as gate keepers to more focused mental health support and may be able to help on a case by case basis without referral.
Most experienced practitioners do however view mental health as a key challenge and whilst some are refining their knowledge in the area, others prefer to concentrate on physical health.
Driving the latter to make clear clinical assessments can be problematic but employers should never just leave an employee with inadequate assessments and without an action plan to get them back to work.
Culture and relationship management is key:
However a key to mental health management is the culture of the organisation. Does it really care about its employees and is there an open communication and dialogue between the managers and employees?
Tangible efforts have been made in this arena and away from the specifics of stress training and policies, these are generally labelled as ‘Work Life Balance Programmes’- but what does that mean?
In simple terms it means whatever the employer wants it to mean! It could be flexible working, annualised hours, family friendly paid leave or duvet days for example. At a more tangible level this could be extended to massage, acupuncture, corporate ‘chill out’ days and a whole plethora of incentives and bonuses.
And this is the key as to how to remedy stress and mental health problems. There is no single answer! What is needed is a synergy of activity around mental health which is customised to the budget and needs of the organisation and its employees.
Quick wins like EAPs and maximising current benefits expenditure should be augmented by more innovative, focused strands of expenditure. Increases in productivity, staff retention and customer satisfaction are only some of the payoffs from having a well motivated and content workforce so surely the need for scrutiny and investment in the stress arena will pay dividends.
For further details please contact Paul Avis at: employmend@drivehouse.co.uk
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