New tools for tackling the mental health epidemic

Mental health absence is soaring but there is a lot consultants can do to help employers make a difference. Edmund Tirbutt investigates

Any employer doubting the risks posed by mental health problems need look no further than the labour market sickness figures released by the Office for National Statistics this February showing that in 2013 an estimated 15.2 million working days were lost through stress, anxiety and depression – compared to 11.8 million in 2010. As the Work Foundation points out, this figure dwarfs the 249,000 working days lost through industrial action in 2012.

There is a growing acceptance that the current mental health crisis has been exacerbated by the recent economic downturn creating unrealistic targets, job insecurity and financial pressures. Young people seem to have been particularly badly affected, with research commissioned by Friends Life in October 2013 finding that 24 per cent of 18-24 year olds had called in sick due to stress during the past year.  

Unum head of vocational rehabilitation services Joy Reymond says: “Although there’s not yet any concrete data, it’s quite a reasonable hypothesis that problems are being labelled on work-related stress during the recession. People are not good with uncertainty, and increased pressure as budgets have got tighter has meant more having to be done for less. Remaining employees can also suffer from survivor guilt. We have noticed an increase in these patterns since 2008.”

New technology has also been adding fuel to the flames, especially with mobile phones having changed out of all recognition during this period, keeping staff tethered to workplace pressures 24/7. Some employees are effectively in touch with the workplace 24 hours a day, even dealing with emails whilst in bed at night.

Experts advise that employers, employees and policymakers should not wait for a silver bullet to come along and solve this problem: Dr. Cosmo Hallstrom, a fellow of the Royal College of Psychiatrists, says new drugs are not likely to prove the answer, and Dr. Doug Nemecek, a US based senior medical director and behavioural expert at Cigna argues that the answer lies both in changing the way technologies are used and improving channels to access existing mental health services.

Where employers can improve their targeting of these stress and mental health problems that are so harmful to individuals’ lives and productivity alike is more creative use of existing tools. In particular, both mindfulness and resilience training have recently been assuming a much higher profile.

Mindfulness, which was actually pioneered as a form of stress relief in the US in the 1970s, uses ancient Buddhist ideas to combat mental suffering and encourages participants to slow down and inhabit the moment rather than dwell on the past or the future.  During the last year in particular there has been a marked increase in the amount of banks, fund managers and professional services firms going down this route, probably as a result of the credit crunch focusing people on the need to find outlets for anxiety.

Resilience in its purest sense refers to the ability to bounce back from adversity so, as this quality is heavily interlinked with the health, happiness and general wellbeing of employees, training can involve a wide variety of focuses and formats. But, as with mindfulness, not everyone views it as a universal panacea, and argue it could be storing up problems that will emerge elsewhere.

Dr. Zofia Bajorek, a researcher at the Centre for Workforce Effectiveness, says: “Employers are paying more attention to resilience and mindfulness but I question how helpful these approaches are. You have to decide whether resilience training is just an inoculation against very stressful environments until they reach tipping points? We just don’t know yet.

“It’s the same with mindfulness. These methods put the onus on the individual to cope and lift the onus from the employer to organise work appropriately and examine the culture of the organisation. So they should only be used in conjunction with something else from the organisational side.”

Mind head of workplace wellbeing Emma Mamo says: “In the last couple of years there has been more of a focus on resilience training and introducing mindfulness training in workplaces but it’s not about revolutionary new approaches or reinventing the wheel. The most important thing is that employers create an environment where all colleagues feel able to discuss their wellbeing openly and honestly, in the same way that they may talk about their physical health.”

Encouragingly, however, this message does seem to have started getting across to employers during the past couple of years, probably because a gradual easing in economic conditions has enabled more companies to revert from survival mode and become receptive to new ideas. The implementation of the Equality Act 2010 has also helped make employers realise the importance of being flexible with working hours and patterns for those with mental health problems.

Oliver Gray, managing director of employee wellbeing services firm EnergiseYou, reports that between 60 and 70 per cent of companies of all sizes are now taking a more holistic view and encouraging the right culture and habits, putting them in a better position to notice the signs of stress by being more open and honest. Two years ago he estimates the proportion was more like 40 per cent.

Other potentially positive developments include the October 2013 launch of the City Mental Health Alliance, which has seen firms of the stature of Goldman Sachs, KPMG and Linklaters join together with the aim of breaking down the stigma attached to mental health and of creating a culture in which mental health is nurtured, and the April 2014 launch of Business in the Community’s Workwell Mental Health Champions Group. The latter has released the report Mental Health: We’re Ready To Talk as part of its campaign to end the culture of silence that surrounds mental health in the workplace.

Some big banks and law firms are also now offering employees access to in-house psychologists, and a wide range of firms are now ensuring that they have a member of staff trained in ‘mental health first aid.’

Healthcare management consultant Peter Marno says: “The idea is to train the mental health first aid staff not to be diagnosticians or therapists but to spot and be with people with mental health problems before handing them over to the authorities. They can spot symptoms that management normally can’t and don’t want to confront.

“Mental health first aid has been going a number of years but has really started catching on during the last year or so. The public sector is proving considerably better than the private sector in training people for it.”

Hopefully, this marked increase in employer awareness of mental health issues will go some way towards compensating for the lack of new treatment methods in the pipeline. The old adage that a stich in time saves nine is probably even more relevant to mental health than physical health, so anything that can help with early intervention should in itself be considered a very major step forward.

HANASAARI MODEL WORKS FOR CANADA LIFE

Although dating back to 1988, the Hanasaari model for occupational health nursing, that looks at the impact that work can have on an individual, is clearly only scratching the surface of what it can achieve for employers. 

Canada Life marketing director Paul Avis says: “It extends the biopsychosocial model to a new level and we’ve had big successes in using it to return people with mental health issues to the workplace by working with their employers to change their working patterns.”

One particular triumph referred to by Avis involved converting a multinational auditor to a new UK based role. He had previously been on call 24/7 when at work and having to cope with the strains with almost permanent hotel living.     

Another involved a construction company’s best project manager, who was parachuted in at the end of every project to ensure that buildings were delivered on time. The pressure that resulted from previous project managers failing to deliver resulted in him being absent due to stress and burnout. But a revised working pattern now means he can work on single projects from commencement to completion.

FUNCTIONAL MEDICINE HAS POTENTIAL FOR CORPORATE MARKET

Private GP service Privategp.com feels that its Functional Medicine approach, which looks at the cause of any malfunction of the body as opposed to treating the symptoms, has the potential to appeal to employers as a means of combating workplace mental health problems.

The nutritional based approach, which has been very popular in the US and has already been used in the UK for several years, is based on the belief that individuals need all their “team players” within their bodies – such as vitamins, minerals and fatty acids.

Privategp.com CEO Dr. Julia Piper says: “With depression we know a good diet can make a huge difference to the way someone feels. High blood sugar is not just a diabetes problem, it’s quite toxic to the body generally and has a lot of metabolic effects that can impact on our mood.

“I could see this catching on in the corporate market as so many employers are beginning to focus on health and wellbeing and this would seem to fit perfectly into a holistic wellness and absence management strategy.”

What actions businesses can take

As part of the BITC Mental Health: We’re Ready To Talk initiative, organisational psychology experts Professor Cary Cooper and Professor Susan Cartwright have suggested a specific three-pronged strategy for stress management in organisations undergoing increased, existing pressures in current workplace culture.

Primary – stress reduction

Secondary – stress management

Tertiary – employee assistance programmes / workplace counselling

Primary prevention

Primary prevention is concerned with addressing sources of stress inherent in the work environment, so reducing their negative impact on the individual. The focus of primary interventions is in adapting the environment to ‘fit’ the individual.

Possible strategies to reduce workplace stress factors include:

Redesigning the task


Redesigning the working environment


Establishing flexible work schedules


Encouraging participative management


Including the employee in career development

Analysing work roles and establishing goals


Providing social support and response


Building cohesive teams


Establishing fair employment policies

Primary intervention strategies are often a vehicle for culture change. Any intervention, therefore, should
be guided by prior diagnosis or a stress audit, or risk assessment, to identify the specific factors responsible for employee stress.

Secondary prevention

Secondary prevention is concerned with the prompt detection and management of experienced stress. This can be done by increasing awareness and improving
the stress management skills of the individual through training and education activities. Individual factors can alter or modify the way employees, exposed to workplace stress, perceive and react to their environment.

Awareness activities and skills training programmes, designed to improve relations techniques, cognitive coping skills and work/lifestyle modification skills, such as time management courses or assertiveness training, have an important part to play in extending the individual’s physical and psychological resources.

In secondary prevention, it is often the consequences, rather than the sources, of stress, which may be inherent in the organisation’s structure or culture, that are being dealt with. They are concerned with improving the ‘adaptability’ of the individual to the environment.

Tertiary prevention

Tertiary prevention is concerned with the treatment, rehabilitation and recovery process of individuals who have experienced, or are experiencing, serious ill health as a result of stress.

Intervention at the tertiary level typically involves provision of counselling services for employee problems in the work or personal domain. Such services are provided either by in-house counsellors or outside agencies,

which provide counselling, information and/or referral
to appropriate treatment and support services, usually through EAPs (employee assistance programmes). There is evidence to suggest that counselling is effective in improving the psychological wellbeing of employees and has considerable cost benefits.

Counselling can be particularly effective in helping employees deal with workplace stress and non-work related stress (e.g. bereavement, marital breakdown etc.) which tends to spill over into work life.

An employer needs to offer interventions at the three different levels to ensure a robust approach to stress management.