The right frame of mind

Mental health is costing UK businesses billions. Removing the stigma attached to mental health issues is the first step to tackling it, says Sam Barrett

Last month’s World Mental Health Day on 10 October fell on a Saturday, when most of us were enjoying our weekend, but mental health remains a key issue for employers throughout the working week. Finding ways to address stress and mental health issues in the workplace is essential. 

The extent of the problem can be seen in figures from The Sainsbury Centre for Mental Health. These show that mental health conditions cost UK employers an estimated £26bn a year, with this figure breaking down into £8.4bn in absenteeism, £15.1bn for presenteeism and a further £2.4bn in staff turnover.

WPA Protocol managing director Rachel Riley isn’t surprised by this. “Mental health problems can be very costly to an employer, affecting productivity as well as potentially leading to absence,” she says. “They can manifest themselves in a number of different ways, from the occasional day off for a headache or stomach bug through to musculoskeletal problems and long-term absence.”

Employer awareness

Given the scale of the problem, it is reassuring that there are signs that attitudes towards mental health are changing. Advo Group commercial director Colin Boxall says he has
seen an increasing ‘top-down’ understanding of the issues over the past few years.

“HR has always understood that it’s good business sense to look after employees’ general wellness, including their mental health, but there is now much more awareness at boardroom level,” he says. “If someone’s affected by stress, it’s not a sign of weakness but a sign of a weak company support structure, which will certainly affect the bottom line.”

A number of high-profile campaigns have also helped to push mental health up the agenda. These include mental health charity Mind’s Time To Change campaign, Business in the Community’s Wellbeing Mental Health Champions and, for organisations within London, the City Mental Health Alliance. 

Out of sight

But while significant steps are being taken, there are also indications that some employers may only be paying lip service to tackling stress and mental health. For example, in summer 2014, Bupa conducted a survey among 50 business leaders and 500 employees to gauge how mental health was being treated in the workplace.

This found that, although 76 per cent of employers said they actively encouraged managers to address and support employees’ mental health, only half of employees had been asked about stress, depression or anxiety in a one-to-one with their manager.

And, while 80 per cent of employers said they had effective measures in place to help tackle mental health issues, only 32 per cent of employees with a mental health condition agreed.

Although this is concerning, Bupa corporate director Patrick Watt says the disconnect may simply be a matter of a time lag.

“Senior managers are talking more about addressing stress and mental health in the workplace but I suspect that the message hasn’t quite worked its way through some organisations yet.”

Another factor that has slowed the removal of stigmas around mental health is the economy. Aviva UK Health medical director Dr Doug Wright says: “During the recession, employers and employees were focused on the viability of the business. This fuels the conspiracy of silence, where employers don’t want to dig too deep into the mental health of the workforce as they’re worried about what it might turn up, and employees are reluctant to raise any concerns as they’re worried about their jobs.

“Now we’re out of the recession, attitudes are slowly changing towards mental health in the workplace.”

Medical insurance support

Some provision for mental ill health has always been included on group medical insurance products. While large corporates can flex their cover, the SME market typically receives the standard 28 days’ cover for in-patient psychiatric care.

On top of this, many group schemes also include an employee assistance programme (EAP) to provide a telephone-based helpline and, in some instances, access to face-to-face counselling. Boxall says EAPs are becoming a much more effective tool.

“Employers were putting EAPs in place more to protect against employment tribunals than as part of a co-ordinated approach to tackling the effects of stress,” he says. “This is changing and I’m seeing employers being much more proactive in how they communicate them as a means to support staff.”

But while it is encouraging that these two forms of cover are commonly included on medical insurance, Axa PPP Healthcare clinical director of psychological health Dr Mark Winwood believes that insurers should be doing more to support employees with mental ill health.

“An EAP is a great way to address a small worry early but there are a whole range of mental health issues that would fall between an EAP and a 28-day psychiatric stay,” he says. “Going straight to psychiatric treatment is a bit like using a sledgehammer to crack a nut.” 

Self-referral pathways

To address this, his firm is working with some of its large corporate clients to open up the EAP more and enable calls to be referred to a wider range of treatments. Referrals can then be supported from the medical insurance claims fund to enable employees to receive appropriate treatment.

Bupa is also using a similar model to support employees with mental health issues. Whether through its medical insurance scheme, where the service is currently available only to smaller employers but will be rolled out to large corporates from January 2016, or its standalone product, Healthy Minds, employees can be triaged and referred to appropriate treatment.

These treatments include counselling – by either telephone, online or face-to-face talking therapies with a psychologist – or, where a clinical need is identified, treatment from a psychiatrist. Where no medical insurance scheme is in place, the employee is given details of appropriate NHS services and how to access these. 

Watt says this self-referral model is particularly important for mental health issues. “By taking out the GP, it makes it as easy as possible to access treatment. Employees don’t need to worry about what the GP might say and it also saves time, potentially making treatment easier and speeding up recovery,” he explains. 

Beyond medical insurance

While it is positive that medical insurers are taking steps to offer broader support to employers looking to tackle mental health issues, a proactive approach requires much more than providing access to treatment.

“It’s about creating the right culture, where employees feel they can talk about any mental health problems they might be experiencing,” says Dr Wright. “Commitment to this needs to come from the CEO down.”

Creating this culture helps to remove the stigma around mental health and make it much easier for employees to feel they can access the treatment provided by the employer. This then encourages early intervention, reducing the incidence of more serious problems and long-term absence.

The final piece of the jigsaw is to use preventative measures to support employees’ mental health and wellbeing. This could include initiatives such as yoga and mindfulness, as well as enabling employees to go for a walk during the day or take time out to read a book or catch up with colleagues. 

Insurance evolution

With so many different interventions helping to support employee mental health, Riley believes there is a strong argument to move towards a more integrated approach to tackling these issues.

“An employer’s mental health spend potentially sits across a wide range of benefits, including the medical insurance. By integrating them, it is easier to measure the effectiveness of the strategy,” she says.

As an example, although an employer may be spending more on some of the so-called fluffy benefits such as yoga or resilience training, by helping employees safeguard their mental health it could reverse the spend on medical interventions and reduce long-term absence and claims on the group income protection scheme.

“It is much more beneficial to an employer to have the mental health spend going towards keeping employees well than paying a long-term claim,” Riley adds. “Happy employees work harder.”

Given this argument, it would make sense to extend medical insurance into these areas to encourage more employers to adopt a broader approach to tackling mental health problems. However, PMI Health Group compliance director Mike Blake does not believe insurers have the appetite to take this step.

“Medical insurance is about providing treatment rather than preventative measures. There’s no underwriting profit to be made from adding benefits such as resilience training,” he says.

But the insurers appear to be a little more open to this change in focus. For example, although Dr Wright admits that, when a client wants to extend its mental health strategy by adding benefits such as on-site counselling and line manager training, his firm’s role is largely as a facilitator, he believes this could change.

“We’ve already seen a subtle shift in the role of medical insurance, where, as well as funding one-off procedures
to fix a problem, it will support long-term conditions such as cancer and provide preventative advice on musculoskeletal problems,” he says.

“When the culture shifts and it becomes much more acceptable to talk about mental health in the workplace, it will be easier for medical insurers to implement a range of services to support mental health and wellbeing.”