MENTAL HEALTH

For many of us, work is a major part of our lives. It is where we spend much of our time, where we get our income and often where we make our friends. Having a fulfilling job can be good for your mental health and general wellbeing.

We all have times when life gets on top of us – sometimes that's work-related, like deadlines or travel. Sometimes it's something else – our health, our relationships, or our circumstances. The value added to the economy by people who are at work and have or have had mental health problems is as high as £225 billion per year, which represents 12.1% of the UK’s total GDP.

It's vital that we protect that value by addressing mental health at work for those with existing issues, for those at risk, and for the workforce as a whole. A toxic work environment can be corrosive to our mental health.

We believe in workplaces where everyone can thrive. We also believe in the role of employers, employees and businesses in creating thriving communities.

Good mental health at work and good management go hand in hand and there is strong evidence that workplaces with high levels of mental wellbeing are more productive. Addressing wellbeing at work increases productivity by as much as 12%. After reading this guide you should:

• have an idea of how to manage your own mental health at work

• have an idea of how to reach out to a colleague in distress

• have an idea how you can work with others to make your workplace more mentally healthy for everyone.

Introduction

Mental health is the way we think and feel and our ability to deal with ups and downs.

Mental health is something we all have. When we enjoy good mental health, we have a sense of purpose and direction, the energy to do the things we want to do, and the ability to deal with the challenges that happen in our lives.

When we think about our physical health, there's a place for keeping ourselves fit, and a place for getting appropriate help as early as possible so we can get better. Mental health is just the same.

If you enjoy good mental health, you can:

• make the most of your potential

• cope with what life throws at you

• play a full part in your relationships, your workplace, and your community.

Your mental health doesn’t always stay the same. It can fluctuate as circumstances change and as you move through different stages in your life.

Distress is a word used to describe times when a person isn’t coping – for whatever reason. It could be something at home, the pressure of work, or the start of a mental health problem like depression. When we feel distressed, we need a compassionate, human response. The earlier we are able to recognise when something isn’t quite right, the earlier we can get support.

What are mental health problems?

We all have times when we feel down, stressed or frightened. Most of the time those feelings pass, but sometimes they develop into a mental health problem like anxiety or depression, which can impact on our daily lives. For some people, mental health problems become complex, and require support and treatment for life.

Factors like poverty, genetics, childhood trauma, discrimination, or ongoing physical illness make it more likely that we will develop mental health problems, but mental health problems can happen to anybody.

Our research shows that most people have some experience of a mental health problem, and the latest large-scale survey in England suggested that one in six people experience the symptoms of a mental health problem in any given week.

Sadly, over 6,000 people a year die by suicide in the UK, and having a long-term mental health problem may reduce life expectancy by as many as 21 years due to associated physical health problems.

Different mental health problems affect people in different ways and its key to understand an individual’s experience. Diagnosis is not a definite way to understand a person’s experience. Some people with schizophrenia for example live pretty much ordinary lives, and some people with anxiety are severely impacted by their condition.

How do I recognise a mental health problem?

If we have significant challenges in our home or work life, the chances are that it has an impact on our mental health.

Mental health problems can have a lot of different symptoms and signs. As a rule, you should seek help from your GP if you have difficult feelings that are:

• stopping you from getting on with life

• having a big impact on the people you live or work with

• affecting your mood over several weeks

• causing you to have thoughts of suicide.

At work, we might notice that we are more tired than usual. We might make uncharacteristic mistakes, find it hard to motivate ourselves, our timekeeping might slip, or we may be short tempered.

We might look or feel very tired or drained. We might find we isolate ourselves, avoid colleagues or appear distracted. We might procrastinate more – or grind to a halt altogether. Or we might speed up or become chaotic, intruding into others’ conversations and work, and taking on more work than we can manage.

We may find these early warning signs hard to see in ourselves, and it can help to have colleagues who can help us connect this to our mental health.

If things progress, you might see more obvious signs of a mental health problem in a colleague – outbursts of anger or emotion, absences from work, or not looking after their appearance as they normally would. You may see signs that they have been sleeping less or perhaps drinking more in the evening.

Why don't people talk about mental health?

Awareness of mental health is increasing, but we still face a world where people with mental health problems face discrimination, and can face challenges getting the help they need. Many people who experience distress try to keep their feelings hidden because they are afraid of other people’s responses.

Fear of discrimination and feelings of shame are among the top reasons people give for not telling their colleagues about their mental health problems.

When we create workplace cultures where people can be themselves, it is easier for people to speak about mental health concerns without fear, and easier for them to reach out for help when they need it. Even so, the decision to disclose distress at work is not one people take lightly. It is vital that workplaces become environments where people feel safe to be themselves.

What does the law say?

We have a wide range of legal rights that protect our mental health at work. These range from basic human rights such as the right to freedom of expression and freedom of association, to the health and safety legislation that keeps us safe from hazards, including psychological hazards.

The Equality Act (2010) in England, Scotland and Wales and the Disability Discrimination Act (1995, as amended) in Northern Ireland

Most people with ongoing mental health problems meet the definition of disability in the Equality Act (2010) and the Disability Discrimination Act (1995, as amended). This means that people with mental health problems are protected from discrimination and harassment and are entitled to reasonable adjustments to adapt their job or work.

To be considered disabled under equality legislation, a person must have an impairment that has "a substantial, adverse, and long-term impact on their ability to carry out everyday tasks". The Equality Commission for Northern Ireland provides information about the different protections for people with mental health problems in Northern Ireland.

Reasonable adjustments

A disabled person is entitled to ask for reasonable adjustments to their job or workplace to accommodate their disability. An adjustment is intended to level the playing field by removing a barrier to the job that is provided by the effect of their mental health problem.

Examples of reasonable adjustments:

• Changing a person’s working pattern to enable them to start later or finish earlier because of the side effects of medication, or allowing them to travel the night before meetings and stay over to avoid early morning travel.

• Providing a person with a laptop, remote access software and permission to work at home on set days, or flexibly according to the severity of their symptoms (within a monthly limit).

• Excusing someone from attending work functions and client events involving food, instead allowing them to set up alternative networking arrangements that achieve similar business returns.

Access to Work is a government-funded scheme that can help to fund equipment, software, and other support if cost is a barrier to making reasonable adjustments.

As well as the duty to consider reasonable adjustments, the Equality Act and the Disability Discrimination Act also protect people from harassment because of a protected characteristic. This means that employers have a duty to address bullying and discriminatory behaviours relating to mental health just as they would for other protected characteristics such as gender, sexual orientation, race or faith/belief.

Looking after your mental health at work

We can all take steps to improve our own mental health, and build our resilience – our ability to cope with adversity. Self-care is a skill that needs to be practised. It isn’t easy, especially if we feel anxious, depressed or low in self-esteem.

Try looking through the 10 evidence-based ways to improve your mental health below.

There’s bound to be one or two you do well. These can be your assets – your go-to methods for working on your wellbeing.

Look for one or two you find hard. These can be your challenges. It may be that these areas are the ones you neglect under stress – for example drinking too much, isolating yourself or comfort eating, are all examples of ways we try and cope that are the opposite of what the evidence tells us works for our mental health.

Finally, look for one or two areas that you feel you could work on or try. These can be goals. Your goals and challenges can be the same but it's sometimes kinder to yourself to have some goals that you can meet more easily.

1. Talk about your feelings

Talking about your feelings can help you maintain your mental health and deal with times when you feel troubled. Talking about your feelings isn’t a sign of weakness; it’s part of taking charge of your wellbeing and doing what you can to stay healthy.

It can be hard to talk about feelings at work. If you have colleagues you can talk to, or a manager who asks how you are at supervision sessions, it can really help.

Identify someone you feel comfortable with and who will be supportive. You may want to think about what you want to disclose, who to and when a good time and place to do this could be.

If you are open about how you feel at work, especially if you are a leader, it might encourage others to do the same.

If you don’t feel able to talk about feelings at work, make sure there’s someone you can discuss work pressures with – partners, friends and family can all be a sounding board.

2. Keep active

Regular exercise can boost your self-esteem and can help you concentrate, sleep, and look and feel better.

Exercising doesn’t just mean doing sport or going to the gym. Experts say that most people should do about 30 minutes’ exercise at least five days a week. Try to make physical activity that you enjoy a part of your day.

You may have a physical job like construction or teaching – you’ll notice if you are off sick because of injury or physical illness how quickly your mood starts to be affected by the change in activity level.

If you work in an office it can make a huge difference to get out for a walk or do a class at lunchtime, or to build in exercise before or after work to ease you into the day or create a space between work time and personal time.

3. Eat well

What we eat can affect how we feel both immediately and in the longer term. A diet that is good for your physical health is also good for your mental health.

It can be hard to keep up a healthy pattern of eating at work. Regular meals, plus plenty of water, are ideal. Try and plan for mealtimes at work – bringing food from home or choosing healthy options when buying lunch.

Try and get away from your desk to eat. You could try a lunch club at work – where you club together to share meals and try new things. For busy times, or times when you are feeling low or stressed, try reducing or giving up caffeine and refined sugar. Make sure there is a ready supply of fruit/vegetables and snacks like nuts or trail mix that provides ready nutrients.

Be aware that some people find public eating at work very stressful because of past or current eating disorders – so if someone doesn't want to come to work dinners, or makes different food choices in the office, don't pass comment or put pressure on them to join in.

4. Drink sensibly

We often drink alcohol to change our mood. Some people drink to deal with fear or loneliness, but the effect is only temporary.

Most people don't drink at work – but most of us recognise the pattern of drinking more at the weekend or in the evening when work is hard going.

Be careful with work functions that include drinking. It can be tempting to have a drink to get 'Dutch courage', but if you feel anxious you may drink too much and end up behaving in a way you'd rather not, which will increase feelings of anxiety in the medium to long term.

5. Keep in touch

Relationships are key to our mental health. Working in a supportive team is hugely important for our mental health at work.

We don’t always have a choice about who we work with, and if we don’t get on with managers, colleagues or clients, it can create tension. It may be that you need to practise more self-care at these times, but you may also need to address difficulties.

Work politics can be a real challenge when we have mental health problems. It can be helpful to find a mentor or a small group of trusted colleagues with whom you can discuss feelings about work – to sense check and help you work through challenges.

Try and make sure you maintain your friendships and family relationships even when work is intense – a work–life balance is important, and experts now believe that loneliness may be as bad for our health as smoking or obesity.

6. Ask for help

None of us are superhuman. We all sometimes get tired or overwhelmed by how we feel or when things don’t go to plan.

Your employer may have an employee assistance programme. These services are confidential and can be accessed free and without work finding out. You may also be able to access occupational health support through your line manager or HR service.

The first port of call in the health service is your GP. Over a third of visits to GPs are about mental health. Your GP may suggest ways that you or your family can help you, or they may refer you to a specialist or another part of the health service. Your GP may be able to refer you to a counsellor.

7. Take a break

A change of scene or a change of pace is good for your mental health.

It could be a five-minute pause from what you are doing, a book or podcast during the commute, a half-hour lunch break at work, or a weekend exploring somewhere new. A few minutes can be enough to de-stress you. Give yourself some 'me time'.

If your employer offers mental health days – discretionary leave to look after your wellbeing – take these, and make sure you use them well. It can be hard to take holidays and time off from work. When we are stressed, it can seem even harder to take the breaks we are entitled to – when we need them most. Try and plan periods of leave for the year so that you always have a break to look forward to.

When you are on leave or at home, resist the temptation to check in with work. If you find that you can’t break away, it may be a sign that you should be re-examining your workload to manage stress.

Sleep is essential to our mental health. Listen to your body. Without good sleep, our mental health suffers and our concentration goes downhill.

8. Do something you're good at

What do you love doing? What activities can you lose yourself in? What did you love doing in the past? Enjoying yourself can help beat stress. Doing an activity, you enjoy probably means you’re good at it, and achieving something boosts your self-esteem.

Concentrating on a hobby, like gardening or doing crosswords, can help you forget your worries for a while and can change your mood. It’s OK to be good at your job – when you feel stressed, it can be easy to forget your talents, or fall foul of imposter syndrome (where you feel like a fraud, or that you don't deserve your successes).

If possible, you should plan your workload to include tasks you know you are good at, so as to 'sandwich' things you know will be harder or more stressful. At work, you may have a hobby you'd like to share or join in with colleagues on – a work cycling club, book group or crafting group can be a great way to share a skill with others.

9. Accept who you are

We’re all different. It’s much healthier to accept that you're unique than to wish you were more like someone else. Feeling good about yourself boosts your confidence to learn new skills, visit new places and make new friends. Good self-esteem helps you cope when life takes a difficult turn.

Be proud of who you are. Recognise and accept the things you may not be good at, but also focus on what you can do well. If there's anything about yourself you would like to change, are your expectations realistic? If they are, work towards the change in small steps.

Self-acceptance and self-care can be very hard when you have a mental health problem – an ongoing challenge people need to work on.

It can be tempting to invest everything in building self-esteem around work success. That often means that people with mental health problems give everything at work and are high achievers. It also creates a risk that when things go wrong, when mistakes are made, or when change is necessary, people may take it personally.

Mindfulness is a form of meditation that involves paying deliberate attention to what is happening, as it happens. Mindfulness practice can help us to be more present with ourselves, our work, and our families. It can help us feel more connected, take stock, and be compassionate to ourselves and others.

10. Care for others

Caring for others is often an important part of keeping up relationships with people close to you.

Working life can provide opportunities to care for others – contributing through vocational jobs like nursing or care work can be hugely significant for mental health. In most jobs, you can choose to be there for colleagues – either as a team-mate, or as a line manager, when strategies like coaching and training are good ways to support others.

Helping can make us feel needed and valued, and that boosts our self-esteem. Volunteering can be hugely rewarding, and it helps us to see the world from another angle. This can help to put our own problems into perspective. Many companies have volunteering opportunities and corporate social responsibility programmes that enable staff to get involved in community work.

Caring responsibilities at home can be hugely rewarding to us, but also a source of stress. Our roles as parents, or carers for relatives, can collide with our work identities. Carers are at greater risk of developing mental health problems – work can provide a respite for carers, as they can be someone else at work – so it is important to retain and support carers in the workplace. Workplaces that support flexible working, carers' leave, childcare voucher schemes and other initiatives to support caring roles can have a big impact on staff mental health and productivity.

Supporting a colleague

Talking about mental health can seem daunting, but we’ve all had conversations with people about bereavements, breakups and other life events – they don’t always start easily but they often mean a lot to a person having a tough time.

It all starts with asking someone how they are doing in a warm and authentic way – giving them a chance to realise that you are being sincere and friendly.

Time and place

There’s a time and place for everything – and when it comes to talking with someone about their mental health, that means a time and place that is most comfortable for them. The last thing anyone needs is to feel rushed. Find a time where you know you have at least 10 minutes of clear time to give.

You may want to arrange a time for a longer chat – either in work time if appropriate, or outside work. You want to find a place that’s comfortable for them. Some people want peace and quiet – others like hustle and bustle.

It’s very important to devote your full attention to the person you are reaching out to. That means minimising disruptions like phones ringing or notifications popping up.

Active listening

Listening is vital for every relationship. Active listening is a term for a range of techniques that keep us present and engaged in a conversation.

Try and have eye contact, unless the person you are talking to doesn’t seem comfortable with that. Be open – that means open arms and turning slightly towards them.

You should acknowledge what's being said with appropriate nods and gestures, and repeat what they've said to check you got it right. Ask direct and appropriate questions – but it's not appropriate to probe for more details than a person is prepared to give.

When the conversation ends, recap what you have discussed and agreed, and make sure you do what you say you will. It can help to have some information to hand. Put some helpline numbers and web links in your phone to pass on straight away.

Managing your own feelings

It can be hard to hear difficult or upsetting things, but you want to reassure and encourage the person – that means not showing signs of surprise or judgement. You want to reassure the person that it’s OK to be speaking to you, and that you will treat what they say with respect.

It is tempting to immediately start suggesting solutions to problems – but it’s wise to ask a person what they want to happen. They may welcome suggestions, but, equally, they may just need to vent.

How do I respond to thoughts of suicide?

A recent survey showed that 20% of people had gone to work while experiencing suicidal thoughts or feelings.

It is a myth that talking about suicide makes it more likely. If you are concerned that a colleague might be having thoughts of suicide, the best thing you can do is ask them directly. You can ask, "Have you had thoughts about suicide?" during a conversation about someone's mental health. Be plain, don't use euphemisms like "You wouldn't do something silly, would you?"

If your colleague says they are feeling suicidal or can't go on, or if you suspect they are thinking of taking their own life, it is important to encourage them to get help. They could contact the Samaritans straight away – they can call 116 123 for free 24 hours a day. You could also help them to call their doctor or a close friend or colleague.

If you are concerned for someone's immediate safety, or they tell you that they plan to end their life imminently, you can call 999 and ask for the police or take them to an A&E Department.

Supporting a person with ongoing mental health problems

Most people who develop mental health problems recover well, if they have right support from the people in their lives.

For some people, an episode of mental ill-health is a one-off – triggered by events. Equally, there may be no cause at all. For others, mental health problems can be longer term, or episodic over a lifetime. Recovery isn’t the same thing as cure – often people learn to live with aspects their mental health problem.

Supporting a colleague who has a mental health problem is about helping them to find ways to recover, helping them to stay well, and ensuring that the workplace is a safe and pleasant place to be, free from discrimination. Remember that the best expert on a person’s needs is themselves – if there is one golden rule for supporting a colleague, it is never to assume and always ask.

How can I support someone if they are off work?

Many people who have mental health problems dread returning to work after they have been off sick because of their mental health. It can be awkward to know what to say when people have been ill, especially if it has never been talked about, or if their behaviour was unusual when they were unwell.

Whether you are a manager or a colleague, keeping in touch and letting someone know you care is a great way to prevent awkwardness:

• Ask the person who is off work what they would like their colleagues to be told. Remind colleagues that the image the person presents to the world – perhaps through social media – might not reflect their reality.

• Invite them out when staff are spending leisure time together – they may decline, but still appreciate being asked.

• Send cards and call your colleague if you would normally socialise with them – just as you would if they had any other health problem.

• Give them a call a few days before they return to work and ask them if there’s anything you can do (maybe give their desk a tidy, agree to meet for coffee and walk in together, or go for lunch on the first day).

• Greet them when they are back – they are unlikely to want a fuss made, but you shouldn’t shy away from talking about their absence. Ask them how they are, and if there’s anything you can do to support them from here onwards.

• Help them get back into work routines – ask if they would like your support or attendance at meetings.

How can I support someone day to day?

Many people who experience mental health problems get through their difficulties and return to life exactly as it was. We can't always assume this. Like with many long-term health conditions, people with mental health problems may need to make long term or permanent changes in their lives or jobs to manage. Colleagues may need your support on an ongoing basis – don't assume that they need special treatment but equally don't assume that everything is fine just because some time has passed:

• Check in with colleagues informally in the office to see how they are doing, and, if you manage someone, offer them the chance to discuss their mental health at supervision sessions.

• You could offer to be a mentor or coach, or just a friendly support on an ongoing basis.

• You can ask if there’s anything you can do to support a person to manage their condition. They might, for example, ask you to help them spot signs that they may miss that indicate that they may be becoming unwell.

Line manager responsibilities

As a line manager, you play a crucial role in supporting staff that experience distress and/or mental health problems. You are the first official contact between the employer and the individual and you can set the tone and set an example. In addition to the tips for supporting colleagues, there are several areas that line managers should be particularly aware of.

Managing absence and return to work

As a manager, you will be responsible for administering an absence. In mental health-related absence, the longer a person is away, the less likely they are to return. Early and appropriate contact can make returning easier. If you require a medical certificate from a doctor, you will get a 'statement of fitness to work' (a fit note) from the GP. Small businesses can benefit from the government’s Fit for Work programme.

This should give you an idea of whether there are reasonable adjustments you should make. Sometimes, a phased return to work can be helpful, with someone working a few hours a day and building back up to working their contracted hours.

If you’re unsure what is reasonable, ask for advice from your HR manager or occupational health advisor. For external advice, the conciliation service ACAS provides a range of resources on managing challenging circumstances at work.

Performance management and appraisal

Good management practice suggests that regular team meetings and confidential supervision sessions between managers and their staff are good for business and good for staff engagement. Supervision sessions that do this are good for mental health and staff engagement.

Sometimes, a subtle (or more obvious) drop in performance is the signal that a staff member might be experiencing distress.

If you have to consider a disciplinary process or competence process, it is wise to keep an open mind as to whether a mental health concern could be part of the picture.

Clearly, unacceptable behaviour and poor performance must be addressed, but be aware that fear can prevent a person disclosing a mental health concern until their job is on the line.

You shouldn’t shy away from using disciplinary or competence policies where needed, just because staff have mental health problems, but those polices should anticipate health- and disability-related issues and enable you to factor those in.

Appraisals and career development can be very challenging to people who have lived experience of mental health problems. It can be hard to think about strengths if your self-esteem is poor, and receiving feedback – positive or negative – can be very difficult.

If a person hasn’t been performing as well as usual, they may feel guilty or fearful about it. Be honest in assessing their performance – they may feel their performance is worse than it is. It can be useful to agree in advance how to handle any continuing problems.

Encourage your colleague to identify factors that might play a role in them becoming unwell and consider how to deal with them. You may also want to agree how best to respond to a crisis, and what adjustments you could make to the job on a permanent basis.

Leading during change

The world of work is changing, and many employers find there is a need to restructure and make redundancies, or change staff working conditions or contracts.

Any change process is a challenge for staff mental health. If you have to plan a change process, you can balance some of the obvious stressful aspects by ensuring that decisions are communicated effectively, that people have as much time as practically possible to digest decisions, and that support is made available both within the workplace and via external support like employee assistance programmes and support to find new employment.

For people with lived experience of mental health problems, change processes can be especially stressful. They may expect to be made redundant, may need extra support, may become unwell, or, conversely, may not put themselves forward for promotion when they are suitable.

If you have staff who you know have a history of mental health problems, it is worth specifically adjusting for this when planning change.

Employer checklist for creating mentally healthy workplaces

Value mental health and wellbeing as core assets of your organisation

• Commit to developing an approach to mental health at work that protects and improves mental health for everyone, whilst supporting those people who experience distress. Designate board champions, and ensure senior leaders and middle managers are responsible for implementing mental health programmes.

• Commit to reviewing the way you do business to ensure your everyday working culture is as mentally healthy as possible. Make evidence based mental health promotion tools like mindfulness and exercise available to all staff.

• Regular staff surveys and other research to build data about staff mental health, using findings to plan and deliver action and inform workplace policies. Recognise and celebrate the impact of existing employee benefits and corporate social responsibility activities on the mental health and wellbeing of staff.

Support the development of compassionate and effective line management relationships

• Provide opportunities for managers to attend relevant training to support staff living with mental health problems and the wellbeing of all staff more widely.

• Provide proactive support for staff line-managing people with mental health problems, including access to HR and, where necessary, occupational health services.

• Recognise that line managers who have personal lived experience of mental health problems are a unique asset to a company.

Address discrimination

• Ensure that discrimination on the grounds of mental health status is seen to be as unacceptable as discrimination in relation to other protected characteristics such as race, gender or sexual orientation.

• Encourage staff to report any discrimination or harassment they face and to blow the whistle on discrimination they witness.

• Support national and local anti-stigma initiatives such as Time to Change, Time to Change Cymru, See Me and Mental Health Awareness Week.

Value the diversity and transferable skills that lived experience of mental health problems bring and support disclosure

• Include mental health in diversity and inclusion strategies, and recognise the mental health component of wider equality initiatives. Ensure your business creates opportunities to link with employability providers to enable people with mental health problems to join your workforce.

• Give people positive reasons to disclose by establishing a culture that values authenticity and openness – this should be led from the top of the organisation.

• Explore setting up peer support and mentoring programmes for staff with lived experience of mental health problems.