What is mental health?

We all have mental health, just as we have physical health. Mental health, like physical health, can fluctuate on a spectrum from good to poor. Poor mental health can therefore affect any of us irrespective of age, personality or background. Mental health problems can appear as a result of experiences in both our personal and working lives – or they can just happen.

Associates may be affected directly or indirectly, if partners, dependants or other family members have poor mental health, which in turn impact on the associate’s own health. People can also be affected by friends’ and fellow associates’ experiences. Poor mental health can affect the way people think, feel or behave. In some cases, this can seriously limit a person’s ability to cope with day-to-day life, which can impact on relationships, work and quality of life.

However, many people effectively manage their mental health condition alongside the demands of a job and daily life, sometimes with treatment and support. Others may experience symptoms of poor mental health but may never be diagnosed with a condition. The crucial thing to remember is that everyone’s experience of poor mental health is different – two people with the same condition may have entirely different symptoms and coping mechanisms. That’s why working with people on an individual basis is so important.

Impact of work and non-work issues on mental health

A common assumption is that mental health problems are just caused by issues at home, so some employers feel it is not appropriate – or indeed their responsibility – to intervene and support associates. In fact, in most cases people’s mental health issues are a combination of problems they face at work and outside work. For example, someone experiencing severe anxiety due to a debt problem might find that the demands of their job, which under normal circumstances are manageable, are now beyond them. Conversely, someone who is under prolonged stress at work might find challenges in their life outside work, such as caring responsibilities, become unmanageable. This can then create a negative feedback loop which further undermines their performance and puts greater pressure on them in the workplace.

It’s therefore impossible to disentangle the impact of various factors on someone’s mental health, and so it’s in employers’ interests to actively support associates with mental health issues, whatever the original cause or trigger. The benefits for the employer can be significant, as many people with even a serious mental health problem can thrive at work if they feel supported and have the right framework in place, thus reducing potential sickness absence and increasing associate engagement.

Types of mental health problem

Mental health is just like physical health: we all have it and we need to take care of it. Good mental health means being generally able to think, feel and react in the ways that you need and want to live your life. But if you go through a period of poor mental health, you might find the ways you’re frequently thinking, feeling or reacting become difficult, or even impossible, to cope with. This can feel just as bad as a physical illness, or even worse.

Mental health problems affect around one in four people in any given year. They range from common problems, such as depression and anxiety, to rarer problems such as schizophrenia and bipolar disorder.

The terms used to diagnose conditions are sometimes words that are in everyday use, such as ‘depression’ or ‘anxiety’. Although this can make them seem easier to understand, their familiarity may lead to confusion. For example, employers should be mindful of the difference between clinically diagnosed depression and the use of ‘depressed’ to describe feeling a bit down.

There are many different mental health problems. Some of them have similar symptoms, so you may experience the symptoms of more than one mental health problem or be given several diagnoses at once. Or you might not have any particular diagnosis, but still be finding things very difficult. Everyone’s experience is different and can change at different times.

Below are some commonly diagnosed forms of mental health problems with examples of some of their symptoms. This is not an exhaustive list, as people will react and respond differently, and men and women can respond differently too, so it is important not to dismiss other symptoms. Research has shown that men tend to have less knowledge about mental health and are also less likely to report their own experiences of mental health problems, as well as less likely to discuss mental health problems with a professional. When supporting associates, it’s important not to label people by focusing on a diagnosis. Instead, talk to them about how it impacts on their work:

Depression: Depression is a feeling of low mood that lasts for a long time and affects everyday life. It can make someone feel hopeless, despairing, guilty, worthless, unmotivated and exhausted. It can affect self-esteem, sleep, appetite, sex drive and physical health. In its mildest form, depression doesn’t stop someone leading a normal life, but it makes everything harder to do and seem less worthwhile. At its most severe, depression can make someone feel suicidal, and be life-threatening. Some types occur during or after pregnancy (antenatal and postnatal depression) or may come back each year around the same time (seasonal affective disorder).

Anxiety: Anxiety is what people feel when they are worried, tense or afraid – particularly about things that are about to happen, or which they think could happen in the future. Occasional anxiety is a normal human experience. But if feelings of anxiety are very strong, or last for a long time, they can be overwhelming. Someone might also experience physical symptoms such as sleep problems and panic attacks. There are different diagnoses of anxiety such as generalised anxiety disorder (GAD), social anxiety (social phobia), panic disorder or post-traumatic stress disorder (PTSD). But it’s also possible to experience problems with anxiety without having a specific diagnosis.

Panic attacks: Sudden, unexpected bouts of intense terror leading to difficulty breathing; rapid, pounding heartbeat; choking sensations; chest pain, trembling; feeling faint. The memory of a panic attack can provoke fear and trigger another.

Obsessive-compulsive disorder: Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. The term is often misused in daily conversation – for example, people may talk about being ‘a bit OCD’, if they like things to be neat and tidy. But the reality of this disorder is a lot more complex and serious. OCD has two main parts: obsessions (unwelcome thoughts, images, urges, worries or doubts that repeatedly appear in your mind), and compulsions (repetitive activities that you feel you have to do to reduce the anxiety caused by the obsession).

Phobias: A phobia is an extreme form of fear or anxiety triggered by a particular situation (such as going outside) or object (such as spiders), even when it’s very unlikely to be dangerous. A fear becomes a phobia if the fear is out of proportion to the danger, it lasts for more than six months, and has a significant impact on how you live your day-to-day life.

Bipolar disorder: Bipolar disorder (once called manic depression) mainly affects mood. With this diagnosis someone is likely to have times when they experience: manic or hypomanic episodes (feeling high); depressive episodes (feeling low); and potentially some psychotic symptoms. Everyone has variations in their mood, but in bipolar disorder these swings can feel very extreme and have a big impact on life. In between, there may be stable times where they experience fewer symptoms.

Schizophrenia: Views on schizophrenia have changed over the years. Lots of people question whether it’s really a distinct condition, or actually a few different conditions that overlap. But a diagnosis may be given if someone experiences symptoms such as:

• psychosis (such as hallucinations or delusions)
• disorganised thinking and speech
• feeling disconnected from your feelings
• difficulty concentrating
• wanting to avoid people
• a lack of interest in things
• not wanting to look after yourself.

Because psychiatric experts disagree about what schizophrenia is, some people argue that this term shouldn’t be used at all. Others think the name of the condition doesn’t matter and prefer to just focus on helping you manage symptoms and meeting your individual needs.

Personality disorders: Personality disorder is a type of mental health problem where your attitudes, beliefs and behaviours cause you long-standing problems in your life. If you have this diagnosis, it doesn’t mean that you’re fundamentally different from other people – but you may regularly experience difficulties with how you think about yourself and others and find it very difficult to change these unwanted patterns. There are several different categories and types of personality disorder, but most people who are diagnosed with a particular personality disorder don’t fit any single category very clearly or consistently. Also, the term ‘personality disorder’ can sound very judgemental.

Because of this it is a particularly controversial diagnosis. Some psychiatrists disagree with using it. And many people who are given this label find it more helpful to explain their experiences in other ways. •

Psychosis: Psychosis (also called a psychotic experience or psychotic episode) is when you perceive or interpret reality in a very different way from people around you. You might be said to ‘lose touch’ with reality. The most common types of psychosis are:

• hallucinations
• delusions.

More detailed information is available from Mind website.

Is mental health protected in law?

Sometimes people who have mental health problems are treated unfavourably because of their mental health condition. This is called discrimination and, if someone experiences it, they may have a legal right to challenge it. The Equality Act 2010 is the law that gives you the right to challenge discrimination. To get protection under the Equality Act, people usually have to show that their mental health problem is a disability. ‘Disability’ has a special meaning under the Act.

All parties (see Table of Definitions) may have duties under health and safety legislation to assess the risk of stress related poor mental health arising from work activities and to take measures to control that risk. The Health and Safety Executive’s (HSE) Management Standards are designed to facilitate this. Because poor mental health is likely to be a ‘hidden’ disability and many people are reluctant to disclose a condition, it is good practice for an employer to make adjustments for someone experiencing poor mental health even if they do not necessarily consider they have a disability under the Equality Act. The Equality Act’s definition of a disability refers to ‘long-term’, meaning 12 months or more – because many mental health conditions can be fluctuating, the law doesn’t adequately protect some people who may still need appropriate support and adjustments at work.

Managing stress at work

Managing stress effectively is a crucial part of a preventative approach to supporting mental health in the workplace.

Being under pressure is a normal part of life. It can help someone take action, feel more energised and get results. But if they often become overwhelmed by stress, these feelings could start to be a problem. We all know what it’s like to feel stressed, but it’s not easy to pin down exactly what stress means. When someone says things like ‘this is stressful’ or ‘I’m stressed’, they might be talking about:

• situations or events that put pressure on them – for example, times where they have lots to do and think about, or don’t have much control over what happens
• the reaction to being placed under pressure – the feelings they get when they have demands placed on them that they find difficult to cope with.

There’s no medical definition of stress, and healthcare professionals often disagree over whether stress is the cause of problems or the result of them. This can make it difficult for people to work out what causes their feelings of stress, or how to deal with them. The HSE defines stress as ‘the adverse reaction people have to excessive pressure or other types of demand placed upon them’. Of course, a certain level of pressure in a business environment is desirable. Pressure can help to motivate people and may boost their energy and productivity levels, but when the pressure individuals are under exceeds their ability to cope – and particularly when there is no respite – it can become a negative rather than a positive force; in other words, unmanageable stress.

People can respond to emotional stress as if it were a physical threat; muscles will tense, heartbeat and breathing will quicken as the body goes into ‘fight or flight’ mode, and various hormones, including adrenaline, are triggered. Unmanageable stress can have physical, psychological and behavioural symptoms which, if not addressed, can lead to mental health problems. Whatever the personal definition of stress is, it’s likely that someone can learn to manage stress better by:

• managing external pressures, so stressful situations don’t seem to happen to them quite so often
• developing emotional resilience, so they’re better at coping with tough situations when they do happen and don’t feel quite so stressed.
• Stress can be linked to physical ill health, including heart disease and back pain. Stress isn’t a psychiatric diagnosis, but it’s closely linked to mental health in two important ways:
• Stress can cause mental health problems and make existing problems worse. For example, if someone often struggles to manage feelings of stress, they might develop a mental health problem such as anxiety or depression.

Mental health problems can cause stress. Someone might find coping with the day-today symptoms of a mental health problem, as well as potentially needing to manage medication, healthcare appointments or treatments, can become extra sources of stress.

Prevention: helping people to stay well and managing stress

Some of the costs associated with poor mental health at work occur because undetected problems are left unchecked and spiral into a crisis. Good communication and people management skills go a long way to preventing stress and poor mental health among associates – often it’s about a common-sense approach.

Onboarding

Onboarding is important for all new associates as starting a new assignment can be a stressful and unsettling experience. A negative first few days in the assignment, in which people are given insufficient guidance about expectations and processes, can undermine people’s confidence and could trigger problems or exacerbate existing symptoms.

An effective onboarding for all associates contains the following elements:

• one-to-one meeting(s) between the new starter and their line manager
• orientation (physical) – describing where the facilities are
• health and safety information – this is a legal requirement
• a clear outline of the assignment requirements and expectations
• information about ways of working, for example office hours.

Managing people

How people are treated and managed on a day-to-day basis is central to their mental well-being and engagement, as well as the level of trust in the employment relationship. The behaviours of line managers will, to a large degree, determine the extent to which associates will go the extra mile in their jobs, are resilient under pressure and remain loyal to their organisation. Good line management can be crucial in supporting wellbeing, spotting early signs of distress and initiating early intervention, while poor line management may exacerbate or even cause mental health issues through an unhelpful approach or behaviour.

CIPD research finds that management style is the second main cause of work-related stress.

Line management behaviours to prevent stress at work

Good-quality people management, particularly by line managers, is one of the core drivers of associate engagement and well-being.

Core management behaviours needed to prevent and mitigate the effect of stress at work, as well as to support associate engagement and health and well-being include.

• to be open, fair and consistent
• to handle conflicts and problems
• provide knowledge, clarity and guidance
• build and sustain relationships
• support development, where appropriate.

It is also important to.

• create realistic deadlines
• clearly communicating output objectives
• deal with problems as soon as they arise
• give associates the right level of responsibility
• encourage participation from the whole team
• regularly asking team members, ‘how are you?’
• act as a mediator in conflict situations.

It is important that line managers should have their own support network in place to support their own mental health and well-being to avoid becoming stressed or unwell themselves.

Line managers who regularly ask associates how they are and take an interest in their team’s lives outside work are more likely to build trust and therefore effectively prevent and manage stress at work. Conversely, line managers who assume associates are okay, are indecisive and inconsistent, give mostly negative feedback and create unrealistic deadlines are likely to exacerbate stress. A common-sense approach extends to flexing your management style as appropriate to each associate – so being aware that some people will be less comfortable sharing details of their personal life than others.

Building resilience

Building resilience can help associates cope with pressure and adversity in the workplace by focusing on building resilience or coping techniques. Resilience can be defined as the ability to recover or bounce back in the face of adverse conditions, change or pressure. Successful approaches focus on building individual and team resilience, which are all interconnected. A focus on building resilience can help associates understand how they can manage and withstand pressure more effectively and also ensure that line managers are taking steps to identify and prevent stress effectively.

Individual resilience

Lead by example to promote simple steps for managing health and ensure the workplace environment facilitates well-being.

Team resilience

Review and support the emotional well-being of the whole team. Huntswood is committed to continuing our risk assessments and using associate advocacy surveys.

Early intervention: spotting the signs of stress and poor mental health

No matter how well associates are managed, some people will experience poor mental health in the workplace. Spotting the signs of stress or poor mental health at an early stage means line managers can hopefully nip problems in the bud before they escalate into a crisis or sickness absence.

The pointers below give ideas of what to look out for.

Workplace or external triggers

A management approach that solely views poor mental health as a medical problem is therefore unlikely to succeed. A key part of spotting the signs is line managers being alert to the potential workplace triggers for distress, such as:

• associates working long hours and not taking breaks
• unrealistic expectations or deadlines
• high-pressure environments
• unmanageable workloads or lack of control over work
• negative relationships or poor communication
• an unsupportive workplace culture or lack of management support
• job insecurity or poor change management
• high-risk roles
• lone working.

External triggers may also have an effect on an associate’s mental health and well-being, such as:

• childhood abuse, trauma or neglect
• social isolation or loneliness
• experiencing discrimination and/or stigma
• social disadvantage, poverty or debt
• bereavement • severe or long-term stress
• having a long-term physical health condition
• unemployment or losing your job
• homelessness or poor housing
• being a long-term carer for someone
• drug and alcohol misuse
• domestic violence, bullying or other abuse as an adult
• significant trauma as an adult, such as military combat, being involved in a serious incident in which someone fears for their life, or being the victim of a violent crime
• physical causes – for example, a head injury or a neurological condition such as epilepsy can have an impact on your behaviour and mood. (It’s important to rule out potential physical causes before seeking further treatment for a mental health problem.)

Line managers who know their associates and regularly hold catch ups to monitor work and well-being are well placed to spot any signs of stress or poor mental health at an early stage. Often the key is a change in typical behaviour. Symptoms will vary, as each person’s experience of poor mental health is different, but there are some potential indicators to look out for.

However, if one or more of these signs is observed, this does not automatically mean the associate has a mental health problem – it could be a sign of another health issue or something else entirely. Always take care not to make assumptions or listen to third party gossip and talk to the person directly.

Indicators of poor mental health

Encouraging people to talk about their mental health: supporting associates to stay well and in work

If poor mental health is suspected or disclosed, it’s crucial that line managers facilitate an early conversation about the person’s needs, to identify and implement appropriate support or adjustments. Basic good line management and the use of empathy and common sense by line managers lie at the heart of effective management of mental health in the workplace. If an individual does not trust their line manager, they are unlikely to want to discuss a sensitive issue such as mental health with them.

Line managers need to ensure they are seen as approachable and listen when associates ask for help. Line managers should also be mindful of whether the workplace culture is conducive to encouraging people to talk about their mental health, including disclosure.

Broaching the subject

While mental ill health is a sensitive and personal issue – like any health problem – most people prefer honest and open enquiries over reluctance to address the issue. Shying away from the subject can perpetuate fear of stigma and increase feelings of anxiety. Often associates will not feel confident in speaking up, so a line manager making the first move to open up a dialogue can be key.

Regular 1-2-1s are an opportunity to start the conversation, which should always be in a private, confidential setting where the associate feels equal and at ease. Questions should be simple, open and non-judgemental to give the associate ample opportunity to explain the situation in their own words. If there are specific grounds for concern, such as impaired performance, it’s important to address these at an early stage, but in all cases people should be treated in the same way as someone with a physical health condition – a good starting point is asking how they are.

Conversation checklist

• Avoid interruptions – switch off phones, ensure colleagues can’t walk in and interrupt.
• Ask simple, open, non-judgemental questions.
• Avoid judgemental or patronising responses.
• Speak calmly.
• Maintain good eye contact.
• Listen actively and carefully.
• Encourage the associate to talk.
• Show empathy and understanding.
• Be prepared for some silences and be patient.
• Focus on the person, not the problem.
• Avoid making assumptions or being prescriptive.
• Follow up in writing, especially agreed actions or support. Encouraging people to talk about their mental health: supporting associates to stay well and in work.

Questions to ask

• How are you doing at the moment?
• You seem to be a bit down/upset/ under pressure/frustrated/angry. Is everything okay?
• I’ve noticed you’ve been arriving late recently, and I wondered if you’re okay?
• I’ve noticed the reports are late when they usually are not. Is everything okay?
• Is there anything I can do to help?
• What would you like to happen? How?
• What support do you think might help?
• Have you spoken to your GP or looked for help anywhere else?

Questions to avoid

• You’re clearly struggling. What’s up?
• Why can’t you just get your act together?
• What do you expect me to do about it?
• Your performance is really unacceptable right now – what’s going on?
• Everyone else is in the same boat and they’re okay. Why aren’t you?
• Who do you expect to pick up all the work that you can’t manage?

Line managers should explore with any associate reporting a mental health issue how to address any difficulties which are work-related, which might in turn help them to cope with any problems in other areas of their lives.

Line managers should encourage associates to see their GP as a first step and ensure they are aware of the support we have available such as talking to Huntswood mental health first aiders.

Responding to disclosure

If you suspect a member of your team is experiencing poor mental health, or they disclose it to you, it’s essential you have a conversation with them about their needs. This will help you to evaluate and introduce appropriate support or adjustments. To manage mental health at work effectively, you’ll need good people management skills, as well as empathy and common sense. You should try to ensure you are seen as approachable and listen when associates ask for help.

Choose an appropriate place

• It’s important to make people feel comfortable; therefore, it’s good to have the conversation somewhere private and quiet.
• Sometimes a neutral space outside the workplace will help the person to feel equal and at ease.

Avoid making assumptions

• It can be difficult for people to disclose information relating to their mental health, so make it easier by keeping an open mind and giving them space to talk it out.
• Avoid trying to guess what symptoms an associate might have and how these might affect their ability to do their job.
• Remember, many people are able to manage their condition and perform their role to a high standard.

Embed confidentiality

• People can understandably be anxious about disclosing, so be prepared to assume responsibility for some confidential and sensitive information.
• Reassure the individual that any private information they disclose will not be leaked to their colleagues.
• Discuss with the individual any information they would like shared with team colleagues and how, as this can be very supportive for some people.

Encourage people to talk

• It’s important to have an open dialogue with associates when discussing their mental health.
• Remember, everyone’s experience of poor mental health is different, and how you deal with a disclosure should be entirely dependent on the individual.
• Follow the conversation checklist to explore how the condition manifests itself, what the implications are and what support they need. Respond flexibly
• Mental distress affects people in different ways and at different times in their lives, so be prepared to adapt your support to suit the individual.
• If it works for both of you, work with your associate to develop an individual wellness action plan (WAP).
• Remember, workplace adjustments for poor mental health need not be costly nor require huge changes – they can be simple, as shown below.
• Be aware of the steps to take if you’re concerned the associate may be having suicidal feelings – refer immediately to our mental health first aiders.
• It’s important to recognise that an associate’s performance or behaviour can be affected if they are experiencing a mental health problem.
• If you have specific grounds for concern, such as high absence levels or impaired performance, it’s important to address these at an early stage.
• The support people receive from their line manager is key in determining how well and how quickly they are able to get back to peak performance.

Develop an action plan

• Work with your team member to develop an individual action plan.
• It’s important that the plan identifies the signs of the individual’s mental health problem, triggers for stress, the possible impact on their work, who to contact in a crisis, and what support they need.
• The plan should include an agreed time to review the support measures to check if they have been effective or whether any further adjustments are needed.
• Include a date to follow up on this action plan and set up a subsequent meeting.

Encourage people to seek support

• People should speak to their GP about available support from the NHS, such as talking therapies.
• Be aware that problems in an associate’s personal life can often have a negative effect on their mental well-being.

Reassure people

• People may not always be ready to talk straight away, so it’s important that you outline what support is available.
• Reassure the individual that your door is always open, and they can speak to you as their line manager at any time.
• Let them know you’ll ensure they get the support they need.

Remember that once aware of health or disability information, there may be a legal duty to consider making reasonable adjustments as well as a general duty of care and responsibility for associate health and preventing personal injury.

Wellness Action Plans

The Wellness Action Plan (WAP) is an evidence-based system used to manage mental health.

Huntswood has templates that you can use to develop your action plan to support your team ( hrenquiries@huntswood.com  ).

It is a personalised, practical tool we can all use – whether we have a mental health problem or not – to help identify what keeps us well at work, what causes us to become unwell and the support we would like to receive from our line manager to boost our well-being or support us through a recovery.

We all have mental health just as we all have physical health, and a WAP has been designed to support us all to manage our mental health, wherever we are on the spectrum. As a manager, encouraging your associates to draw up a WAP gives them ownership of the practical steps needed to help them stay well at work or manage a mental health problem. It also opens up a dialogue between you and your team member, to help you better understand their needs and experiences and therefore better support their well-being. This in turn can lead to greater productivity, better performance and increased job satisfaction.

WAPs are also particularly helpful during the return-to-project process, when someone has been off work because of a mental health problem, as they provide a structure for conversations around what support and/or reasonable adjustments might be useful.

A WAP can help associates to develop approaches to support their mental well-being, leading to a reduced likelihood of problems such as work-related stress. If your team member does experience a mental health problem, you will have an idea of the tailored support that could help, or at the least a tool to use in starting that conversation. By regularly reviewing the agreed, practical steps in the WAP, you can support your team member to adapt it to reflect their experiences or new approaches they find helpful. By allowing the individual to take ownership of the process and of the WAP itself, you will be empowering them to feel more in control.

The WAP is not legally binding but is intended as an agreement between you and your associates to promote their well-being or address any existing mental health needs, including any adjustments they may wish to discuss.

Workplace adjustments

Various aspects of work and the workplace can cause substantial disadvantages for people with disabilities. When this happens the Equality Act 2010 says that employers must take reasonable steps to remove the disadvantage. The purpose of the law is to place a duty on employers to address the disadvantages encountered at work by people with disabilities, and the starting point for any consideration of reasonable adjustments should be what difficulties someone is experiencing in the workplace.

‘Reasonable adjustments’ for people with disabilities or health needs are commonly perceived as adaptations to the physical environment where this causes difficulties, such as wheelchair ramps, or communication assistance, such as sign language interpreters. In relation to mental health, more often the obstacles are less tangible and relate to negotiating the social, rather than the physical, world of work. A requirement to work set hours, for example, or the practice of only having occasional supervision might cause a substantial disadvantage for someone with certain mental health problems. Effective adjustments can be simple, low cost and are generally changes in practice or requirements, such as flexible working hours or increasing one-to-one supervision.

What is ‘reasonable’?

An employer is only under a duty to make adjustments that are reasonable, which will depend on the circumstances of the case. Potential adjustments should be considered on a case-by-case basis, but factors which may be helpful to consider include:

• the effectiveness of the adjustment in preventing the disadvantage
• the practicability of making the adjustment
• the extent to which making the adjustment would impact on service delivery
• financial and other costs
• the potential impact on colleagues.

It can be useful for line managers to discuss with the associate the practical implications of any reasonable adjustment request, including what has been done before, the ease/ difficulty of accommodation, any service delivery and team implications, as well as any other relevant issues. Both the associate and line manager need to be clear about the considerations that will be taken into account in reviewing whether an adjustment is reasonable and practicable to implement.

It is best practice to offer support to all associates, whether or not they have a formal diagnosis or a disability according to the legal definition. Allowing flexibility in how and when they perform their role, where possible in line with business needs, can reap rewards in terms of loyalty, increased productivity and reduced absence, and can help normalise mental health and disability in the workplace. The key point to remember is that everyone’s experience of poor mental health is different – so two people with a diagnosis of depression may have very different symptoms and need different adjustments.

This may seem complex, but often the person will be the expert on their condition and know their own support needs. In essence this means managing the person as an individual, in the same way that you flex your general management style. Following a WAP approach and having a dialogue with the associate about what adjustments might help is a straightforward way to identify what support line managers need to put in place.

Often this can be very simple: for example, one person with anxiety requested that her manager remembered to say thank you after she completed a piece of work to prevent self-esteem and paranoia issues spiralling into distress.

Below are some types of adjustments that may help mitigate mental health symptoms and the impact on the associate’s performance at work. They are not prescriptive but associates with a mental health condition have found some or all of these useful in their experience. It is important to always be guided by what the person with the mental health condition says – this list could act as a prompt for line managers and associates to explore symptoms and support needs together.

Possible adjustments

• flexible hours or change to start or finish times; change of workspace, for example quieter, more or fewer people around, dividing screens
• working from home at certain times or on certain days in a given period
• changes to break times
• provision of quiet rooms
• lightbox or seat with more natural light
• agreement to give an associate time off for appointments related to their mental health, such as therapy and counselling
• temporarily changing duties, for example changing the balance of desk work and customer-facing work, reducing caseloads, changing shift patterns
• reallocation of some tasks or amendments to the associate’s job description or duties
• redeployment to a more suitable role
• increased supervision or support from manager, buddy or mentor
• extra help with managing and negotiating workload
• debriefing sessions after difficult calls, customers or tasks
• mediation can help if there are difficulties between colleagues
• identifying a ‘safe space’ in the workplace where the person can have some time out
• encouraging associates to work on building up their resilience and doing things that support good mental health such as exercise, meditation or eating healthily
• providing regular opportunities to discuss, review and reflect on people’s positive achievements – this can help people to build up positive self-esteem and develop skills to manage better their triggers for poor mental health.

Supporting people to return to the project

An important time in managing and supporting someone with a mental health problem is when they are off sick for periods of two weeks or longer. During this time, it is important that the line manager agrees with the associate how often and how they communicate, for example by telephone, email or home visit. In the event that the line manager is the source of the individual’s distress, another colleague should be the person that maintains contact.

Return-to-project interviews

These catch ups are an effective intervention for managing sickness absence. An effective interview can build trust and engagement with the associate and support their smooth and sustainable return to the project.

If the individual is not yet open about their mental health, this meeting is a great opportunity to explore what factors are contributing to their absence and identify if they have an underlying mental health problem. Effective interviews can ensure mental health issues are identified at an early stage, before any work-related problems escalate and the individual’s condition worsens if possible.

Return-to-project interview – tips for line managers

• Tell people they were missed.
• Ask the person how they’re feeling.
• Reassure the associate that they aren’t expected to walk straight back into full-time hours or manage a full-time workload.
• Use open questions that require more than just a ‘yes’ or ‘no’ answer and give people lots of space and time to talk.
• Listen and try to empathise with the associate.
• Ask if there are any problems at work that might be causing them stress.
• Discuss whether there are any difficulties outside work that might be contributing to their absence.
• Talk about the person’s mental health problem, if they have disclosed it, and its possible impact on their work.
• Discuss possible solutions and make sure you are aware of any sources of available support, whether internal or external.
• Help the person think about how they want to manage their return; for example, what they want to say to colleagues.

Returning to the project

The first day back at work is very important. As a manager, you should try to make the event as trouble-free as possible for the returning associate. People are often very anxious about returning to work. They may feel self-conscious about something that happened before they went off sick, or feel they’ve let down colleagues. The manager and associate should decide together beforehand exactly what colleagues will be told about the situation. The individual may like to be met at the workplace door or travel in with you or a colleague. It’s important to check that the returning associate has plans for lunch – possibly with a colleague to whom they feel close.

The manager needs to be proactive during the first few weeks of the individual’s return to work to provide support. It’s important to remember that an associate is unlikely to be fully fit when they return to work, and will need ongoing support as well as possible adjustments to their workload to help ease them back into their work routine, particularly if the absence has been long term.

Return-to-project checklist

While the associate is off sick

Line managers should:

• regularly communicate with the individual via telephone or email, while being mindful not to place undue pressure on the associate to return earlier than appropriate (the approach must be agreed in advance)
• communicate any key project or team developments to keep the individual in the loop, but not so that they feel pressurised to work when off sick
• focus conversations on the individual’s well-being, while being respectful of any boundaries the individual wishes to keep in terms of the details of their condition
• be in touch with the individual’s close colleagues about their health (but only with the individual’s consent)
• with the individual’s consent, encourage work colleagues to keep in touch with the individual
• make it clear that the individual should not rush back to work if they don’t feel ready, and that we are ready to make adjustments such as a phased return if this would help their earlier return
• make it clear that you will support the individual during their absence

Line managers should:

• consider giving the individual lighter duties/ different jobs during their initial return to work
• incorporate a phased return to work for the individual, if appropriate
• remain objective when discussing return-to-project adaptations for the individual
• explain any changes to the individual’s role, responsibilities and work practices
• meet the individual on their first day back
• make the individual’s first weeks back at work as low-stress as possible
• keep in regular contact with the returning associate and regularly ask if they are doing okay.

Managing the team

Line managers should:

• ask the individual about what ongoing information should be shared with colleagues
• make the individual feel like they were missed by the project
• encourage colleagues to help in the individual’s rehabilitation process
• promote a positive working environment

Ongoing support

Line managers should:

• be proactive in arranging regular meetings to discuss the individual’s condition and the possible impact on their work
• communicate openly
• listen to the individual’s concerns
• understand that, despite looking fine, the individual may still be ill
• appreciate the individual’s wishes
• have an open-door policy so the individual can always approach them with any concerns.

Managing performance

Often, the reasons for poor performance are not properly explored, even where a mental health issue is suspected, so the approach from line managers can be only performance based, when it should also recognise any health factors.

This is sometimes driven by misunderstanding or prejudice, as poor mental health can be viewed as an ‘excuse’.

Although we have policies and procedures in place for performance management, where there are suspected or known health issues, these should also be explored, prior to any formal processes. If the root causes of poor performance are not addressed, any solutions are unlikely to fully resolve the issue, so problems can spiral. Performance management should in essence be a positive and supportive process. It is your interest as well as the associate’s interest to discuss potential adjustments and support where appropriate, and help the individual perform to their full potential.

There could be times when performance could be affected, particularly if associates are afraid of disclosing their condition and accessing the support they might need at certain times. An effective service improvement plan should be responsive to people’s needs and take into account any health issues they may be experiencing. It is important to ensure associates are given the opportunity to disclose any health condition that could potentially affect their performance. Line managers should make it clear that any disclosure of a mental health condition will be dealt with in a supportive manner and not prompt disciplinary action.

Discussions or meetings about performance should concentrate on the individual’s work and how it is being impacted, but asking simple, open questions about how the associate is and whether anything is affecting their performance can encourage people to talk about any health issues. It is also useful to explore any other potential workplace issues, such as negative relationships with colleagues, which may be impacting on the associate’s wellbeing and, in turn, their performance. Line managers should not force someone to disclose or suggest they are ill but using the conversation tips to help explore this area in a way that is not intrusive or judgemental.

An effective service should include regular and constructive feedback and discussion. This informal dimension is crucial to encouraging a two-way dialogue and trust-based relationships. This will make it much easier to address any health issues, identify any extra support or coaching the person may benefit from and set timescales for improvements.

For further guidance on managing performance where there are underlying health concerns, please contact your Engagement Manager or Huntswood HR.

Tips for managing underperformance

Each associate will need to be managed on a case-by-case basis, but the general rules of thumb are:

• Focus on the person, not the problem – don’t make assumptions about how mental health affects performance, because people with even a serious mental health condition can still thrive at work.
• Ask simple, open and non-judgemental questions.
• Consider health-related solutions, not just performance-based approaches.
• Make it clear that the organisation is prepared to put in place support or adjustments to help the individual perform to their full potential.
• Allow the associate to be supported in discussions or meetings, for example by an advocate or someone who understands their condition.
• Use mediation to resolve any conflict if necessary/appropriate.

Useful definitions

For the purpose of clarity, when we refer to ‘mental health’ in this guide we are using it in the broadest possible sense.

Some useful definitions are below:

Mental health: We all have mental health, just as we all have physical health. How we feel can vary from good mental well-being to difficult feelings and emotions, to severe mental health problems.

Mental well-being: Mental well-being is the ability to cope with the day-to-day stresses of life, work productively, interact positively with others and realise our own potential. When we talk about well-being, we are referring to mental well-being.

Poor mental health: Poor mental health is when we are struggling with low mood, stress or anxiety. This might mean we’re also coping with feeling restless, confused, short tempered, upset or preoccupied. We all go through periods of experiencing poor mental health – mental health is a spectrum of moods and experiences and we all have times when we feel better or worse.

Mental health problems: We all have times when we struggle with our mental health. A mental health problem is when difficult experiences or feelings go on for a long time and affect our ability to enjoy and live our lives in the way we want. You might receive a specific diagnosis from your doctor, or just feel more generally that you are experiencing a prolonged period of poor mental health.

Common mental health problems: These include depression, anxiety, phobias and obsessive-compulsive disorder (OCD). These make up the majority of the problems that lead to one in four people experiencing a mental health problem in any given year. Symptoms can range from the comparatively mild to very severe.

Severe mental health problems: These include less common conditions such as schizophrenia and bipolar disorder. They can have very varied symptoms and affect your everyday life to different degrees. They are generally regarded as severe mental health problems because they often require more complex and/or long-term treatments.

Work-related stress: Work-related stress is defined by the Health and Safety Executive as the adverse reaction people have to excessive pressure or other types of demand placed on them at work. Stress, including work-related stress, can be a significant cause of illness. It is known to be linked with high levels of sickness absence, associate turnover and other issues such as increased capacity for error. Stress is not a medical diagnosis, but severe stress that continues for a long time may lead to a diagnosis of depression or anxiety, or more severe mental health problems.

Table of Definitions

The table of definitions provides definitions of terms used within the policy document

Policy Responsibilities

The following table defines the business roles and their responsibilities in regard of the policy document.

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