Published: 24/03/2005, Volume II5, No. 5947 Page 37

The mental health of workers has always been a consideration for occupational health staff in the NHS. This is true whether at pre-employment screening, sickness monitoring or return-to-work support, says Stuart Shepherd

The best practice to meet this need is not written in stone and procedures develop to reflect shifts in the need of the organisation and society. And there are times when those developments move along more quickly than others.

A raft of policy changes that began in 2002 with the Department of Health's Mental Health and Employment in the NHS and expanded recently with amendments to the Disabilities Discrimination Act have had a significant influence on how to approach working with an employee with mental health problems.

What this new approach calls for, as Dr Bob Groves, director of the employment programme at the Sainsbury Centre for Mental Health explains, is an attitudinal shift that goes beyond occupational health and into the NHS as an organisation.

'The policy and practices of occupational health and human resources still exist in a climate of regulation and risk aversion, ' he says. 'For example, equal opportunities often proves to be a stumbling block because It is mis-applied, excluding rather than including.' Bob has been working with the NHS to develop policy and practice in light of the changing demands. 'The DoH mental health document reversed the previous good practice guidelines. The thrust now is to let go of the bureaucracy that sprang out of the Beverly Allitt case [in which a nurse murdered children in her care].

'That doesn't mean getting rid of things like risk assessment when it comes to employing and keeping people at work. It means using it as a tool for supporting the individual rather than the organisation.' Bob believes that change is best introduced by highlighting examples of good practice in the workplace. 'I like to get managers to meet people with mental health problems who have succeeded in employment, thanks to the right support.' He cites the employment policy of London's St George's Healthcare trust as pioneering in its adaptation to more person-centred procedures and principles.

'St George's offers employees treatment and counselling rather than leaving them facing the sack. The chronically sick are also given genuine employment opportunities.

'The NHS can't ask others to do what it is not prepared to put into action itself.

This kind of change is a moral imperative.' Peter Christison spent 18 months at Mid Hampshire primary care trust leading the Healthy Minds in the Workplace programme and now promotes workplace mental health as an independent training consultant. He is well placed to assess the causes of mental illness at work and how trusts can minimise them.

'The key factor in statutory services is the shifting that comes from a neverending stream of new initiatives and targets, which affects workload demand.

People start tasks under a new boss without a sense of finishing what they'd been doing previously. This role conflict and lack of control creates stress.' The statistics support his argument.

Thirty-nine per cent of those working in the public sector will have some form of mental illness at some point, compared to a business sector figure of 27 per cent.

'NHS managers must promote a culture sensitive to these predictors, ' says Peter, 'one open to the value of good two-way communication and supervision'.

'Look out for employees who soldier on regardless. They tend to be the ones retiring on health grounds aged 50.' Thinking about mental health at work also means considering the needs of employees who develop an illness and the recruitment of people with a history of mental health issues.

'According to the [Disabilities Discrimination] act, a mental illness covers clinically recognised conditions but excludes others such as substance abuse, ' says Warren Wayne, a partner in the employment department at legal firm Bird & Bird and an authority on the legal aspects of managing mental health at work.

To avoid discrimination, an employer must make changes to the workplace and working practices to ensure that a person with disabilities is not treated unfairly. They might include allowing an individual returning to work after a period of illness to do so initially on a part-time basis.

'Occupational health experts play a vital role in assessing the adjustments a manager might consider. But it depends on your circumstances. Financial constraints can make implementing them difficult.

'However, a tribunal will want to know that an employer explored every possible avenue. The act's code of practice is a useful tool for confronting these issues.'