NHS Employers is working with managers to ensure staff’s mental health problems are finally given as much attention as physical ailments, writes Jennifer Trueland

Mental health problems, including stress, account for more than a third of sickness absence in the NHS, and trends suggest that this is getting worse.

This is clearly a serious issue for managers, for the NHS and for patients and service users, as well as for the individuals who are experiencing the problem.

Historically, looking after staff mental health and wellbeing has not been a priority, but this should be set to change: a plethora of high level policy documents – from No Health Without Mental Health to the government’s response to the Francis Report – make it clear that public sector employers have an important role in supporting the mental health and wellbeing of staff.

Twin challenges

According to Ruth Warden, head of employment services at NHS Employers, managers face the twin challenges of dealing with staff who have mental health problems and attempting to create a workplace environment which promotes wellbeing and good mental health more generally.

“There is still a stigma around talking about mental health problems, and there’s also the paradox that we are health organisations looking after other people, but we don’t know how to look after ourselves. Clearly that’s not the case everywhere, but it’s the perception, and it’s something we have to deal with.”

‘There’s the paradox that we are health organisations but we don’t know how to look after ourselves’

It’s something that NHS Employers is taking seriously, she says. “From our perspective, we are continually trying to provide support and guidance for line managers to fill the gaps in competence, or confidence, in dealing with these issues. We want line managers to know there are things they can do, and that support is available.”

Skilling up managers to recognise that there are practical steps they can take to support members of staff with mental health problems is important, she says, but that’s not the whole story.

“Yes, there are things like flexible return to work, but there’s also talking to staff about triggers, so that work can be arranged around that. It’s about having open conversations about mental health at any point, not only when something has happened.”

NHS Employers wants to support managers in thinking about the workplace and how it can promote mental heath and wellbeing, she adds. “We want to help line managers to think through what they would do if someone has mental health problems,” she says. This could involve noticing that a member of staff isn’t coping very well, and talking to them in an open and non-judgmental way about whether they need extra support.

Exemplar employer

Changing cultures in workplaces more generally is also important, she says, and managers can lead by example. That means making it clear that reasonable adjustments for people with mental health problems are just as important as those for people with physical problems.

“If I come into work with a broken leg, people will understand that it hurts, and that I might need help, but a mental health problem is more difficult for people to understand,” she says. “People struggle with what to do.”

‘If I come into work with a broken leg, people will understand that it hurts, but a mental health problem is more difficult for people to understand’

As well as having conversations about people’s wellbeing, managers should make it clear that the conversation is an ongoing one, she adds, so that staff feel able to raise issues subsequently if they wish.

NHS Employers’ role is in supporting organisations to put that into practice, she says. “It’s getting organisations to see the improvements they can make.”

Leading by example

Public Health England is also trying to promote the importance of mentally healthy workplaces throughout the public sector and, says director of health and wellbeing Kevin Fenton, is making every effort to become an exemplar employer itself.

“In public health, there’s a general understanding of the importance of mental health and wellbeing. Organisations where there is good staff engagement and which promote wellbeing are more productive and have better morale – it really has an impact on the bottom line.”

‘Organisations where there is good staff engagement and which promote wellbeing are more productive and have better morale’

PHE wants to see a greater recognition of the prevalence of mental ill health, believing that it should be given the same weight as physical health issues and that organisations should be open and transparent about it.

PHE “means business” on this, he says, and has signed up to the Public Health Responsibility Deal Pledge on Mental Health, Wellbeing and Resilience, setting out a public commitment to do more to train line managers to support staff early. As an organisation, PHE has also put in support measures like Big White Wall and Mental Health First Aid, which teaches people to recognise signs of mental health problems and signposts help.

Good business sense

According to Tony Vickers-Byrne, director of human resources at PHE and chair of its Health and Work Programme Board, it also makes good business sense to take mental health and wellbeing at work seriously.

Although the latest figures on workplace absence show that some 40 per cent of sickness is stress-related, that’s only the people who take time off, he points out. “There are a significant number of people who are coming into work but suffering from mental health issues. That has a significant impact not just on their productivity but on that of their teams.

‘There are a significant number of people who are coming into work but suffering from mental health issues’

“What we’re trying to do is train managers to spot the early symptoms in staff and to support them.

“People spend so much of their time at work that managers have a real opportunity and a responsibility to help staff.”

To that end, NHS Employers has published a number of resources to help line managers to support staff and to promote mental health and wellbeing in the workplace. Its managers’ guide is divided into two sections: on creating and supporting a positive culture around mental health and wellbeing in the workplace; and how to support staff who are experiencing mental health problems.

“I’m not saying this is easy,” says Ms Warden. “But staff resilience is something that a lot of organisations are recognising as important. There will always be change in the health service, and change can be difficult, so it’s about developing resilient teams, and the line manager is key to that, because he or she has a big impact on the wider workforce.”

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