Mental Health Awareness Week
This article is being released in Mental Health Awareness Week 2020. For more information check out the Mental Health Foundation website and watch this short video:
Employee stress levels and wellbeing at work: background
Research has consistently shown that employee stress levels have risen in line with the demands of the twenty-first century workplace.
Between 2000 and 2016, the Chartered Institute of Personnel and Development (CIPD) published an annual absence management survey which explored trends, policy and practice in the UK. In 2016, this survey found that stress and mental ill health were among the most common causes of long-term absence (together with acute medical conditions, musculoskeletal injuries and back pain) (see CIPD: Absence Management Survey 2016). It noted that:
- The most common cause of stress remained workload, followed by non-work relationships, management style and personal health issues.
- While public sector and non-profit organisations that ranked stress among their top five causes of absence were particularly likely to be making efforts to address it, nearly two-fifths of private sector organisations that similarly ranked stress were not doing so.
- The most common methods used to address stress were staff surveys, risk assessments or stress audits, as well as flexible working options or other steps to improve work-life balance.
- Most organisations took some action to promote good mental health, with many providing training for line managers to more effectively identify and manage stress in their teams. Provision of employee assistance programmes (EAPs) and counselling, as well as involvement of occupational health specialists, were common in larger organisations.
- Presenteeism (people coming to work when unwell) was growing in prominence, particularly in organisations where long working hours were the norm. As in previous years, this was associated with stress-related absence and mental health problems.
The absence management survey has now become “health and wellbeing at work”. While it continues to monitor trends in absence management, the survey has an increased focus on health and wellbeing policies and practice. The CIPD reported in 2019 that mental ill health was increasingly prevalent as a cause of both short and long-term illness and remained one of the most common causes of long-term absence. The same report also confirmed the rising culture of presenteeism was potentially more harmful to individuals and business than sickness absence. It considered that this could be masking more deep-seated organisational issues that could be undermining people’s health and wellbeing at work, such as unmanageable workloads (which was again identified as by far the greatest cause of stress). The report noted that while employers can introduce exemplary wellbeing policies and make serious investment in employee health, these would not have a real impact unless people were managed well, with there being a supportive and inclusive culture and committed leadership. (See CIPD: Health and Wellbeing at Work (April 2019).)
The Health and Safety Executive (HSE) is an executive non-departmental public body which regulates and enforces health and safety law. It suggests that the total number of cases of work-related stress, depression or anxiety in 2017/18 was 595,000 (44% of all work-related illnesses). The HSE also found that the total number of working days lost due to work-related stress, depression or anxiety was 15.4 million in 2017/18, an average of 25.8 days per case. (See HSE: Work related stress, anxiety and depression statistics in Great Britain 2018 (31 October 2018).)
Understanding stress and mental health
What is stress?
The HSE defines stress as “the adverse reaction people have to excessive pressures or other types of demand placed on them” at work (see HSE: Work-related stress and how to tackle it). The World Health Organisation (WHO), which was set up as the lead agency for international health by the United Nations, aims to promote good health worldwide. The WHO’s definition of work-related stress is similar to the HSE’s, since it suggests that it is “the response people may have when presented with work demands and pressures that are not matched to their knowledge and abilities and which challenge their ability to cope”.
While stress is a reaction or a response and will not normally amount to an illness itself, it may result in or be a trigger for illness. The effects of stress may manifest themselves in both mental conditions, such as anxiety and depression, and physical health problems such as heart disease.
There is sometimes confusion between stress and pressure. It is healthy for staff to have challenges to meet and, while challenges produce pressure, pressure can have a beneficial effect in improving performance and job satisfaction. Too much pressure can, however, result in stress and be harmful to health. Similarly, unhappy relationships with managers, colleagues or clients or undertaking an unsuitable job can result in stress which may, in turn, lead to ill health.
The WHO notes that:
- Stress occurs in a wide range of work circumstances but is often made worse when employees feel they have little support from supervisors and colleagues, as well as little control over work processes.
- There is often confusion between pressure or challenge and stress and sometimes it is used to excuse bad management practice.
In May 2019, the WHO announced that burn-out was to be included in the International Classification of Diseases as an occupational phenomenon (which is a factor that influences health status or contact with health services, but which is not a medical condition). It suggests that burn-out is a result of chronic workplace stress that has not been successfully managed and which is characterised by an employee experiencing all of the following:
- Feelings of energy depletion or exhaustion.
- Increased mental distance from their job, or feelings of negativism or cynicism related to their job.
- Reduced professional efficacy.
It can be difficult to identify staff who are under stress, particularly when an employer might not be aware of factors external to the workplace that might be involved. Lives outside work (for example, relationship breakdown, financial worries or bereavement) can lead to stress, or they can compound pressure at work and result in stress.
Some of the possible signs of stress are set out below.
|Declining or inconsistent performance||Arriving late to work|
|Uncharacteristic errors||Leaving early|
|Loss of control over work||Extended lunches|
|Loss of motivation or commitment||Absenteeism|
|Lapses in memory||Reduced social contact|
|Increased time at work||Elusiveness or evasiveness|
|Lack of holiday planning or usage|
|Arguments||Criticism of others|
|Irritability or moodiness||Shouting|
|Over-reaction to problems||Bullying or harassment|
|Personality clashes||Poor employee relations|
What is mental health?
The Acas guide on promoting positive mental health at work defines mental health as “our emotional, psychological and social wellbeing; it affects how we think, feel and act and how we cope with the normal pressures of everyday life” (see Acas: Promoting positive mental health at work (June 2019)). It notes that positive mental health is rarely an absolute state and that factors inside and outside work affect mental health so that an individual moves up and down on a spectrum that ranges from good to poor. It gives two examples:
- An employee may have generally positive mental health but a relationship break-up may trigger a period of depression moving them into poor mental health.
- An employee with a mental health condition, such as anxiety, may have developed good coping strategies and so for most of the time, they experience good mental health.
The WHO defines good mental health as:
”A state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.”
In October 2017, the Department for Work and Pensions, in co-ordination with the Department of Health, published Thriving at work: the Stevenson/Farmer review of mental health and employers (Stevenson/Farmer Review). Written by Paul Farmer (chief executive of Mind) and Dennis Stevenson (former HBOS chair), it suggested that “the correct way to view mental health is that we all have it and we fluctuate between thriving, struggling and being ill and possibly off work” (page 5).
This raises the question of what a working environment which is conducive to good mental health looks like. The WHO suggests that:
- A healthy job is likely to be one where the pressures on employees are appropriate in relation to their abilities and resources, to the amount of control they have over their work, and to the support they receive from people who matter to them.
- As health is not merely the absence of disease or infirmity but a positive state of complete physical, mental and social wellbeing (WHO, 1986), a healthy working environment is one in which there is not only an absence of harmful conditions but an abundance of health-promoting ones. These may include continuous assessment of risks to health, the provision of appropriate information and training on health issues and the availability of health-promoting organisational support practices and structures.
- A healthy work environment is one in which staff have made health and health promotion a priority and part of their working lives.
Stress, mental health and disability
A person who is suffering from work-related stress or mental ill health may be “disabled” for the purposes of the Equality Act 2010 (EqA 2010):
“A person (P) has a disability if P has a physical or mental impairment, and the impairment has a substantial and long-term adverse effect on P’s ability to carry out normal day-to-day activities”. (Section 6(1).)Section 6(1) Equality Act 2010
An employer needs to bear in mind the consequences of an employee being protected by the EqA 2010. By taking steps to manage stress and mental wellbeing at work, an employer may be able to avoid an employee developing a mental impairment or, where an employee has or develops an impairment, the employer can ensure it meets its obligations (for example, by making reasonable adjustments).
Workplace stress and health and safety law
All employers have a duty to take reasonable care for the safety of their employees; they have a duty to see that reasonable care is taken to provide them with a safe place of work, safe tools and equipment, and a safe system of working. A detailed consideration of workplace health and safety law, which is highly regulated and enforced by the HSE, is outside the scope of this note. However, the Health and Safety at Work etc Act 1974 imposes a general duty on employers to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all their employees. In particular, the Management of Health and Safety at Work Regulations 1999 (MHSW Regulations) impose the following specific duties on employers:
- Undertaking risk assessments. An employer needs to undertake a “suitable and sufficient” assessment of the health and safety risks that employees are exposed to at work. The purpose of the assessment is to identify measures the employer needs to take to comply with the statutory requirements and prohibitions. The employer needs to review the assessment whenever there is reason to suspect that it is no longer valid or there has been a significant change in the matters to which it relates. Where the employer employs five or more employees, the significant findings need to be recorded as does any group of employees identified as being especially at risk. (Regulation 3.)
- Applying the principles of prevention. Where an employer implements any measures as the result of a risk assessment, the employer needs to apply the “principles of prevention” set out in Schedule 1 (regulation 4). Those relevant to stress are:
- avoiding risks;
- combating risks at source;
- developing a coherent overall prevention policy which covers technology, organisation of work, working conditions, social relationships and the influence of factors relating to the working environment; and
- giving appropriate instructions to employees.
- Providing information to employees. An employer needs to provide “comprehensible and relevant information” to employees about the risks to their health and safety identified by the assessment and the measures that will be implemented as a result (regulation 10(1)).
The MHSW Regulations also require employees to tell their employer (or health and safety representative) about either of the following that affects their health and safety or that arises out of or in connection with their work (and which has not previously been reported):
- Any work situation which, given their training and instruction, the employee reasonably considers represents a serious and immediate danger to health and safety.
- Any matter which, given their training and instruction, the employee reasonably considers represents a shortcoming in the employer’s protection arrangements for health and safety.
Generally, health and safety legislation does not create rights for employees to sue employers directly for damages in the event of a breach by the employer. The HSE penalties levelled on employers are criminal sanctions (fines or imprisonment (or both) in serious cases) resulting from enforcement action taken by the HSE.
However, the scope of the common law duty of care under the law of negligence is influenced by the employer’s obligations under health and safety law. Failure by an employer to comply with regulations may assist an employee in establishing the extent of the employer’s duty to prevent an employee being made ill by stress at work. It may also assist an employee in establishing the breach of the common law duty by the employer and whether an injury to the employee was reasonably foreseeable.
The HSE publishes a wide variety of advice and guidance for employers and employees. It has developed the Management Standards approach to managing the risks to employees from work-related stress, which it describes as an organisational, preventative process. The Management Standards are six “main areas of work design” (demands, control, support, relationships, role and change) which, if not properly managed, are associated with poor health, lower productivity and increased accident and sickness absence rates. In relation to each area, the HSE sets out the standard to be achieved and what the employer will need to do to meet that standard. The Management Standards approach is intended to help employers prepare for and conduct an appropriate step-by-step risk assessment and gives ideas for what to do when they have the results.
HSE Management Standards for work-related stress
The HSE’s Management Standards cover six key areas of the way in which work is designed (demands, control, support, relationships, role and change) which are considered below. They are also set out in Appendix 6 to the HSE’s workbook Tackling Work-Related Stress Using the Management Standards Approach which looks at practical ways in which the standards can be achieved.
Demands covers issues such as workload, working patterns and the working environment.
The HSE Management Standard is achieved when:
- Employees indicate that they are able to cope with the demands of their jobs.
- Systems are in place locally to respond to any individual concerns.
For this to happen:
- Employers should provide employees with adequate and achievable demands in relation to agreed hours of work.
- Skills and abilities should be matched to the job demands.
- Jobs should be designed to be within employees’ capabilities.
- Employees’ concerns about their work environment should be addressed.
Control covers how much say a person has in the way they do their work.
The HSE Management Standard is achieved when:
- Employees indicate that they are able to have a say about the way they do their work.
- Systems are in place locally to respond to any individual concerns.
For this to happen:
- Where possible, employees should have control over their place of work.
- Employees should be encouraged to use their skills and initiative to do their work.
- Where possible, employees should be encouraged to develop new skills to help them undertake new and challenging pieces of work.
- The employer should encourage employees to develop their skills.
- Employees should have a say over when breaks can be taken.
- Employees should be consulted over their work patterns.
Support concerns the encouragement, sponsorship and resources provided by the organisation, line management and colleagues.
The HSE Management Standard is achieved when:
- Employees indicate that they receive adequate information and support from their colleagues and superiors.
- Systems are in place locally to respond to any individual concerns.
For this to happen:
- The employer needs to have policies and procedures to adequately support employees.
- Systems need to be in place to enable and encourage managers to support their staff.
- Systems need to be in place to enable and encourage employees to support their colleagues.
- Employees need to know what support is available and how and when to access it.
- Employees need to know how to access the required resources to do their job.
- Employees should receive regular and constructive feedback.
Relationships includes promoting positive working to avoid conflict and dealing with unacceptable behaviour.
The HSE Management Standard is achieved when:
- Employees indicate that they are not subjected to unacceptable behaviours, for example, bullying at work.
- Systems are in place locally to respond to any individual concerns.
For this to happen:
- The employer needs to promote positive behaviours at work to avoid conflict and ensure fairness.
- Employees need to share information relevant to their work.
- The employer needs to have policies and procedures in place to prevent or resolve unacceptable behaviour.
- The employer needs to have systems in place to enable and encourage:
- employees to report unacceptable behaviour; and
- managers to deal with unacceptable behaviour.
Role looks at whether people understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles.
The HSE Management Standard is achieved when:
- Employees indicate that they understand their role and responsibilities.
- Systems are in place locally to respond to any individual concerns.
For this to happen:
- The employer needs to ensure that, as far as possible, the different demands it makes of employees are compatible and that these are clear.
- The employer needs to provide information to enable employees to understand their role and responsibilities.
- The employer needs to have a system in place to enable employees to raise concerns about any uncertainties or conflicts they have in their role and responsibilities.
Change concerns how organisational change (large or small) is managed and communicated in the organisation.
The HSE Management Standard is achieved when:
- Employees indicate that the organisation engages them frequently when undergoing an organisational change.
- Systems are in place locally to respond to any individual concerns.
For this to happen:
- The employer needs to provide employees with timely information to enable them to understand the reasons for proposed changes.
- The employer needs to ensure adequate employee consultation on changes and provide opportunities for employees to influence proposals.
- Employees need to understand the probable impact of any changes to their jobs and, if necessary, be given training to support those changes.
- Employees need to be aware of timetables for changes and to be given access to relevant support during changes.
Undertaking a Management Standards risk assessment
The HSE’s Management Standards represent a set of conditions that are intended to:
- Demonstrate good practice through a step-by-step risk assessment approach.
- Enable assessment of an employer’s current situation using pre-existing data, surveys and other techniques.
- Promote active discussion and working in partnership with employees and their representatives, to help decide on practical improvements that can be made.
- Help simplify risk assessment for work-related stress by:
- identifying the main risk factors;
- helping employers focus on the underlying causes and their prevention; and
- providing a yardstick by which organisations can gauge their performance in tackling the key causes of stress.
The HSE recommends a five-step approach to risk assessments for work-related stress. By following this correctly an employer will demonstrate that it has taken a “suitable and sufficient” approach to its duty to undertake a risk assessment to protect employees from stress at work. The HSE also recommends undertaking the following preparatory work:
- Senior management needs to understand both the business case for stress management and the employer’s legal duties. As a result, it should commit to tackle work-related stress and provide adequate resources (particularly time) to do so.
- Ensure that employees and their representatives are committed to participate in the process. It is important for an employer to remember that staff may need support to participate effectively. For example, line managers may want more information about the Management Standards process and staff may need assistance when being asked to participate in workplace surveys.
- Set up a steering group. This group will typically include senior and line managers, health and safety managers, trade union health and safety representatives, employee representatives as well as representatives from human resources and occupational health.
- Develop a project plan.
- Develop a communications and employee engagement strategy.
The HSE points out that while undertaking a risk assessment is concerned with preventing and managing common health problems and improving the performance of an employer’s organisation, the process is continuous. The evaluation and monitoring activities suggested as the final step (see Step 5: monitor and review the action plan and assess effectiveness) should merge into everyday management after the assessment has been undertaken. Employers may also need to review their existing policies and procedures (for example, their anti-bullying and harassment or sickness absence policies) in the light of findings from their risk assessments.
Step 1: identify the stress risk factors
This involves members of the steering group, and others involved in the project, gaining a clear understanding of the six Management Standards (demands, control, support, relationships, role and change and considering how these map onto the employer’s organisation.
The HSE suggests that employers should first focus on organisational level issues that potentially impact on a group and possibly large numbers of employees since it is more effective to remove a stressor or significantly reduce its impact than it is to manage lots of individual cases. Once the employer has put in place an organisational approach, it needs to consider how to help those who may already be experiencing problems.
Before moving to the second step, the members of the steering group and others involved in running the risk assessment process should have a clear understanding of the Management Standards approach, including:
- The six standards.
- How the approach translates to their organisation.
- Work-related stress risk factors that may be specific to their organisation or workplace.
- A focus on preventing and managing the root causes of work-related stress.
- A focus on exploring organisational level issues.
For further information, see HSE: Stress Management Standards: Step 1: Identify the risk factors.
Step 2: decide who might be harmed and how
The second step requires the steering group to assess any gap between the employer’s current performance and the position that the Management Standards seeks to achieve. This can be done by data gathering and analysis.
There are likely to be existing sources of data that can be used to identify the extent to which work-related stress is a problem in the organisation. Most employers collect data about sickness absence (whether through self-certification or fit notes) and staff turnover and their use of exit interviews. Productivity data that shows a lower than expected performance (when compared with previous years or between different parts of the organisation) may indicate a problem. Information may also be available from disciplinary action, staff or union complaints, and comments made in team meetings or at performance appraisals.
The HSE recommends using more than one source of data and for employers to look for consistency in the messages they are giving. For example:
- If a single team has a few disciplinary issues, it may indicate poor management, dissatisfaction with the work or dissatisfaction with how work is organised.
- If a team has a high staff turnover and sickness absence rate, this may demonstrate a stress problem.
- Where sickness absence coincides with periods of high work demand.
- Where one particular department is suffering from high staff turnover.
The Management Standards approach suggests using a survey as one (but not the only) source of information on whether work-related stress appears to be a potential problem and, if so, who is likely to be affected and how. A survey is not an essential step and for smaller organisations it would not be proportionate to use a survey, particularly where the same data can be gathered in other ways.
The HSE has produced a survey tool, the HSE Management Standards Indicator Tool, which consists of 35 questions about working conditions known to be potential causes of work-related stress, which correspond to the six Management Standards, to be answered by employees. Their responses can then be compiled into the HSE Management Standards Analysis Tool, which produces an analysis of the scores given in responses, giving an average figure for each of the six Management Standards between 1 (poor performance) and 5 (achieving the standard). The results of the survey can be shared with the workforce, although it is the start of the risk assessment process and a broad indicator of the employer’s situation in an organisation.
For further information, see HSE: Stress Management Standards: Step 2: who can be harmed and how.
Step 3: evaluate the risks and develop solutions
The initial information obtained from step 2 can be explored and possible solutions considered using a representative sample of the employer’s workforce. This might be done using focus groups or discussion groups. This will enable the employer to explore the main potential sources of excessive pressure in the workplace and to consider possible solutions. The HSE recommends limiting groups to between six and ten people, especially if the topics are sensitive or complex and the employer is looking to develop solutions. The number of groups will depend on the size and structure of the organisation, available resources and, most importantly, the results of the data analysis from step 2.
Developing solutions is seen as the most difficult part of managing the causes of work-related stress. The focus or discussion groups should aim to produce a set of suggested actions aimed at addressing specific issues. Where an employer has used several focus groups it will normally be for the project team or steering group to collect and prioritise the suggested actions. A key outcome is the creation of a preliminary action plan in relation to which the HSE suggests considering the following factors:
- Identifying the type of intervention required:
- primary interventions. These focus on addressing issues at source, preventing the problem from continuing and having an adverse effect on employee health. Primary interventions are the ideal type of intervention and are normally the most cost-effective;
- secondary interventions. These focus on helping employees deal with the situation (but do not address the underlying cause of the problem); and
- tertiary interventions. These are aimed at improving the health of employees who have been made ill by their work and if absent, help their return to work.
- The level of the organisation at which the intervention will be aimed. This can be:
- strategic: where the issue is having a detrimental impact on the performance of employees across the organisation;
- macro: where an issue is affecting a particular team or group of employees; and
- micro: where an issue is affecting an individual and where interventions can be important as they demonstrate that the employer is listening to such concerns and is taking action to address them.
- The time period over which action will be taken:
- action in the short term enables an intervention to be designed to give the employer the opportunity for a “quick win”;
- action in the medium term will be required for an intervention to deliver results in months rather than days or weeks (in which case the employer should consider how employees will be kept informed of progress); and
- action in the long term will be required where an intervention will not deliver a positive outcome for a number of months or possibly years (in which case it will be important to consider how employees will be kept informed of progress).
In its workbook on the Management Standards approach, the HSE makes some suggestions for interventions for each of the Management Standards. These are not intended to be pre-packaged, off-the-shelf interventions, but as a resource to use to when employers are considering their own interventions.
Step 4: record findings
By this stage the employer should have consulted its workforce, explored areas of concern and taken initial steps to develop some proposed solutions. The HSE suggests that the employer should produce and share an action plan. Not only will his enable the employer to record its findings but the action plan can be used to:
- Prioritise and set goals to work towards. Actions should be given an order of priority, be created to adequately tackle an issue, have sufficient resources allocated to achieve this and an agreed realistic timescale for completion.
- Demonstrate that the employer is serious and committed to addressing concerns.
- Review progress as measures are put in place to address areas or issues of concern.
Step 5: monitor and review the action plan and assess effectiveness
The final step of the Management Standards approach is for the employer to continue to assess the actions it is taking to tackle any identified causes of work-related stress. This will involve:
- Monitoring the action plan to ensure agreed actions are being implemented.
- Evaluating work being undertaken to ensure that it is effective.
- Deciding what further action is needed. If agreed actions are not proving to be effective, the employer should consider what alternatives could be pursued. If they are effective the employer might consider rolling them out to other parts of its organisation.
It may also be appropriate for the employer to review its strategy following major changes (such as a restructuring or redundancy exercise) or on a periodic basis to ensure that it captures changes in its organisation.
Where an employer conducted a survey as part of its approach it is suggested that the employer repeat the process as part of a “continuous improvement” model, perhaps on an annual basis.
Guidance on the HSE Management Standards
The HSE has produced:
- How to tackle work-related stress: A guide for employers on making the Management Standards work. This is intended to support employers implement the Management Standards approach by offering step-by-step guidance and practical examples through “What works at work?” suggestions. It emphasises the importance of effective line management and the behaviours needed to successfully manage the causes of stress at work.
- Tackling work-related stress using the Management Standards approach: a Step-by Step Workbook. The workbook has been written with a view to assisting employers meet their legal duty to assess the risks to its employees from work-related stress and gives advice and practical guidance on how to manage work-related stress. It promotes the Management Standards approach to tackling work-related stress using a step-by-step method (including checklists) to help employers ensure they have completed each step in the process.
- Working together to reduce stress at work: A guide for employees. This looks at what the Management Standards should mean to employees, how they can participate in their employer’s implementation of the standards as well as what action they should take if they feel that they are becoming stressed at work.
Guidance has also been issued jointly by the HSE, CIPD and Investors in People (see CIPD: Preventing stress: Promoting positive manager behaviour).
The Trades Union Congress (TUC) has published a guide to help union safety representatives encourage employers to work with them to implement the HSE stress management standards (see TUC: Tackling Workplace Stress using the HSE Stress Management Standards: Guidance for union health and safety representatives).
Acas has issued an advisory booklet, which expands on the HSE’s approach, focusing on providing practical examples of how employers can tackle stress in the workplace. In particular, Acas refers to two factors that often determine the nature of the relationship between employers and employees: policies and behaviours. (See Acas: Advisory booklet: Stress at work.)
Taking steps to manage mental health at work
Since mental health is integral to how staff feel about their jobs, how they perform and how they interact with colleagues and clients, Acas guidance notes that it will be in an employer’s interests to:
- Improve mental health awareness within its organisation.
- Tackle the causes of work-related mental ill health.
- Create a workplace culture where staff feel able to talk about their mental health.
- Support staff who are experiencing mental ill health.
(See Acas:Promoting positive mental health at work (June 2019) (Acas Guide).)
As the Acas Guide observes, to fulfil these objectives an employer will need to recognise what mental health is, identify the causes of mental ill health in the workplace, recognise the stigma associated with mental health and consider how this can be removed from its workplace.
In October 2017, the Stevenson/Farmer Review set out a ten-year “vision” of reducing the number of those leaving work with mental health problems, so that:
Employees in all types of employment would have “good work”, which contributes positively to their mental health, to society and the economy.
Everyone would have the knowledge, tools and confidence, to understand and look after their own mental health and the mental health of those around them.
All organisations, whatever their size, would be:
- equipped with the awareness and tools to not only address but prevent mental ill-health caused or worsened by work;
- equipped to support individuals with a mental health condition to thrive, from recruitment and throughout the organisation; and
- aware of how to get access to timely help to reduce sickness absence caused by mental ill-health.
The proportion of people with a long-term mental health condition who leave employment each year is dramatically reduced and everyone who can benefits from the positive impacts of good work.
The review proposed six “mental health core standards” that could be implemented across all workplaces at little or no cost. These require employers to:
- Produce, implement and communicate a mental health at work plan. This should promote good mental health for all employees and outline the support available for those who may need it.
- Develop mental health awareness among employees. This should be done by making information, tools and support accessible.
- Encourage open conversations about mental health and the support available when employees are struggling. During the recruitment process and at regular intervals throughout employment, appropriate workplace adjustments should be offered to employees who need them.
- Provide employees with good working conditions and ensure they have a healthy work life balance and opportunities for development.
- Promote effective people management through line managers and supervisors. All employees should have regular conversations about their health with their line manager, supervisor or organisational leader who should, in turn, be trained in effective management practices.
- Routinely monitor employee mental health and wellbeing. Employers need to talk to employees and identify and understand risk factors.
The Stevenson/Farmer Review also outlined a series of more ambitious “enhanced” standards for employers who they considered could and should do more to lead the way, by building on the core standards. The review recommended that these be adopted by all public sector employers and by private sector employers with more than 500 employees. These require employers to:
- Increase transparency and accountability through internal and external reporting. This would include a leadership commitment and outline of the organisation’s approach to mental health. As regards reporting:
- internally, employers should consider producing an annual report on mental health, potentially within a report on wider employee health and wellbeing, to be shared with all employees. The report could include a statement from the person responsible for the employer’s mental health plan, priorities for the next period, relevant data such as staff survey results, sickness absence data, engagement in mental health activities or take up of support and mental health disclosure rates. Employees should be given the opportunity to give feedback on this report; and
- externally, employers should consider sharing information with board members or through their websites or annual reports.
- Demonstrate accountability. A health and wellbeing lead should be nominated at board or senior leadership level, with clear duties and responsibilities.
- Improve the disclosure process. Openness should be encouraged during recruitment and throughout employment, ensuring employees know why information is needed. The right support should be in place to support a good employer response following disclosure.
- Ensure provision of tailored in-house mental health support and signposting to clinical help. This should include digital support, employer-purchased occupational health or EAPs, or NHS services, among others.
Mental health plans
A mental health plan should encourage and promote good mental health of all staff and an open organisational culture. It should outline the approach to improving and protecting the mental health of all employees, including any awareness activities or training, and the support available to employees who need it. The plan can be developed collaboratively with employees, through informal discussion for small and micro employers, but should include mental health champions or other leads in larger organisations.
Between them, the Acas Guide and the Stevenson/Farmer Review make the following suggestions for inclusion in an employer’s mental health plan:
- The employer’s commitment to promoting positive mental health, what its objectives are and how it intends to measure itself against those objectives.
- How the employer intends to identify and tackle the causes of mental ill health in its workplace.
- How the employer is improving the physical environment to improve employee health.
- How the employer encourages and supports employees to engage in physical activity, staff networks or social action.
- The support available for staff experiencing mental ill health.
Employers may choose to engage in national initiatives, such as Mental Health Awareness Week (which has been run by the Mental Health Foundation since 2001; see Mental Health Foundation: Good mental health for all) and World Mental Health Day (which is recognised by the WHO on the 10 October each year).
Some employers may choose to set out their approach through a policy which addresses work-related stress, mental health and wellbeing. Whether they use a plan or a policy, employers can link their commitment and proposals to other plans in the organisation, including strategies to improve staff engagement, corporate social responsibility plans, and supportive and proactive sickness absence policies.
Raising mental health awareness
Awareness of mental health encourages individuals to care for themselves and to help provide support for others. As the Acas Guide notes, an employer that understands mental health is better able to support and encourage staff to be open about their mental health. To fully understand mental health, it considers that employers should:
- Recognise what mental health is and what mental ill health means.
- Identify causes of mental ill health in the workplace.
- Recognise the stigma associated with mental ill health and consider how this can be removed from its workplace.
- Know its legal obligations to staff.
All staff should be trained to understand mental health issues. Who can provide that training will depend on whether senior managers or members of an employer’s HR department have themselves received appropriate training. It may be appropriate to use a qualified external trainer. Training should cover:
- The employer’s commitment to promoting mental wellbeing.
- The relevance of the law on equality and discrimination to mental health at work.
- Standards of behaviour expected of all staff.
- What staff can do to improve and maintain their own mental wellbeing.
- How to spot the signs that they, or someone else, may be experiencing mental ill health.
- Who they should go to if they need help and support. For example, their manager, mental health champion or mental health first aider
An employer should train managers to deal with mental ill health. The role of a manager is to support team members to be healthy and motivated so that they can perform at their best. Managers need training to spot the signs that one of their team might be starting to suffer from mental ill health, have the confidence to approach the matter and have the means to support the individual in work or, if they need to take time off work, to support them back into work when they are well enough to return. To enable managers to be confident in dealing with mental ill health they should receive training to:
- Become more emotionally intelligent and improve their self-awareness and social-awareness.
- Understand the common types of mental ill health, the differences between them and how to spot the signs of mental ill health.
- Understand the types of support and possible adjustment that may assist a team member suffering from mental ill health and be able to refer them to services provided by the employer or to external support.
Where employers do not have resources to train all managers, they should consider designating a number of managers to be mental health champions
Mental health should be discussed with employees to create an environment in which employees feel able to talk openly. Engaging with external campaigns to address stigma can be a good first step, and encouraging staff networks and groups of individuals with similar interests and experiences can encourage openness. Managers and supervisors should have regular conversations with their employees so that they have the chance to raise issues. Giving and receiving feedback, as part of a positive management process, can help identify problems early on.
Trade union and other employee representatives can also have a role in promoting positive mental health at work. They are often trained in, or have experience of dealing with, mental health issues and can assist an employer in identifying areas of concern and can suggest how similar issues have been dealt with successfully in other organisations. Representatives can also be a source of support for employees experiencing mental ill health, especially when employees are not yet ready to talk to their manager. The Acas Guide suggests that it can be useful for an employee’s representative to attend meetings with them to provide reassurance and help them speak more openly.
The Acas Guide notes the mixture of means of communication that are available to employers to promote positive mental health, remind employees of their training and ensure that they do not revert to old habits:
- Team meetings. These are a good way to regularly discuss how the team are feeling about workload and upcoming challenges and to encourage team members to consider their own mental health and what affects it. Talking about mental health in team meetings normalises the topic. While it is likely that some members take a more active role, managers should encourage everyone to participate.
- One-to-one meetings. These provide regular opportunities to discuss mental health, check on how a team member is doing and identify any issues early. This provides an opportunity for a team member to raise personal information that they do not want to share in a team meeting.
- Informal workplace chats. These should be a normal part of workplace life with managers regularly working around their team. This can help them check on how staff are doing and whether they are any issues that may be affecting the mental health of their team.
- Mental health awareness week. This can be used as a focal point to ask staff to think about their mental health and for initiatives such as talks by people who have experienced mental ill health sharing their insights. In addition to staff sharing their experiences, it can be an opportunity for the employer to remind staff of its commitment to positive mental health.
- Noticeboards. Whether physical or online, a noticeboard is a fixed place for an employer to share general information and key messages about mental health.
- Newsletters and email. These are useful for general communications and for keeping staff up to date with any actions the employer is taking to improve mental health in the workplace.
Mental health champions
The Acas Guide suggests that in larger organisations, making senior managers responsible for putting support processes in place can help to prioritise mental health and drive change across the organisation. Those managers could be designated as mental health champions and their role should include:
- Raising mental health awareness across the organisation to normalise the topic.
- Promoting positive and preventative approaches to good mental health.
- Seeking thoughts from staff on how to improve mental health across the organisation.
- Being available to speak to staff and provide support.
However, it is should be recognised that while staff can be encouraged to speak to their manager, or a mental health champion, regarding concerns about their mental health, they may find it easier to speak to someone who is not a manager. Therefore, an employer should consider alternative means of supporting staff and, where it has the resources, it could designate colleagues to be mental health first aiders.
Mental health first aiders
A mental health first aider is intended to be a member of an employer’s workforce who has been trained to recognise the signs and symptoms of common mental health illnesses and who can effectively guide a colleague towards the right support. Many employers have physical first aiders who are on hand to deal with accidents at work and the government has been petitioned to make it a legal requirement for workplaces to have someone trained in mental health first aid.
There are many training providers who offer courses to train staff in mental health first aid (these appear to take one or two days). Some of the issues in training and using mental health first aiders are considered below.
Employers may wish to begin by piloting mental health first aiders in part of their organisation to establish what works for them before rolling it out more widely (depending on the structure of the organisation and the demands on the workforce). For some organisations it may be worthwhile aiming to have as many mental health first aiders as physical first aiders. For multisite organisations, employers should consider ensuring that there is always a mental health first aider available to support employees at each location.
Regular refresher training is also recommended for mental health first aiders (half a day’s training) every three years, in line with physical first aid training.
Who should train to be a mental health first aider?
When considering who should be a mental health first aider, it is suggested that an employer should consider the following issues when deciding who to train:
- Applications for training should be sought from a wide range of individuals in order to represent the diversity of the employer’s workforce. Factors to take into account include seniority levels, locations, gender and ethnic backgrounds.
- Applicants should want to learn more about mental health to support others, regardless of whether they have experienced mental ill health themselves. All applicants (not just those who have disclosed personal experience) must understand what the role will involve and have considered their own wellbeing to decide if they wish to proceed.
- A mental health first aider needs to demonstrate an ability to relate well to others and be trusted to maintain confidentiality (where appropriate).
- To be effective, a mental health first aider will be someone who spends most of their working hours on site at the workplace for which they are nominated, who can commit to the time required and can be called away from their normal duties at short notice if needed.
The role of a mental health first aider
Any member of staff who is appointed as a mental health first aider should have a clear understanding of the expectations and boundaries of their role.
The employer needs to identify the specific responsibilities that it has decided that the organisation’s mental health first aiders are going to be asked to perform and how these fit in with their job duties. It is important to recognise the limits to the role of a mental health first aider. The type of training available means that they will not be counsellors. They should not be asked to provide ongoing support but rather should be a point of contact who can reassure a person who may be experiencing a mental health issue or emotional distress, and signpost them to professional support. They should therefore be familiar with the process for signposting colleagues to support, both within the workplace (for example, through Human Resources or EAPs), and to external organisations. They should only make themselves contactable during work hours and should not give out personal contact details.
Red Umbrella recommends that mental health first aiders should record the support conversations they have with colleagues on an anonymous basis, using a standard form. The guidance also suggests that confidentiality never applies when a person appears to be a danger to themselves or others, when it may be appropriate to contact someone in the employer’s organisation and the emergency services.
Support for mental health first aiders
Once an organisation has mental health first aiders in place, Red Umbrella recommends setting up a first aider network which should be overseen by a Human Resources representative or the person who is leading the initiative. The network should meet regularly and be an opportunity to remind mental health first aiders to be conscious of their own wellbeing.
Mental health first aiders should have a point of contact with whom they can raise any questions or concerns about their role, or if they need support themselves. They should be encouraged to take a break or step down from the role if they feel they need to, and to communicate this with their named contact.
Making staff aware of mental health first aiders
Everyone in the employer’s organisation should know who its mental health first aiders are. For example, the employer should:
- Put their contact details alongside the physical first aiders’ contact details in key areas around the workplace such as the photocopier, kitchen or toilets.
- Put each first aider’s name, photograph and contact details on the intranet.
- Give first aiders lanyards, badges or distinctive email signatures for easy identification.
- Include contact details of all first aiders in new starter induction packs.
- Include information in return to work interviews or packs so employees who have been off work unwell are reminded of the support available to them, including how to contact a first aider should they need to.
- Hold a launch event linking in with an awareness campaign such as World Mental Health Day.
Good work and good working conditions
The Stevenson/Farmer Review observed that:
”Good work consists of autonomy, fair pay, work life balance and opportunities for progression, and the absence of bullying and harassment. Good work can help prevent new mental health problems and support those with existing conditions to get on in work and thrive.”
The review also notes that job security, good working conditions, education and training, staff consultation and representation are part of the provision of good work.
The Acas Guide suggests that an employer will need to identify how it could change its workplace to improve the mental health of its staff. In particular, it suggests that employers should:
- Tackle the work-related causes of mental ill health.
- Provide additional resources to support staff.
- Work with trade unions and employee representatives.
The employer needs to identify what areas of the workplace might be a cause of mental ill health. Gathering information on staff turnover, sickness absence and performance absence can be a good starting point. Staff should be involved in this process as they will be aware of what the employer does well, and which parts of its organisation need to improve. Involving staff can give them a sense of ownership in the programme and can lead them to commit to resultant changes. Larger employers can do this through staff surveys or team meetings while in smaller organisations managers can talk to staff on a one-to-one basis to get their views.
The Acas Guide notes common workplace causes of mental ill health and suggests possible solutions:
- Unmanageable workloads or demands. Job roles should be reviewed or redesigned to ensure that their demands are reasonable and appropriate. Job descriptions should be clear and enable staff and their managers to properly understand the duties and tasks of each role. Support and additional training should be provided to enable staff to manage their workloads effectively.
- Poorly defined job roles and responsibilities. The targets and objectives of a job should be closely aligned to the organisation’s own goals. Induction processes should provide a new member of staff with an introduction to their role, how it fits within their team and the organisation as a whole.
- Lack of control over work. Staff should be given as much control over their work as is practicable. For example, they should have clearly defined objectives but be allowed to control how they approach the task. Staff should be involved in workplace decisions that affect them. For example, team meetings and employee surveys or staff forums should be used to seek their views on how the organisation might be improved and to inform them of how their suggestions have been considered and actioned where practicable.
- Unhealthy work-life balance. Staff should be encouraged to consider flexible working arrangements to help them meet their responsibilities outside work and reduce the stress these can cause. They should take the breaks (such as a lunch break) they are entitled to during the day and take their annual leave entitlement each year.
- Poor relationships with management or colleagues. Managers should provide positive feedback promptly in response to good work and should have regular one-to-ones and catch-ups with their team members to help build good working relationships. Managers should have an open-door policy for team members to discuss any problems with them. Discipline and grievance procedures should be clear and any complaints should be investigated thoroughly and fairly.
- Organisational change or job insecurity.Staff should be involved in any decisions that may affect them and be kept updated about potential changes. Suggestions from staff should be considered and the reasons behind a decision fully explained to them. Employers need to be honest with their staff, even if that means giving bad news.
- Lack of variety in work. Job roles should be reviewed or redesigned to reorganise working processes and create more varied responsibilities. For example, rotate duties between staff working at the same grade. Staff should understand why their work is important.
- Limited career progression opportunities. Employers should discuss how staff might be developed further to benefit them and the organisation. Opportunities should be identified, for example, further education, training courses, or the delegation of work for staff to acquire new skills or experience.
Monitor mental health and wellbeing
How an employer approaches measuring staff wellbeing will depend on its size. Most employers will hold basic information about their staff, including sickness absence data, return-to-work interviews after sickness absence, performance appraisals and information provided in team meetings and one-to-one meetings with staff, which can be used to spot problems and provide support. Employers can also use staff surveys and other tools to improve communication with employees and better understand risks to mental health.
Occupational health and other support
As one of the steps it takes to address work-related stress and mental wellbeing in its workplace, an employer will need to consider how it can provide support and assistance to employees.
Employee assistance programmes (EAPs)
Many employers provide support to their employees through an EAP or independent confidential counselling service. An EAP can provide round-the-clock support for staff dealing with a range of personal problems that might have an adverse impact on their wellbeing, health and performance at work.
The Employee Assistance Professionals Association is a not-for-profit organisation that represents the interests of individuals and organisations concerned with employee assistance, psychological health and wellbeing in the UK. For details of of EAP providers, see EAP: Association: The voice of UK employee assistance.
Occupational health service and other professional advice
There will be times when the impact of work-related stress or the nature of mental ill health being suffered by an employee means that an employer needs to take detailed advice. For example, where an employee is on sick leave, the employer will need advice on when they are likely to return and of any adjustments that need to enable them to do so successfully. In other cases, an employee may still be at work but requires adjustments to enable them to remain at work.
It may be that the employee is themselves best placed to tell the employer what changes will assist them. If they are referred to occupational health, the employee may tell an occupational health adviser what they would otherwise tell the employer or they may feel able to be more open with the adviser (rather than feeling that they are making “demands” of their employer). The employer also ought to consider whether an occupational health adviser, as a generalist, is best placed to advise or whether the input of a mental health specialist should be sought at an early stage.
There are a range of possible adjustments that might be suggested to enable an employee to continue working:
- Changes to how the employee performs their role:
- flexible working whether in changed start and finish times or working from home;
- changes to the workspace, by finding a quieter area for a desk (perhaps by using dividing screens) or a desk by a window for natural light or using a lightbox;
- changes to break times; and
- allowing time off to attend therapy or counselling sessions.
- Changes to the employee’s role (on a temporary or permanent basis):
- temporary change to duties (for example, changing shift patterns, reducing caseloads, reducing customer-facing work);
- reallocation of some of the employee’s tasks or amendment of the employee’s job description or duties; and
- redeployment to a more suitable role.
- Support in their role:
- increased supervision or support by manager, buddy or mentor;
- debriefing sessions after particular tasks;
- access to a mental health support group; and
- identifying a “safe space” where the employee can take time out where needed.
For further information on taking medical advice, including the processing of information about an individual’s health which is “special category data” under the GDPR. From 6 April 2020, the scope of non-taxable welfare counselling services will include related medical treatment, such as cognitive behavioural therapy, when provided to an employee as part of an employer’s welfare counselling services.
Stress and mental wellbeing policies
An employer may choose to set out its approach towards stress and mental wellbeing (whether resulting from acts inside or outside the workplace) in a policy. Staff then have a central reference point from which they can understand the employer’s position and be directed to resources that they may need.
A policy should be created in consultation with staff and their representatives where possible and may include:
- The employer’s commitment to promote positive mental wellbeing and to tackle the causes of work-related stress.
- The aim to provide a workplace where everyone feels able to talk openly about their mental health and not fear discrimination, bullying or harassment. There should be clear and open channels of communication and effective methods of investigating reported workplace incidents or unacceptable behaviour.
- Advice on the measures that will be taken to monitor and, where necessary, eradicate work-related stress and to support mental wellbeing at work. These may include:
- including stress in risk assessments in which case the policy can set out how stress risks are going to be assessed, how they will be carried out and who will be responsible;
- explaining the role and expectations of managers and supervisors. For a policy to be effective, managers need to be trained to assess and manage the risks of stress on an ongoing basis. Employers need to be clear about what they require managers to do and how they will be enabled to do it; and
- training for managers (who will implement the policy) and for staff (to raise awareness and develop skills).
- Recognition of the impact that work-related stress or mental ill health may have on performance or behaviour and a commitment to provide appropriate support and adjustments where possible. For example, an employer may commit to making reasonable adjustments to job roles and working conditions to accommodate disabled employees or reduce causes of stress, where possible and necessary.
- A request that anyone who feels that they are suffering from work-related stress or mental ill health seeks help at the earliest opportunity in the knowledge that the employer will do its best to support them.
- Details of all support services in place to tackle work-related stress or mental ill health. An employer should indicate how it will make internal support available whether by providing training and workshops on work-life balance and the avoidance of stress, facilitating mutual support groups (encouraging staff to informally support each other), appointing mental health champions and mental health first aiders or dedicating members of its HR department as points of contact. It should also state what, if any, external support is available such as EAPs or occupational health advisers.
- The processes it will use to reintegrate staff absent from work due to stress or mental ill health back into the workplace.
Employers should ensure that they can (and do) follow through on commitments made in a mental health at work policy. As with all policies, a stress and mental wellbeing policy should be kept under review to ensure that it remains relevant and achieves its aims.
Confidentiality and data protection issues
Information about a person’s mental health is particularly sensitive. Employers should make clear those circumstances in which employees can expect the confidentiality of that information to be respected and those where it may be necessary to share information. If employees are to be encouraged to seek assistance, they need to understand how information that they share will be treated. For example, an employer may use its policy on stress and mental wellbeing to indicate a primary expectation of confidentiality for information that the employee shares with mental health first aiders, mental health champions, the employer’s HR department or any support services (such as an EAP) that it provides. However, it should also clarify those circumstances in which information may need to be shared, for example where an employee is seeking adjustments (in order that these can be considered), where an employee is raising a grievance or making an allegation of bullying or harassment (in order that these may be investigated and any necessary internal proceedings undertaken), or where there is a safeguarding issue. In those circumstances the employee can be given the opportunity to agree a course of action with the employer.
Employers need to be careful in their approach to confidentiality when asking an employee to see their occupational health adviser, or other medical specialist, since they will be asking the employee to give the adviser permission to share information about their health with the employer.
In limited circumstances, an employer may be faced with a decision as to whether to share information about an employee’s mental health with third parties, regardless of the employee’s wishes, because the employee is threatening harm to themselves or others. An employer again may use a policy to make clear that in those circumstances it will take action it considers to be appropriate in the circumstances and this may include contacting an employee’s next of kin, an occupational health provider or the emergency services.
Information about a person’s health constitutes “special category data” under the GDPR and Data Protection Act 2018, so particular obligations apply to the processing of such data. The general prohibition on the processing of the special categories of personal data does not apply in specified circumstances which include those where:
- The data subject has given explicit consent for one or more specified purposes. For further consideration of this ground,
- It is necessary for carrying out rights and obligations under employment law.
Where an employer issues privacy notices to staff it is likely to have highlighted the potential to process special category data in these cases.
Given that carrying out rights and obligations under employment law includes ensuring health and safety at work and a safe working environment, it appears that processing data in relation to an employee’s mental health will be permitted by the GDPR in the circumstances anticipated above. Nevertheless, sensitivity is required for the maintenance of ongoing trust if the employer wishes to encourage openness about mental health in its workplace.
Voluntary reporting on disability, mental health and wellbeing
On 22 November 2018, the Department for Work and Pensions and the Department of Health and Social Care published a framework to support employers to report voluntarily on disability, mental health and wellbeing in the workplace (see DWP: Voluntary reporting on disability, mental health and wellbeing). The framework was produced following the recommendation in the Stevenson/Farmer Review that employers should report more information about their actions on workplace mental health on a voluntary basis.
The framework is aimed at large employers with over 250 employees but can be used by smaller employers who are keen to drive greater transparency in their organisations. The framework recommends that employers produce a narrative explaining the action they have taken to recruit and retain disabled employees and to support the mental health and wellbeing of their employees.
The framework itself is a two-page guide “to support employers to take a first step on the journey to greater transparency”. There are two separate reporting recommendations: the first for disability and the second for mental health and wellbeing which is considered below. The publication also considers the benefits of voluntarily reporting information and how it can be a useful tool for employers with case studies. Where to report information is a matter for the employer. For those who chose to report publicly, the Voluntary Reporting Working Group recommend that annual reports are the most suitable place.
Mental health and wellbeing: reporting recommendation
It is intended that employers will report on Part A and Part B:
- Part A is the provision of a narrative to explain the action the employer is taking to support the mental health and wellbeing of its employees. The framework notes that information should provide context, be accurate and complete. It suggests a non-exhaustive list of information which should address:
- employee take up of mental health support offered by the organisation;
- the training offered to employees related to mental health;
- the percentage of individuals within the organisation that are comfortable disclosing information about their mental health; and
- whether a public commitment has been made to adhere to both the care and enhanced standards as set out in the Stevenson/Farmer Review and how they are being achieved.
- Part B contains a number of questions that provide a starting point to measure employee wellbeing, including the following from the Annual Population Survey carried out by the Office for National Statistics:
- overall, how satisfied are you with your life nowadays?
- overall, to what extent do you feel that things you do in your life are worthwhile?
- how happy did you feel yesterday?
- how anxious did you feel yesterday?
This article is reproduced with thanks to Thomson Reuters and Practical Law under licence.