Mental Health and the Workplace

1. Mental Health and the Workplace Developing a programme of mental health awareness to meet the needs of businesses in Kingston

2. Executive Summary Most participants had at least some understanding of mental health. For some there was confusion between mental disability and mental health. Most medium and large organisations have experienced mental health issues in the workplace. Larger organisations have policies that cover mental health but few organisations have specific mental health policies and responsibility for mental health is often spread between a range of departments. Organisations monitor absence and illness, some for performance measures, others to monitor wellbeing and many for both purposes. Many organisations �keep in touch� with employees during sickness absence but others see this is an intrusion. Access to �local� information on dealing with mental health issues would be helpful to both large and small businesses. The Internet is a preferred delivery mechanism for information. There is a need for a reactive service � something that can be called upon when a mental health issue occurs � especially for small businesses Local web and telephone based information must be well publicised.

3. Contents Report Introduction Research Objectives Methodology Recruitment Research Findings Awareness, Understanding & Experience Policies and Responsibilities Recruitment Work Practices Effects of Recession Support and Assistance Recommended Actions for Kingston PCT Appendices Recruitment Questionnaire Depth Interview Questionnaire

5. Research Objectives MVA Consultancy was commissioned by Kingston PCT to undertake qualitative research with local employers about mental health in the workplace. The research sought to understand: how local organisations deal with mental health issues; where responsibility for mental health issues lies; what sources of information and assistance are currently used; and what organisations would find helpful in dealing with mental health issues in the future.

6. Methodology Twenty in-depth interviews were conducted with a wide range of organisations across the Royal Borough of Kingston. Half were conducted in person, and the remainder by telephone. Organisations interviewed came from the public, private and voluntary sectors. The following areas of business were represented: public administration; charity; retail; finance; information technology; personal services; and education. The range of organisations interviewed is shown at Appendix

7. Methodology Organisations were of a range of sizes: small (Less than 50 employees) medium (50-250 employees) large (Over 250 employees). All organisations were located within the Royal Borough of Kingston. Some were part of a larger organisation with headquarters elsewhere in the UK. Interviews were conducted with the person responsible for employees well being. This included human resource and occupational health professionals, managing directors, senior officers and business owners. A donation of �20 was paid to MIND Kingston for each interview conducted.

8. Recruitment The recruitment process began by sourcing lists of businesses in Kingston. These included the Royal Borough of Kingston�s business database; the list of attendees from the Chamber�s April Expo, and discussions with both the Economic Development Team at the Council and the Chamber of Commerce. Potential recruits were telephoned and the purpose and nature of the research was explained (see Appendix 1 for recruitment script). At this stage there were several possible outcomes: interview arranged; interview refused; interest but more information required �> follow up email was sent; passed to another person �> telephone / email as appropriate. Follow ups took place a day or two after initial contact.

9. Recruitment Process

11. 1. Awareness, Understanding & Experience Understanding of mental health Experience of mental health issues Existence of stigma Steps taken to remove stigma

12. Understanding of Mental Health

13. Understanding of Mental Health For many participants mental health went beyond stress and depression. One participant talked about a range of mental health issues from mild depression to psychosis and a few participants referred to more severe mental health issues including schizophrenia and bi-polar disorder. Participants from larger organisations, particularly those with occupational health departments, were likely to have a greater understanding of mental health issues than those from smaller organisations. Knowledge on mental health came from professional training for those who worked in human resources or occupational health. For a few participants knowledge had come from personal experience, both within and outside the workplace. The remaining participants had a limited knowledge gained from a range of sources such as friends, family and the media.

14. Understanding of Mental Health A minority of participants, from smaller organisations, did not view stress and anxiety as mental health issues. These participants saw mental health as an inability to function fully in the workplace and dependent on an individual�s coping mechanisms. For several of these participants stress was a normal part of work. For some participants mental health also meant mental incapacity: one participant felt those with mental health issues have lower intellectual abilities and may need things more thoroughly explained; two participants mentioned learning difficulties as an aspect of mental health. Another participant agreed stress was an aspect of mental health but was unclear as to whether stress was a cause or a symptom.

15. Experience of Mental Health Issues Participants were asked if they had experienced mental health issues in their organisation. Whilst the majority of participants had experience of mental health issues affecting their employees, several participants from smaller organisations were not aware of any mental health issues affecting their staff. One large employer reported 500 cases a year, countrywide, and another said mental health issues affected around 15% of their employees each year. Stress is the most commonly reported mental health issue. Several participants felt this could come from work or home life but one participant said it was usually issues outside the workplace. However participants from all sizes of organisation were likely to perceive stress as potentially an issue both in and outside the workplace. Several participants recognised that there were stresses in their own workplace. Larger organisations aimed to mitigate these stresses as far as practicable but smaller organisations were likely not to have mitigation measures in place. Depression was the next most frequently mentioned issue, with anxiety less likely to be mentioned.

16. Experience of Mental Health Issues One participant was aware of several staff who took anti-depressants. Three participants had experienced staff being diagnosed with bipolar disorder and another reported two staff with schizophrenia. One participant mentioned that a �few� staff had been hospitalised as a result of mental health issues and another reported an employee suicide seven years ago. One participant felt that mental health issues in the workforce were increasing.

17. Organisations with an occupational health department and public sector organisations were more likely to have a positive approach to mental health issues and a supportive culture. Two non-profit organisations mentioned that some of their employees work with clients with mental health issues, so there is no stigma if colleagues have similar issues. Existence of Stigma

18. Existence of Stigma Several participants considered there was definitely a stigma in their organisation, with one saying that employees, especially young males, were unwilling to admit to mental health problems. Another participant positively welcomed the stigma he felt was attached to all illness, not just mental illness. His view was that employees should not take time away from work unless absolutely necessary. Unwillingness of employees to disclose information about mental health issues suggests that stigma does exist, even in some organisations that say it does not exist.

19. Taking Steps to Remove Stigma Few organisations have formal procedures to prevent stigma but many organisations take informal steps to prevent stigma being attached to those suffering mental health issues, and hence feel they have appropriate support structures in place. Larger organisations train managers in awareness, recognising signs, where to go for help and how to tackle mental health issues. One organisation runs diversity training that includes disabilities and another has mental health awareness training. Others felt preventing stigmatisation was embedded in their culture, for example encouraging openness, but took no formal steps. Three organisations tackled stigma informally in group discussions or over a coffee break. Many organisations feel stigma does not exist and therefore feel no action is necessary to remove it. Many say they would act if they felt there was an issue.

20. 2. Policies and Responsibilities Investors in People Mental health policies Associated policies Where responsibility lies Adequacy of policies

21. Investors in People Many organisations, particularly larger ones, are IIP* certified. Some organisations mentioned alternative quality standards (such as PQASSO~ QUILT@ and NHS policies) which are more appropriate to their area of work. Some organisations had been certified but had not kept it up due to funding issues or a move to alternative standards. There was low awareness of the new IIP health and wellbeing standard. Some felt it seemed to overlap with other standards and policies. Improving our Working Lives, HSE and CIPD standards were mentioned. Some large organisations are very interested in working to the new IIP standard. Low awareness and internal processes meant that this was yet to happen. Others planned to investigate to see if it added to existing policy and procedures.

22. Mental Health Policies Organisations tend not to have a specific policy on general mental health but many cover this aspect of wellbeing across several policies. For some organisations these policies were very specific to the nature of their work. Policies mentioned that cover aspects of mental health were: health and safety stress staff vulnerability policies on how HR can support staff violence and aggression dignity at work trauma support mediation service for conflict at work

23. Associated Policies The majority of organisations have policies on anti-bullying and discrimination. Most also carry out regular health and safety assessments. Several organisations have policies that cover bullying and discrimination to some extent, but one saw such policies as only appropriate to larger organisations. A number of organisations also have associated polices on harassment, diversity and equality. One organisation offered �harassment contacts�. Another two organisations had policies relating to dignity at work. A few, usually smaller, organisations had no further policies and appeared to promote an attitude of �just deal with it�. This attitude was not specific to any particular industry.

24. Where Responsibility Lies In small organisations, mental health is the responsibility of CEOs, MDs, or their deputies. In larger organisations, line managers or local office managers are usually the first line of responsibility. Beyond them, responsibility is passed to human resources, occupational health or health and safety managers. Aspects of mental health and wellbeing typically fall between several departments in larger companies � this appears to lead to some confusion over where responsibility lies.

25. Adequacy of Policies Most organisations feel there is room for improvement in their mental health policies � one realised this during the interview. One participant said that mental health was increasing so they should improve the services on offer. Another said their policies did not cover the whole spectrum of mental health issues and so could be improved. Other participants thought that policies were not embedded in company policy but were more reactive and that this could be improved. Several smaller organisations felt their policies were sufficient for their size of organisation. A few larger organisations, with a series of policies, under regular review, felt they did have sufficient policies in place.

26. 3. Recruitment Employing people with mental Health Issues Dealing with mental health issues of new recruits Knowledge of schemes to help those with mental health issues into work

27. Employing People With Mental Health Issues Half of the organisations interviewed reported employing staff with declared mental health issues. One participant pointed out that they were a �2 ticks�* organisation. Some organisations covered mental health issues on application forms. This generally took the form of asking about illness, disability or long term absences and following this up with more detailed health questions following a job offer. One participant collected this information via a tear off anonymous slip on application forms. One organisation thought that asking about such illness was illegal and another said this information was not relevant, it was only important that the applicant could do the job. Smaller organisations had fewer processes in place and some were unsure about what questions could be asked on mental and other health issues.

28. Dealing with Mental Health Issues of New Recruits Larger organisations have clear procedures in place when employing those with mental health issues. This typically involves talking to the individual after a job offer, assessing whether any adjustment to the role is required or whether it is �safe� for the person to do the job. One participant asked employees about their support structures and requested a medical report, if appropriate, and if permission was given. Several participants mentioned considering the levels of stress in the job. Another participant felt they could deal with a staff member with mental health issues in a less �important� role where it would not matter if they took time and a team could cover. One participant specifically mentioned following the two ticks procedure. Several participants had not knowingly employed staff with mental health issues and did not know how they would deal with it. For many organisations it would not make much difference to employ a person with declared mental health issues.

29. Knowledge of Schemes Smaller organisations had little or no knowledge of schemes to help those with mental health issues into work. A number of larger organisations had heard of such schemes, some had participated in them in the past, and would be willing to consider future participation. One smaller company had outsourced work to a packing company that employed a number of young people with mental health difficulties and had been happy with the work done. Another small company was concerned about the cost to them and whether individuals employed through such schemes would be able to do the job. Some organisations would consider using such schemes on a case by case basis � dependent upon the role available and individual ability to do the job.

30. 4. Work Practices Absence policy Returning to work Training for managers

31. Absence Policy Absence recording reported by participants was of two forms: that which is to monitor attendance to ensure employees are at work and performing, and that which is carried out to monitor staff welfare. Some organisations maintain absence data for both purposes. Larger companies monitored absence with concern for the welfare of their employees whereas smaller organisations were more likely to issue a reprimand for absence or poor timekeeping. Some companies lay the onus on the employee to keep in touch during periods of absence but most make contact during prolonged absences, typically by telephone. A few organisations thought staff would not want to be contacted during illness and avoided keeping in touch. Participants set different stages at which to intervene in absence. This can range from a single absence of 4 days, to multiple absences on 3 or more occasions, to an absence of 13 weeks. Contact is usually made by line managers but in some organisations it is a human resources or occupational health function. In one organisation the staff nurse calls as this is seen as less threatening.

32. Absence Policy For some organisations a verbal, followed by a written warning is issued if there are multiple absences. Others see a need for support and put this in place. Short term absence or issues such as poor time keeping are typically dealt with informally. One organisation did not provide sick pay to its employees.

33. Returning to Work Back to work meetings are common, either in person or by telephone. These happen after only short absences with larger organisations but tend to be only after a long absence for those returning to smaller organisations. Some organisations, mainly the larger ones, are able to accommodate staff returning on reduced hours or in a different role following illness. This is usually not possible in smaller organisations. Those organisations with occupational health provision have a clear programme for returners and make regular progress checks. One educational establishment has its own programme �Step into Success� to get people back into study and work.

34. Training for managers Few organisations specifically train managers in dealing with mental health issues. Participants typically referred to training during induction, occasional training, coaching by HR, close working with occupational health or general awareness raising. Several organisations referred to training on mental health issues as part of stress management, health and safety, work life balance or general training on ill health. Only one had a staff member who attended a workshop specifically on awareness of and good practice in dealing with mental health issues, and this person had responsibility for training others. Training was more likely to take place in larger organisations. However in some of these organisations it seemed that take-up depended very much on individual managers. One organisation was considering providing training on mental health issues in the future. Another referred any such issues to a contracted out HR function. One organisation saw no need for such training as they did not consider they had a problem with stressed employees because staff were not expected to work extended hours.

35. 5. Effects of the Recession Effect of the recession Dealing with the effects of the recession

36. Effects of the Recession Most participants were not aware of the recession having an effect on the mental health of their employees but two reported redundancies having taken place, resulting in increased stress / anxiety levels amongst others. Another commented that whilst he had seen no evidence of stress from the recession he assumed there was probably greater stress among employees. Several participants were aware of the potential need to deal with any future issues that may arise from the recession. Some expected mental health issues arising from the recession to come from employees life outside work rather than stress or other factors in the workplace. Several public sector organisations saw potential for mental health issues among staff as a result of working with clients affected by the recession. One participant was bucking the recession and expanding.

37. Dealing with the Effects of Recession Those organisations that had seen no effects of recession had nothing in place to deal with any future effects. Some said that nothing was required. Several participants would like to do more but were limited by time and money. One organisation felt they were covered by an existing employee assistance programme and another had recently expanded their employee benefit programme which offers access to services such as debt counselling. Several participants were at the stage of thinking about possible strategies.

38. 6. Support and Assistance Awareness of existing sources of help and support Information sources used Information which would be helpful Preferred delivery methods Working with larger organisations

39. Awareness of Existing Help and Support Several participants were unaware of any sources of help or support they could access as employers when dealing with mental health issues. Many were also unaware of services their employees could access if they were suffering from mental health problems. The following help and support for employees with mental health problems were mentioned by some participants: support from government programmes and the voluntary sector such as Kingston Workstart, Kingston Mind, Access to Work; the organisations� own doctor (in larger organisations); local government employees groups (in public sector organisations); and employee assistance programmes (in public sector organisations). The following help and support for employers dealing with mental health problems amongst staff were mentioned by some participants: employment consultant � used by one participant organisation in lieu of a human resources department ; community mental health team employment support advisers; and company doctor.

40. Information Sources Used Internal Resources Company occupational health Company doctor Employee Assistance Provider (EAP) Contracted human resources provider Colleagues NHS resources Professional Sources Chamber of Commerce seminars Royal College of Nursing External Resources Internet � especially Google Local government sources NHS providers NHS website / NHS Direct ACAS Official publications Recruitment consultants HSE Health, work and wellbeing website MIND General Practitioner Crisis teams at A&E

41. Information which would be helpful Participants were asked what would help them in dealing with mental health issues in the workplace. Several participants would like access to information at the first signs of mental illness in an employee. Knowing what was available in terms of support, and being able to access it when needed, was key for most participants. Locally based information, delivered over the web or through a telephone helpline would be most useful to Kingston organisations. Several public sector organisations said they would like the PCT to work in partnership with local voluntary organisations and other parts of the health service e.g. on joint training courses. Kingston Voluntary Association had run training on mental health issues in the past and would like to do so again.

42. Preferred Delivery Methods Training Participants would find training in dealing with mental health issues useful, but would prefer it as one session in a wider progamme of management or other ongoing professional training. One participant suggested a module in management tools for dealing with stress. Some said they would use this information to develop into their own courses for managers. Help Line Many thought a helpline would be beneficial, as long as the contact details were well publicised. This type of reactive service would be particularly useful for smaller organisations. Literature Leaflets and other literature would be useful to some but others felt this information might be ignored. Website Web based information would be useful to all participants, particularly if it contained locally based information.

43. Working with Larger Organisations Larger organisations were less likely to identify how they could receive assistance from Kingston PCT. They tended to feel they could deal with mental health problems in their workforce. However some would welcome any additional information or support. Organisations with occupational health services would welcome a more efficient and faster method of referral to mental health specialists. Several larger organisations would like to work together with other local organisations to share information and best practice.

45. Recommended Actions The following are recommended actions which Kingston PCT could consider: Develop a model mental health policy that could be adopted by local organisations. This could set basic principles for smaller and mid sized organisations, and for larger organisations may be an index to existing policies. Provide a well publicised website with key information on how organisations can deal with mental health issues in the workplace. In addition it should provide information on local organisations working with people suffering from mental health problems. Provide / build links with an appropriate, well publicised telephone help line. Involve interested local organisations in developing best practice. Promote local / national schemes such as Access to Work. Act as a facilitator for training and management practices.

47. Appendix 1 : Recruitment Questionnaire

48. How many staff do you employ in Kingston? < 50 ��������� 1 51 � 250 ������. 2 250+ ��������. 3 Are you an organisation from the �? Private sector �..�� 1 Public sector ..���. 2 Voluntary sector �. 3 Are you an organisation that operates �? Locally �������� 1 Nationally .�����. 2 Would you say the majority of staff in the core business of your organisation work in Customer facing roles (face-to-face contact) Office based work with customer contact by telephone / email etc Office based work without customer contact Non-office based work

49. Appendix 2 : Depth Interview Script Introduction Good morning / afternoon. Thank you very much for agreeing to take part in this research. Your contribution is much appreciated. As agreed I�d like half an hour of your time to discuss mental health issues in the workplace. I am from MVA Consultancy, an independent research organisation. We are working with Kingston PCT who want to understand how they can assist businesses in the Borough of Kingston in dealing with mental health issues in the workplace. This could be in relation to management tools to enable employees with mental health issues to stay at and perform well in work rather than taking unnecessary sick leave, helping employees to return to work after a period of illness, or in relation to employing staff who disclose that they have had mental health issues in the past. With your agreement I will be recording the interview. This will be solely for my own purposes so I can write up what we have discussed afterwards. Current understanding To begin with I am going to ask about your current understanding of the term mental health. There are no right or wrong answers I would just like to know what this term means to you. What does mental health mean to you in the context of the workplace? [IF NOT MENTIONED PROMPT WITH] Do you consider stress to be a mental health issue? In your view is anxiety a mental health issue? And, what about depression? [HAVING GATHERED RESPONDENT�S CURRENT UNDERSTANDING GIVE A BRIEF SUMMARY OF THE DEFINITION OF MENTAL HEALTH ISSSUES IN THE WORKPLACE � this can be adapted according to respondent�s level of knowledge on the issue] One in 4 UK residents, and between 15% and 30% of UK employees may suffer from a mental health issue in a given year. This costs businesses �93 Billion in lost working hours, underperformance and sickness payments each year. Mental health issues can manifest as absence, poor timekeeping, underperformance, reduced productivity and lead to an increased risk of errors and poor decision making. Stress, depression and anxiety are all mental health issues in the workplace. Feeling undervalued or suffering from bullying in the workplace is known to lead to mental health issues for some employees. The natural recovery is just 20% for depression and 5% for anxiety disorders so the majority of people need support to achieve recovery from common mental health problems and to help keep them in work. Mental Health In Your Workplace Having discussed your understanding of mental health and told you a little more about the definition of mental health issues I would now like to talk about the mental health of employees in your organisation. Are you aware of mental health issues affecting employees in your organisation? [WE ARE NOT LOOKING FOR ANY PERSONAL DETAILS JUST AN OVERVIEW E.G. ONE MEMBER OF STAFF OFF ILL WITH STRESS LAST YEAR]

50. Do you think there is stigma attached to mental health issues in your organisation? [IF YES HOW DOES THIS MANIFEST ITSELF?] Does your organisation take any steps to remove the stigma from mental heath issues? [IF YES HOW DOES YOUR ORGANISATION DO THIS?] Are you aware that Kingston Workstart can offer help and support to both employers and employees in Kingston? [IF YES WOULD YOU KNOW HOW TO MAKE CONTACT?] [IF NO WOULD YOU LIKE FURTHER DETAILS?] Current Procedures and Policies We have talked about any mental health issues that may occur in your organisation now I would like to ask about what procedures and policies, if any, you have in place in relation to the mental health of employees Is your organisation certified for Investors in People (IIP) Are you aware of IIP new Health and Wellbeing at Work standard? Is this something your organisation is working towards or would consider working towards in future? [IF �CONSIDERING� WHAT WOULD ENCOURAGE YOU TO TAKE THIS FORWARD ] Who in your organisation is responsible for mental health issues (e.g. personnel, hr, organisational health, owner / manager)? Does your organisation have any policies on mental health / emotional wellbeing of employees? [IF YES] Can you provide me with a short summary of these policies? Would it be possible to get a copy of these policies?

51. Are health and safety assessments regularly undertaken in your organisation? Do you ask staff to attend an exit interview at the end of their employment? [IF YES WOULD THIS COVER STRESS AND ANXIETY IN THE WORKPLACE ?] Do you think the current policies / practices in your organisation in relation to mental health are sufficient? [IF NO WHAT ELSE DO YOU THINK YOUR ORGANISATION COULD DO?] Current Climate I would like to talk about anything your organisation is doing differently in the current recessionary climate. In the current recessionary climate are you aware of greater stress on staff? [PROMPT HOW HAS THIS MANIFESTED ITSELF?] Is your organisation putting any further support structures in place to support staff at this time? [PROMPT WHAT HAS BEEN PUT IN PLACE?]

52. Are you aware of schemes to help those with disabilities or health problems (including mental health problems) into work e.g. Access to Work, Pathways to Work? [IF YES] Has your organisation taken advantage of any of these schemes? [IF YES] What has the impact been on your business? [IF NO] Would you consider taking part in this type of scheme? [IF NO] Why not? What do you think could be provided that would assist your organisation in dealing with mental health issues in the workplace? [IF NOT MENTIONED PROMPT WITH] Do you think any of the following would be useful Information about common mental health issues, leaflets for example A telephone helpline to call for information and advice A website to consult for information and advice Training on dealing with mental health issues for key staff Close Thank you very much for participating in this interview. Your contribution is much appreciated. A donation of �20 will be made to Kingston MIND in recognition of your time.

53. Appendix 3 Range of Organisations Interviewed

54. Contact us Name: Ann-Marie Barker Telephone number: 01483 742933 Email: abarker@mvaconsultancy.com Office address: MVA Consultancy, First Floor, Dukes Court, Duke Street, Woking, Surrey GU21 5BH