Common mental health problems Mental health is a positive attribute and something that we all have. It is about more than whether we experience mental health problems, and is not about whether or not we have a diagnosed mental illness. Many things affect our mental health, including having good relationships, coping skills, and feeling respected. An important contribution to mental health is having employment or some form of meaningful activity. The following commonly agreed definition of mental health emphasises a positive sense of wellbeing, resilience to cope with life s difficulties, and self-esteem: Mental health is the emotional and spiritual resilience which enables us to enjoy life, and survive pain, disappointment and sadness. It is a positive sense of wellbeing and an underlying belief in our own dignity and self-worth. Anyone can experience stress at work, depending on the demands of their job, the conditions in which they work and their individual susceptibility, which can be increased by problems outside work. Common symptoms of stress include: increased anxiety and irritability impaired sleep and concentration verbal or physical aggression reduced attention span and impaired memory. Early recognition of signs of stress is crucial to prevent it becoming more serious. Most people make a full recovery, often without needing to take time off work. Individuals should be encouraged to seek help from their GP, from the occupational health service if there is one, or from another professional. It can be difficult to know when stress turns into a mental health problem, or when existing mental health problems are made worse by stress at work. The term mental health problems covers a wide range of conditions. This factsheet aims to help you understand more about some of the most common mental health problems stress, anxiety, depression, bi-polar disorder and schizophrenia. Remember that we are all individuals, and two people with the same diagnosis may experience very different signs and symptoms and behaviour. Stress Stress is the adverse reaction people have to excessive pressure or other types of demand placed on them. If pressure is excessive and goes on for too long, it can lead to mental health problems such as depression and anxiety, and can also increase the risk factors for coronary heart disease, such as smoking and unhealthy eating. Stress can be caused by factors at work or at home, with the latter being the more frequent cause. How people cope with pressure will be affected by a variety of factors including the amount of support the person has from friends, family and work, as well as their personal coping mechanisms. Anxiety Anxiety is a normal response to stress or uncertainty, but problems arise if it becomes too great to handle and stops the individual coping with everyday life, including work. There are different types of anxiety. Generalised anxiety is anxiety that affects a person all the time. Phobias lead to extreme fear of a particular object or place. In obsessive-compulsive disorder, certain words or ideas keep coming to mind, causing anxious feelings. For people with panic attacks, anxious feelings may come out of the blue. Common symptoms of anxiety include: agitation sleep disturbance difficulty in concentrating loss of appetite or excessive appetite physical symptoms such as headaches, stomach disorders or palpitations panic attacks. Recovery can be greatly helped by support received from people at home and from managers and colleagues at work. Treatment aims to help the person reduce the symptoms of 80 Think fit! Think well!
anxiety to an acceptable level so that they do not interfere with day-to-day living. People can help themselves by learning to relax, doing more physical activity, and learning more about their symptoms. Depression This is one of the most common forms of mental health distress. We all go through difficult phases in our lives. Depression is used to describe a range of moods, from low spirits to a severe problem that interferes with everyday life. Depression is only a significant problem if it lasts for more than two weeks. Common symptoms of depression include: low, depressive mood with negative thoughts about self and others numbness, emptiness and despondency lack of interest in life and motivation to do things difficulty in concentrating social withdrawal lack of appetite, or comfort eating sleep disturbance increased use of alcohol, tobacco or other drugs feelings of guilt self-neglect anxiety suicidal thoughts or thoughts of self-harm. Over 80% of people with severe depression can be helped quickly, 50% will recover with only minor relapses, and 25% will recover completely. 1 Recognising that someone is experiencing depression and supporting them to seek help and treatment will reduce needless distress and speed their return to normal performance at work. little or no sleep, or waking early reckless decision-making, or lack of inhibitions in extreme cases, delusions or hallucinations. Bi-polar disorder can be managed successfully with support, medication and other forms of treatment, and many people make a full recovery. Schizophrenia Schizophrenia is a term used by mental health professionals to describe a condition where thoughts, feelings, beliefs and experiences are severely disrupted. Roughly a quarter of people diagnosed will recover completely, two-thirds will have multiple episodes and 10% to 15% will experience more enduring problems. 3 Many people with schizophrenia lead full and fulfilling lives that include having relationships, children, work and study. Common symptoms of schizophrenia include: strongly held beliefs which are out of keeping with the person s background and usual way of thinking hearing voices paranoia seeing, tasting, smelling or feeling things that are not there believing that people, events or objects control thoughts and actions in a way that cannot be logically explained confused or muddled thinking or speech loss of feelings. First symptoms of schizophrenia tend to be experienced by men in their 20s and women in their 30s. Bi-polar disorder This is a disorder that affects a person s moods. These mood changes can be extreme and unpredictable. Most often there is a high period alternating with a low period, with a stable period in between. It is difficult to generalise about how the illness will affect someone. About 1 in 100 of the general population is likely to develop bi-polar disorder. 2 Common symptoms of bi-polar disorder include: elated mood with no obvious cause periods of deep depression lack of energy, or boundless energy and restlessness rapid speech and disordered thoughts References 1 Stewart G, revised by Darton K (2007) Understanding Depression. London: Mind. 2 Singleton N, Bumpstead R, O Brien M et al (2001) Psychiatric Morbidity among Adults Living in Private Households. London: Office for National Statistics. 3 Hill F (2005) Understanding Schizophrenia. London: Mind. For details of organisations that can provide more information about mental health problems, see Resources, in Part 4. Think fit! Think well! 81
The early warning signs of stress and mental health problems Most people will experience aspects of stress at work at times, and no employer can totally prevent this. However, when employees become so stressed that their health and functioning are affected, there will usually be characteristic signs and symptoms. The earlier you can pick up on a problem, the better. Whether the issue is stress-related or a mental health problem, action taken early can help stop the problem escalating. Any of the following can be a sign that something is wrong, and as an employer or manager you need to take appropriate action to help. Signs of stress in an individual An increase in unexplained absences or sick leave Poor performance Poor time-keeping Increased consumption of alcohol, tobacco or caffeine Frequent headaches or backaches Withdrawal from social contact Poor judgement or indecisiveness Constant tiredness or low energy Unusual displays of emotion, eg, frequent irritability, anxiety or tearfulness. Signs of group-level stress Problems with recruitment Disputes and disaffection Increased staff turnover Increased grievances and complaints. These can all be signs that stress has built up to such an extent that an individual may be in danger of developing more severe anxiety or depression. Effective help in the early stages can help to prevent long-term problems both for individuals and for the organisation. Clearly this should be sensitively handled or the intervention may exacerbate the problem. The emphasis should be on providing reassurance and giving the individual the opportunity to talk about how they are feeling and encouraging them to seek help. For more information about stress, the early signs of stress, and how to deal with it, see Resources, in Part 4. 82 Think fit! Think well!
Managing people with mental health problems Managers need the information and skills to manage a person who has a mental health problem, is distressed, or is off sick or returning to work after an absence due to a mental health problem. Managing someone with a mental health problem Try to enable the employee to continue to contribute to the organisation for as long as possible. Regular review of progress, as part of the normal annual appraisal scheme, is essential. Focus on achievements and successes, not on the disability. Encourage the person to assess his or her own performance. If there have been any changes, establish why. Consider how existing adjustments might be made more effective, for example, part-time working, job-sharing or working from home. Establish whether medical advice is needed from the person s GP, or from occupational health or another health professional. Agree with the individual what they want colleagues to be told. When an employee is in distress Be accepting, calm and reassuring, and ask the person how you can help. Try to find or make private space. Ask the person what they would like someone to talk to or to be left on their own, or to contact someone from home or a close work colleague. Explore if work is a factor in their distress and ensure the person knows what kind of support the organisation can offer. When the person is calm, he or she may wish to carry on working, or it may be appropriate to suggest they take some time out or go home early. Keeping in touch during sickness absence It is important to keep in touch with the person while they are off work, so that they know they are not forgotten and that support is available. Keep in touch. Reassure the person about practical issues such as financial worries, and job security. Ask if there is anything you can do to help. Reassure them about confidentiality. Assisting return to work Effective planning about return to work should involve the individual and his or her line manager and, where appropriate, their GP, and occupational health or human resources if your organisation has these. Discuss whether any adjustments to the person s job or working conditions are needed (see page 76). Agree how progress will be monitored. Ensure the person does not return to a massive build-up of work, such as a huge number of emails. Be realistic about workloads. Give positive and constructive feedback. Discuss what colleagues will be told. Make the person feel welcomed back. Absence management Work-related stress is now recognised as a significant cause of absence from work. Stress may result from a variety of underlying causes, including: poor, unsafe working conditions boredom work overload perceived lack of control over work activities job insecurity worry over career and promotion prospects workplace relationships stress from some cause outside work. Looking at sickness absence One way to assess levels of stress in your organisation is to look at patterns of sickness absence. Some level of absence is inevitable, but high levels of employee absence are costly. Employee absence needs to be handled sensitively. Reviewing absence patterns Conduct a systematic review of your absence patterns to identify trends or issues that may be affecting your workplace for example, certain areas of the organisation consistently experiencing high levels of sickness, or certain times when absence is high. If absence is widespread across the organisation, this may be related to the overall culture of the organisation. If particular departments or work groups experience higher than average levels of absence, you need to target these Think fit! Think well! 83
and investigate the reasons. It may be due to the nature of the work they do, management styles, or the physical environment in which a particular department or group works. Or it may be a few individuals who make up most of the days off work. Record the following information: name of employee date of first absence cause of absence (to include the categories of stress-related and long-term chronic illness which may include mental illness) whether the illness or injury is considered to be work-related working days absent date the employee was last contacted, and outcome expected length of absence, if known, and return-to-work date. Identifying the underlying reasons for sickness absence patterns Use: interviews with managers and team leaders group sessions with samples of employees questions incorporated into annual staff attitude surveys. Return-to-work interviews Conduct return-to-work interviews for all staff who have been absent. This should be carried out by the person s immediate supervisor or manager. Use the interview to identify the cause of absence and explore any problems: Ask for the reason for the absence. Assess whether the reasons offered are consistent with other reliable evidence. Raise any doubts, and allow the employee to explain. Keep some written record in case the formal disciplinary procedure needs to be invoked in future. Identifying solutions If stress is identified as the cause of absence, identify solutions, such as: interventions through the occupational health department, if you have one Employee Assistance Programmes individual counselling organisational change, eg, in work design, management style, communications or resources. Setting a target for improving sickness absence You could set a target of, for example, reducing sickness absence by 1 1 /2 days per employee per year, or by 10% per year for a particular department. 84 Think fit! Think well!
Mental health awareness training Training courses on mental health awareness are designed to help create a work environment where resilience is enhanced and mental wellbeing is protected, allowing people to respond positively to challenges and perform at their best. Any training provided will need to be tailored to the needs of your organisation, including the culture, working environment, or particular issues relevant to mental wellbeing and stress for example, if your organisation is about to have a major reorganisation, or down-size, or move site. Training needs to be simple, cost-effective and focused on benefiting all involved. Training for employees Training for employees should aim to enable them to: develop skills to recognise when colleagues need support at work and gain confidence in handling difficult conversations or situations value differences and recognise the strengths individuals bring to the team experience reduced levels of stress, leading to a more pleasant and productive working environment identify sources of potential stress and recognise the importance of achieving a healthy work/life balance recognise potential problems in themselves or colleagues and know what to do contribute to a workplace culture that promotes mental wellbeing and reduces stress know some simple steps they can take to look after their own mental wellbeing. Training for managers Training for managers should aim to enable them to: develop skills to recognise when a person needs support at work and to gain confidence in handling associated management situations identify potential sources of stress and put systems and practices in place to reduce the impact on staff achieve reduced levels of stress for staff and enhanced effectiveness of teams lead successful teams, contributing to a productive and profitable organisation recognise potential problems in themselves and their staff and know what to do about them communicate more effectively when handling challenging management situations recognise how management style and the culture of the organisation can impact on the mental wellbeing of staff apply learning to reduce levels of stress and enhance the effectiveness of the team. Formats for training Training needs to be interactive, providing a variety of group and individual exercises, case studies, scenarios, questionnaires, group discussion, personal reflection and action planning. Sample course contents Managing stress What is stress and what is stress risk management? Early identification of stress and stress-related problems Stress and the law, including the HSE Management Standards Case studies Creating a good climate Stress prevention exercise How do you react? Behaviour management strategies to minimise risk Stress scenarios, appropriate support and adjustments Individual stress risk assessment and management Personal action planning Managing mental wellbeing What does mental wellbeing mean? Factors affecting vulnerability Early warning signs The link between work pressure and vulnerability Prevention of stress and enhancement of wellbeing through effective management of work pressures Enhancing enjoyment and satisfaction at work Creating a climate of openness and trust at work Action planning to enhance wellbeing at work Tools and techniques for individuals Understanding the nature of stress Increasing awareness of stress in yourself and others Taking control of your life Time management Assertiveness Identifying pressures that you can do something about, and tackling key stressors Coping strategies social support, relaxation, physical activity and sleep Think fit! Think well! 85
Resources for mental health awareness training Resources WorkLife for managers Tackling stress in the workplace An interactive CD-Rom which aims to reduce the potential for stress at work by developing managers skills and confidence to tackle problems before they escalate, thus increasing productivity and profitability. For information contact: Samaritans 020 8394 8300 www.samaritans.org For other useful resources, see Resources in Part 4. Providers of mental health awareness training Samaritans 020 8394 8300 info@samaritans.org www.samaritans.org Offer a range of workplace training, including: WorkLife for teams WorkLife for managers Communication and listening skills. Kipepeo 01263 862286 info@kipepeo.co.uk www.kipepeo.co.uk/mentalillhealth.html Provides training about interventions on stress and mental health at work. In Equilibrium 01383 622 002 training@in-equilibrium.co.uk www.in-equilibrium.co.uk Other providers You could also try the following: Contact your local primary care trust (PCT) and ask for the public health department or health promotion specialist or mental health promotion specialist. They may be able to provide help with mental health awareness training, or point you to someone who can. Contact a local mental health charity such as Mind, the Mental Health Foundation or Rethink. They may be able to offer training. (See pages 102 and 109 for contact details.) Contact Mindful Employer. (See page 109 for contact details.) For more information on mental health awareness training providers see pages 105-110 in Part 4 Resources. Offers a range of in-house training and consultancy, including: stress management for managers, stress management for individuals, managing wellbeing, bullying and harassment, stress risk assessment, increasing energy levels, the HSE Management Standards, and conflict resolution. 86 Think fit! Think well!
Charter for employers who are positive about mental health The Charter for employers who are positive about mental health shown below right is one element of the Mindful Employer initiative. (Mindful Employer is a voluntary, informal network of employers and support organisations, which provides information, advice and practical support for people whose mental health affects their ability to find or remain in employment, training, education and voluntary work.) The initiative is facilitated by WorkWays, which is managed by Devon Partnership NHS Trust. The Charter is a way of supporting employers in the recruitment and retention of staff who experience mental ill health. It is open to any employer small, medium or large; public, private or voluntary sector anywhere in the UK, and signing up is free. Since Mindful Employer was launched in 2004, 195 employers representing over 250,000 employees have signed the Charter. The Charter is about working towards principles, not the immediate fulfilment of them. Signing up is a step along a journey, not the end of it. It is a voluntary agreement which seeks to support employers in working within the spirit of its positive approach. It is not legally enforceable and doesn t negate the need for employers to get the right person with the right experience, qualifications and skills for the job. The Charter fully respects that there will be many different priorities, policies and practices which influence the way staff are recruited and retained the employer is the expert on their business. By signing up to the Charter an employer: shows their company is working towards putting its principles into practice will be supported by other Mindful Employers will receive a personalised Charter showing the company name and logo will be able to use the Mindful Employer logo on literature, letterheads, websites and job advertisements will receive posters to display on staff noticeboards. (These can be viewed on the Mindful Employer s website www.mindfulemployer.net) working towards the aspirations of the Charter, and improving policies and practice, two years after signature. To help implement and review commitment to the Charter, support, training and assistance are available from other Mindful Employers and WorkWays. To find out more about the Mindful Employer initiative and about the Charter, visit www.mindfulemployer.net. The website also provides information about how to work towards achieving the aims of the Charter. Charter for Employers who are Positive about Mental Health As an employer we recognise that: People who have mental health issues may have experienced discrimination in recruitment and selection procedures. This may discourage them from seeking employment. Whilst some people will acknowledge their experience of mental health issues in a frank and open way, others fear that stigma will jeopardise their chances of getting a job. Given appropriate support, the vast majority of people who have experienced mental ill health continue to work successfully as do many with ongoing issues. As an employer we aim to: Show a positive and enabling attitude to employees and job applicants with mental health issues. This will include positive statements in local recruitment literature. Ensure that all staff involved in recruitment and selection are briefed on mental health issues and the Disability Discrimination Act, and given appropriate interview skills. Make it clear in any recruitment or occupational health check that people who have experienced mental health issues will not be discriminated against and that disclosure of a mental health problem will enable both employee and employer to assess and provide the right level of support or adjustment. Not make assumptions that a person with a mental health problem will be more vulnerable to workplace stress or take more time off than any other employee or job applicant. Provide non-judgemental and proactive support to individual staff who experience mental health issues. Ensure all line managers have information and training about managing mental health in the workplace. Mindful Employer Reviewing and implementing the Charter Signing up to the Charter is a way of showing your commitment to working towards the aspirations within it. Organisations are asked to review how their workplace is The Charter for employers has been drawn from similar charters being operated by a number of NHS Trusts around the UK, the Line Managers Resource: A Practical Guide to Managing and Supporting Mental Health in the Workplace, and original material by Devon Partnership NHS Trust. It was compiled in conjunction with and agreed by employers supporting the Mindful Employer initiative. Think fit! Think well! 87
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