Roundtable discussion
With the rise in mental health difficulties and stress problems in the workplace, HSENI brings together key professionals in occupational health to discuss how managers should respond. As well as its intrinsic benefit, improving staff well-being is good for customer service and will become increasingly important in the public sector as spending cuts add pressure to staff.
Why is workplace mental health becoming increasingly important?
Bryan
In the traditional areas of health and safety, the logic of our involvement has evolv
ed over the last eight to nine years from an emphasis on hard safety issues to a more balanced position with greater focus in relation to health.
We saw an increased interest in the whole area of stress at work. It became very clear that, during the transition, mental health issues were becoming one of the major contributors in people suffering because of their work.
That was the seed for expanding out in terms of our focus, to include not only stress at work but also mental health issues. This has continued and now we promote both good mental well-being and general well-being in the workplace.
The statistics indicate that work-related stress and the associated mental health issues are the main cause of absenteeism in many organisations. In a workplace climate which has to focus on corporate risks and their prevention, strategies which address both the causes and consequences of mental health issues are increasingly in demand.
Peter
Increasingly organisations are beginning to appreciate more that people matter and there needs to be an examination of what that means. The CIPD nationally has for a number of years produced an absence survey which captures a lot of data from public, private and voluntary sectors.
Leslie
We know that mental health problems are a key factor in absenteeism and we certainly see that in the health and social care sector. It is recognised generally that health and social care is one of the more stressful environments in which to work.
Just looking at our own referrals to occupational health, the figures over the last two years show a rapid increase of people being referred with psychological problems.
It’s possibly partly management awareness but I think a big factor is the financial constraints we are experiencing. It’s putting staff under more and more pressure, so it’s a real priority for us.
Should this be a management or personal issue?
Ken
It’s for both. For the individual who has a mental health condition or is suffering from stress it is certainly an issue for them and their family, and then it’s an issue for the employer in relation to increased absence or poor performance and productivity. Although, quite often stress and mental health problems are seen to be the same whereas in fact they may not be.
Maureen
I think it is both a management and a personal issue and it’s a very important one. Happy and healthy employees are more productive and therefore provide better service for our customers. The organisation has to provide the right type and level of support and the individual needs to be aware of, and use, the tools and support available. In this way the organisation gets the best from the employee and that individual feels that the organisation cares about them.
Has this issue come up gradually or just recently?
Ken
Over the past decade or more the reporting of poor mental health and stress among workers has been a pattern across Europe, so it’s not an issue specifically liked to this part of the world.
It has impacted on sickness absence undoubtedly. If you look at the Northern Ireland Civil Service that employs around 27,000 people, mental health problems account for almost 25 per cent of all absences and about a third of all long- term absence so it’s pretty significant.
I can follow on from what Leslie said, as an occupational health service, over a period of a decade or more, we’ve seen an increase of referrals to our service of employees with mental health problems to represent 50 per cent of all cases that our doctors and nurses are dealing with currently.
When you see that kind of change in profile and a swing away from a decade or more of muscular and skeletal issues to mental health problems, you need a different response because it’s a complex area that requires many different approaches in terms of how you tackle it.
Bryan
Industries where there are large organisational structures are in a better position to identify problems. Some smaller employers don’t actually realize that they have a problem because they don’t have the same systems in place.
It comes down to managers being able to identify better with their staff, finding ways to both assist and support them. Whilst it appears a lot of the time that this is an issue to the public sector and large employers, in fact it is probably occurring right across the board but it is not being properly identified.
Peter
A recent CIPD absence management survey identified that management style was one of the top three causes of work- related stress overall. So quite clearly there’s a big training and development issue here in both helping the employee and the line manager on behalf of the employer to ensure that these sorts of issues can be addressed.
What strategies are available to improve mental well-being?
Leslie
We’ve recently produced a health and well-being strategy for the Belfast Trust. We’ve identified four strands: Firstly, our occupational health service and the various supports we can offer people such as counselling and low intensity psychological therapies.
Secondly, there’s training and development. Thirdly we have human resources policies on capability and flexible working. Fourthly, is what we can offer staff on a broad lifestyle and well- being agenda through our health improvement team such as promoting mental health, physical activity and so on.
Maureen
Different companies adopt different approaches. BT takes this issue very seriously. We have policies, websites and other tools including a number of short guides for individuals and managers. We recognise that a long policy document can be quite hard for people to interpret and fully grasp how to apply it. Short guides on the other hand can be quite helpful, giving hints and tips on how to deal with mental health issues.
Our approach probably falls into three key areas.
The first one is prevention: making sure there are lots of pro-active and preventative activities carried out in the organisation, to raise people’s awareness.
Secondly, early intervention is important. So if someone does take time off with a mental health-related problem, we intervene quite early to understand how best we can help.
Then thirdly, once the individual has been off for a period of time, it’s working directly, and with the occupational health support services, to encourage and support them back to work and make it easy for them to come back.
Bryan
One of the key things we have been promoting is prevention.
Prevention is discussed but often one of the shortcomings we see is people going for the cures to issues once they have materialised. You need to identify potential causes and deal with them before they become an issue.
Conversely, we have seen some very good work done by companies looking at the HSE management standards and building that approach into how they operate. Their line managers are trained in key good practice. It doesn’t mean that people have to become experts in stress and stress management. It’s often about taking the good work that has already been done and making it simple for managers to implement.
Ken
I agree with what has been said. In November last year, Minister Wilson launched the Civil Service charter for mental well-being and associated with that were guidance documents on mental health and stress.
We are looking at it from three themes;
Work – including job design, training, management behaviours etc;
Health – promotion of health and positive health lifestyle behaviours and health protection, which would include health and safety and health surveillance;
Support – including HR policies, occupational health, welfare and external counselling.
The difficulty lies at the individual level and how you look at that.
Surveying the workforce is fine but does it let you get down to the individual level? That’s where some of the complexity might rest.
I think it’s important that organisations look at positive management behaviours, which the HSENI have already supported work on, in conjunction with the other work they have done on management standards.
How do organisations take those positive management behaviours and put those into the competencies of their own people?
Competency frameworks for managers within organisations take account of those positive management styles, which the management standards research has flagged up as being useful.
Is it difficult to get mental health on management’s agenda?
Bryan
It’s like any other issue, if something is given a degree of importance and the leaders in any organisation are visible in supporting it then you will see an improvement.
It does need leadership commitment and if you don’t have that, it is a very difficult thing to drive through in an organisation.
Peter
In Northern Ireland in the public sector, we have had to come to terms with the equality legislation in the Northern Ireland Act. Mental health needs to be similarly mainstreamed by all organisations.
Leadership issues have to be dealt with and frameworks need to be put in place. Training is required both from the individual and line manager’s point of view so that the individual knows when to say: “I need some help.” The stressors may not only be work-related; they may also be from outside.
Line managers must be prepared to talk and find out what the issues may be. It’s the softer HR skills that line managers need to have in order to achieve results and help.
Maureen
It’s important that a culture of openness is created in an organisation, so an individual knows where to go to get help and what tools are available. Also there should be no issue for employees when they ask for help or raise a concern. They should feel comfortable to do so.
Leadership is absolutely crucial, principally calling out to managers the sorts of behaviours that are expected, and how they should treat employees in these sensitive situations.
To ensure that mental health is on the agenda it needs to be recognised at senior level as an important issue and it needs to be built into the relevant frameworks.
What are the benefits of putting resources into an improvement plan?
Leslie
I think a lot of the things that have been touched upon already. It’s about reducing absenteeism and increasing performance. There is good evidence that patient satisfaction increases if you reduce stress in the workplace and reduce people’s experience of stress.
Ken
For me, promoting well-being can be done well within an organisation if you have senior level commitment, good management behaviours, transparency and appropriate support.
If your staff are motivated to do the work that they are employed to do, the more satisfaction they are going to get out of it, the more resilient they are going to be in terms of pressures and demands, and the better their performance is going to be.
Leslie
Health care is so dependent on teamwork. And where you have good teamwork you’re going to have less stress, so it’s all inter-related.
Is it more difficult with the present economic downturn and cutbacks that could focus management attention elsewhere?
Bryan
A number of other large organizations ‘hard’ safety issues but in general well- being. It often does come down to the very simple things like your relationship with your line managers and how they communicate with you.
What useful resources are available for managers?
Peter
If you go onto the CIPD website (www.cipd.co.uk), there’s a wealth of free information that can be drawn down, including sign-posting to best practice.
Ken
Business in the Community also has a good website with lots of links to guidance and advice. The Health and Safety Executive’s own website, of course, would also do that.
There’s lots of information out there. When you looked at this 15 or more years ago there was very little about well-being in workplaces, never mind mental well- being. The whole landscape has changed now and the issue of employee well-being has mostly been taken into the heart of how good organisations run their business.
In the Northern Ireland Civil Service ‘people strategy’ for the next three years – employee health, well-being and engagement is one of the seven strategy themes.
Leslie
Business in the Community have also added a health dimension to the Health and Safety Executive’s survey tool. People get feedback on how they are doing in terms of lifestyle and access to resources to help them improve their health.
Mental health first aid is something we are beginning to use within the health sector. From Australia, it’s a training programme that helps people identify the signs of stress and mental illness in colleagues and signpost people to support.
We, as a health trust, came out of a merger of six organisations three years ago so our staff have been through massive change. One of the things we have achieved in that three-year period is Investors in People, which is about good management practices, which is really important in terms of an organisation dealing with stress.
Peter
I think it’s important that we don’t lose sight, in a time of recession, of the emphasis on what organisations should be doing.
There are a lot of organisations out there in both the public and the private sector who really haven’t embraced mental well- being and yet they are going to have to embrace this because of the cuts and the economic situation. There is a risk that we could see an increase in problems in organisations, that is why we must harness the information that is out there and really get more buy-in to tackling mental well-being, for example using the recent guidance that HSENI have produced.
The Participants
Dr Bryan Monson
Dr Bryan Monson was promoted to the position of Deputy Chief Executive of the Health and Safety Executive for Northern Ireland (HSENI) in February 2006. Bryan joined the Department of Economic Development’s Health and Safety Division as an inspector in 1994. In the autumn of 2008 Bryan took over HSENI’s Support Division and was responsible for establishing the Workplace Health Group, which brings together a range of experienced professionals from the fields of stress management, physiotherapy, health promotion and inspection.
Dr Ken Addley
Ken is a consultant occupational physician and Director of the Northern Ireland Civil Service’s occupational health service. A graduate in medicine from Queen’s University Belfast, he is a fellow and immediate past Dean of the Faculty of Occupational Medicine at the Royal College of Physicians in Ireland. He was awarded a doctorate by Queen’s University in 2000 for research into the impact of mental health and stress in an occupational setting.
Peter Aiken
Peter chairs the Northern Ireland branch of the Chartered Institute of Personnel and Development (CIPD). He works in human resources for the Northern Ireland Policing Board, and entered the profession in 1999 following a career in local government in Northern Ireland, England and Scotland. From July 2001 to December 2009, he was a member of the Southern Education and Library Board. Peter is Chairman of Portadown College’s board of governors and a licensed Irish Amateur Rowing Union umpire.
Dr Leslie Boydell
Leslie is Associate Medical Director for Public Health in the Belfast Health and Social Care Trust. She is responsible for promoting the trust’s goals of improving health and reducing health inequalities and leading personal and community involvement in the trust’s business. She is responsible for the trust’s occupational health service and chairs its health and well-being at work group.
Maureen Walkingshaw
Maureen Walkingshaw is HR Director for BT in Ireland. She joined BT over four years ago when the organisation was aligning its operations in Northern Ireland and the Republic of Ireland. Prior to joining BT Maureen held a number of senior HR roles in the manufacturing, ICT and telecoms sectors, most recently working for Virgin Media. Maureen chairs the judging panel of the BT Young Scientist and Technology Exhibition. She is also a member of Business in the Community’s Cares Leadership Team and the CIPD.
