Dr Filippo Passetti, our Consultant Psychiatrist, reflects on mental health issues that arise at the workplace and how to manage or mitigate them.
Mental health problems are responsible for 40% of work-related sick leave in the UK, costing the economy some £10 billion per year. If you add to those direct costs, those related to presenteeism (being at work, but not being productive because of ill health) and those related to indirect effects, such as loss of management time, lowering of morale in the workplace, etc, some estimates suggest the cost might be closer to £26 billion per year.
Our productivity and work are invariably enmeshed with our psychological wellbeing. As Sigmund Freud once said, ‘Love and work are the cornerstones of our humanness’.
People don’t seek help.
This is a complex challenge, because help-seeking is not very common at work. For example, the National Employee Engagement study found that a third of employees with poor mental health will not approach anyone for support.
In our organisation, we treat people in a variety of organisation, across business, services and elite sports. As we cover the whole spectrum of mental health in these organisations, from mental illness at one end to prevention to optimising performance under pressure, we are able to compare organisations with minimal mental health awareness vs organisations which have a mental health awareness program. We find that there are much greater rates of depression and anxiety in the former, compared to the latter, while the opposite is true of lesser syndromes such as ‘burnout’.
The first point to make, as they say in medicine, is that Common Things are Common. One in four people is affected by a mental health problem, so as an employer you must be prepared that a proportion of your employees will have one. It may be that, occasionally, one of those individuals suffers from some more unusual mental health problem, but the vast majority will have one of the anxiety or the depressive disorders. These are the ones to focus on.
A list of general symptoms that are forewarning of mental health problems might look something like this:
- Irritability, loss of focus, loss of concentration, loss of perspective, loss of a capacity for decision-making and to prioritise, fatigue, lack of motivation and worry (internal signs, but inferable if not observable)
- Fidgetiness, restlessness, over-reacting, inter-personal conflict or avoidance/ withdrawal from challenging inter-personal interactions, missing deadlines, atypical working hours, reduced productivity and out-of-character behaviour (external, observable signs)
One particular aspect, notable for its frequency, is procrastination. We procrastinate when we feel stressed, because we feel we can’t do well the things we have to do and so we expect no positive reward from the effort we would have to put in to do them. So we put them off, which in turns makes them bigger and less rewarding, feeding back into the same reluctance to get on with those tasks.
While for anxiety, restless, tension, the appearance of someone with racing thoughts and a sense of loss of control, who is seeking to escape/avoid situations in which they feel exposed might be the most common features; for depressive disorders, tearfulness, an appearance of fatigue and indecisiveness might be more apparent. However, for employers/ managers diagnosis is not the issue. The issue is how to approach an individual part of your workforce, whom you think is struggling.
An effective approach: CARE
Every Mental Health Awareness program has its own acronym, to underline the concept that how to approach someone who is struggling is crucial. In our program we like to use Approach with CARE, where CARE stands for:
Ask and Listen
Repeat and Reassure
It is important to make Confidentiality explicit. Stigma is still a big obstacle to help-seeking in mental health and most employees remain concerned that ‘coming out’ with their mental health difficulties will jeopardise their position in the company.
There is an art to handling these situations effectively and Ask, Listen, Repeat and Reassure are the core skills. The National Employee Engagement study mentioned above also has interesting things to say about help-giving. Eighty-six percent of the employees surveyed would think twice before offering to help a colleague they were concerned about. There might be a range of reasons for that, from the fear of being nosey, to embarrassment at raising personal matters with someone you know only superficially, to a fear of the reaction of this individual. The point is that someone who is struggling with a troubling thoughts and feelings will be relieved to be able to offload them, provided they are reassured of the true confidentiality of the interaction and they feel they are truly being listened to.
It would be unhelpful to approach someone in these predicaments without having some solutions to offer. So it is important to approach the task of offering help armed with a knowledge of the tools that will be at that person’s disposal. Increasingly, organisations subscribe to Employee Assistance Programme (EAP), but some organisations have more sophisticated systems in place, such as a GP or counsellor on-site, or an ongoing arrangement with an occupational health centre. The organisation’s Occupational Health office or the Occupational Health officer in Human Resources will usually be helpfully involved, either to advise on options or to provide a framework within which appropriate help can be delivered.
In summary, we are becoming increasingly aware, and effective at managing, mental health problems in the workplace. Organizations and their leaders have tools at their disposal. The challenge is to be proactive and to create an organisational culture that fosters awareness and openness in optimising employee mental health.
We are thankful to Dr Passetti for sharing his personal opinions for improving mental health at work place.
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