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Why does mental health continue to be the elephant in the office?

Mental health issues affect 1 in 4 of us. Following Mental Health Awareness Week in the UK, we caught up with Time to Change to learn how to erase the stigma of mental health among employees in the workplace.

Originally posted in Simply Communicate for Mental Health Awareness week 2013; find it here.

In a survey conducted by Time to Change:

  • 67% of people said that the fear of stigma had actually stopped them from telling an employer or prospective employer about a mental health problem.
  • 92% of the British public believe that admitting to having a mental illness would damage a person's career. And when asked which particular vocations they felt would be most adversely affected they came up with doctors, emergency services and teachers.

Time to Change is an anti-stigma programme delivered by two of the leading mental health charities, Mind and Rethink Mental Illness. Incorporating traditional and social media, the programme aims to challenge mental health stigma and discrimination and dispel misconceived fear when it comes to talking about mental health. We spoke to Libby Peppiatt, Organisational Engagement Manager at Time to Change, to find out more about stigma in the workplace and how Time to Change is combating the problem.  

“We're aiming for an additional 5% improvement in public attitudes and behaviours when it comes to mental health,” reports Peppiatt. The workplace can be just one area of people’s lives where they perceive stigma and discrimination. Peppiatt continues, “A central part of our work is an invitation to employers to make the Time to Change organisational pledge. This is essentially an aspirational statement that they make to tell their employees and the general public that they want to be active in tackling stigma and discrimination around mental health.”

Whilst the Time to Change pledge is neither a kite mark or quality assurance, the pledge is linked to an action plan that details the tangible anti-stigma activity that an employer can deliver to ensures the pledge is meaningful. TTC also offer free workshops on related activities, responding to demands that often organisations want to reach out to communities, or provide stress-management and resilience building workshops for their employees.

Who can start an anti-stigma campaign in the workplace?

The short answer is that anyone can. It depends on the structure of the organisation; it can be people in HR, or it can be people with lived experience of mental health problems or who have that within their personal network. It could also be people with a wellbeing remit or disability network within their organisations. Because of the Time to Change social marketing campaign, it's not just people in a HR role, it's people across the board who want to get their organisations involved. Peppiatt adds, “We do advise the need for senior buy-in to give the campaign gravitas. We’ve found that a combination of top-down communication with a staff champion can be the most effective.”

Anti-stigma activities and how internal communications can play a role

“Often organisations aren't clear on where to start,” admits Peppiatt. “I think it's always about messaging. One of the elements of discrimination and stigma is that people are scared to talk about mental health because it’s considered a taboo subject. The key thing for organisations is to create a safe environment in which to start that conversation.

“Lots of organisations find that creating a mini internal comms campaign is a good starting point. We have a wealth of collateral that organisations can take and run with and digital content that really gets the message out. It's about demystifying mental health problems and really seeing it on parity with physical health problems and that mental health problems are actually part of normal human experience." 

Many organisations have run campaigns around improving physical health such as walk to work schemes and maintaining a healthy diet. Campaigns around mental health can work in the same way and help reduce stigma and encourage positive conversations.

Anti-stigma activities and campaigns can include:

  • Email banners and posters to raise awareness
  • Blogs from staff with lived experience
  • Social contact events: This is when somebody without experience of mental health has a conversation with somebody that has. It normalises the experience and people often realise that they are just alike, it is one of the most impactful things around breaking down stigma and discrimination
  • Setting up a network of Mental Health champions or a mental health support group: this provides employees with another port of call, so they can have those conversations in a quiet, safe space
  • Specialist training for line managers around having those conversations and managing disclosure
  • Time to Change health check

“Underpinning every activity has to be the ultimate aim to create a culture where there is no space for stigma around mental health and where it feels safe and appropriate to have those conversations,” says Peppiatt.

The response from the initiative has been overwhelming. “Across sectors, I think we have around about 70 organisations who have taken the pledge so far, reports Peppiatt. “These include Ernst & Young, Lloyds Banking Group, Comic Relief, Premier League, BT, E.ON, a growing number of local councils as well as universities and NHS foundation trusts. We're really pleased with the breadth of the reach.”

How healthy is my organisation?

Time to Change has developed the organisational health check. This is a supportive intervention whereby a fully trained Time to Change consultant, who themselves has lived experience of mental health problems, works with an organisation to look at whether their policy aspirations at the higher level around mental health are actually matching the experience of staff on the ground.

It allows organisations insight into their own interventions to look at what's working and what could be improved. It can give employers and organisations the information they need to make sure their staff are supported in the most effective way.

A Time to Change consultant with lived experience will review an organisation’s existing policies, gain an understanding of their aspirations around mental health, conduct an all-staff survey and will hold in-depth interviews with specific staff members. From this they produce a report which will outline the key findings and offer supportive suggestions for how an organisation can provide support around wellbeing for their staff and reduce stigma and discrimination. The process is confidential and a member of Time to Change management team will meet with every organisation post health check to talk through key aspects of the report so that they are supported fully throughout the process and have a chance to seek any points of clarification or sign posting.

Peppiatt adds, “It's really important for organisations to know that whilst you have may have a range of fantastic processes in place you may find that a huge number of your workforce don't even know what support is available to them via their employer!”

This ready-made tool is built from a pool of research and expertise and provides a fresh pair of eyes. By bringing in an external consultant, someone who has that lived experience, in a confidential environment means that employees often feel more comfortable to open up, talk about organisational culture and suggest improvements. Peppiatt points out, “If staff are to perceive stigma and discrimination, they’re not likely to disclose personal information in an internal audit. Our health check allows for objectivity.”

During this current period of austerity, why should employers invest in anti-stigma activities?

Based on the statistic that 1 in 4 people will be experiencing a mental health problem in any given year, means that as an employer you have a number of employees currently living with a mental health problem. The huge cost of mental health problems to employers is now widely recognised. With sick leave, presenteeism and staff turnover due to mental illness, mental health is costing British business nearly £26 billion a year, which roughly translates at £1035 a year for every employee.(Sainsbury's Centre for Mental Health)

“So the cost of an employee not getting the right support, not feeling comfortable to disclose, is going to keep these costs very, very high. Creating the right culture is not only better for staff but it makes clear and obvious economical sense as well,” says Peppiatt.

How can organisations promote wellbeing?

Work environment and culture can, in some circumstances, be triggers for stress and mental distress. But Peppiatt suggests that there are lots of solutions. The key is taking ownership, “I think senior buy-in is very important so that an employee feels that this isn't just a flash in the pan; this is something that their employers are taking seriously and is going to be sustained.”

Ways to encourage wellbeing might include:

  • Managing workloads effectively among staff
  • Enabling a good work-life balance
  • Allowing flexible hours or home-working, where appropriate or possible
  • Promoting positive working relationships and social activities - Peppiatt believes these are really important as they show that good staff mental health is being promoted and invested in by the organisation.
  • Ensuring managers are trained to recognise mental ill-health and feel confident in supporting their staff and having those conversations about mental health and wellbeing
  • Regular supervisions and one-to-one meetings need to be standard practice, Peppiatt believes, since “these are really crucial to build trust and give employees an opportunity to raise issues at an early stage.”
  • Publicising available support pathways, for example, employee assistance programs
  • Providing information about wellbeing that's easy to access on the staff intranet or in the staff induction pack can help to demystify mental health Policies and reasonable adjustment and phased return to work
  • Wellness and Recovery Action Plans (WRAPs)

What is a WRAP?

It is a relatively new and innovative tool that adopts a mature attitude to mental health. The Wellness Recovery Action Plan is an evidence-based system that is used world-wide by people who are dealing with mental health and other kinds of health challenges, and by people who want to attain the highest possible level of wellness.  It's a personalised document which identifies personal triggers of stress and what support the employee may need to ensure positive wellbeing is maintained. Importantly, they are written by the employee themselves when they are healthy and have positive wellbeing.

WRAPs include:

  • Trigger points for a personal issue or stress trigger
  • It can be confidential or open; the employee can choose to share it with their line manager.
  • Every employee is invited to write their own one, irrespective of whether they've declared lived experience of mental health problems or not.
  • It doesn’t focus on mental health problems but wellbeing.
  • It is a confidential document for the employee and HR will hold it. And then, should something happen, that information will guide them as to what support that employee needs.

Peppiatt elaborates, “Essentially they are a really good tool that employers can use to promote a culture that supports staff productivity and wellbeing but also gives a clear message to all staff that they are aware that they need to look after their wellbeing too. Where an employee does choose to share it with their line manager and it's entirely up to them, it can give that manager a head's up and it normalises the process of dealing with a problem, like the way you would respond to someone with a physical ailment.”

One employee who has completed their WRAP said, “I think it was s a really helpful process. It was completely optional and it was a nice process to go through for myself; to think through what support works for me and how would I like to be dealt with in an acute situation.”

It supports the personal approach to mental health; what works for one person isn't necessarily going to work for the next. Peppiatt believes this tailored approach can reduce the time delay if the person themselves has provided guidance on their preferred methods of health and treatment. She believes it is a really good preventative tool as well. More information about Wellness Recovery Action Plans can be found here: http://www.mentalhealthrecovery.com/.

Case Study 1: E.ON

E.ON, one of the UK's leading energy companies, recognised that mental health can be a really difficult issue to address. After taking the Time to Change organisational pledge they realised that they needed a really innovative approach to getting staff talking about the subject. This developed into the Headway program, which is an all inclusive program for staff.

E.ON set themselves 4 very clear objectives for the program:

1 - reduce the stigma of mental health within the workplace

2 - to reduce the risk of work related mental health issues

3 - to provide mental health awareness training to line managers and staff

4 - to provide support to those who those who have mental health problems.

The programme involved running road shows across all their office sites, to reach all staff. They also transformed a garden shed into what they called the 'Head Shed', set up in communal areas which provided an area of focus to their campaign. Where individuals could meet socially and learn, they posted information and resources on mental health in the shed and used Time to Change materials. Staff could also leave anonymous tips and comments related to mental health issues. This also accompanied very positive series of activities around mediation, stress busting as part of these roadshows to encourage staff to look after their own mental wellbeing.

They had about 2,500 employees engaged in this programme and it's still continuing with more activity planned. E.ON have reported the number of new cases of mental health absence has reduced by over one quarter since the launch of the program. They've also reported that productivity has increased following access to the Headway program.

Peppiatt adds, “It really does show if you look at what your needs are in an organisation and you run with tangible anti-stigma activity, you can yield dramatic results.” Find out more about the work E.ON have been doing.

Case Study 2: Kent Police

Wayne Goodwin has been an ambassador for mental health within Kent Police, transforming the culture and working with Time to Change to raise awareness across the country. I caught up with Wayne recently to find out more.

SC: Why is reducing discrimination against mental health so important for you?

WG: It was important for me because I have lived experience. Throughout that lived experience, I had built up a belief that I could not speak to anyone about it, it was a sign of weakness and I thought it would be career defining. That was the reason I kept it to myself, I built it up in my head to be a massive thing but the reality is that is wasn’t. I was in the military before the police, two stereotypically thought of as masculine organisations where to show any sort of chink in your armour is perceived as bad. I succumbed to the stereotype of my organisations and kept it inside.

As I started moving up the ranks in the police force, I started dealing with members of staff that were having mental health issues. It was quite ironic that I would direct them to welfare, occupational health, give them the support they needed, yet I never used those services for myself!

It reached a point in 2008 where I was struggling to deal with everything and decided to do something about it. My first point of call was my GP and then referred myself to welfare where I put myself back together. As a result, I began to think, as an organisation we could do more in essence for people out there in similar situations to myself. As the police service, we are very good at looking at and dealing with mental health in the community, the Mental Health Act and sectioning people but when it actually comes to looking inwards, I personally, didn’t think there was very much available.

When I became more and more aware of my own issues I joined the staff disability support group, “Crystal Clear”, and with their support, we decided to put together a workshop to assist supervisors and managers with dealing with members of staff who have mental health issues, or identifying those who they think might have. We worked with them, giving them the tools and the confidence needed to have that first conversation with them and signposting them in the right direction. We did that May 2012, as a result of doing that I met Sue Baker, Director of Time to Change, at an event, got talking and it all cascaded from there. I realise that what Time to Change were trying to do, which I wasn’t aware of at the time, was exactly the same thing I was trying to do within the organisation. So it seemed quite natural that we worked together, to raise awareness of the issues.

Although the police services had signed up to the pledge, it was only Kent that were hosting workshops off the back of it. Since those first 2 workshops, I’ve been round the force quite a bit; helping supervisors with their staff returning to work and it’s created ripples in the water. There have been some people with cases of post-traumatic stress, feeling open enough to come and talk to me about their experiences, their medication and their concerns. It’s created an environment where people are now much more open about tackling mental health issues and having those conversations.

SC: What is the effect of the police being at the sharp end of mental health in the community?

WG: We often find, after office hours or at the weekend, invariably we are the first port of call in a crisis, we’re very much at the coal face of mental health and its impacts in the community.

When we deal with mental health issues in the community, it’s usually because we’re about to section them or at a crisis point. I guess, it does tend to jade our minds that if someone says they have a mental health issue then we think it will be at the extreme end of the spectrum rather than the sliding scale that leads all the way down to leading a fulfilling and balanced life. Which is why I guess, when someone in the organisation reports a mental health issue, that jading takes over from a supervisors’ perspective, and they think ‘right you’ve got to go off sick and I’ll see you in a year’s time’, rather than putting in place some reasonable adjustments right at the very start to enable them to stay in work and be effective.

SC: How has Time to Change helped you and your work?

WG: I’d say from a campaign perspective it’s excellent, because I would have stumbling around in the dark trying to change an organisation. The campaign itself gave me some structure to actually build my work around and obviously it gave me the support and the materials, advice and all those things I needed to drive things forward on a much larger scale. Now it’s been taken up nationally, with Kent being used as a beacon for good practice.

SC: Can you tell us more about your campaign? What channels are you using?

WG: On the disability support group, we have drop-in sessions once a month where people can come along and talk about whatever they want to. We highlight mental health day, we use our intranet and notice boards at work to raise the profile of mental health. We’ve got an internal magazine as well, calledSpotlight, with several articles around mental health being featured.

We had the royal nod from an organisational point of view and as for budget; we’re only talking about refreshments required for our support group. We also use practical workshops to work through scenarios where a member of staff is returning to work after a period of long-term sickness and that doesn’t have to be mental health based. We deliver training around mental health and wellbeing using different toolkits. We cover reasonable adjustments to work, as well as returning to work interviews after a period of 6 months, that’s really important, to make sure we get it right.

The most important question you can ask of someone returning to work is ‘How many sugars do you want?’ It’s not rocket science, there’s a real simplistic ice breaker. Let the other person take the conversation how they want it and let them know that there is someone happy to listen. We make it a bigger deal than it ever needs to be. If someone had a broken leg, we would easily say, ‘wow, how are you doing?’

SC: What does the future hold?

WG: We will be measuring the effect of our work later on in the year but already people have noticed a difference and more staff are coming to me telling me of personal experiences or supervisors dealing with those issues.

I’ve been invited to speak regionally at our Kent Police meetings and there’s scope to spread this further and already we’ve been working with Time to Change to pilot other projects as well as working on programmes for ex-servicemen as well.

I’m working from the ground up, and Sue from Time to Change is working with chief officers and drilling down, so hopefully at some point we’ll meet in the middle. 

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