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Line Managers'
Resource
Shift produced the 2007 guide as part of its Action on Stigma initiative,
which aimed to support employers in promoting good mental health and
reducing discrimination.
The Line Managers' Resource has been revised and updated over the past
ten years, including by Mental Health First Aid (MHFA) England in 2013.
MHFA England has also developed this new, fourth, edition (2016).
Line Managers’ Resource
Copyright © 2016, MHFA England CIC
www.mhfaengland.org
2
Foreword
3
Foreword cont.
Awareness of mental health issues For too long stigma and taboos have
at work is growing, and employers fuelled fear and misunderstanding
are putting in place many positive around mental ill health and prevented
interventions – from healthy food in people from speaking out and seeking
the canteen, to gym membership, to help. The Line Managers' Resource is
resilience training – to help promote based on the understanding that mental
wellbeing. Mental ill health is typically health and wellbeing, like physical
caused by a range of factors, from health, can be sustained and improved
relationship problems, financial worries or through some simple yet effective steps.
poor housing, to poor management and/ Communication is vital. We know that if
or stress in the workplace. But whether someone experiencing a mental illness
the primary cause is 'home' or 'work'– has a line manager who is comfortable
related, a healthy working environment talking about mental health and knows
– and, in particular, managers who are what support to provide or signpost
skilled in spotting early signs of mental people to, that individual feels better
ill health and providing appropriate supported and is more likely to be able
support – plays a critical role in keeping to continue working successfully.
employees healthy and preventing full–
blown mental illness. Treating people as People who have or have had a mental
individuals is key – hence the pivotal role illness are working effectively at all
of line managers. No one knows their levels of seniority, in all sorts of different
people better than they do, which makes organisations. By using the clear,
them ideally placed to create a climate concise guidelines in The Line Managers'
that is conducive to the wellbeing of their Resource, organisations will help even
team and to spot changes in behaviour more people who have a mental health
or performance that could indicate an issue not just to remain in employment,
underlying mental health issue. Much of but also to flourish at work.
this comes down to good management
practice, but enlightened employers are
also training their managers specifically
in how to manage the mental and
emotional health of their teams.
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MHFA Line Managers' Resource
MHFA England
5
6
Contents
2. Promoting wellbeing 16
Creating working conditions that foster good mental and
physical health helps to prevent mental ill health and addresses
some of the stigma and stereotypes associated with it.
8. Appendix 52
7
1. The relationship between
work and mental health
and wellbeing
Facts and figures on mental health
- One in four people will experience a - In a Bupa poll in 2014, 94% of business
mental health issue in any given year. (2) leaders admitted to prejudice against
people with mental health issues in
- Between one in five and one in their organisation. (8)
six working age adults is depressed,
anxious or experiencing stress-related - In a survey of UK adults 56% said they
problems at any one time. (2–4) wouldn't hire someone with depression,
even if they were the best candidate for
- T
he Chief Medical Officer estimates the job, according to a report by Unum
that around 70 million working days and the Mental Health Foundation. (9)
are lost every year because of mental ill
health, costing Britain between - W
ork is beneficial to physical and
£70bn and £100bn. (1) mental health: periods out of work can
exacerbate a mental health condition
- In 2014/15 anxiety, depression and because people feel isolated, forgotten
stress accounted for 35% of all and purposeless. (10)
work-related ill health, and 43% of all
working days lost to ill health, according - A
mental health issue is not a sign
to the Health and Safety Executive. (4) of weakness; in fact it can be just
the opposite. Determined, energetic,
- T
he Centre for Mental Health purposeful high achievers can be the
estimates that presenteeism accounts most vulnerable, because they push
for 1.5 times more losses in productivity themselves so hard. Winston Churchill,
than absences. (5) Isaac Newton, Charles Dickens and
Ludwig van Beethoven all experienced
- One in five people take a day off due to mental health issues.
stress, yet up to 90% feel unable to be
honest about this being the reason for - Nine out of ten people with
their absence. (6) mental ill health experience stigma
and discrimination. (11)
- Research from Time to Change found
that 49% of respondents would feel - A
report from Bupa, based on You Gov
uncomfortable talking to their employer research among 6,000 employees in a
about their mental health. (7) range of industries, found that one in
five middle managers had felt stressed
for more than a year and one in ten felt
close to breaking point. Half the
managers surveyed felt 'constantly
worried' and four in ten had
experienced depression as a
result of being stressed. (12)
8
The World Health Organisation defines Employers are constantly seeking ways
9
The relationship between work and
mental health and wellbeing cont.
- D
emonstrable corporate What do we mean by ‘stress’?
social responsibility. The Health and Safety Executive
(HSE) defines work-related stress as
- Reduced staff turnover. “the adverse reaction people have to
excessive pressures or other types of
- Reduced sickness absence. demand placed on them at work”.
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MHFA Line Managers' Resource
As we noted earlier, there is typically a
complex interplay between the pressures
people face at work and those they face What you can do to support your staff
at home. For example, someone who has
suffered a bereavement or a relationship - T
he organisations that are leading
breakdown may be temporarily unable to the way in understanding, identifying
cope with a workload that under normal and supporting the need for good
circumstances they find eminently mental health in the workplace are
manageable. The line manager's investing in developing their managers.
attitude and approach to supporting MHFA training is one way to educate
that individual can have a significant managers and teams to spot the first
impact on their attendance, behaviour signs of mental ill health and give them
and performance. the knowledge and confidence to help
colleagues in distress.
How an individual copes with pressure
is determined by a variety of factors, - T
he Health and Safety Executive
including support systems at home and (HSE) Management Standards use
work, and their own personality and a risk assessment process to help
coping mechanisms. What may be too organisations identify the extent and
much pressure for one person at one causes of employees’ work-related
particular time may not be too much for stress, and suggest ways that everyone
the same person at a different time or for in the organisation can work together
a different person at any time. to prevent and manage stress
more effectively.
Clearly, this resource is designed to help
line managers prevent and deal with - T
he Health and Safety Executive (HSE),
a broad range of mental health issues, Chartered Institute of Personnel and
rather than stress per se, but the way Development (CIPD) and Investors in
you manage staff who are experiencing People have also developed a stress
pressures at home and/or at work will management 'competency indicator'
have a significant effect on their ability framework of tools to allow managers
to cope with it, on their resilience and to assess whether they currently
on their mental health. Management have the behaviours identified as
behaviour is often highlighted as a effective for preventing and
major factor by those suffering from reducing stress at work.
work-related stress. Employees whose
line managers have learnt good people
management skills are more likely to
develop healthier ways of coping with
the competing pressures on their time.
The result is higher levels of wellbeing
and resilience, which can help to prevent
more serious mental health issues.
11
The relationship between work and
mental health and wellbeing cont.
Mental ill health: a short guide Mental ill health affects different people
in different ways, including the length of
As a line manager, you're not expected to time they experience it for. In general, we
be a medical expert. But this short guide categorise mental ill health as temporary,
is intended to give you a quick insight into fluctuating or ongoing.
why and how people become mentally
unwell, and what they can do about it. - T
emporary – the person experiences
the condition for a short time and
Anyone can develop mental ill health at recovers after treatment.
almost any time in their life, just as they - F
luctuating – sometimes the person
can a physical illness. Mental ill health experiences the condition, and
is no respecter of age, background or sometimes they don't.
circumstances. It can be triggered by a
range of things – including ostensibly - O
ngoing – the person experiences the
happy events like getting married, mental health condition all the time, but
having a baby, getting a new job or controls it through one or a combination
being promoted. of the following:
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MHFA Line Managers' Resource
Mind your language Usually, a GP will be involved in
Terminology is important when diagnosing conditions and in prescribing
talking about mental health or dealing or advising on treatment. But a clinical
with someone who is experiencing a diagnosis doesn't dictate what an
mental health condition. What may individual can or can't do; indeed, the
be appropriate language for clinicians way people experience and live with their
may be less helpful for employers or mental health, along with the level of
job seekers. For the purposes of this support they need, varies from person to
resource, we generally use the phrase person.
'mental ill health' or ‘mental health issue’
to describe the distress someone Everyone should have the opportunity
is experiencing. to work, whatever their mental health.
Mental ill health is common and most
We avoid the term 'mental health of us will either experience it, have
problems' deliberately: we don't want experienced it, or know someone else
to suggest to employers and others that who has experienced it. Mental ill health
someone experiencing mental ill health touches us all and should not be a barrier
is necessarily a problem to themselves to treating people fairly, with respect and
or to anyone else. Someone may have a understanding.
mental health condition, either chronic or
fleeting, but still enjoy wellbeing: the two The most helpful approach for a manager
are not incompatible. is to try to understand the mental
health issues an employee is facing, but
In this sense (as in most senses) our then put these in the context of their
mental health is no different from our strengths and capabilities. That involves
physical health. Someone with a lifelong, talking to them in order to get a clear
long-term or fluctuating mental health understanding of what they can do,
condition may experience an acute phase rather than what they can’t do – which is
that requires them to take time off from the same strengths-based approach you
work for treatment or recuperation. At would adopt for any employee.
this point we refer to them as 'unwell'.
13
The relationship between work and
mental health and wellbeing cont.
The law and mental health There are many different types of mental
health condition that can lead to a
disability, including:
Relevant legislation
- anxiety disorder
- H
ealth and Safety at Work Act
1974 (HASWA) - bipolar disorder
- M
anagement of Health and Safety - eating disorder
at Work Regulations 1999
- obsessive compulsive disorder (OCD)
- Equality Act 2010
- personality disorder
- M
ental Health (Discrimination) Act
2013. (This removed legislative bar- - post-traumatic stress disorder (PTSD)
riers to people with mental health
issues being company directors.) - postnatal depression
- schizophrenia
- self-harm.
14
Other key legislation and strategic - Match job requirements with an
Health and Social Care Act (2012) - Achieve a successful return to work
15
2. Promoting wellbeing
By tackling the issue of mental health in managers in promoting the mental
the workplace from the starting point of wellbeing of employees through
promoting wellbeing you may find that supportive leadership styles and
in itself begins to address some of the management practices. This would
stigma and stereotypes associated with involve the following.
mental ill health, and achieve early buy-in
from staff. If employees are more aware - Promoting a management style
of what 'wellbeing' is, what the benefits that encourages participation,
are, and how they can achieve it, they delegation, constructive feedback,
will be better equipped to look after mentoring and coaching.
themselves and be more sensitive
to the needs of others. - Ensuring that policies for the
recruitment, selection, training
Much of this comes down to good and development of managers
general line management skills, as recognise and promote these skills.
guidance from the National Institute
for Health and Care Excellence (NICE) - Ensuring that managers are able to
in 2009 indicates. The guidance aims to motivate employees and provide
help employers to promote wellbeing them with the training and
through productive and healthy support they need to develop their
working conditions. performance and job satisfaction.
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MHFA Line Managers' Resource
Full NICE guidance ‘Mental wellbeing at Everyone feels under pressure at some
work’ is available at: www.nice.org.uk/ time, and pressure can be a spur to
guidance/PH22 perform. It is sustained, unrelenting
pressure that creates the stress
Line managers should pay close attention associated with mental ill health.
to these guidelines, given the fact that
they are invariably seen as the cause of
much workplace stress and anxiety. But
in addition to improving their practice Tips for supporting the
generally, they need to focus specifically wellbeing of your team
on other ways of boosting the wellbeing
of their teams. They are not expected to - D
evelop a work culture where
have specialist knowledge of mental ill everyone is treated with respect
health, but they are well placed to help and dignity and issues such as
all of their team by providing information bullying and harassment are
on how they can look after their mental not tolerated.
wellbeing and where to access
services and support. - D
evelop a culture where open
and honest communication is
One of the easiest first steps encouraged and support and
towards improving the mental health mutual respect are the norm.
of your workforce is to discuss with them Encouraging an ethos whereby
issues that might affect their wellbeing. staff know that it's OK to talk
These may or may not be purely work about mental health and that it is
related. For example, sometimes people safe to disclose their experiences
don't know that making healthy choices, will help to reduce the stigma and
like eating a balanced diet, taking stereotypes associated with it. It
exercise and having a sensible will also allow staff to tell inform
work-life balance, can protect their you of any adaptations you need to
mental health in the same way that it make to working practice to help
does their physical health. them do their job.
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2. Promoting wellbeing cont.
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MHFA Line Managers' Resource
A holistic approach to wellbeing at work the point they are first recruited, through
The chart below presents some ideas a mental ill health episode and then back
for a holistic approach to wellbeing. It into work.
is based around an employee’s journey
within an organisation and how their The chart recognises that each
experience can be positively shaped at employee’s journey is different and
an individual level by their line manager, that the support provided operates at
and also at an organisational level, from different levels and in multiple ways.
Organisational level
Individual level
o rk Re
cr u
w
to it m
n
Rehabilitation policy Organisational drivers
nt
t
Re
Reasonable
Return plan Job/person fit
adjustments
Active Clear induction
monitoring/
support
Corporate
commitment
Early, active Management to employee
Support engagement processes e.g. wellbeing:
from - appraisal awareness-raising
internal and Plan for return - work planning activities and
external sources - training/ training e.g.
co-ordinated to Managing
rk
development eg MHFA courses
Off s
assessment
absence policy - flexible working
k
Monitor - childcare
- diversity
External support/information
‘Distress’
We gratefully acknowledge the work of Heron and Teasdale which has informed this diagram.
19
2. Promoting wellbeing cont.
- A
t the organisation level, for example, Again, most of the ideas presented here
it is good to have policies, structures are just good management practice.
and appropriate processes in place to But what enlightened organisations do
cope with an employee’s physical and/ is encompass mental wellbeing within
or mental ill health as it should arise. the boundaries of normal working life,
rather than focusing on it as 'out of
- But it is equally important that the ordinary' and therefore potentially
managers observe what is happening stigmatised.
at work on a day-to-day basis, and to
keep a close eye in particular on the The remaining sections of this guide
interaction between the employee explore in more detail how line managers
and their immediate manager and can support their employees
colleagues or team. through this journey.
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3. Recruitment
21
3. Recruitment and promotion cont.
The full guidance can be found at: Often the greatest barriers faced
https://www.gov.uk/government/ by people who are known to have
uploads/system/uploads/attachment_ experienced mental ill health is being
data/file/85013/employment-health- denied the opportunity to prove their
questions.pdf effectiveness. The Equality Act 2010
is designed to prevent this happening.
And because mental health conditions
and previous absences are not reliable
indicators of future illness, sickness
absence – or indeed, an individual's
ability to do a job – the Act also reduces
the chance that employers inadvertently
miss out on talent through discriminatory
recruitment practices.
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MHFA Line Managers' Resource
By using the HSE Management Managers and occupational
Standards (see section 1) you can do a health advisers should not do
risk assessment for the job in respect of either of the following.
work-related stress. You can then review
this assessment should problems develop - A
sk for information about treatment,
during employment, and use it as the the history of the illness, or any other
basis of a referral to occupational health information that is not relevant
or other health professionals. to the work situation.
23
4. Identifying the early
warning signs and talking
at an early stage
In essence there are four broad Line managers should know their team
categories of people in any workplace. better than anyone. They are therefore
ideally placed to spot the early warning
- People with a mental health diagnosis signs that someone is mentally unwell.
who are healthy and performing There will be times when you notice that
well because they are managing someone whom you manage is behaving
their condition through medication, out of character or seems unhappy.
counselling, support at work and so on. Some of the key things to look out for
are changes in an employee’s usual
- People with a diagnosis who are behaviour, such as poor performance,
unwell. tiredness or increased sickness absence.
You might notice they are smoking
- People with no diagnosis who are well. or drinking more, or taking drugs, or
experiencing problems with colleagues.
- People with no diagnosis but who are A normally punctual employee might
very unwell and may not even realise it, start turning up late, or, conversely,
but whose performance is likely to be they might start coming in much earlier
impaired. This group is at the highest and working later. Other signs might be
risk of suicide. tearfulness, headaches, loss of humour
and mood changes. See the box for a
more extensive checklist.
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MHFA Line Managers' Resource
Early warning signs of mental ill health - Being adamant they are right.
- W
orking too many hours – first in,
Here's a list of behaviours and warning last out/emailing out of hours or
signs to watch out for. while on holiday.
- Loss of confidence.
- Unplanned absences.
- T
aking on too much work and
volunteering for every new project.
25
4. Identifying the early warning signs and
talking at an early stage cont.
One of the most important things
you can do as a line manager is know Presenteeism
your people – that way it's easier to
spot when something's wrong. If you Presenteeism is a term used to describe
do perceive a potential problem with someone at work who is not working to
an individual, try to establish whether their full capacity because of ill health.
certain tasks, work environments, times A report in 2010 from The Work
of the day or particular team dynamics Foundation, Why do employees come to
are contributing to their distress. If the work when ill? found that the reasons for
problem persists for more than a few presenteeism include the following.
days, find a way to talk to them about
it. Be aware that the employee him – or - P
ressure from managers and colleagues,
herself may not even recognise what's especially in environments where
happening to them, pretend it's not attendance management policies
happening, or feel anxious (which are designed to reduce
about seeking help. sickness absence) are in place.
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MHFA Line Managers' Resource
Using everyday management - A
sk for a private meeting at a mutually
procedures to identify problems convenient time and give yourself
and needs plenty of time so you don't have to
rush or are perceived to be in a hurry.
If any employee is experiencing mental
ill health at work, ideally they should - Meeting outside the office – in a
feel able to raise this with you, as coffee shop, for example – might feel
their manager. Regular work planning more private and less intimidating.
sessions, appraisals or informal
chats about progress are the kind of - Back up your concerns over particular
everyday management processes that behaviours or performance with
provide neutral and non-stigmatising concrete examples, dates and times
opportunities to talk about any problems
they may be experiencing. But if they - Y
ou don't want to be disturbed, so turn
don't bring up an issue, and you have your phone off or onto silent.
noticed a change in their behaviour
that you think might indicate they are - W
hen you ask them how they are,
becoming unwell, you need to find a way don't take 'I'm fine' for an answer. Be
of broaching it. prepared for them to be evasive or
defensive. Use specific examples to
Be aware that a sudden dip in underpin your concern and move the
performance or punctuality are likely to conversation forward.
be signs of a deeper underlying problem,
so it is inappropriate and unhelpful to - Mind your language. Say 'I' not 'we'
take a hard line approach. You clearly to avoid the employee getting the
need to talk about the issue at an early impression that 'everyone is talking
stage, but ask questions in an open, about them'.
exploratory and non-judgemental way.
For example: "I’ve noticed that you’ve - Reassure them that you are there to
been arriving late recently and wondered help them, not censure. This is not a
how you are?" That gives the employee disciplinary meeting and they aren't in
the opportunity to express their concerns trouble. If they get upset, let them take
in their own way. their time, and resist the temptation
to offer water or tissues as they may
If you listen and are empathetic, perceive that as an attempt to stop
positive and supportive, an employee will them. They will tell you when they are
feel more able to open up and be honest ready to continue.
with you, which then makes it easier
for you to offer the help they need. - Listen to them in a non-judgemental
Frame the conversation in the context way (see panel/box).
of exploring the issues and working out
how you can help. - Don't be tempted to rush into action.
Tell the employee you need to reflect
Sometimes your concerns may be such on what you've heard. Thank them for
that you need to have a conversation talking to you, reassure them that you
outside the regular informal chats. Think will sort it out between you and fix
carefully about how, when and where to another time to talk. Switching to the
have the conversation. pronoun 'we' at this stage is helpful,
because it includes them.
27
4. Identifying the early warning signs and
talking at an early stage cont.
- Empathy – the ability to place yourself - Keep appropriate eye contact (don't
in the other person's shoes and stare or avoid their eyes).
demonstrate to them that you hear and
understand what they are saying and - Maintain an open body position.
feeling. You get on their wavelength.
- Sit down even if the other
It requires a combination of person is standing, to make you seem
verbal and non-verbal skills. less threatening.
Verbal - T
ry not to sit directly opposite
the other person, which can
- Listen without interrupting. seem confrontational.
- Pay attention.
- A
sk appropriate questions to
make sure you are both clear about
what is being said.
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MHFA Line Managers' Resource
Understanding patterns of absence If this employee has seen others with
similar problems being discriminated
If someone is having frequent short against, their caution is understandable.
bursts of sickness absence, giving
a variety of reasons such as stress, - Meet the person somewhere
migraines and back pain – or, indeed, if private – perhaps in a place of their
they give no reason – they may have an choosing, where they feel comfortable.
underlying, mental health issue that you
need to discuss with them. - A
sk them if they'd like to bring an
advocate – maybe a trusted colleague,
But if you are going to look systematically friend or family member – to support
at patterns of absence for employees, them. Indeed some people might find
they need to be able to trust you, and it easier to talk to someone other than
feel reassured that your motive is not you in the first instance – someone of
to castigate them but to help them the same age, gender or ethnicity, or
work healthily. Therefore, once you're at least someone who is not their line
reviewed absence patterns you may need manager. Ask them who they
to communicate with staff what changes would choose.
you are going to make to improve people'
health and wellbeing at work generally. - In larger organisations you might
enlist the help of occupational health
(OH). However, the employee may be
reluctant to talk to OH. Whatever the
Engaging with someone who approach, you need to communicate
is reluctant to talk about their clearly with OH to ensure that
mental health contact with the employee is co-
ordinated and supportive.
Sometimes you have to work quite hard
to get an employee to open up the - A
ll three parties must be clear
problems they are experiencing. This is about confidentiality boundaries
likely to mean that you need to step up and who will be told what.
the dialogue.
- Deal with hurtful gossip or bullying
- Reassure the employee that you promptly and effectively. You have a
will treat anything they tell you in legal duty to ensure that employees
confidence, except where there are are not bullied or harassed on account
issues that pose a health and safety of any disability or additional needs.
risk to either them or others.
- If the employee finds it too difficult to
- Consider why they might talk now, reassure them that your door
be reluctant to talk. is always open.
- A
re they worried about being
judged, or that they might lose
their job?
- W
ill you treat any disclosures
they make sympathetically
and positively?
29
4. Identifying the early warning signs and
talking at an early stage cont.
Issues to raise with an employee - Is there any aspect of their medical
who is experiencing mental ill health care that it would help you to know
about? (For example, their medication
- A
sk open questions about what is could have side-effects that affect their
happening, how they are feeling, what work.) While you have no right to this
the impact of the stress or mental ill information, they need to understand
health is. Ask them what solutions they that you can't make ‘reasonable
think there might be but appreciate adjustments’ if you don't understand
that they may not be able to think what the problem is.
clearly about solutions while
experiencing distress. - Do they have ideas themselves about
the kind of adjustments to their work –
- How long have they felt unwell? Is this either short- or long-term – that might
an ongoing issue or something that an be helpful?
immediate action could put right?
- Do they have any ongoing mental ill
- Discuss whether work has contributed health that it would help you to know
to their distress. Listen without passing about? If so, is it useful to discuss their
judgement and make sure you address established coping strategies and how
their concerns seriously. the organisation can support them?
(See section 6 for more information.)
- A
re there any problems outside work It is up to them whether they want to
that they would like to talk about and/ reveal this, but again, you can explain
or it would be helpful for you to know that doing so will make it easier for you
about? However, don't put pressure to make reasonable adjustments.
on the employee to reveal external
problems if they appear reluctant. - Establish precisely what they want
their colleagues to know, and who will
- A
re they aware of possible external communicate this. An inappropriate
sources of support, such as relationship breach of confidentiality or misuse of
or bereavement counselling, drugs/ the information they have told you
alcohol services/advice, legal or might constitute discrimination.
financial advice?
- A
gree what will happen next and who
- A
sk them if there is anything you will take what action.
can do to help, and make sure that
they are aware of any support that - Record all conversations accurately,
the organisation may provide, such and provide employees with a copy
as referral to occupational health, to ensure you both agree that it is
counselling, Employee Assistance an accurate record. This protects the
Programmes (EAP), brief psychological organisation and the employee and
therapies, health checks and so on. allows you to monitor progress
Make sure they know that if they take against agreed actions.
advantage of any of this help, it will be
confidential.
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MHFA Line Managers' Resource
higher level and another person to
Try to be sensitive to the level of underperform. What's motivating for one
information and support the employee is a hindrance for another.
can cope with at a given time. In the
midst of a crisis they may not be able Also, someone's ability to work
to think clearly or absorb information. under pressure may vary according to
The important points are to talk to what’s happening outside work. Most
them, reassure them their job is safe, people can cope with short bursts of
state positively that all help, assistance stress, but prolonged stress is linked to
and support will be offered, and affirm mental health conditions such as
that the discussion will continue at a anxiety and depression.
pace that suits them.
The employer has a legal duty to ensure
that work doesn't make employees ill.
Problems can build up over time and Failing to assess the risk of stress and
while you may feel the pressure to take mental ill health and to take steps to
action immediately, it might be better alleviate them could leave you open to
to reflect and consider the options. costly compensation claims. There is
Together with the employee in question, now considerable case law in this area.
try to distinguish between what's urgent
and what's important. Fortunately, employers are usually able
to make adjustments easily and relatively
You might also consider whether the cheaply: after all, most adjustments come
employee has been affected by an down to good management practice that
issue that may affect others in the will help others, not just the particular
team/organisation, such as the threat employee in question.
of redundancy. If this is the case you
need to carry out a stress risk audit and For more information about good
address any issues that emerge together management practice, including risk
with other departments, such as health assessment, on work-related stress, see
and safety or HR. the HS website (www.hse.gov.uk/stress).
You may also want to make use of the
Workplace Pressure Support Plan
Things to consider when an employee tool overleaf.
appears or says that they are ‘stressed’
But managing the mental health of your
The term ‘stress’ is not always helpful workforce is about much more than legal
as it means different things to different compliance. Investing now in ensuring
people. We all feel under pressure some your workforce is confident and able to
of the time but not everybody suffers support themselves and each other pays
the adverse reaction of stress, or off not just in financial terms, but also in
the same level of stress. We all react team morale, productivity and loyalty.
differently: the same amount of pressure
can spur one person to perform at a
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4. Identifying the early warning signs and
talking at an early stage cont.
- A
sk them if they would like you to
contact anyone or if they would like
someone to be with them.
- A
lternatively, you might suggest
that you both leave the building for a
short time, and have a hot drink or a
short walk to give them time to
collect themselves. They may choose
to go on their own, but it is advisable
to accompany them – or have
someone else of their choosing to
accompany them – if they are still
very distressed.
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MHFA Line Managers' Resource
Workplace Pressure Support Plan Of course, issues at home could also be
a problem and it’s important to recognise
If an employee tells you that they feel this may impact on the employee at work
‘stressed’, under too much pressure or if and offer support where possible.
you have noticed some signs that they
may be having some difficulties coping, Having a conversation need not be
you can use this action plan to help difficult or embarrassing and doing
structure a conversation and record any something about a problem doesn’t
suggested solutions or actions. need to be time consuming or expensive.
In fact, getting the issues out into the
Remember that what may feel like open and agreeing a way forward is the
a reasonable amount of pressure to most effective action. Putting support
one person could be overwhelming to in place early to deal with any issues
another. It is important to respect the could prevent the problem escalating
way someone tells you they feel and having a larger impact on both the
and treat any issues as real and individual and the team.
warranting support.
The action plan overleaf can be used
There are several key sources of pressure to record the issues raised, identify the
at work which could lead to stress either sources of the problem where possible,
individually or in combination. any actions agreed to help along with
timescales for review. This can be used
- Demands – workload, targets, to support an employee at work and
time pressures, working patterns, could be at an informal 1:1, return to
balance etc. work discussion or formal appraisal.
You can keep this record and review it
- Control – inability to have an with the employee as required.
adequate say over how a job is done
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34
Employee concerns Impact at work Suggested solutions Action agreed Review
What does the employee How are the What could solve the What actions have been Review date of
believe are the main issues affecting the issues? (manager and agreed & why? (for manager actions in place
issues? employee at work? employee) and employee)
talking at an early stage cont.
By signing, the manager and employee Name of Line Manager Signed by employee
agree the notes are a true reflection of
the discussion and agree to complete Name of Employee Date
the agreed actions without
4. Identifying the early warning signs and
35
4. Identifying the early warning signs and
talking at an early stage cont.
This behaviour may affect colleagues, Such episodes are rare, and when they
clients or customers, and you need to do occur it is not usually completely ‘out
be mindful of your responsibilities of the blue’. This is why it is so important
for all employees. to be alert to changes in behaviour and
to act promptly to pre-empt these
- T
ry to take the person to a quiet more extreme manifestations of
place and speak to them calmly. mental ill health.
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MHFA Line Managers' Resource
If an employee draws up an advance
statement that is agreed with you, you Additional support for an
must put it into practice as agreed if/ employee who is distressed or
when they become unwell. develops mental ill health at work
- A
n inclusive process increases the The National Institute for Health
likelihood that people will complete the and Care Excellence (NICE) has shown
statement. that psychological therapies can help
people overcome depression and/or
- It makes people think about their own anxiety, and people are increasingly
and others' mental health. being offered 'talking treatments' as a
result of significant government
investment in the Improving Access
to Psychological Therapies (IAPT)
programme. The programme focuses
on cognitive behavioural therapy (CBT)
but over time will extend to the other
NICE-compliant treatments.
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5. Keeping in touch
during sickness absence
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MHFA Line Managers' Resource
Tips on supporting an - Families often play a key role in
employee who is off sick supporting people when they are
unwell and helping them to recover.
- It is essential to keep in touch. If Their knowledge and understanding
there is little or no communication, is often unique and can be an
misunderstanding and barriers can important resource for employers to
quickly arise, the employee may feel tap into. Members of the family can
that they are not missed or valued act as valuable intermediaries and
and this can exacerbate their already potential partners in helping an
low self-esteem. Inviting them to so- employee back to work. You
cial events shows that you still think need to respect the employee's
of them as one of the team. confidentiality, but don’t assume that
they wouldn't want you to engage
- W
hen they call in sick suggest and with their family – indeed, they might
agree a time they will call you or you be relieved that you have offered
will call them. At the end of each to do that.
exchange you can agree on the
timing of the next follow-up call. - Y
ou might find it helpful to think
about the support you would offer to
- Y
ou could explore different means someone with a physical condition.
of contact – phone, text, email or Is your approach to someone
face-to-face meetings in a neutral suffering from stress/distress
setting, for example. The employee different – and, if so, why? The
could ask someone of their choice to employee might appreciate hospital
accompany them to any meeting. visits, cards, flowers and so on – but
ask them first. The main thing is to
- A
sk them who they would prefer as let them know they have not
their main contact. It might be you, been forgotten.
as their line manager, or it could be
another line manager, or an HR or - Y
ou could ask them what, if any,
OH adviser. This may be particularly treatment they are having and the
important if the employee’s relation- effect this is having, but you must
ship with their primary contact is poor never put pressure on the person
or if that person contributed to their to divulge personal or medical
absence in the first place. information. It is up to them
whether or not they reveal it.
- Early intervention is key. The longer
someone is off work the harder it - A
sk them if they feel able to do some
may be for them to return, so it is work despite their health issue, and
advisable to refer them to OH when they think might be able to
early on. return to work. However, timing is
critical: when someone is in crisis the
- If the employee is too unwell to be very thought of returning to work
contacted directly, find out whether could exacerbate the problem, and
someone else – a family member they may have no idea how long it
or friend, for example – can keep in will take them to recover. Here the
touch on their behalf. Switch back to input of their GP, in particular the ‘fit
direct contact as soon as the note’, will be helpful.
employee is well enough.
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5. Keeping in touch during
sickness absence cont.
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MHFA Line Managers' Resource
The role of GPs Occupational health
The GP’s role is to provide care and Occupational health (OH) provide
treatment and help people recognise impartial and confidential advice on
that getting back to work can be good fitness to work. Managers can refer
for recovery and health. They are helped employees to OH with their consent to
in this by the ‘fit note’, which, unlike obtain advice on the type of support
the old medical statement or certificate required and to ensure a successful
that it replaced in 2010, focuses on return to work. GPs may also prefer
what people can do rather than what to share information on an employee
they can’t do. The fit note helps to with other health professionals, rather
improve the flow of information between than with line managers. Therefore,
employers, individuals and GPs by if you have access to OH support, it
enabling patients to convey information would be sensible to refer the employee
to their employer about when the GP to them. OH, in turn, would write to
thinks they may be ready to return to the employee’s GP – again, with their
work and what adjustments might help written consent. It then becomes the
facilitate that. responsibility of OH to share with
the GP what the employer can
In addition to this, provided you have reasonably facilitate at work in the
the written consent of the employee, way of adjustments.
you could contact their GP highlighting
any factors that might have a bearing The advantage of involving OH at this
on the employee’s return to work stage is that their medical knowledge
that it would be useful for the GP to means they can ask the GP specific
know. Such factors might include the questions about the diagnosis and
nature of the work they do, a stress risk how it affects the individual, and the
assessment and/or information about the implications for the work the individual
organisation’s rehabilitation policies. You does, the prognosis and treatment issues.
could also propose specific options for
the employee such as adjustments The GP will send a confidential report
at work and/or a short-term to the OH practitioner, who then has
reduction of hours. to provide the employer with guidance/
recommendations on how best to
You should enclose a copy of the consent support the employee based on this
form with your letter to the GP. confidentially-held knowledge of their
medical background.
If the employee does not wish you to
contact their GP, that is their right and However, at some point, you, as the line
you must respect it. manager, will have to make decisions
about the employee based on the
information that you have.
41
6. Returning to work and
reasonable adjustments
- Y
ou may want to encourage the
Planning the return individual to come into work informally
before their formal return.
You need to put various things in place
before the employee returns to work. - It's always good practice to have
a ‘return to work’ interview when
- Develop, in discussion with someone returns to work after an
the employee, a return-to-work absence. Even though this might be
action plan. just a quick informal chat, it gives you
the opportunity of finding out how
- Discuss whether you need to make they are and making them feel valued.
any adjustments to ease their return
(see below for some ideas).
42
Reasonable adjustments If necessary you should obtain a report
- Look at aspects of the job that the - Give them a mentor or buddy.
person finds particularly stressful and
rearrange responsibilities. - Give them time to exercise – so
longer lunch breaks to go to the
- A
llocate some of an employee’s duties gym or have a run.
to another colleague and adjust the
content of the job. - Identify potential training needs and
consider developing the skills of the
- A
llow the employee greater control individual and their colleagues. This
over how they plan and manage their might cover the specific requirements
time and workload. of the job the individual performs
and/or enhance skills such as
- Offer the option of working at home communication and time
for some, or even all, of the time. management for everyone.
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MHFA Line Managers' Resource
- Consider transferring the employee to What to do when an
another role. This is usually a last resort employee returns to work
once all reasonable adjustments have
been fully explored in the individual’s Above all make sure you and the
existing role. team make the person feel genuinely
welcomed back into the workplace.
Most adjustments are simple, You might consider offering them a
inexpensive and need only be temporary. mentor - a colleague or manager from
Some mental ill health can be episodic elsewhere in the organisation - so that
and so it may be better to agree they can talk to someone who isn’t their
certain adjustments on an ad hoc basis manager. This will ease their transition
rather than introducing them all in a back into work.
blanket fashion. However, many of the
adjustments listed above could be seen Do...
as good management practice that will
benefit all employees. - Ensure the returning employee
doesn’t have to face an impossible
Remember the following. in-tray, thousands of emails or a
usurped workspace.
- Don’t make promises that you
can't keep – be realistic. - Be realistic about workloads – some
people will want to prove themselves
- If you're not sure what will help and may offer to take on too much.
someone, ask them. Instead, set achievable goals that make
them feel they are making progress.
- Review the adjustments regularly to
ensure they are still working or - Make the time to have frequent
still necessary. informal chats with them to give you
both the opportunity to discuss their
progress and/or problems in a non-
threatening context. However, be
careful not to make them feel that their
work and/or behaviour is being overly
monitored or scrutinised.
Don't...
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6. Returning to work
and reasonable adjustments
Managing reactions
Points to consider around from colleagues and clients
staff who are on medication
Fear, ignorance and hostility from
- T
hey may experience distressing side colleagues and clients can be a source
effects, which they might or might of great distress. Many people who have
not want to discuss with you. experienced mental ill health describe
this as a particular area of stigma and
- Some side effects might look like discrimination. Communicating openly
manifestations of the illness the about mental health/ill health is critical to
medication is treating, and they may eliminating the discrimination and stigma
be short-lived. Therefore the ef- associated with it, and nowhere is this
fects on the individual's work may be more vital to the employee's recovery
temporary. They may also need the and rehabilitation than at the point that
medication for only a short time. they return to work.
- T
reat people returning from absence
due to mental ill health in the same
way as you would those returning
after physical ill health.
- W
atch out for hostile reactions –
stamp out any hurtful gossip or
bullying promptly.
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MHFA Line Managers' Resource
- T
reat mental ill health in a matter-of- continue to treat the individual with
fact way – it is common and should respect and consideration, and help them
not be a source of office gossip or to move on with dignity. You should,
conjecture. of course, fully explore options such as
any health-related benefits they may be
- A
fter a time, ask the employee how entitled to – including health-related
they are getting on with peers/clients. retirement and pension.
Review the support you're giving them,
and if you don't already have initiatives
in place to raise awareness of mental ill
health, consider introducing them. Managing an ongoing illness
while at work
Avoid:
Most people who have ongoing mental ill
- Shrouding the issue in secrecy health can continue to work successfully
with either minimal support or no
- Making assumptions about someone's support at all.
workload and their capacity to cope.
This section discusses how, where
someone does need support, they can
work with managers to ensure that
What happens if the return support is sufficiently flexible to suit what
to work is not successful? might be their varying health needs.
47
6. Returning to work
and reasonable adjustments
48
7. Sources of further
Available from:
BITC (Business in the Community) https://www.fdf.org.uk/publicgeneral/
Workplace%20Wellbeing%20doc_13.pdf
Phone: 020 7566 8650 (Accessed 08/09/2016)
49
7. Sources of further help
and information cont.
Health in Construction Leadership Group Mental Health Foundation
workplace resources
Phone: 0113 261 5368
Website: www.mentalhealth.org.uk/tags/
Website: workplace
www.healthinconstruction.co.uk
The Mental Health Foundation has
Health In Construction Leadership developed a range of resources aimed at
Group works with construction CEO’s to tackling mental health in the workplace.
improve health within the sector, with a This includes the helpful guide ‘Managing
current focus on mental health. mental health in the workplace’, produced
Brings together contractors, clients, with employee benefits specialist Unum.
the Health and Safety Executive, Available at the link above.
professional bodies, trade
associations and trade unions.
Mindful Employer
Email: support@edsupport.org.uk
Website: www.
educationsupportpartnership.org.uk
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Mind’s guide to workplace mental health Time to Change’s guide to
Phone: 0207 697 3300 The Shaw Trust is the UK’s largest third
sector provider of employment services
Website: for disabled and disadvantaged people.
www.richmondfellowship.org.uk
This is Me
Website: www.thelordmayorsappeal.org/
power-of-diversity/this-is-me
51
Appendix 1: due to work and has subsequently been
supported by her counsellor and the
MHFA training occupational health team, had a period
off work and has since had a successful
MHFA training courses give people managed phased return.”
the confidence and communication
skills to support colleagues and teams “The learnings from the Mental Health
experiencing mental health issues. First Aid course were useful when one of
Below is a selection of comments from my counselees was signed off work with
MHFA-trained line managers. depression a few months later. Knowing
what support was available and how
“A few months after I took the course, to access it meant that we got the
one of my counselees was diagnosed by individual into the appropriate care
their GP with depression. He came to pathway immediately, and having
tell me about it, as was advised by his attended the course I could be
GP. While it was still a new experience absolutely confident that my employer
for me to deal with, having attended the expected and wanted me to focus on
Mental Health First Aid training was a their personal needs rather than the
huge help. I knew what to say to him, needs of the organisation. Being clear
and what resources to point him to. about this priority made a difference to
More importantly, I knew to reassure how I approached the situation, and now
him that it does not stop his career from that the individual is back at work we
progressing and the firm will support him are able to have an honest and ongoing
through this challenge. After a course dialogue to try and prevent issues
of treatment and a few weeks off work, building again.”
things have improved for him. He is now
happy to be back at work. I am really glad “Having various close friends with
I had the training and had the knowledge depression, I had seen mental illness
and tools to be there for him.” close hand. I had used the internet to
find out more, and tried to help as best
“I have been more aware of my as I could, but the Mental Health First
own illness and have been able to Aid course gave me further insight,
acknowledge the impact that it can helped me deal better with my emotions,
have on my day-to-day life. I have had and allowed me to offer help in a more
the confidence to discuss this with useful way to my friends. In particular,
my counsellor and management team I learnt that my role as a friend was not
and to take steps to start identifying to 'fix' their depression, but rather to be
triggers and adapt my working pattern open for conversation, and to understand
and relationships in order to manage my that because I am not a professional I can
illness and begin to reduce the negative help guide them to the correct source
impact it has on my life.” of help. Furthermore, I found that the
difficult topic of suicide was discussed
“Someone called me deeply upset prior openly and skilfully, and I found it
to going into one of our offices (not her especially useful to be given guidance
home office). She felt she was having a on how to discuss suicide with someone
panic attack and reached out for support, who has been thinking of, or has
knowing I had attended the Mental attempted, suicide. It was refreshing to
Health First Aid training. I recalled how hear difficult subjects being approached
to provide immediate support. Long head-on, stripping away the taboos
story short, she was suffering from stress
52
MHFA Line Managers' Resource
associated with them, and allowing us Appendix 2:
to have a much better understanding
of what people with different types of The small things
mental illness go through and how we
can help.” The #smallthings campaign from Time to
Change highlights all the little ways you
“Following the MHFA course I have can help someone you know who has a
been able to help a colleague to seek the mental health issue. See the links below.
support needed in respect of a family
member suffering with an undiagnosed https://www.youtube.com/watch?v=46-
(at the time) psychotic illness who was 1Rv13gXQ&index=2&list=PLW8cG1kJhc
refusing help.” vemCxldyQ7XHv_BhtAHbOQl
53
Appendix 3: References
54
MHFA Line Managers' Resource
55
Notes
MHFA England™ © 2016 MHFA. All rights reserved.
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