Work-related stress (WRS) is the second most reported cause of occupational ill health in the UK. While the highest incidence rates are recorded in public services – education, health and social care, prisons, emergency services, local and central government – there is increasing evidence that it is becoming a significant problem in other sectors.
When it is prolonged, WRS can lead to problems with physical as well as mental health, the key stressors most often identified are high workloads, high demands and insufficient support from managers.
What is the difference between poor mental health and ill mental health?
What is stress?
Definition of stress HSE defines stress as ‘the adverse reaction people have to excessive pressure or other types of demand placed on them’. This makes an important distinction between pressure, which can be positive if managed correctly, and stress, which is likely to be detrimental to physical or mental health if it is prolonged.
What is ill mental health?
Definition of ‘mental health’ - a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her own community. (World Health Organisation)
The definition of ‘mental ill health’ covers a very wide spectrum, from the worries and grief we all experience as part of everyday life, to suicidal depression or complete loss of touch with everyday reality. According to the Health & Safely Executive (HSE) one in four people in the UK will have a mental health condition at some point in their lifetime - harmful levels of stress, anxiety, depression. The most common diagnosable mental health conditions are briefly described below:
Depression - Depression can be described as mild, moderate or severe. Symptoms include low mood and lack of energy, sadness that doesn’t go away. Motivation can be affected, lack of energy, loss of confidence and people may experience thoughts of life not being worth living, which in extreme cases can lead to suicidal behaviour.
Anxiety - Anxiety becomes a problem when feelings of tension and fear intensify and prevent a person from carrying out everyday tasks. There are often strong physical symptoms (chest pain, shortness of breath). People may suffer panic attacks or phobias. Obsessive Compulsive Disorder (OCD) is a form of anxiety where people have recurrent, intrusive thoughts, which they may feel ‘forced’ to act on (e.g. checking or compulsive behaviours, to try and reduce the anxiety).
Psychosis and Schizophrenia - Psychosis is a term used when a person appears to lose touch with reality. Schizophrenia is the most common form but is not a ‘split personality’. People may hear, see or believe things that aren’t real to others (e.g. hearing voices, thinking that others are ‘out to get them’). If the illness becomes chronic (long term) the person may withdraw from the outside world and neglect themselves.
Bi-Polar Disorder (Manic Depressive Illness) - Both these terms are used to describe this condition where a person may ‘swing’ between episodes of extreme low mood and depressive symptoms to being ‘high’ or elated. During a manic episode a person may have high energy levels, grand or unrealistic ideas and become reckless (e.g. taking risks, overspending). People may go through the mood cycles at different rates and times.
Personality Disorder - These are a range of long-term, inflexible attitudes and behaviours which make it difficult for people to maintain relationships and co-operate with others. People may find it difficult to control their emotions or behaviours or register their impact on others. There are up to ten different categories, including paranoid, antisocial and dependent.
Eating Disorders - These are extreme ways of controlling food intake and weight gain, usually as a way of coping with emotional difficulties. People with anorexia nervosa severely restrict their calorie intake, while those with bulimia nervosa may binge eat. Both conditions may lead to people using other techniques to lose weight including vomiting, use of laxatives and excessive exercising.
Self-Harm and Suicide - People may hurt themselves deliberately to deal with problem emotions. Methods include self-neglect, cutting, burning or overdosing. Suicidal behaviour may occur when a person feels they have no other options. It may be a cry for help, a mistake or a deliberate act.
What are the signs of mental health deterioration in the workplace?
Although individual mental health condition may have unique symptoms, the key is to pick up changes in the person’s usual thoughts, emotions or behaviours and physical signs can also appear. Remember also that other hormonal changes can reflect some of the following too:
Psychological signs include:
- Irritability;
- Aggression;
- Tearfulness;
- Fearfulness;
- Indecision;
- Inability to concentrate;
- Loss of confidence;
- Difficulty in remembering things;
- Confusion;
- Changes in thought patterns;
- Restlessness;
- Loss of humour;
- Low self-esteem;
- Suspiciousness; and
- Lack of insight
Physical signs:
- Frequent headaches/aches and pains;
- Frequent stomach upsets;
- Frequent minor illnesses;
- Difficulty in sleeping;
- Constant tiredness;
- Weight gain/weight loss;
- Being physically run down;
- Lack of care over appearance; and
- Changed energy levels.
Behavioural signs:
- Social withdrawal
- Arguments or conflict with others
- Erratic or socially unacceptable behaviour
- Avoiding particular situations
- Being louder or more animated than usual
- Increased use of caffeine/cigarettes/drugs
- Evidence of self-harm
- Evidence of eating disorders
At work behavioural signs:
- Difficulty in carrying out usual tasks
- Procrastination
- Complaints about workload
- Missed deadlines/forgotten tasks
- Unplanned absences
- Increase sickness absences
- Increase errors/accidents
- Negative towards colleagues/less socialising
- Over working or working longer hours
What can you put in place to support your employees?
- Speak openly about mental health within your organisation – people will realise they are not alone.
- Create a culture of noticing employee’s behaviour (low mood/irritability) and asking them if everything is OK. Sometime just someone listening to you can help them release stress, so things don’t progress.
- Hold one to ones/reviews where you get to know your employees and ask them about their health, safety and wellbeing.
- Design a mentally healthy workplace - overall wellness increase when people feel comfortable in a workplace with natural lighting, plants, and other positive features.
- Mental health first aiders – communicate that your trained team are there to listen, support and signpost if a mental health issue arises.
- Mental health awareness training throughout your management team – so they can spot the signs of deteriorating mental health and support their colleagues.
- Employee assistance programs – communicate the process and telephone number of using this service, if it’s to hand people are more likely to use it.
- Wellbeing events – on-line or in-person, that people can register for, keep them short 30-40 minutes on subjects such as self-massage, stress management, mindfulness, healthy eating, sleeping well, digital wellbeing, working from home etc.
- Have easy access to ‘back to work plan’ information for your managers to access to support them in helping their colleagues back to work after mental ill health.
- If an employee is experiencing a mental health problem, the charity MIND has some informative guides that can support you https://www.mind.org.uk/media-a/4661/resource4.pdf
Where can people get more support with their mental health when they need it?
By encouraging a healthy working environment and committing to supporting employee’s mental health at work, business leaders and managers can make a real difference to employee wellbeing and enhance business performance.
Treatments, therapies and recovery
Up to one in four people may need to seek professional help for their mental health at some point in their lives. Some may benefit from access to self-help or non-statutory support and information. Others may need additional input, via their GP to other forms of treatment (see below).
For self-help the internet is useful and there is a vast range of self-help literature available on any topic relating to mental health. There are many different voluntary or charity organisations offering help and support to people with mental health problems. The wide range of services on offer include telephone support lines, self-help groups, advocacy services and accommodation.
Medication
Many people with mental health problems will be prescribed medication to help relieve their symptoms. Medication can be very effective especially if used alongside ‘talking treatments’, support from others and lifestyle changes. Medication can cause side effects or withdrawal symptoms and does require careful monitoring.
Psychological Therapies
There are many different types of therapies or ‘talking treatments’ which range from brief to long term. People can attend individually, with partners or families or in a group setting. Therapy can involve talking over difficulties and feelings, changing the way they communicate or behave, or make decisions that affect their lives. Some common talking treatments are counselling, cognitive behaviour therapy (CBT), and psychotherapy. Therapies can be offered through the NHS usually via GP referral or can be paid for privately.
Specialist Services
If a person’s symptoms are severe enough, they may be referred by their GP to specialist or ‘secondary care’ mental health services. Support can be provided by Community Psychiatric Nurses, Social Workers, Occupational Therapists and Community Support Workers, they may also receive input from Psychiatrists and Psychologists.
Other services available may provide rapid, home based assessment and short term treatment for people in mental health crisis as an alternative to hospital admission (Crisis Resolution Teams); intensive support to people who may be difficult to engage with other services (Assertive Outreach Teams); A specialist service for people who may be experiencing early signs of psychotic illness (Early Intervention Teams); specialist help and support to people with substance misuse/abuse problems and eating disorders.
Some people may require a stay in hospital for specialist treatment. Most people go in voluntarily but if a person is felt to be a risk to themselves or others and refuses admission, they may be detained (‘sectioned’) under the Mental Health Act (1983, England and Wales). Some general hospitals have Liaison Psychiatry Teams for people admitted to them who are thought to have a mental health problem. There may also be specialist Vocational Services offering help to access training and employment or help in retaining existing work.
Recovery
Recovery from mental ill health is possible, it’s about people seeing themselves as capable of recovery, rather than as passive recipients of professional interventions. The personal accounts of recovery suggest that much personal recovery happens without professional help. Recovery involves personal development and change, including acceptance there are problems to face, a sense of involvement and control over their life, the cultivation of hope and using the support from others.
This guide is of a general nature. Assurity Consulting is the UK's leading independent compliance consultancy specialising in workplace health, safety and environmental solutions. We have over 30 years' experience of helping customers of all sizes, from across all sectors, manage their compliance responsibilities, making sure that their organisation is compliant, their employees are safe, their processes are cost effective and their management team is in control.