Mental health and mental ill health are both terms that we are all becoming increasingly familiar with. Yet until we’re negatively affected by mental illness, it’s probably not something that we even consider. We may get up in the morning and notice how we physically feel, but not many of us will do a mental health morning check, unless we have experienced mental ill health. How often do we question our mental and emotion state? Even if it is something we do acknowledge – ably assisted by publicity campaigns and recent media reports of celebrities experiencing mental health issues – mental health remains something many of us find it difficult to talk about and even harder to disclose to family members and friends, not to mention employers.

And it’s here in the workplace that mental health becomes particularly difficult with employees feeling vulnerable, colleagues finding it difficult to talk about and managers finding it difficult to listen, often without the skills or knowledge to know how to support staff experiencing mental ill health. In this article, Amanda Smith from the UK Employee Assistance Professionals Association ( reflects on mental health in the workplace and reviews why organizations need to face the issue head on and what steps can be taken to support employees affected by it.

So what exactly is mental health? 

Mental health is common to all of us and can be described as a state in which we are able to cope with the ‘normal’ stresses of everyday life, whilst being able to work productively, interact well with colleagues and customers and generally make a valuable contribution to the workplace. Mental ill health will affect one in four of us in any one year and can range from feeling a bit down to more common mental health disorders such as: anxiety, depression and more seriously, bi-polar disorder and schizophrenia.

For organisations, mental health and its impact upon employees is costly. The Organisation for Economic Co-operation and Development (OECD) estimates the cost to the UK economy at £70 billion each year, equating to 4.5% of GDP and a cost to businesses of £26 billion, £1,035 per employee. And a recent report by Businesses In The Community (BITC) reported UK businesses are less competitive due to a culture of silence around mental health in the workplace, with 15.2 million days of sickness or absence due to stress in 2013, which is a rise of 3.4 million days from 2010. The study also highlighted the effects upon our organisations with:

  • 37% of suffers more likely to get into conflict with colleagues
  • 57% finding it harder to juggle multiple tasks
  • 80% finding it difficult to concentrate
  • 62% finding it takes longer to do normal tasks
  • 50% potentially less patient with customers / clients

Furthermore, the study found that stress is now the major cause of long-term absence in both manual and non-manual workers.

Investment in employee mental health, it seems, is therefore a crucial factor when building and maintaining a successful business and organisation. In fact, the way in which mental health issues are handled at work is an important management responsibility, with inappropriate forms of response such as hostility, stigmatising attitudes or the perpetuation of stressful working conditions, giving rise to unnecessary costs as well as reputational and legal risks.

It should also be remembered that mental health is classed as a disability under the 2010 Equality Act, referencing it as any illness that has a “substantial and long term adverse effect on a person’s ability to carry out normal day to day activities”.

Supporting employees with pre-existing mental health issues

As a clinician working within a workplace mental health and employee support provision, I am aware of the confusion and difficulty that clients feel when experiencing firstly a new episode of mental health difficulty, as well as an existing one.

For example a client with bi-polar disorder recently discussed how she felt her illness affected her workplace. She felt that when she had a good idea or showed enthusiasm or ideas about service improvements, colleagues and managers who were aware of her condition would often see this as an indication that her illness was heading towards a manic phase. The impact of this on the employee was self-doubt and led to her questioning her creativity and ideas, leading to her asking herself whether something was a good idea and initiative or instead her illness thinking she could do something that wasn’t realistic. Such a situation was frustrating and debilitating for her and frequently confusing for her colleagues.

Another example of the impact of mental health in the workplace was a report I heard on a local radio station. The presenter was talking to a man who had been a legal professional until the age of 49 years. At this point the man had noticed changes in his memory ability and increased stress in dealing with his day-to-day workload. Eventually he sought GP intervention and many months later was diagnosed with early onset dementia. Two years later, the individual made the decision to enter into residential care where he could receive support for day-to-day living and quality of life despite his difficult and life changing diagnosis. He reported the difficulties that he and his employer had faced trying to help him to remain in work and the hard decision to stop working.

Whilst there are no typical employee situations, it’s useful to look at a typical client journey that may arise where employees need support or intervention within the workplace and how this situation can affect the organisation, colleagues and the employee themselves.

Let’s meet Peter…

‘Peter’ is a forty-five year old man in an organisation employing over 4,000 staff. He has a history of two episodes of sickness absence in his 25 years of employment. One for a hernia operation and one when he broke his leg in a sports related accident. Physically active and well, with a family of teenage children and married to his wife of 20 years, Peter was finding life more difficult than usual. He had relationship problems and was worried that his marriage was about to break up. Financially things were also difficult and his wife’s income had been reduced due to cuts in her hours. Peter had recently moved teams and had received an increase in work as a colleague hadn’t been replaced. He also felt that his new line manager was unapproachable and they were also new in post.

Colleagues had begun to notice changes in Peter’s normal day-to-day attitude. Normally approachable and supportive of the team and their client load he seemed to have become withdrawn and surly. He was unusually short with a client and rude to a manager. Some colleagues put that down to the fact that everyone was stressed, whilst others thought he wasn’t happy that the new manager had come in and felt he thought the post should have been his. Peter himself had never wanted the new post and hadn’t applied for it fearing that the additional pressure may well be the final straw for his relationship even though the additional income would have been helpful.

Over the last few months there were several occasions where Peter had had such a difficult evening with his wife that he had consumed too much alcohol and the next morning hadn’t felt up to work. His sickness absence had come to the attention of his HR department as hit a trigger point in the sickness absence policy.

Because Peter’s line manager was new in post she didn’t know Peter well, found him difficult to engage with and felt he was often obstructive. This meant that any communication between the two of them felt difficult and Peter didn’t feel he could approach her and disclose his difficulties. She also had no experience of working with Peter when he wasn’t under the pressure and therefore had no comparison to the man she was working with now.

The situation continued for six months until one morning Peter arrived in work late, smelling of alcohol. The line manager advised him to return home because she felt he was unfit for duty. Peter reacted angrily, telling her she was part of his problem. He then proceeded to tell her he was at the end of his ability to cope, felt unsure these days what life was about and didn’t feel anyone would care if he was here or not.

Several of Peters colleagues heard this exchange, were shocked at how he was and about what he was saying. Some felt guilty that after many years of working with him they had not noticed things change or that they hadn’t been able to help him before now. Those who were previously critical now felt uncomfortable, whilst others within the team felt resentful towards colleagues that had been critical and blaming when Peter was “obviously unwell”.

What to do if Peter worked for your organisation?

Whilst a fabricated scenario, Peter’s experience emphasises that often employees are reluctant to access support for their mental health and wellbeing. They’re often not sure what support would look like or they may lack the confidence that it will be supportive rather than punitive, fearing the loss of their job or sanction. Factors such as our own personality, background and experiences all affect whether we feel we can or cannot engage with support services, colleagues, line managers or HR.

So how can organisations ensure they reach staff like Peter and many others like him before they reach rock bottom and their work, managers, colleagues, and customers are impacted? Certainly, it’s the role of line managers as a first point of contact, supported by HR, organisational policy and employee support provision to enable and signpost staff to seek assistance at the earliest point possible.

From an organisational perspective how do we support our line managers, employees and HR to manage mental health and wellbeing? In Peter’s situation his behavior may indicate a diagnosable anxiety disorder or depression, particularly as there had been deterioration over the previous 6-12 months. And it’s also important to acknowledge that Peter hadn’t sought GP intervention, so how could the organisation support him?

His difficulties seemed to affect his ability to manage and alcohol had become part of his self-medication for this. He had hit organisational sickness absence triggers and his line manager wasn’t aware of his more normal ‘baseline behaviors’ prior to this situation. Colleagues had noticed changes in Peter’s behaviors and,  as is commonly the case, hadn’t received the training or knowledge base to see these behaviors as possible ill health.

Certainly, from an organisational perspective HR now has the opportunity to support Peter and signpost him to psychological support and Occupational Health to evaluate how to support him and help him to manage what may be an alcohol issue.

So, what really happens in your organisation today?

Whatever the size of your organisation or staffing numbers do you have an organisational mental health and well-being strategy to target prevention and allocate intervention? Although Peter’s problems were outside of work, the impact on workplace performance and other employees and clients eventually evoked the company’s sickness absence process.

Here are four key questions you can ask yourself and your organisation to assess the extent to which you’re building a mentally healthy workforce:

What access to mental health support exists in your organisation today? 

Take a moment to think about the support you offer for employees who may have mental health difficulties? Sometimes managers will question why it’s necessary to provide services to support staff with issues outside of work. Should this happen in your organisation, it’s important to remind them that we bring our whole selves to work and therefore the cost of mental health to the business means it makes economic sense to support staff to enable early support or resolution.

Also, remembering that the earlier affected employees receive support and the right type of intervention, the better the long-term outcome for them and your business. Research show that employers offering access to employee assistance provision, for example, reap the benefit in reductions in sickness absence, presenteeism, staff turnover alongside enhanced health and wellbeing.

Do you make mental health awareness training available to managers?

Within my own organisation our training and development director, Tracy Paxton, is also a CBT psychotherapist and experienced Mental Health Practitioner. She argues: “Mental health awareness training for managers, front line staff and all employees is essential for all organisations and not dependent on industry sector. Whether manufacturing, housing academic or health care, we all as individuals will have planned or unplanned life events that impact on our ability to cope with day-to-day activities. Therefore, training line managers to recognise the early warning signs and symptoms of a mental health problem and how to signpost employees to the relevant organisational support process, whether this is HR or your EAP, will ensure the organization can optimise employee engagement, performance and commitment to the organisations in which we work”.

What preventative activity do you take to minimise mental health issues?

The prevention, reduction and management of mental health at work are key components in preventing organizational and individual employee risk. As such, try to create procedures that enable employees to access appropriate support and intervention. Ensure staff have easy access to policy information and instruction on how to access EAP and other organisational support mechanisms. Training managers and HR to recognise the early signs of common mental health problems such as anxiety and depression is a great investment for your organisation.

Did you remember to think about mental health from the employee perspective?

Finally, remember that employees often don’t think about services and support for mental health issues until the need arises. There may be anxiety about accessing services or disclosing information to line manager or the HR team so regular investment in health and wellbeing promotion will remind staff of the services available to them and encourage them to access such as early as possible.

Amanda K Smith is a qualified counsellor and psychotherapist and is also trained as a workplace mediator. She is an Executive Committee member of the UK Employee Assistance Professionals Association and Clinical Director at Amian EAP.