Some 50 years after the introduction of the Health and Safety at Work etc. Act in the UK, it finally feels as though the mental health and wellbeing of workers is being valued as equally by employers as their physical health and safety. Arguably, the process began back in 2004 when the HSE introduced a set of management standards to help organisations tackle work-related stress. In 2007, the new Health Act introduced a ban on smoking in the workplace, to protect the health of employees. Both signalled an acceptance that employers had an overt duty to intervene even where there was no immediate physical danger to health.

Mental Health First Aid (MHFA) training took off when the HSE changed its official guidance on first aid in 2018, advising employers how to support employees experiencing a mental health issue. Globally, more than four million people have completed the MHFA training programme in 24 countries.

The prize is certainly worth fighting for. Approximately one in four people in the UK will experience mental illness each year. It’s the biggest cause of sickness absence, with cost to the UK economy of £74-99bn.Two years ago, the world’s leading health and safety body, IOSH, developed a new course designed to help line managers proactively address psychosocial health and safety risk before the need for first aid might arise.

Here at International Workplace, we’ve been developing a special version of the IOSH Managing Occupational Health and Wellbeing course for delivery in eLearning and virtual classroom formats, more information about which can be found later in this guide. The course is aimed firmly at front-line managers, to help them understand how to deal with fluctuations in people’s health. It fills a very important gap that links the risk management principles used in health and safety with the people management practices used in human resources.

It’s widely agreed that line managers are the first line of defence in terms of employee health and wellbeing – but it’s a big burden to carry. And so they need help. Adopting organisation-wide training such as IOSH’s Managing Occupational Health and Wellbeing will not make a difference to workers’ mental health and wellbeing overnight. But by taking these measures on board, organisations are agreeing what they need to do. And by committing to it, they’re telling their workers very publicly what they can expect. We hope you find this guide useful.

Employers have a legal duty to ensure that work doesn't negatively impact their employees’ health. Failing to assess the risk of stress and mental ill health and to take steps to alleviate them could leave employers open to costly compensation claims. So how can organisations better support individuals with mental health problems to remain and thrive in work? According to the Institution of Occupational Safety and Health (IOSH) report, Workplace Wellbeing: the role of line managers in promoting positive mental health, around 300,000 people with a long-term mental health condition lose their jobs each year. This is an alarming figure. The human cost is woefully high, as is the financial burden on businesses – poor mental health is estimated to cost employers between £33bn and £42bn a year in sick pay and lost productivity.

IOSH says line managers, given their position within an organisation, are often best placed to spot the signs of poor mental health in the workplace and – if equipped with the right skill set – can manage issues effectively before they reach crisis point.

Says IOSH:

“A good line manager will foster the kind of working environment that makes employees feel valued, respected and supported, and will act as a ‘gatekeeper’, protecting them from any working conditions that present risks to their mental wellbeing. Conversely, a bad line manager can aggravate and, in some cases, even be the cause of stress, anxiety and depression.”

Line managers should know their team better than anyone. They are therefore ideally placed to spot the early warning signs that someone is mentally unwell.

PHYSICAL

• Headaches
• Indigestion and heartburn
• Lack of appetite or overeating
• Muscular tension, aches and pains
• Nausea/being sick
• Indigestion
• Dizziness and palpitations
• Fatigue

BEHAVIOURAL

• Increased use of alcohol or smoking
• Change in appetite
• Restlessness or fidgeting
• Absence
• Lack of motivation or commitment
• Increased aggression
• More prone to accidents
• Avoiding contact with others
• Loss of sense of humour

THINKING

• Poor concentration
• Unable to listen to others
• Memory lapses
• Confusion and disorientation
• Difficulty making decisions
• Poor planning and task execution
• Negative or unhelpful thought patterns

EMOTIONAL

• Irritability
• Becoming angry with others too easily
• Depressed or tearful
• Frightened, worried or anxious
• Impatient
• Mood swings
• Panic attacks

There will be times when you notice that someone whom you manage is behaving out of character or seems unhappy. Some of the key things to look out for are changes in an employee’s usual behaviour, such as poor performance, tiredness or increased sickness absence. You might notice they are smoking or drinking more, or taking drugs, or experiencing problems with colleagues. A normally punctual
employee might start turning up late, or, conversely, they might start coming in much earlier and working later. Other signs might be tearfulness, headaches, loss of humour and mood changes.

Although some workplace demands trigger a stress response, frequent or severe stress is far riskier. Unmind advises that, over time, this can lead to various psychological issues, including fatigue, anxiety, depression, burnout, and even post-traumatic stress disorder (PTSD).

Unmind says:

“Mental and physical health are like our two feet. Technically, they’re separate. But at the same time, very much connected. If you sprain your right ankle, your left foot is forced to do extra. In doing so, you risk a brand new injury; this time, on your left. A second sprain wouldn’t be a direct result of the first, though you sense that, without the extra burden, your left foot would’ve probably been safe. It’s the same with physical and mental health. Different, yet entwined. In fact, there’s a known link between poor mental health and various physical issues, such as high blood pressure, obesity, heart disease and certain cancers, as well as a shorter overall lifespan.”

Every person in the organisation has a responsibility and role to improve psychological health and safety in the workplace. It is a joint responsibility between employer and employee. It is important for the employer to clearly articulate the expectations, roles and accountability of different people in the organisation, from senior leadership, to head of human resources, board and management, all the way to employee.

Pam Loch, Employment Law Solicitor and Managing Director of Loch Associates, discusses whether mental health is the responsibility of the manager.

"Clearly the COVID-19 pandemic has accelerated awareness of mental ill health in the workplace. However, the law has been clear for some time now that an employer has a legal obligation under health and safety legislation to care for the mental, as well as the physical, safety of staff at work. Looking after physical safety has been with us for many decades. Employers with more than five employees must have a health and safety policy and for all employers there are obligations under the Health and Safety at Work etc. Act 1974 and the Management of Health and Safety at Work Regulations 1999 (MHSW Regulations).

"What is often overlooked is that this applies to mental health and that there is also a legal duty placed on employees under Regulation 14 of the MHSW Regulations to look after their colleagues’ health and safety.

"Under health and safety legislation, employers are required to carry out risk assessments and provide employees with relevant training and information on the risks they face, and the measures put in place to control these risks. This is where there is a potential problem with mental health as opposed to physical health. While many managers are aware of their obligations to look after the physical safety of their teams, many are unaware of their and their teams’ obligations to look after the mental health of their colleagues.

"This is partly due to the lack of awareness and training provided by employers to their managers. Many managers therefore may also genuinely believe it is not their responsibility. While it has been a positive move by employers to train mental health first aiders, doing so may have reinforced managers’ views that it’s not their problem or responsibility. This is why employers need to revisit their obligations and update their approach to health and safety.

"Training for all staff (but especially for managers) is essential, so they recognise it is their responsibility to look after mental health, as well as physical health and safety. Managers also need to be informed and trained to know what to look out for and to spot any signs or issues and how to deal with the situation. Managers should then, as a minimum, cascade that downwards to their teams so that each employee shares the obligation to look after the mental, as well as physical, health of each other."

The findings of an IOSH survey revealed that 62% of line managers say they don’t get enough help from their organisation to support the mental wellbeing of their staff.

“If line managers are to be effective in promoting positive mental health in the workplace, it is vital they understand how to manage fluctuations in workers’ mental health, what the causes of ill health can be, how to recognise when employees may be unwell, and how to advise on where to access further support,” it says.

“Armed with this knowledge, they can shape the work environment to be conducive to positive mental health and wellbeing. These are all things that can be achieved through proper training, but as our survey results show, many businesses are failing to adequately educate their line managers.”

Other findings of the survey include:

• Only 31% of respondents say they feel they have been sufficiently trained to recognise the signs of poor mental health in their direct reports.
• More than half (57%) say their organisation offers no mental health and wellbeing training and/or support for managerial staff.
• Those that do have training and support in place within their organisation report in most cases it is optional (79%) rather than mandatory (22%).

Taking into account that businesses have both a legal and moral duty to ensure the health, safety and welfare of their employees, training senior staff to deal with mental health issues should be a top priority, says IOSH.

“Employers are already required by law to provide proportionate advice or training on health and safety, and IOSH believes it is now a matter of time before regulators sharpen their focus on mental health. Line managers can be a key asset in creating healthier, happier and more productive workforces and helping their employers comply with the law, providing they are equipped with the relevant skills.”

The National Institute for Health and Care Excellence (NICE) recommends that organisations should strengthen the role of line managers in promoting the mental wellbeing of employees through supportive leadership styles and management practices. This might involve the following:

• Promoting a management style that encourages participation, delegation, constructive feedback, mentoring and coaching.
• Ensuring that policies for the recruitment, selection, training and development of managers recognise and promote these skills.
• Ensuring that managers are able to motivate employees and provide them with the training and support they need to develop their performance and job satisfaction.
• Increasing understanding of how management style and practices can help to promote the mental wellbeing of employees and keep their stress to a minimum.
• Ensuring that managers are able to identify and respond with sensitivity to employees' emotional concerns, and symptoms of mental health issues.
• Ensuring that managers understand when it is necessary to refer an employee to occupational health services or other sources of help and support.
• Considering the stress management competency indicator framework developed by the Chartered Institute of Personnel and Development (CIPD), the Health and Safety Executive and Investors in People as a tool for management development.

“At the organisation level, says MHFA England, “it is good to have policies, structures and appropriate processes in place to cope with an employee’s physical and/or mental ill health as it should arise. But it is equally important that managers observe what is happening at work on a day-to-day basis, and to keep a close eye in particular on the interaction between the employee and their immediate manager and colleagues or team.”

In October 2017, the UK Government published Thriving at work: The Stevenson / Farmer review of mental health and employers, which dug into the economic impact of mental illness. To upgrade the nation’s mental health outcomes, it also urged a wide range of goals for the next decade. Among these, it stated all organisations, whatever their size, should be:

• Equipped with the awareness and tools to not only address but prevent mental ill health caused or worsened by work;
• Equipped to support individuals with a mental health condition to thrive, from recruitment and throughout the organisation; and
• Aware of how to get access to timely help to reduce sickness absence caused by mental ill health.

In terms of how to use how to use routine management tools to identify problems early, the Health and Safety Executive (HSE) advises:

“Use scheduled work meetings, appraisals or informal chats about progress to find out more about any problems an employee may be having. You could have health and safety as an agenda item at meetings. As well as things like display screen equipment assessments etc, this can be used for stress or mental health issues.

“If you have specific concerns about someone's health, talk about these at an early stage. Ask questions in an open, exploratory and non-judgemental way. These conditions affect people differently, so making adjustments to their job could relieve symptoms. You should be positive and supportive while exploring the issues and how you can help.

“If a person has been off sick, you should discuss their return to work and reintegration into the workplace beforehand. A written plan can help. You both might want to agree when they have reached the stage of 'business as usual'. At this point, you can use existing management processes to review their performance, needs and work plan.”

• Time and place: Choose a suitable time and appropriate place – this should be somewhere private and quiet.
• Encourage people to talk: It can be difficult to talk about mental health. Asking simple open questions and letting people speak about their issues in their own words will help.
• Don’t make assumptions: The person may not need help or may feel they are able to manage their condition themselves. They may just need support every now and again when they are going through a difficult period.
• Listen to people and respond flexibly: Make sure that the person, rather than their problem, is the focus. Adapt the support to suit them and make sure they are involved in finding solutions to any work-related difficulties they have.
• Be honest and clear: If there are concerns about high absence levels or low performance, these need to be addressed at an early stage.
• Ensure confidentiality: People need to feel that anything they say will be kept as confidential as possible and in accordance with any data protection laws.
• Develop an action plan: An individual plan can identify the person’s mental health problem, what their triggers are, possible impacts on work, who to contact in a crisis, and what support they need.
• Encourage people to seek advice and support: The employee should be encouraged to seek help themselves if they haven’t already. Many organisations have employee assistance programmes that can offer counselling, or helplines.
• Reassure people: Remember that people may not want to talk straight away. It’s important to let them know what support is available and that whenever they feel able to talk, you will make sure that they get the support they need.
• One size does not fit all: Many people are able to manage their condition and perform their role to a high standard. Avoid guessing what symptoms they might have or what support they will need.

We are entering a new world of work, where managers need to address the mental health of employees working from both home and office. As they draw up their post-lockdown plans, managers and leaders should explore the potential for a genuine ‘best of both’ model: a ‘healthy hybrid’ that can deliver inclusive productivity gains for their business alongside a healthier, happier workforce.

Where those measures have already been put in place during the pandemic, a survey by Vitality/RSA found many homeworkers have found working from home helpful for managing mental health, wellbeing and stress levels. Four in ten (44%) remote workers have found it “much” or “somewhat” easier to manage their mental health and wellbeing as a result of remote working.

“Most senior leaders we interviewed suggested that clear communication and shared safe spaces to discuss emerging issues have been a key part of their crisis management strategy, for both wellbeing and productivity purposes,” says Vitality/RSA. “This idea – that colleagues can openly and respectfully share their feelings without the fear of negative consequences – is called “psychological safety” and is the key ingredient in the individual bonds that ultimately lead to a healthy workplace culture.

“As we move further away from the acute crisis, organisations should not throw these gains away. Informal shared spaces set up to manage wellbeing and productivity through the pandemic should continue and, where relevant, new formal employee representation forums should be set up to protect against backsliding. Employee voice and representation can help provide employees with a shared space of their own to express concerns about management and unhealthy hybrid behaviour. But in an organisation that is committed to psychological safety they can also provide a quick and constructive feedback loop between employees and senior leaders, that can help to lock in healthy behaviours.”

Line managers have a fundamental role to play in the promotion of positive mental health in the workplace. “The positive impact they can have on the wellbeing of their direct reports is huge,” says IOSH, “therefore it is vital they receive the best possible support from their organisations to empower them to champion positive mental health within the workplace.”

IOSH’s research found evidence that much more work needs to be done from the top. Organisations need to take a more proactive approach to building and maintaining a positive, supportive workplace culture, as early action can make a vast amount of difference in helping avert any issues or nip them in the bud before they escalate.

“Businesses also need to work hard to break down the taboos surrounding mental health and create more open lines of communication,” IOSH adds. “They need to support their managers to fulfil their role by equipping them with the skills and knowledge to promote positive mental health, but without placing unrealistic expectations on them. In return, they will reap the rewards of happier, healthier, more engaged and productive employees.”