A little more conversation

Fans of 1990s American TV sitcoms will no doubt remember the wonderful series ‘Frasier’ and the titular character – a radio psychiatrist – played by the inimitable Kelsey Grammer. At the end of every radio phone-in show, Dr Frasier Crane would sign off by wishing his listeners “good mental health”.

More than 20 years later, “good mental health” is as much of a holy grail as ever. One in four people in the UK will suffer from mental ill health at some point in their lives1 and, in the workplace, it remains the leading cause of sickness absence. In 2016/17, HSE statistics revealed that 12.5 million of the 31.2 million working days lost due to work-related ill health and non-fatal injuries were because of stress, anxiety and depression (40%). On average, each person suffering took 23.8 days off.2

There have been myriad initiatives over the last 20 years – Securing Health Together, the HSE’s stress Management Standards, the work by Dame Carol Black, among many, many others – yet, the incidence of work-related ill health, and mental-health problems in particular, has remained broadly flat over the last ten years, or so.

Lately, however, there has been a renewed focus on mental health in the workplace, with a plethora of government reports published on the subject, as well as the development of new training on and approaches to tackling it. This may or may not have anything to do with the wider, public movements like ‘MeToo’ and ‘TimesUp’. While not about mental health per se, what these and similar campaigns do help with is breaking down stigmas and encouraging people to come forward and speak up if they have a problem. 

According to Mike Robinson, chief executive of the British Safety Council, this is crucial to solving the problem. He says: “The key is to get people talking – in the case of mental health, about a subject that is still taboo in some workplaces. A lot of people with mental-health issues will lie about why they are off work, so one solution is to get more people talking about it openly. Having more public acceptance of mental-health issues is important, but such acceptance is absolutely vital in the workplace. We need mental health to be seen no differently to physical health.”

Training courses 

To this end, the British Safety Council (BSC) has recently launched a series of training courses designed to “start difficult conversations” and support people suffering from mental ill health.3 

Robinson explains: “We have developed three levels of training: ‘Start the Conversation’, which is aimed at everyone in an organisation and lasts 45 minutes. The idea is to get people to start talking openly about mental health and the issues around it. People understand that every individual has mental health and sometimes it’s better than other times, just like physical health.

“The second level is ‘Manage the Conversation’. We realised that most people go to their manager or supervisor first, so we need to equip these people – anyone with line-management responsibility – to be able to have those conversations.”

The third level of the BSC’s training involves delivery of the two-day Mental Health First-Aid England (MHFA) course.4 MHFA training courses were first developed in Australia in 2000 and have since evolved into a global movement, with licensed programmes in 24 countries. They came to the UK in 2007, as part of a national approach to improving mental health. MHFA courses teach people to spot the symptoms of mental-health issues, offer initial help and guide sufferers towards further support. 

No judgement

Andy Flockton, an approved MHFA instructor who has been delivering courses across the UK for more than ten years, explains that the approach is about “acting on the distress a person is in and asking ‘are you OK?’ We teach people to respond in a non-judgemental way. Often, that is what causes the most stress – thinking you are going to be judged. Often, sufferers just want someone to listen.”

He goes on: “I like to use the ‘stress bucket’ analogy: imagine we all have a container that demonstrates what we can cope with before we break. Life experience has a great impact on our capacity to cope. I could have a thimble, you could have a skip – it doesn’t mean I’m weaker than you, just that I’ve had different life experiences and thus more vulnerability. The role of the mental-health first-aider is to spot who are the thimbles and who are the skips, but also people themselves need to know what their own level is and what their personal stress signature is.” 

Transport for London

One large employer that has been successfully using the MHFA approach – as part of a much wider programme of employee mental-health support – is Transport for London. The company has run a Stress Reduction Group (SRG), centred around resilience-building, for more than 15 years and a Trauma Support Group for train drivers and station staff, among whom certain types of stress and, in severe cases, psychological trauma are, understandably, more common. In addition, it carries out ‘hot spot’ work, where feedback from staff is acted upon to target teams among whom stress and mental health are bigger issues, and offers face-to-face counselling as well as a 24-hour employee-assistance telephone counselling and well-being service.

Ray Roberts and Ben Gatty, of TFL’s Mental Health Team, explain: “MHFA is now a firm part of TFL’s Health & Well-being Improvement Plan. Last year, we trained 170 people in mental-health peer support as part of our Supporting Colleagues Network (SCN) programme and will train about the same number again this year. A lot of the focus of training is on boundaries, as we want to make sure that staff have sufficient input to enable help of this sort to be safe.”

The BSC, MHFA and TFL all agree that early identification of mental-health problems is key to assisting sufferers, but this is often the hardest part – especially if those suffering won’t open up. The best way to tackle this is to raise awareness of mental-health issues and embed that awareness in the company culture such that any stigma is removed. Say Roberts and Gatty: “Clearly, it takes time to embed such a culture but, at TFL, we are progressing this by working with the workforce from multiple angles. 

“For example, towards the end of 2017, we delivered presentations to the Board of Directors and saw our mental-health peer-support network grow. We are also working on incorporating mental health into HR policies and procedures, and into core training. As leaders, managers are particularly influential, so we’ll shortly be developing mental-health components in the annual CPD for all managers, too.”

Government response

All of these approaches are very much in line with the Government’s current thinking on the issue, if its responses to recent independent reviews are anything to go by. In February 2018, following publication of Good Work – the review of modern working practices by Matthew Taylor, chief executive of the Royal Society of Arts5 – the Government’s response highlighted the fact that “well-being at work not only refers to an individual’s mental health or satisfaction at work, it also relates to how supportive and inclusive an organisation is, helping to retain and support employees in work”.6

Thriving at Work: The Stevenson Farmer Review of Mental Health and Employers – published in November 2017,7 – set out a number of recommendations for the Health and Safety Executive (HSE), in recognition of the regulator’s “important role in encouraging employers to effectively implement the mental-health core and enhanced standards”. These included revision of HSE guidance to raise employer awareness of their duty to assess and manage work-related mental ill health, and an increase in focus on workplace mental health during inspections.

Asked if it is acting on these recommendations, the regulator replied: “The HSE has recently revised its web guidance and reviews this content regularly. This has included providing a workbook to help employers work through the Management Standards approach to tackling work-related stress. We are working with employers to trial the Management Standards approach to ensure it remains fit for purpose.”

It added that while it has not increased its focus on mental health during inspections, it would “never preclude the use of enforcement action where there has been a failure to carry out any regulatory duty, where the action is warranted and there is sufficient evidence to do so”.

Mike Robinson believes that all of this activity around mental health in the workplace is causing a sea change in how it is perceived and addressed. He says: “The focus on mental health is now ten times greater than what it was even three years ago. Something like our ‘Start the Conversation’ course is pretty unique – it immerses the whole organisation in talking about it. And there has also been a change in the mindset of company leadership: when I talk to CEOs now, we invariably discuss employee mental health. I really do believe a corner has been turned.”

And it really does seem that more and more people – employers, colleagues and others with the power and/or resources to effect change and ensure we all enjoy good mental health – are saying, to borrow another of Dr Frasier Crane’s catchphrases, “I’m listening”.

References

    1)    http://www.hse.gov.uk/stress/mental-health.htm

    2)    www.hse.gov.uk/statistics/overall/hssh1617.pdf

    3)    https://www.britsafe.org/training-and-learning/find-the-right-course-for-you/mental-health-training-programmes/

    4)    https://mhfaengland.org

    5)    https://www.gov.uk/government/publications/good-work-the-taylor-review-of-modern-working-practices

    6)    https://www.gov.uk/government/publications/government-response-to-the-taylor-review-of-modern-working-practices

    7)    https://www.gov.uk/government/publications/thriving-at-work-a-review-of-mental-health-and-employers (includes a link to the Government’s response)