A Blog by Araminta Jonsson

Mental Health is defined by the World Health Organisation (WHO) as a state of mental and psychological wellbeing. When an individual can understand their own potential and can manage everyday stresses, they can work productively and contribute to their community, and ultimately, the economy. Mental health has been shown to be based on a range of socioeconomic, biological and environmental factors[1], and has been consistently proven to be more prevalent in those living in deprived areas.

Deloitte breaks down “workplace health and wellbeing” into four categories; The mind, focused on mental and emotional wellbeing; the body, concerned with physical health and fitness; purpose, where we find connection and fulfilment; and workplace, in the organisational context[2]. It is argued that these four categories are connected, and where one begins to falter, the others will suffer as a result.

As well as providing the monetary resources essential for material well­being, employment links the individual to society. Gordon Waddell and Kim Burton found that ‘there are economical, social and moral arguments that work is the most effective way to improve the well-being of individuals, their families and communities.[3]’ Rights to employment are preserved in Article 23 of the United Nations Declaration of Human Rights, which states that ‘everyone has a right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment[4]’.

The impact of mental health conditions on benefit payments shows that mental health problems considerably increase the risk of leaving employment compared to other health problems. Mental health conditions are also known to hinder a person from gaining employment. In recent years the proportion of all claimants of incapacity benefits based on mental health conditions has risen from 26% to 40% and it has overtaken musculoskeletal disorders such as rheumatoid arthritis as the leading cause of claims.[5]

Work gives an employee a social identity and ranking; a network for social connection and support; a way of organising and occupying time; a means of activity and involvement; and a sense of personal achievement[6]. As employment opportunities decrease, so do social networks, enthusiasm and awareness, leading to a sense of rejection and apathy. This, understandably, creates a vicious cycle that many struggle to break free from.

People with mental health problems are more susceptible to these adverse effects of unemployment[7]. The social exclusion that they experience as a result of mental illness is improved by employment and exacerbated by unemployment[8] . Work is therefore central to two of the values that underpin mental healthcare for people with a mental health condition – social inclusion and recovery. While 1 in 3 employed people in the UK have been found to be diagnosed with a mental health condition at some point in their lives, only 54% of them feel comfortable discussing their mental health at work[9]. This strongly indicates that businesses must dedicate more resources on how to engage with and support those who are suffering with ill mental health. The lack of quality mental health training for line managers has been widely cited as a key issue.

The Adult Psychiatric Morbidity Survey found that the overall prevalence of all mental health disorders, with the exception of panic disorders, had risen between 2007-14; when assessing psychiatric disorders according to the DSM-5, 1 in 6 adults met the criteria for a common mental health disorder in 2014[10]. Taking into consideration the significant rise in reported mental health conditions it is not surprising, then, that ill equipped businesses are finding their employees taking more time off work, with fiscal implications.

People with mental health problems are more likely to develop physical health problems and vice versa, however Deloitte found that physical and mental health are not treated equally; 60% of workers stated they would always attend work while suffering from ill mental health in comparison to just 27% reported going to work if they were physically unwell[11]. UK law states that there should be no distinction drawn between physical and psychological injury[12]. Employers therefore should create a culture where employees feel able to discuss difficulties that might cause mental health problems with their managers in the knowledge that they will receive support and not be marginalised as a result of disclosure.

The Sainsbury Centre (2007) found that impaired work efficiency, known as “presenteeism”, whereby a person is present, but is not able to carry out their work duties effectively, has incurred a great cost to UK economy. According to Deloitte, the cost of presenteeism due to ill mental health was estimated between £17bn and £26bn, this has grown faster than the cost of absenteeism, at an estimated £8bn per year[13]. Research findings have shown that financial and social pressures lead people to attempt to hide their mental health conditions. Some people reported that they stopped taking medication due to concerns that it will impact their work performance or that the side effects will make it obvious to colleagues or employers that they have a condition[14].

The Mental Health at Work 2018 report it was found that only 16% of people who suffer from a mental health issue felt they could disclose to a manager, and 11% of respondents who disclosed a mental health issue at work faced disciplinary action, demotion or dismissal as a result[15]. If employees do not feel able to disclose or discuss their mental health, it is no wonder that there is a disconnect between how employers view their support structures, in comparison to their employees; the same report found that 58% of senior staff believe they adequately support their staff, whereas 42% employees felt those with mental health issues are supported. Businesses that take bold, innovative action to encourage and support good mental health at work are gaining multifaceted benefits through improved staff recruitment and retention[16].

Workers in certain roles are more likely to develop common mental disorders or have sickness related absence. This includes teachers, nurses, social workers, probation officers, police officers, the armed forces and medical practitioners[17]. More recent research by Deloitte found that mental health is more costly per employee in the public sector, particularly in healthcare and education[18]. The public sector makes up around a fifth of the UK workforce, but takes on a quarter of total mental health costs[19]. On average a public sector worker will take off 3 days per year in comparison to 1 day per year in the private sector[20].

Differences between the genders and between generations are also prominent, according to the Mental Health at Work Summary Report. Black, Asian and minority ethnic (BAME) employees are less likely to feel comfortable speaking about their mental health at work or to reach out to colleagues or line managers. BAME managers reported feeling less able to find the support they need to help employees. Similarly, Lesbian, Gay, Bisexual and Transgender and other (LGBT+) workers were found to be significantly more likely to suffer from mental health issues and less likely to discuss them. A staggering 72% of LGBT+ employees reported experiencing a mental health issue as a result of work. These findings go some way to explain the disparity of intersectionality in businesses and require urgent attention.

Research has shown that a diverse, inclusive workforce only serves to benefit communities, and the economy. By removing barriers that might be perceived by some groups, businesses can attract an intersectional workforce with a wider variety of skills and knowledge. It has been recommended by various reports that engaging with employees to gain feedback as to what they consider current structures to be working or lacking, enabling two way communication required to show employees that they are being listened to, understood and provided for. Furthermore, a top down approach to inclusion is necessary, according to various research findings. Senior leaders are required to “lead from the front” and create a supportive culture that encourages employees to feel at ease discussing mental health issues, providing relevant resources and signposting to relevant services for ongoing support. Employers must set the right example and act as role models.

The Mental Health at Work report 2018 stated that ‘Positive improvements are being made but the pace of change is too slow.[21]’ Deloitte’s report suggested that businesses think, act and react differently, according to the changing nature of work; developing skills that will be more important in the future, such as active listening, deductive reasoning and social perceptiveness.

The gap between what senior managers and employees believe is in place for mental health must close; line managers must be adequately trained and provided the time and resources to support their employees, and deal with mental health related absence and extended sick leave. It has been recommended that employers introduce a gradual, phased return to work policy after a period of poor mental health.

Taking part in campaigns such as the Mental Health Awareness week can go far to remove stigma in work and allow open discussion. Furthermore, using Stonewall’s Workplace Equality Index to routinely evaluate the progress made on inclusion regarding BAME and LGBT+ issues can inform evidence-based decision making for workplace diversity. Not only will this be financially and socially beneficial, it helps create an inclusive culture with awareness of the specific needs of different people.