Psychological Health at Workby Dr Christopher C Ridgeway
In a nutshell
1. The effects of psychological ill health
By the time that you, as their manager, are aware that there is a problem, the symptoms of psychological ill health in an individual are likely to be affecting the smooth running of your team. Psychological distress may be exhibited in a wide range of changes in work behaviour, including
- Changed interpersonal behaviour
- An increase in alcohol or un-prescribed substance abuse
- An increase in smoking
- An increased number of errors
- A decline in work output
- Fewer ideas.
2. The causes of mental illness
Company causes include
- Occupational stress
- An unhealthy in-company environment, such as the presence of toxic materials
- An in-company accident
- An in-company trauma, such as a robbery, a car crash or the death of a work colleague.
Potentially traumatic event(s) possible external to company causes:
- Life events, such as divorce
- Brain damage caused outside work, due to alcoholism, accident or an inherited problem.
The list could include any personal, physical or psychological event which results in significantly changed behaviour.
3. The legal position
In December 2005, the Disability Discrimination Act was amended so that mental illness is now a clinically-recognised condition under the act. Managers must therefore be aware that those suffering, or claiming to suffer, from psychological illness might consider a discrimination claim in relation to
- Salary and or benefits
- Work-related psychological distress illness
- Their return to work after psychological illness.
Managers should also be aware that physical and/or psychological injuries may result in claims for compensation.
4. Types of psychological illness
Managers should not be concerned if they cannot themselves categorise the symptoms they observe or that are reported to them. Even most mental health professionals find this difficult. However, managers may well find themselves receiving reports from, and having discussions with, mental health professionals, who use standard classifications of psychological distress. The chief illness categories are
- Eating disorders
- Bipolar disorder
- Psychopathic disorder
- Problems with an organic cause.
5. If you suspect psychological illness
When you suspect a member of staff may have a psychological health problem, you should take the steps explained below.
- Check the evidence. Ensure that you can clearly describe the behaviour changes, detail when they began and explain the degree of severity.
- Consult your in-house doctor or nurse, if you have one.
- Consider in-house treatment, if the problem is mild.
- If the person needs time off work, maintain contact via the in-house nurse or a well-briefed member of HR.
- Investigate whether any treatment will be covered by insurance.
- Consider whether company procedures may need to be changed.
6. The major therapeutic methods
Therapy can take many forms, and there is no ‘one size fits all’. Many therapists may well use a number of therapies, tailoring their choice of method(s) to suit the client’s particular needs, perhaps combining hypnotherapy with CBT, for example.
- The aim of CBT is to help the client to abandon negative, unhelpful beliefs and behaviours. Therapy is normally short, about six to ten sessions being the average. Some therapists will also provide skill training in relaxation and/or anger management.
- Person-centred therapy assumes that the person (patient) has the answer to the psychological problems within themselves.
- Psychodynamic therapy is often used when the cause of mental illness is thought to be a result of early life experiences. The focus is generally on the client’s childhood, and its current influence on depression, anxiety or phobias. The basis of the therapeutic approach is generally the work of Freud, Jung or their followers.
- Other therapies include hypnosis, transactional analysis and Gestalt therapy.
Many people who consult doctors and are diagnosed with a psychological illness will be referred to a psychiatrist.
- Psychiatrists are medically qualified and have specialist training in psychological medicine.
- The psychiatrist’s major treatment mode is drugs.
- If a therapeutic intervention is prescribed, the psychiatrist will usually recommend a clinical/counselling psychologist or a psychotherapist.
7. Helping recovery
There are actions you, as their manager, can take to facilitate the most efficient and effective recovery of a member of your staff and enable them return to work in a manner which benefits both the individual and the organisation. (You can also, where necessary, enable the ill person to develop a satisfying life-style outside their current organisation and, probably, their current job.) Psychologically ill people often have problems with housing, finance and benefits. You may be able to
- Provide legal advice or offer help with obtaining alternative housing
- Assist them to make homelessness claims
- Facilitate the required provision of letters from neighbours or others to support claims for housing transfer or, if homeless, suitable accommodation
- Offer assistance with the move to supported housing or a care home
- Provide staff who can help the ill person and/or their families/carers deal with the financial problems
- Use reports on the person’s health, with the permission of the carer and/or the psychologically ill person (if they are able to understand and give permission), to make sure that they make an efficient and effective claim for benefits.
8. Returning to work
Assuming the person is able to come back to work within the company, you should consider taking some of the steps suggested below, as appropriate.
- Seek to ensure that consensus is reached between professionals about the kind of job role that would most suit the returning employee.
- If consensus is not reached or if there are significant issues about the individual’s capacity to perform at an acceptable level in a new role or their old one, seek further advice.
- Consider using the government-sponsored training facilities.
- If appropriate, consider a phased re-entry, starting with only a few hours a week.
- Allocate them a mentor, usually their direct manager and/or a counsellor, who could be a company nurse, a member of HR or a nominated member of a job centre or rehabilitation unit.
9. Long-term psychological health problems
Some employees, though probably only a small number, will be away for several months to a year or more.
- Ask the professional advisors about their prognosis, including the likelihood of relapse and what might trigger it.
- Check on the feelings of team members.
- Check with health and safety, especially about the possible side effects of medication.
- Continue to monitor the situation for at least a year after the person has returned to work.
10. Policies and strategies
Company procedures and practice with regard to psychological ill health should be regularly reviewed to keep up with best practice and changes in legislation.
- Information on employee’s health is considered ‘sensitive personal data’ under the Data Protection Code on Employment Practice 2003.
- Consider training supervisory and management staff about psychological health, specifically, how to successfully manage those who are recovering from or experiencing psychological health problems.
- Ensure that job applicants know that their doctor will, subsequent to an offer of employment being made, be sent a personal health form asking them to comment on the applicant’s physical and psychological suitability for a particular job.
11. Crisis intervention
A crisis can be personal, such as a major unexpected breakdown or psychological health issue, or it can take the form of a group occurrence with potentially serious consequences for a number of your staff’s psychological health.
- Sometimes, either one major event in a person’s life or a series of small events can cause a major psychological distress problem. In all such cases, immediate action is required. If no outside agency is involved, it may be necessary for management to organise a rapid de-briefing and psychological assessment and, where required, to make professional advice or suitable therapy available.
- A group from the organisation might require crisis intervention if a major incident, such as a serious fire or explosion, the collapse of a building or a bomb incident, occurs within the company. There should be a crisis plan detailing what should happen in such a case.
12. Particular groups
The following groups may require specific procedures when dealing with psychological ill health:
- Ethnic minorities, some of whom tend to seek advice, diagnosis and treatment from healers recognised within their community
- Suicidal people and self harmers – over a five-year period, most large organisations will have at least one employee who commits, plans or thinks about suicide; self-harming may be a sign of underlying depression
- Alcohol abusers – who present health and safety problems, as well as problems with absenteeism, irritability and low performance
- Non-prescribed drug abusers – management should have a clear policy, similar to that for alcoholics
- Women have the additional stressor of changes in their body chemistry, during their menstrual cycle, leading up to and during the menopause, and after childbirth
- Older employees who have performances which change significantly, particularly after the age of 50, may have Alzheimer’s or suffer from a similar form of dementia.
13. Post Traumatic Stress Disorder
PTSD can occur when a person experiences a traumatic event(s) in which both of the following are present: they were witness to or personally experienced actual or threatened death or serious injury, and they experienced, as a result, intense fear, hopelessness or horror.
- The symptoms are that the event is persistently re-experienced in recurrent dreams or in response to cues; sufferers may avoid places, people and activities associated with the event, feel detached, have a limited future perspective, and be unable to have loving feelings.
- In any PTSD event there are likely to be at least three more people involved as secondary victims, in addition to the main victim.
- Claims for PTSD are on the increase.
- Most sufferers can be helped by therapy, though the time taken to recover can vary greatly.
14. Some final thoughts
Managing physical health issues is often problematic. Psychological ill health, where there are rarely x-rays, blood reports or other ‘objective’ measures or symptoms, is much more complex and difficult. Managers are therefore advised to
- Proceed with caution
- Whenever possible, take professional advice and guidance
- Remember that whatever actions you take about any member of staff with psychological ill health, other team members will be thinking ‘if it can happen to them, it may happen to me.’