Psychological Health at Workby Dr Christopher C Ridgeway
If you suspect psychological illness
When you suspect a member of staff may have a psychological health problem, you should first take the steps explained below. What should happen next will depend to a great extent on the severity of the problem.
Don’t jump to conclusions. The first steps are to collect all the evidence and then discuss the matter with a professional. Make sure that you have detailed notes of behaviour that seems out of character or that is worrying, including mistakes, lowered work output, outbursts of anger and so on.
Check the evidence. Are there any gaps? Does any evidence conflict? If you can, ensure that you are able to effectively describe the behaviour changes and can state, as accurately as possible, when they began and with what severity the behaviour was exhibited.
If you have an in-company doctor, consult them. Depending on the severity of the symptoms of the potential mental illness, consult an in-house nurse, if you have one.
Managing the issue
Which of the following steps are taken will depend, to some extent, on the nature of the illness, its duration, and the course of treatment advised by the professional(s).
Discuss the issue with the individual concerned.
- You should at this stage have gathered, analysed, sought advice and discussed the changed behaviour information with HR and your senior management. You should treat the discussion with the individual in the same way you treat a disciplinary meeting (see the topic on Discipline and Grievance). In essence, you should inform the individual beforehand that you want to talk about ‘a personal issue’ that is causing you (and perhaps others) concern. You should advise them that they can be accompanied by a colleague, if they wish, or, depending on company procedures, a union representative. Should they choose to be accompanied, it is advised that you should also have a colleague with you.
If you feel that you don’t really have much understanding of the problem or are unsure how the employee is likely to react, you should seek professional advice on how best to conduct the discussion. On occasion, it might be helpful to practise what may occur: a role play could help here.
- At the interview, set out the observed changes in behaviour, as sensitively as possible, and ask ‘Is this what you do?’ ‘Are you like this?’ You might then progress the meeting by asking ‘When does this happen?’ ‘Who tends to be there?’ ‘How often does it happen?’ ‘What do you think about it?’ ‘What do you feel about it?’ ‘What advice have you taken about the problem?’
Where a manager has evidence from other sources, this should be put to the employee for their comment.
- It should be noted there are some basic processes that should be applied, such as an opening statement about when, where and how any information discussed might be communicated to others and how the discussion will be recorded.
Keep detailed notes.
A belief that the employee is likely to do harm to themselves and others (for example, harm to children, self harm and so on) should be communicated to the relevant ‘authorities’.
Professionals have an obligation to inform relevant authorities where they believe an individual will do ‘harm’ to others. In my opinion, managers also have a ‘moral’ responsibility to inform professionals, or, if none are involved, other relevant authorities.
At the least, where you have the opinion, probably supported by medical opinion, that the employee could be violent, you should take appropriate precautions, such as a panic button.
- As with any meeting with someone who has psychological ill health, it is difficult to judge how open they will be, what level of self-awareness they will have, what responses they will have to potentially perceived criticism and so on, but the basic rules are these:
- Let them do the majority of the talking
- Use pauses/silence
- Listen carefully
- Try to build rapport
- Be sensitive
- Where they find it hard to communicate, allow their colleague/friend to talk for them
- Feel empathy.
- Unlike disciplinary interviews, it should be expected that
- The discussion may not be completed; another may be necessary
- There may be no immediate conclusion
- With some psychological health conditions, you, the manager, may not understand what is communicated
- The discussion could be emotional – anger, tears or other responses are not uncommon. Managers who are empathetic may find they also have an emotional response. If possible, this should be controlled.
Psychological health is a complex issue. Even professionals, from time to time, find it problematic. Expect the unexpected, complex, ambiguous and difficult.
- Seek professional advice on how to handle this
- Consider whether a colleague should conduct the discussion
- Finally, if you determine that a discussion is not possible, you will then have to proceed on the ‘evidence’ and professional advice you have been given.
If you and your in-house doctor/nurse consider that the psychological illness, and its associated psychological distress, is mild, and its behavioural effects are limited as far as work is concerned, then consider in-house treatment. The situation will require close monitoring and probably a recommendation that the sick person consults their doctor.
The doctor may recommend a short time off work and a short course of drug treatment.
When a psychologically ill person has a short time off work, it is useful to maintain contact. This can be done through weekly visits from, if you have one, an in-house nurse or, if not, a well-briefed member of HR.
This procedure should not be followed if the ill person is a senior member of staff. In the latter case, the visits should be made either by the HR director, or someone of a similar level, or the ill person’s manager, who should also be well briefed. If possible, at all visits, other members of the household of the sick person should be involved in the discussions. An objective of the visit(s) is to gather information about behaviour changes.
A number of policies either do not cover mental illness or do not explain what value of cover will be available.
Where necessary, help should be provided to complete claim forms.
If a psychotherapeutic intervention is recommended (see The major therapeutic methods), management should consider providing financial assistance. Should the absent employee have private medical insurance, help should be offered to facilitate their contact with the insurer. The objective of the insurer contact is to establish what cover is available. Of course, the individual concerned may not require help with this but, depending on the severity of the problem, many psychologically ill people find handling such practicalities difficult.
Where employees do not have private insurance, but the company is a member of an employment assistance program (EAP), the same process (in other words, checking about the insurer’s liability to provide psychotherapy) should be followed. Where the sick absentee does not have either private medical insurance or access to a company EAP scheme, then management needs to consider whether to fund private treatment. Funding treatment will enable psychologically ill people to receive help earlier and thereby return to work quicker.
NHS treatment, even with government’s recent funding of treatment centres, will generally involve relatively long waiting lists. The use of private schemes will usually result in a more rapid treatment and could provide a more appropriate therapeutic intervention. The NHS will, generally, only provide Cognitive Behavioural Therapy, which may not be appropriate.
Referral could be made to clinical or counselling psychologists; if so, make sure they are chartered (checks can be made on their qualifications at the British Psychological Society – see Want to know more? for contact details).
Where the causes of psychological health issues are diagnosed as being within the company (for example, work-related stress), management needs to explore what changes might need be made to the company’s practices, policies and procedures to reduce the likelihood of future stress-related mental illnesses. It might also consider reviewing or establishing alcohol and/or drug policies, practices and procedures (see Particular groups) on ‘long- or medium-term strategies for improved mental health at work’.
At all stages, management should seek to ensure it receives the best advice it can obtain:
- If HR staff are members of the Chartered Institute of Personnel and Development, they can access information from them
- If the company is a member of the Chamber of Commerce, then the chamber should be able to provide useful information
- The company or individual directors may also be able to seek advice from the Institute of Directors.
When the sick person’s doctor determines they should return to work, after a short time away, the short-term return-to-work procedure should be used (see Returning to work).
In all cases of mental illness absence, care should be taken to keep the reason for the absence confidential. Many people continue either not to understand mental illness or to have a fear of it, both of which may make it hard for the ill person to successfully return to work.