Line Managers’ Resource

A practical guide to managing and supporting

people with mental health problems in the workplace
This resource has been developed by Shift, the Department of Health’s
programme to reduce the stigma and discrimination directed towards
people with mental health problems. It is part of Shift’s ‘Action on Stigma’
initiative aimed at supporting employers to promote good mental health
and reduce discrimination. The resource is an update of the Mind Out for
Mental Health Line Managers’ Resource.

Shift has produced this resource in partnership with the Department of

Health, Department for Work and Pensions, Health and Safety Executive and
Health Work Wellbeing.

Further information about these partners can be located at

www.shift.org.uk/employers

DH INFORMATION READER BOX

Policy Estates
HR/Workforce Commissioning
Management IM&T
Planning Finance
Clinical Social Care/Partnership Working
Document purpose Best Practice Guidance
ROCR Ref: Gateway Ref: 8765
Title Line Managers’ Resource

Author DH/CSIP/Shift
Publication Date 10 October 2007
Target Audience PCT CEs, NHS Trust CEs, SHA CEs, Care Trust CEs, Foundation Trust
CEs, NHS Trust Board Chairs, Special HA CEs, Directors of HR, GPs

Circulation List

Description Guidance for line managers in managing mental distress and

illness in the workplace

Cross Ref ‘Action on Stigma’, Shift, 10/10/06

Superseded Docs Line Managers’ Resource, published by Mind Out for Mental
Health 2003
Action Required N/A
Timing N/A
Contact Details Gary Hogman
Programme Lead
Shift
11-13 Cavendish Square
W1G 0AN

0845 223 5447

For Recipient’s Use
Talking about mental health

Foreword: Ivan Lewis MP and Lord McKenzie

Tackling mental health problems in the
workplace is a priority for this Government.

The extent to which employees and fellow

managers experience stress, anxiety, depression
and other mental health problems has gone
widely unrecognised. It has recently been
estimated that nearly three in every ten
employees will have a mental health problem of
some sort in any one year.

Despite good practice amongst some employers, the cost to the economy of mental illness is
enormous. It has been estimated that a total of 12.8 million working days were lost to stress,
depression and anxiety in 2004/5. This costs the country billions of pounds each year.

What’s more, many people are sometimes unnecessarily forced to give up their jobs because
they have a mental health problem - this is a terrible waste of talent for British business.

All this happens despite the fact that the medical outlook for people with mental health
problems has never been brighter. Contrary to popular belief, the vast majority of people who
develop problems can and do make a good recovery.

Often, it is not their health that stands in their way of getting back on their feet. It is the fear,
ignorance and discrimination - often unconscious or unintentional - they face when telling
employers about their diagnosis.

We have been delighted by the positive reaction we have had from employers to our efforts
to help businesses address these issues. Almost all the employers we’ve talked to from both
the public and private sector are fully supportive of our efforts to improve how mental health
problems are handled in the workplace.

The business benefits from tackling these issues, like improved productivity, reduced sickness
absence and better staff morale, are increasingly widely appreciated. The price of failure is
immense – in human and business terms.

Employers told us they wanted to know what you can do to prevent mental health problems
at work and how you can help staff when they develop them. There has clearly been a
shortage of information and advice about what to do.


 This handbook was developed to meet this need. It is intended for line managers – those
at the coalface of managing mental health problems at work. Of course, there is no simple
template for what to say and do – everyone is different. But the clear message is: it’s better to
talk, even if you sometimes get it wrong, than to sweep the problem under the carpet.

We encourage you and your staff to take full advantage of this handbook – and spread the
word to friends and colleagues. I have no doubt your organization will reap the benefits

Ivan Lewis MP Lord McKenzie of Luton

Minister for Care Services Parliamentary Under Secretary of State
Department of Health Department of Work and Pensions


A business perspective: Dr. Paul Litchfield, BT
Businesses that don’t take mental health seriously will not be successful in
the 21st century. The global economy is changing fast and the capabilities
that companies require now centre more on innovation, communication
and emotional intelligence than just the more straightforward
requirements of strength, dexterity and intellect that characterised
previous eras.

The demographics of our society are also changing – in almost every

economic region of the world the birth rate is falling, time in education
is increasing, the population is ageing and the labour market is
tightening. Companies are therefore engaged in a war for talent and
a key differentiator between those that are successful and those that are not is the diversity of
their workforce. True diversity encompasses the full range of the human condition. Achieving
a rich blend of employees means addressing not just age, gender, ethnicity, religion and sexual
orientation but also disability, including those who have experienced mental ill health.

The World Health Organisation estimates that by 2020 depression will become the second most
important cause of disability in the world.
Whatever the causes of increased mental illness, the reality is that it has become so common that
people at work will inevitably have to deal with it in themselves, in their superiors or in those who
report to them.

Line managers and colleagues in the front line can make the biggest difference in the field of
mental health at work. Reacting appropriately to signs of distress, maintaining contact with
people who may be plumbing the depths of despair and constructing practical return to work
plans for those recovering from mental illness are the simple things that can prove job saving and,
sometimes, even life saving.

This guidance is therefore a much needed resource that should be widely available in the
workplace. None of it is difficult and much of it is common sense but it does provide sound
practical advice for those times when we’re not sure quite how to handle a situation. Helping
people through a difficult time can be enormously rewarding on a personal level. However, for
the organisation there is an even greater prize because those who receive help will repay any
investment many times over and those who are part of offering help will feel more engaged
and motivated. Raising the bar for mental wellbeing in a company therefore promotes higher
productivity, better customer service and, ultimately, increased shareholder value.

The business case for addressing mental health issues in the workplace is now established. This
guide can help managers and others to make a difference not only to individuals with whom they
work but also to the overall health of their organisations.

Dr Paul Litchfield OBE OStJ FRCP FFOM, Chief Medical Officer, BT Group plc

Contents

Introduction 5
How to use this resource and a brief look at what we mean by stress and
mental health problems.

Promoting well-being 9
This section sets out why it is important to make information about
mental health and well-being available to all employees. It explains
the value of a positive approach that prepares individuals and the work
environment for good outcomes rather than a negative approach that
starts when something goes wrong.

The recruitment process 10

Based both on good practice and on the 2005 Disability Discrimination
Act, this section advises managers on what to ask and what not to ask
when recruiting.

Talking at an early stage 12

This section offers advice on monitoring the well-being of staff and on
early steps that can be taken when an employee experiences mental
health problems.

Keeping in touch during sickness absence 17

Keeping in touch during an employee’s absence is important. This
section discusses managing contact in a sensitive but constructive way.

Returning to work 19
Most people with mental health problems make a successful return
to work. Effective planning and monitoring of the return to work are
covered in this section.

Managing an ongoing illness while at work 22

We offer advice on working with an employee and supporting them in
meeting the demands of his or her job.


Introduction

1
How to use this resource What do we mean by ‘stress’ and
This resource is written for managers – it
‘mental health problems’?
recognises that workplace settings are vast and
Stress
very diverse. However much of this guide is
relevant whatever the context within which you
A useful definition of stress is provided by the
are working. It offers practical advice on managing
Health and Safety Executive (HSE): “the adverse
and supporting people who are experiencing
reaction people have to excessive pressures or
stress, distress and mental health problems. It is
other types of demand placed on them.”
intended to be used as a source of practical help.
People can also experience stress when too few
The resource is designed in a modular format
demands are made on them. People can feel
so that you can go directly to the section that is
stressed when they are bored, under-valued
most useful. You can use it both to learn good
or under-stimulated. Stress can also be caused
practice in preparation for when an employee
by factors at work and at home, with the latter
or employees are off on mental health grounds
being the more frequent cause.
and to support their return to work.
In any one person the effect of pressure will
Our aim is to directly address the fear, ignorance
be modulated by a variety of factors including
and stigma around engaging with someone
support systems at home and work, personality
experiencing mental health problems. The key
and coping mechanisms.
message is the importance of talking openly
and with trust. We suggest practical steps that
What may be too much pressure for one person
managers and employees can take together to:
at a specific time may not be for another or
• Match the job requirements with the
even that same person at a different time.
person’s capabilities
• Talk at an early stage of distress to prevent
This resource focuses more on ‘mental health
problems’ than ‘stress’. If you want more advice
the problem escalating
• Keep in touch during sickness absence to
and help on managing stress in employees,
including using the Management Standards to
offer support and plan for the return to
tackle stress, see the HSE website:
work
• Achieve a successful return to work
www.hse.gov.uk/stress
• Manage a long-term illness whilst
The Management Standards use a risk
remaining in work
• Access sources of support and information
assessment process to identify the extent
and causes of employees’ stress within an
organisation, and by working with employees,
On the accompanying website
to identify interventions to prevent and manage
(www.shift.org.uk/employers) we also provide
their stress more effectively.
advice and information for employees to help
them to assess their own needs and plan for
meetings with their manager. Mental health problems

We recommend that managers read the In practice, it can be hard to distinguish when
information for employees and vice versa. ‘stress’ turns into a ‘mental health problem’ and
when existing mental health problems become
exaggerated by stress at work.

The most common forms of clinically diagnosed


1
mental health problems are depression and approach to promoting the mental and
anxiety. Many of the symptoms are similar to physical well-being of your staff will repay
those that people experience when they are your investment many times over in terms
under considerable pressure e.g. sleepless of productivity, morale and creativity. By
nights, loss of or increased appetite, increased presenting the issue in terms of well-being
used of alcohol, etc.; the key differences are in you are also much more likely to overcome
the severity and duration of the symptoms and barriers around stigma and to achieve buy-
the impact they have on someone’s everyday in from staff.
life. • engage with people. Dwelling on
definitions and diagnoses is unlikely to be
Usually a general practitioner (GP) will be helpful as, too often, a diagnostic ‘label’
involved in diagnosis and in offering treatment leads to preconceptions of what a person
in the form of medication or talking therapies or can – or cannot – do. The most productive
a combination of the two. approach is to talk to the person, get a clear
understanding of what they can do, rather
Information on the most common mental than what they can’t do and so understand
health problems and advice on what to look out problems or issues and work on the basis
for when considering a person’s well-being can of the person’s capabilities
be found on the Line Managers’ Web Resource:
www.shift.org.uk/employers The chart on page 8 suggests some ideas for
an holistic approach to well-being. It is based
A checklist for managers can also be found on around the journey of an individual from
the web resource. recruitment, through ill health, and back into
productive working.
This provides a quick summary of suggested
actions that you and your organisation can take The key message behind this chart is that
to improve mental health in the workplace. mental health needs to be approached at
different levels. At the corporate level, it is
More severe illnesses possible to formulate policies and to
develop structures. But equally important is
It is important to remember that only 1 in 100 what is happening on the ground –
people experience the more severe illnesses. especially the interaction between the
Those who do will have regular contact from employee and their immediate manager and
their medical, social or other support network colleagues or team.
and an agreed plan should their condition
deteriorate (this is often referred to as a care Most of the ideas are ordinary good
plan or Care Programme Approach CPA). management practice. The way forward is to
Evidence shows that employment can be of bring mental well-being within the boundaries
great benefit, both to the employer and to the of normal working life , rather than focusing on
employee. it as out of the ordinary and thereby something
‘different’ or stigmatised.
The vast majority of people with mental health
problems are treated by their GP and most of A more comprehensive section on common
these people are capable of continuing to work mental health problems can be found on the
productively. Line Managers’ Web Resource:
www.shift.org.uk/employers
This resource has two key messages:

• Focus on mental well-being. A holistic


 1
What the law says

The main areas of legislation that relate to

mental well-being in the workplace are:

• The Health and Safety at Work Act 1974

(HASWA).
• Disability Discrimination Act 1995 & 2005
(DDA).
• Human Rights Act 1998 (HRA).
• Management of Health and Safety at Work
Regulations (1999).

For more information about these pieces

of legislation, see the Line Managers’ Web
Resource at www.shift.org.uk/employers

It is beyond the scope of this document to

discuss the provisions of this legislation.
However key points to bear in mind are that
disability is defined by the DDA as: “A physical or
mental impairment which has a substantial and
long-term adverse effect on a person’s ability to
carry out normal day-to-day activities.”

In respect of people with mental health

problems, employers should be aware that a
person may be disabled even when this is not
obvious. The assessment of whether someone
is legally disabled is done after discounting
the beneficial effect of any treatment they are
undergoing.


 Chart 1: An holistic approach to managing an individual

Organisational level

Individual level
o rk Re
tow cru
it m
rn
tu Rehabilitation policy Organisational drivers

en
Re

Corporate culture

t
Retirement policy
‘exit with dignity‘ Fair recruitment practice

Return plan Job/person fit

Active monitoring/ Clear induction

support

Corporate commitment
Management processes eg: to employee well-
being: physical and
Active engagement • appraisal mental
Support from internal • work planning
Plan for return Policies eg:
Off si

• training/development

rk
and external sources
• assessment • stress risk
co-ordinated to meet

o
Spot signs early assessment
individual needs At w
• flexible working
ck

Discuss support/adjustments • childcare

Sickness absence policy
• health and safety
Monitor • diversity

Workplace counselling/Employee Assistance Programmes

Occupational health, human resources

External support/information

‘Distress’

We gratefully acknowledge the work of Heron and Teasdale which has informed this diagram.


Promoting well-being

Your first step to improving mental health and Look after your mind
well-being of people at work is to talk to staff
so they become more aware of the issues that Evidence suggests that there are simple steps
might have an impact on their well-being. people can take to protect and maintain their 2
mental well-being. You can help by making
Sometimes people do not know that healthy their staff more aware of these healthy choices
choices they can make, like eating a balanced – and making sure they can take advantage of
diet, can protect their mental health in the same them
ways as their physical health.

When someone does develop a problem, they

Tips for staying happy
may not recognise it as such or seek help at an
1. Keep physically active
early stage. Staff and employers will benefit
from a greater awareness. 2. Eat well

A work culture where everyone is treated 3. Only drink in moderation

with respect and dignity and issues such as
4. Value yourself and others
bullying and harassment are not tolerated will
improve the mental well-being of employees. 5. Talk about your feelings
If you can promote such a culture you will see
a reduction in sickness absence, grievance 6. Keep in touch with friends and family
and discrimination claims, complaints and the 7. Care for others
incidence of mental health problems.
8. Get involved, make a contribution
If staff are more aware they will be more able to
help themselves and be more sensitive to the 9. Learn a new skill
needs of others. If you recognise the problems 10. Do something creative
of colleagues early you can help them more
effectively and give appropriate support. 11. Take a break

As a manager, you are well placed to help 12. Ask for help
people help themselves by providing
information about mental health and access Reference: Making it Possible: Improving Mental
to services. Promoting good mental health Health and Well-being in England (CSIP 2005)
practices such as operating flexible working
hours so that employees can balance the
demands of home life with work will create a
more positive working environment.


 The recruitment process

In this section we offer advice to managers In smaller companies or companies without

about what to ask – and what not to ask. access to an occupational health service, the
issue may arise during the interview process.
The following advice is based on existing It is important to ask future employees what
good practice as identified by employers and additional help they might need and then to
people who have experienced mental health work with appropriate professionals to meet
problems and on the 1995 & 2005 Disability that need.
Discrimination Act.
3 There is no way of predicting who will
Under discrimination law, the employer’s duty
is to assess whether the candidate is the best
experience mental health problems that will person for the job in terms of his or her skills,
then interfere with their work. So issues around aptitudes and experience, fairly assessing
recruitment usually arise in respect of a person the capability of a person with mental health
who has experienced a problem earlier in life or problems to do the job, taking into account
who has an ongoing problem. reasonable adjustments.

It is important to emphasise that the vast If a person has an employment history with
majority of people who have experienced a periods of absence, you are entitled as
mental health problem continue or return to a manager to enquire about these but not to
work successfully. probe excessively: people have employment
gaps for all sorts of reasons.
Neither diagnosis or severity of symptoms
are good predictors of likely employment If an interviewee does raise the subject
outcomes. of mental health it may be suitable at the
interview or at a second interview to ask if
The greatest barrier people face is the chance they would require any kind of adjustment or
to prove their effectiveness when it is known additional support from you or the organisation
they have experienced mental health problems. to help them to do the job as specified.
Research indicates that once given this chance,
they take sick leave less than average and It is also worth considering the ‘formality’ of
demonstrate strong loyalty towards their the interview process which can make people
employer. uneasy and therefore does not always get the
best out of the candidate.
While some people are prepared to
acknowledge their experience of mental health Managers should avoid:
problems in a frank and open way, others fear
that stigma may jeopardise their current job, or • asking for information about treatment,
negatively affect their chances of getting a job the history of the illness or any information
in the future. that is not relevant to the work situation,
and
In larger companies, there may be an • assuming that a person with a mental
occupational health check before a final job health problem will be more vulnerable to
offer is made. This creates an opportunity for a workplace stress than any other employee.
potential employee to talk to an occupational
health professional and agree a strategy for As with any other candidate, it is good practice
how disclosure and any subsequent episode of to ensure that the candidate understands
mental ill health will be managed. both the particular demands of the job and
the working culture of the organisation, such
as shift patterns, the cyclical nature of the
10
business, deadline pressures, etc. A current
stress risk assessment for the job, based upon
HSE management standards can be useful. This
assessment can then be reviewed if problems
develop during employment and form the basis
of a referral to occupational health or other
health professional.

For more detail on recruiting issues please see

the accompanying website:
3
www.shift.org.uk/employers

There are a range of actions that employers

should consider in these circumstances:

• include a positive statement about

employing people with disabilities in job
advertisements
• ensure that the recruitment process is fair
– if a person with a mental health problem
fulfils all the selection criteria, his or her
disability should not be a barrier, and
• ensure that you can give fair and truthful
justification to a person with a disability
who is turned down.

Additional actions and information about the

recruitment process can be found at
www.shift.org.uk/employers

11
 Talking at an early stage

The earlier you notice that an employee is Using ordinary management tools to
experiencing mental health difficulties the identify problems and needs
better for all concerned. Your early actions can
help prevent the employee becoming more Regular work planning sessions, appraisals or
unwell. As a line manager, you can and should informal chats about progress are all ordinary
play a key role in identifying and addressing the management processes which provide neutral
barriers to normal working life the employee and non-stigmatising opportunities to find
might experience rather than trying to out about any problems an employee may be
understand his or her diagnosis. having.

The longer you leave a situation like this the You might find it helpful use open questions
harder it is to solve the problem and indeed the that allow the employee maximum opportunity
employee might become more unwell. to express concerns in his or her own way. For
example:
4 If an employee is already off sick it is more
likely lack of contact or involvement from you “How are you doing at the moment?”
might mean they feel unable to return. Your
involvement and reassurance at an early stage “Is there anything we can do to help?”
will minimise risks of people not returning
to work and any associated problems being If you have specific grounds for concern – such
difficult to solve. as impaired performance, it is important to talk
about these at an early stage. Ask questions in
This section suggests how you can use ordinary
an in an open, exploratory and non judgmental
management processes to look after the well-
way. For example,
being of your staff.
“I’ve noticed that you’ve sometimes been arriving
Identifying early signs of distress. late recently and wondered if there was a
problem?”
There is a wealth of existing literature on
picking up the early signs of mental health
When talking to an employee three points to
distress (see the accompanying website at
remember are:
www.shift.org.uk/employers). Some of the key
things to look out for are changes in a person’s
usual behaviour, poor performance, tiredness
• don’t assume stress affects everyone
equally.
and increased sickness absence. You might
notice or colleagues might comment on an
• make adjustments if a person is stressed,
and
increased use of alcohol, drugs or smoking.
A normally punctual employee might start
• ‘chats’ should be positive and supportive
– exploring the issues and how you can
turning up late or experience problems with
help.
colleagues.
Understanding patterns of absence
Other signs, particularly if someone is
depressed might be tearfulness, headaches,
If the employee is having frequent short
loss of humour and changes in emotional
bursts of sickness absence with a variety of
mood. As a manager you should be aware of
reasons such as stress, back pain or there is no
the wider organisation’s impact on employees.
reason given, there may be an underlying, if
It might be the case that certain tasks, work
transitory mental health problem that should
environments, times of the day or particular
be discussed.
teams are more likely to be associated with
people experiencing difficulties.
12
If you are going to look systematically at Engaging with someone who is reluctant
patterns of absence, staff need to be able to to talk
trust you. They need to be reassured that your
motive is to improve healthy working, not to First, make it clear that the discussion will
castigate. be absolutely confidential. Then you should
consider – from the employee’s point of view
It is good practice to have a ‘return to work’ why he or she might be reluctant to talk. Is it
interview when someone returns after absence. really safe for them to be open with you? Will
For brief absence this can be just a quick any disclosures be treated sympathetically and
positively? If this employee has seen others with
informal chat. It is always a useful opportunity
similar problems being discriminated against
to check how they are. It is important that these then from their point of view they are wise to
interviews happen for all absences – not just be cautious.
stress/mental health related absences.
You need to be realistic. You may not be able to
Stress goes with the job – we’re all change the culture of the organisation overnight 4
stressed! but you may be able to take some first steps.

In the short term you can meet the person in

It’s helpful to make a distinction between
a private confidential setting. You could even
‘pressure’, ‘stress’ and ‘mental health problems’. meet outside the office in a café for example.
Everybody may feel under pressure but not You should reassure them your door is open to
everybody suffers the adverse reaction of stress talk later if it is too difficult for them now.
or a mental health problem. Also, everybody
reacts differently – one person’s spur to action Before the meeting ask if the person wants to
is another’s nightmare and a cause of paralysis bring an advocate, friend or family member to
at work. support them in a meeting. Also consider some
people might find it easier to talk to someone of
A person’s ability to work under pressure may their own choosing, e.g. someone of the same
age, gender or ethnicity – or someone who is
vary depending on what’s happening in the
not their line manager.
rest of their life. Remember that, in law, it is
your duty to ensure that your employees are You should be clear about confidentiality and
not made ill by their work. Failure to assess the who will be told what. You cannot offer 100%
risk of stress and mental health problems and confidentiality but can clearly explain the
to take steps to alleviate them could leave you limits of your confidentiality (such as personal
open to costly compensation claims. information is confidential but issues that may
have a health and safety risk will need to be
There is now considerable case law in this area. discussed further).
Fortunately, in most cases, adjustments can
Agree with the employee how problems
be made easily and inexpensively and most
will be monitored. If adjustments are being
adjustments are about good management made, ask the person how they wish this to be
practice that will help others’. For more communicated to other staff.
information about assessing the risks or good
management practice on work-related stress You need to ensure that any hurtful gossip or
see HSE’s website (www.hse.gov.uk/stress). bullying is dealt with promptly and effectively.
It is your responsibility under the Disability
Discrimination Act to ensure that staff are
not being bullied or harassed on account of a
disability.

13
 Issues to raise with an employee who is distressed

• Ask open questions about what is happening, how they are feeling, what the impact of
the stress or mental health problem is and what solutions they think there might be
• How long have they felt this? Is this an ongoing issue or something that an immediate
action could put right?
• Are there any problems outside work that they might like to talk about and/or it would
be helpful for you to know about? (You should not put pressure on the person to reveal
external problems)
• Are they aware of possible sources of support such as: relationship, bereavement
counselling, drugs/alcohol services/advice, legal or financial advice?
4 • Are they aware of support that the organisation may provide such as reference
to occupational health, counselling, Employee Assistance Programme (EAP), brief
therapies, health checks?
• Is there any aspect of their medical care that it would be helpful for you to know about?
(For example, side effects of medication that might impact on their work). While you
have no right to this information, the employee should be aware that you cannot be
expected to make ‘reasonable adjustments’ under the terms of the DDA if you are not
informed about the problem
• Does the employee have ideas about any adjustments to their work that may be
helpful? These could be short or long term
• Do they have any ongoing mental health problem that it would be helpful for the
manager to know about? If so, is it useful to discuss their established coping strategies
and how the organisation can support them? (See section 7 for more information). It is
the employee’s choice whether to reveal this. But you cannot necessarily be expected to
make reasonable adjustments for a condition if you don’t know it exists
• Establish precisely what they wish colleagues to be told and who will say what. Any
inappropriate breach of confidentiality or misuse of this information might constitute
discrimination under the DDA.
• Agree what will happen next and who will take what action.
• You might also consider whether the employee has been affected by an issue that
may affect others in the team/organisation? If the latter then you need to undertake a
stress risk audit followed by team-based problem solving . Discuss this with your H&S
department, (you might consider bringing in someone from outside the department or
an external expert to help).

It is important that you record all conversations accurately - not just to protect the
organisation and the employee, but also to show that the actions have been carried out fully.

14
Managing an employee who becomes Recognising when professional/clinical
tearful and upset help is needed

This can happen for any number of reasons If someone remains unwell despite support then
and can be connected to something at work or you should encourage them to seek appropriate
outside of work. help. Consider referral to your occupational
health department if available with their written,
• reassure them that it is OK to be upset and informed, consent or encourage them to see
that you are listening. In fact, the process their own GP. Again, you should state what their
of listening may provide an important job involves in the referral letter.
space for both you and the employee to
gain insight into the problem and possible One in four people will experience ‘mild to
actions, and moderate’ mental health problems, such as
• ask if they would like someone of their reactive anxiety and depression. However,
choice with them a much smaller percentage will experience 4
episodes of more severe anxiety or depression
Try to be sensitive to the level of information that may be associated with episodes of ‘mania’:
and support the individual can cope with at
a given time. In the midst of a crisis they may • extreme heightened activity or psychosis
not be able to think clearly and take on board • loss of touch with reality, hallucinations,
complex information. The important points distortion of the senses e.g. seeing or
are to talk to them, reassure them their job is smelling things that aren’t there, or
safe, state positively that all help, assistance • very severe depression.
and support will be offered, and affirm that
discussion will continue at a pace that suits In these rare instances, an employee may
them. behave in ways that impact on colleagues or
clients. In this situation you need to be aware of
Try and be calm yourself! your responsibilities for all employees.
Many problems build up over time and whilst Try to take the person to a quiet place and
you may feel the pressure to do something speak to them calmly. Suggest that you contact
NOW, it may be better to take some time to a friend or relative or that they go home and
calm yourself and consider the options. Try to contact their GP or a member of the mental
distinguish, with the person, between what is health team if appropriate.
urgent and what is important.
You might also be able to help them to make
You may also need support in managing this an appointment and even go with them to the
kind of situation. If the session is not proving surgery – if they wish this.
helpful for the employee or you then rearrange
another time in the near future to discuss the Be aware that if someone is experiencing
issues when the person is less upset. hallucinations or mania, they may not be able
take in what you are saying. In this case the
Managing the rest of the team. person will need immediate medical help.

Be aware of the impact one employee’s mental If an employee is disturbing others and refuses
health problems could have on the rest of to accept help, you should seek advice
the team, whether as a result of reasonable from your occupational health provider if you
adjustments that have been made or because have one, or from the person’s GP if you know
of person’s particular symptoms or behaviour who that is. Otherwise contact NHS Direct, or
while unwell. the ambulance service if the problem is urgent.
15
 Communicating with colleagues

You should agree with the person whether

and precisely what they wish colleagues to be
told. In general it is best to talk to someone
experiencing mental health problems in an
honest, matter-of-fact way – that is in the same
way you would deal with someone’s physical
health problems.

If the person takes sick leave you should ask

whether they want to be visited, receive flowers
and cards or not and respect their wishes.

4 The person’s requests may change over time.

If they initially request little contact, this may
change as their mental health improves. As
far as possible, someone with a mental health
problem should be treated in exactly the same
way as any other sickness absence.

If your organisation has a written absence

policy, you will be in a position to discuss with
the person at the start of absence how often
contact should be made. The employee then
has a right to expect that frequency of contact.

Proactive health promotion

There are many steps that even small

organisations can take to promote employees’
physical and mental health. A list of sources is
provided on the accompanying website:
www.shift.org.uk/employers

Some employers find that access to talking

therapies and company-funded counselling
schemes provide a safe space for staff to explore
emerging problems before they become acute.
Counselling using brief, solution-focused
approaches has proved particularly successful.

16
Keeping in touch during sickness absence

Managers often fear that contact with someone Supporting an employee who is off sick
who is off sick will be seen as harassment.
However, the overwhelming view from people • it is essential to keep in touch. Many
who have experienced mental distress is that managers are hesitant about this in case
appropriate contact is essential. This view is they say the wrong thing or are perceived
endorsed by companies that have pioneered to be hassling. However, if there is little
active absence management. or no communication, misunderstanding
and barriers can quickly arise, then the
Employees should be informed that they too employee may feel that they are not
have a responsibility to keep in contact. Many missed or valued and this can exacerbate
organisations have policies around sickness already low self-esteem. Inviting them to
absence that require minimum levels of contact social events will show that you still think
(see www.shift.org.uk/employers). of them as one of the team
• you should reassure them about practical
If your company does have access to issues such as their job security and deal
occupational health support, it is important with financial worries
that you co-ordinate approaches to the • give the employee the chance to explain
individual. This helps to ensure clarity about the problem and what is happening by
professional roles and about what personal asking open questions
support is offered. While the employee might • ask if there is anything you as their 5
not wish to be ‘out of sight, out of mind’ it could manager can do to help
be confusing or overwhelming to receive • reassure them that you understand
a number of uncoordinated contacts from medical and personal boundaries and will
different people. respect them
• review their needs/wishes for support
If an employee rings in sick, you should, as their • depending on the severity of the illness,
line manager, take the call personally. The best explore if it would be helpful to have a
outcome from this initial call probably is to half-way house between work and absence
agree that the employee will make a follow-up such as working for a couple of hours a day
contact. (It might be useful to agree with the at home
employee how this will be made. They might • plan a phased return to work as they
prefer to do it by text or e-mail.) approach fitness for work, and
• it is helpful to think about the support you
If the employee does not make contact in the would offer to someone with a physical
agreed way, you are then ‘licensed’ to respond. problem. Do you have a different approach
At an early stage, the fact of being in contact for stress/mental distress, and if so – why?
may be more important than what is actually Visiting in hospital, cards, flowers etc can
said. be appreciated – but ask. The bottom line is
to let people know they are not forgotten.
Don’t make them feel their problem is
shameful.

Avoid :

• putting pressure on the person to divulge

personal or medical information – it is their
choice to reveal this or not, and
• putting pressure on them to name a return
date. When someone is in crisis it may be
17
 impossible for them to know how long to provide the employer with guidance/
recovery will take. Deadlines will only add recommendations for employment based
to the pressure. on this confidentially held knowledge of the
medical background.
Contact with GPs
Remember that at some point, as a manager,
If the employee does not wish you to contact you will have to make decisions about the
their GP, that is their absolute right. employee based on the information that you
have.
The GP’s role is to be the patient’s advocate and
to provide care and treatment. GPs have no What to do if the person requests no
responsibility to the company and are unlikely contact
to be trained to give competent advice to an
employer. However, they may well recognise This is not uncommon and the worst thing you
that a state of employment is usually more can do as a manager is to accept it at face value
“healthy” than unemployment. and sever all contact with the individual – all
the evidence shows clearly that this hinders
Some GPs will respond to a request for help and the person’s recovery and greatly reduces the
guidance when this is channelled through the chances of a successful return to work. People
5 patient. You could write to the GP to describe may request no contact because they feel
the nature of the work and any factors that embarrassed or ashamed about the way that
might have a bearing on the employee’s return they feel and are behaving – a sympathetic
like including a copy of the job description and manner and treating the person normally can
stress risk assessment. help to overcome that.

You could provide information about your Sometimes the request for no contact arises
policies on rehabilitation and propose specific because you, the manager, are perceived to
options for the employee such as modifications have been a factor in becoming unwell. In such
to work and/or a short term reduction of hours. circumstances, options include offering the
services of another manager and/or making use
If you have access to occupational health, these of an intermediary such as a colleague, family
professionals should be involved over any member or trade union official. If there are
health problems that may affect their ability to work issues (real or perceived) it is essential that
work and where work and job adjustments may these are addressed or it will be unlikely the
be required. person will return to work.

Most GPs would be uneasy about sharing You may wish to revisit this tactfully. As the
such information with health professionals person begins to recover, contact may seem
other than another doctor. The use of an less daunting.
intermediary occupational health practitioner,
acting on behalf of the employer is essential. It is worth considering a policy of ‘light touch’
This intermediary can ask specific questions of regular contact for all people off sick. This is a
the GP about diagnosis, functional disturbance neutral, non-stigmatising way to engage with
as this relates to occupation, prognosis and all employees. A person with mental health
treatment issues. problems is then much more likely to react
positively.
The GP’s report then goes back as a confidential
note to occupational practitioner of the
employing firm. It is then up to practitioner
18
Returning to work

Most people with mental health problems You will also need to discuss honestly the things
recover completely and have the capability to you can change and those you can’t. Some
resume work successfully. The organisation has organisational factors are out of your control.
made an investment in that individual and in Can they be mitigated?
most cases, a planned return to work will be
more cost effective than early retirement. You might also consider a mentoring scheme
with another employee so that the person
Effective planning – between the individual returning can also talk to someone who isn’t
and the line manager and, where appropriate, their manager.
involving other sources of support such as the
GP, occupational health or HR – will maximise Above all make sure you and team make the
the chances of success. So will support and person feel welcomed back.
monitoring at the early stages of return.
Avoid:
This section offers advice on planning the
return to work and monitoring how things • making the person feel they are a special
are going. case – this can cause resentment both with
the individual and with peers, and
Factors to consider in planning the • failing to deal with their work whilst they
return have been off work. Check whether a
backlog of unfinished work has built up
You should consider with the employee and deal with this also.
any factors that contributed to their
absence that could realistically be changed Be aware:
or accommodated. Discuss whether any
adjustments need to be made to ease their If the employee is on medication they may 6
return (see the next page for some ideas). experience distressing side effects. They may
You can then agree how their progress will be or may not feel able to discuss this with you.
monitored. However it may be helpful to consider that it
can be easy to confuse side effects with the
You must make sure the employee doesn’t illness. Any effects on work may be temporary
return to an impossible in-tray and thousands and/or the person may only take medication for
of emails. a short time.

When they return, brief them on what’s For people with a longer term problem, it
been happening – social life as well as work may take some time and patience to establish
developments. Be realistic about workloads the right medication and dosage. Hence
– be aware that some people will wish to prove the employee may not immediately know if
themselves and may offer to take on too much. medication will affect their ability to do the job.
Instead, set achievable goals that make them
feel they are making progress. It is important they continue with their
medication until they have discussed this
Take the time to have frequent informal chats with their mental health physician. You also
so there is an opportunity to discuss progress/ need to ensure that any side effects are
problems without a formal (and possibly considered against their job requirements. This
intimidating) session. is particularly crucial in jobs where there are
health and safety risks.
Give positive and constructive feedback.

19
 Some adjustments to consider such as: part-time, job-share; flexible working
around agreed outputs.
Almost no-one is ever fully fit when they return
to work after an illness (physical or mental) and You might offer a later or earlier start to avoid
it takes some time to recover speed, strength rush hour travel and review if any provisions are
and agility of both mind and body. necessary or useful in terms of their physical
health. You should also look at their physical
Waiting for people to be become 100% fit environment and review what adjustments
for their work before allowing them back is would be desirable. You could also suggest a
therefore unrealistic – it lengthens absences quiet place where they can go if feeling anxious
unnecessarily and may ultimately even or stressed, and, if relevant, you could consider
compromise their future employability. offering support with childcare.

It is common sense to adjust work in the early Most adjustments are made based on common
days after an extended spell of absence to sense and following discussion between the
promote full recovery and to ease the individual manager and the employee about what might
back into productive employment. In some be helpful and what is possible. Rarely “expert”
cases applying reasonable adjustments will opinion (such as that of occupational health
be required to discharge duties under the practitioners or disability employment advisers)
Disability Discrimination Act but in all cases it is required to help define impaired capability
will make business sense. Most adjustments and/or adjustments.
are simple, inexpensive and need only be
temporary. Remember that you are not bound by external
6 opinions, whether commissioned or gratuitous
Some examples of adjustments are a phased (as from GPs, etc) – the decision on what is
return to work – starting with part-time “reasonable” rests squarely with management,
working and building up. Perhaps you could though it is always preferable if the individual
look at aspects of the job that the person concerned agrees.
finds particularly stressful and rearrange
responsibilities. You might think about Examples of agreements and GP letters are
adjusting the content of the job. referenced in the accompanying website:
www.shift.org.uk/employers
You might think about whether you have
identified the training needs of the individual. Managing reactions from colleagues and
After their return to work, it may be helpful clients
to have a review of training, development
or support needs. These may be around the Fear, ignorance and hostility from colleagues
specific job requirements and/or around skills and clients can be a source of great distress.
enhancement such as: communication skills, Many people who have experienced mental ill
time management, etc. health describe this as an area of stigma and
discrimination. A key theme of this resource
You could offer the option of working at home has been the need for both managers and
for some of the time; time off for attending employees to think about how communications
therapeutic sessions. (This should be allowed will be managed.
for all medical problems); changing shift
patterns or exploring different work options

20
Usually, stigmatising behaviour arises more reasonable adjustments have been made in the
from fear and ignorance than ill will. People are current post, it may be necessary to consider
not sure what to say and find it easier to avoid transfer to another job.
the individual or not to mention mental health.
Use normal procedures if it is a performance,
• try to talk to the employee and agree who attendance or conduct issue rather than one
will be told what, by whom and when. relating primarily to health or disability, and if
Think about the language you use. Be clear matters cannot be resolved then you may have
about confidentiality and boundaries to move to termination. You should help the
• be guided by the employee’s wishes. Some individual to move on with dignity and issues
people are prepared to be more open than such as health related pension benefits (e.g.
others. Encourage the person to talk if they medical retirement) should be fully explored.
wish but don’t pressurise them to do so
• treat people returning from absence due to
mental ill health in the same way as those
with physical ill health
• watch out for hostile reactions – stamp out
any hurtful gossip or bullying promptly,
and
• treat mental health issues in a matter-
of-fact way – they are common and
should not be a source of office gossip or
conjecture.
6
After a time, ask the employee how they are
getting on with peers/clients. Review if there
is any support that you can give, and consider
mental health awareness raising for all.

Avoid:

• shrouding the issue in secrecy, and

• making assumptions about workloads and
capacity to cope.

What happens if the return to work is not

successful?

The ‘return’ could either apply to a one-off

absence or to successive attempts if a person
has an ongoing illness.

In this scenario, try to go through the

reviewing progress, options for making further
adjustments and talking to the employee. Then
talk realistically with the employee about the
best way to move forward. For example, if all
21
 Managing an ongoing illness while at work

Most people who have ongoing mental health It is worth noting that employees who have
problems can continue to work successfully developed a coping strategy may be better
– without or with or only minimal support. equipped to deal with pressure than employees
who have never experienced a mental health
Where someone needs support, this section problem.
discusses how managers and employees can
Advance statements
work together to ensure that it is flexible to suit
varying health needs. Some people find it useful to draw up an
‘advance statement’ which explains how they
Remember – it is discriminatory to make wish to be treated if they become unwell. The
assumptions about people’s capabilities, their statement can cover practical arrangements
potential for promotion or the amount of sick as well as treatment preferences, including
leave they are likely to need, on the basis of their details of the people who should be contacted
illness. People with mental health problems or provided with information. (An advance
should be treated in exactly the same way as statement is different from an advance directive,
which any of us can make, and is a decision
any other member of staff unless they ask for
to refuse medical procedures if you become
help or demonstrate clear signs through their mentally incapacitated due to illness or
performance or behaviour that help is needed. accident).

Using regular management processes to It might be helpful for someone with mental
monitor needs health problems to draw up an advance
statement which relates to the workplace. It
If a person has experienced a period of sickness could include information such as: signs that
indicate that the person is becoming unwell,
absence and re-entry to work, you should
who to contact (perhaps a close relative, care
discuss the format of their return to work coordinator or GP), what sort of support is
and integration back into their in advance of helpful and what is not. If an employee draws
any return date. A documented plan can be this up in agreement with you, it would be
valuable. You both might want to agree when important for you to put the statement into
they have reached the stage of ‘business as practice to maintain trust.
usual’. At this point, the most appropriate
7 response is to use normal management Further information is available at
processes to review their performance, needs www.shift.org.uk/employers
and work planning.
Supported work projects
Coping strategies There are many projects around the country
that offer support both to employees who
Most individuals are encouraged to develop a have experienced mental health problems
coping strategy as part of their care. This often and to employers. These projects have
involves noting signs of a possible relapse excellent success records in placing people in
and taking pre-emptive action to avoid it. employment and in supporting them to be
For example, cutting down on work or social effective employees in the long term. In fact
activity, being careful about drinking alcohol, many people require only minimal support
once they have been given the opportunity to
taking exercise and finding time to relax.
work. They are also useful points of contact.
It is important you support the employee at You may wish to advertise a post through your
this first warning stage. Small and inexpensive local supported work project or you can contact
adjustments may well prevent a more costly period them for advice. People should find information
of illness. on supported work schemes from the Disability
Employment Advisor at their local Jobcentre Plus.
22
Line Managers’ Resource
A practical guide to managing and supporting
people with mental health problems in the workplace

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Shift believes that people with a
history of mental health problems
should have the same chances and
opportunities as everyone else.

For more information about Shift and

our work, visit www.shift.org.uk