Mental health at work: a measure of performance

Sickness at work is usually counted in time lost. Indeed common mental conditions – stress, anxiety and depression - account for more days of absence than any other condition, a huge tax on work and the NHS.

Now a Work Foundation report into sickness presence has provided support for the Centre for Mental Health’s findings that illness while at work is an even larger iceberg-shaped financial problem.

‘Why do employees come to work when ill? An investigation into sickness presence in the workplace’ surveyed the 1,600-odd employees of AXA, the insurance company.

By its own account, AXA prides itself on its ‘modern employment practices and for the wide range of employee benefits available to our people.’ It has a 96.5% attendance rate and low staff turnover. Overall it felt it placed a high regard on the health and wellbeing of its workforce, which in a sense makes the findings all the more troubling.

510 employees responded to the survey (about a third of employees), of which 19% self-reported depression, 25% migraines and 26% difficulty in sleeping. The other two health problems in the top five were skin problems (including hayfever and eczema - 30%) and muscular-skeletal (20%).

45% of those responding stated they had taken one or more days of sickness presence over a four week period – that is they had come in to work while ill enough to remain home.

This was the Work Foundation’s definition of sickness presence – a refinement of ‘presenteeism’, which in some definitions could include those who were perfectly well but just slacked off at work.

In the same period, 18% of the same respondents had actually taken a day off sick, indicating that sickness presence was three times the rate of absence.

It would be nice to think of the good old British worker struggling in to work for the good of the company. However what the Work Foundation found was that negative factors such as workplace stress, pressure not to take time off and money worries were the main drivers of sickness presence. Just over 40 % of employees perceived pressure from senior managers, line managers and colleagues to come to work when unwell.

This has significant repercussions for organisations. First, any data they might have on the health and wellbeing of their workforce is seriously unreflective of the actual situation. Nearly all AXA employees interviewed as a follow up to the survey stated they would go in to work with stress, anxiety or depression (although some would not if their condition was pronounced).

Second, sickness presence is directly related to performance. The Work Foundation looked at the performance data of 164 surveyed employees, and found that those reporting higher levels of sickness presence were lower performers - the 27% rated as ‘excellent’ reported half a day of sickness presence over a four-week period, whereas the 61% rated ‘successful’ had taken over a day.

Third, using pressure and stress to force employees into work just worsens the situation. Both work-related stress and pressure were significantly related to psychological wellbeing. Those reporting lower levels of psychological wellbeing (and higher levels of anxiety) were more likely to report higher levels of workplace pressure to come into work when unwell and higher levels of work-related stress.

Mental health is not just the biggest health problem at work today, it is also the measure of the corporate culture which underpins it.

Improving access to psychological therapy at work

A report on the new government programme to help people with anxiety and depression recover has claimed an overall 42% success rate in its first year.

Improved Access to Psychological Therapies is the brainchild of London School of Economics professor Richard (Lord) Layard. He is also co-author of the new report.

In the 'Depression Report' Lord Layard imagined something like a national mental health service made up of two hundred and fifty teams providing Cognitive Behavioral Therapy in GP surgeries, job centres, workplaces or premises provided by voluntary organisations.

The service would pay for itself in people lifted out of unemployment or retained in work. Research showed that 'The typical short-term success rate for CBT is about 50%. In other words, if 100 people attend up to sixteen weekly sessions one-on-one lasting one hour each, some will drop out but within four months 50 people will have lost their psychiatric symptoms over and above those who would have done so anyway.'

It is to Lord Layard's great credit that this service has come into existence, though it seems at the moment to be somewhat short of his vision. With the recovery benchmark set at 50%, this was only achieved with Generalised Anxiety Disorder (52% recovered after a course of IAPT). The recovery rate was as low as 35% for recurrent depression and 27% overall in some areas of the country. On the other hand 63% showed reliable improvement across all conditions after at least two sessions of IAPT.

Whereas Lord Layard imagined up to sixteen sessions of CBT per case, the average number for the first year was only four sessions for so-called 'Low intensity CBT '- guided self-help, structured exercise and computer-based CBT - and five sessions for 'High Intensity CBT,'  which is actual one-to-one therapy. The report found a person was more likely to recover if they received more therapy, indicating more resources are needed in this area.

A goal of IAPT was to widen access to therapy - not just in the number of therapists available (which are thin on the ground in the NHS), but also in providing ways for employees to be referred from work or for people to refer themselves without going through a GP. Bearing in mind the strain on GPs of patients with depression and anxiety and the high error rate in diagnosis, this seemed like a good idea.

Disappointingly the report found that only 7% self-referred with 85% coming through GPs and the rest through services such as A & E. There was no evidence that employers had referred employees at all.

Perhaps this is through a lack of awareness that the service exists, or because services offering IAPT are generally only accepting referrals from GPs. My small test using NHS Choices seemed to indicate that therapists were mainly only taking GP referrals. It also the case that employers tend to shy away from discussing mental health with their employees, to the detriment of both.

The recent DWP reports on mental health at work indicate that depression and anxiety are the leading causes of workplace illness, costing a minimum of £1,000 per head of the workforce per year according to the Centre for Mental Health.

Further investment in IAPT would seem to be one way the government could help.

All quiet on the depression front

The mental health establishment has collectively called on the government not to drop the indicators measuring how GPs treat depression.

The Quality Outcomes Framework is a public - if not particularly accessible - database where GPs are scored against twenty common clinical areas, from heart disease to smoking.

The National Institute for Clinical Excellence has recommended their 'retirement' as of 2012 because they were a pretty ineffective guide for patients. Unlike say heart disease, for example, the depression indicators did not cover types of treatment offered or ill-heath rates.

NICE admits in its Depression guidance that diagnosis of depression is a lottery, being based on the ability of GPs to detect emotional distress in their patients inside a ten minute consultation time. Only 39% of patients with depression are recognised as such, 'mainly because most of such patients are consulting for a somatic [i.e. physical] symptom and do not consider themselves mentally unwell, despite the presence of depression.'

According to the latest Health and Safety Executive figures, 57% of work-related absences certified by GPs were for mental ill-health. In an article for the Guardian, a GP reported that up to 50% of consultations were taken up with cases of depression and anxiety.

With depression now topping the list of all work-related illnesses, it is time for businesses and government to increase monitoring of this silent condition, and not quietly ignore it.

£400k for failing to make reasonable adjustments for stress

A 55 year old branch manager has been awarded £390,870 by an Employment Tribunal against building merchants Jewson Ltd.

Mr Jones had worked for Jewson for 22 years when he had a severe stroke and took five months sick leave to recover.

Prior to his illness he had been averaging over 60 hours working time per week, was not taking his full entitlement of holidays and was consistently carrying over a considerable proportion of untaken holiday each year.

His GP advised that on returning to work he needed to avoid stress. His employers decide there was no role in the organisation that was without stress and he was dismissed on grounds of incapacity under the Employment Rights Act.

However they had failed to consider any reasonable adjustment. Jewson were complacent in accepting that its existing working practices of long hours was necessary. The Tribunal found that some reallocation of duties and additional managerial support could have created a less stressful environment.

This note from Jackson Osborne, Mr Jones' lawyers, had the following warning:

'Jewson assumed that Mr Jones’ condition was so severe that his health was at risk if he returned to work in any role.  Jewson assumed its working practices were necessary for an efficient business.  The golden rule is: never assume.  It is nearly always worthwhile to take time to challenge your assumptions, to look at matters from a different perspective.'

The Tribunal found that the dismissal was unfair and amounted to disability discrimination by reason of failure to make reasonable adjustments.

The award is believed to be the third highest of its kind in British history.

Stressed out! Making the business case for change

An interesting post from HR Zone came my way this morning.

Quoting the DWP report 'Health and wellbeing at work: a survey of employers' (the companion to the survey of employees referred to in my earlier post), it made the point that 'only 17% of employers have any form of stress management advice and support in place despite the fact that short-term stress-related absences topped 42,000 in the three months to December last year.'

The DWP report also found that although nine in ten employers agreed there was a link between work and employees’ health and wellbeing, there was less certainty over the business case for investing, particularly in smaller companies and the private sector.

Making the business case seems to be the best way of getting through to those at the top of organisations, without which the necessary changes in organisational culture will not happen.

The new Investors in People 'Health and Wellbeing' award lists a number of business advantages for taking an active interest in heath at work:

• Improving productivity
• Reducing absence
• Increasing quality
• Better customer service
• Staff retention
• Increasing loyalty and motivation
• Attracting the best people

It also makes the point that:

'Adopting effective health and wellbeing practices doesn’t need to cost money. Some of the healthiest organisations – those that are performing well, with excellent employee engagement and motivation – don’t operate expensive wellbeing schemes. They succeed by concentrating on the fundamentals: good communication, flexible working practices, effective and fair line management, and the team support people need to meet the challenges they face at work.'

New survey of wellbeing at work

A new DWP report, 'Health and Wellbeing at work; a survey of employees' has found that 'depression, bad nerves or anxiety were reported as the most common symptoms of ill health caused by work.'

Given a list of symptoms, employees reported as follows:

• Depression, bad nerves or anxiety: 10%
• Problems/disabilities connected with your back or neck: 9%
• Chest or breathing problems, asthma, bronchitis: 8%
• Heart, blood pressure or blood circulation problems: 8%
• Problems/disabilities (including arthritis or rheumatism) connected with your legs or feet: 7%
• Other health problems or disabilities: 7%

In addition, 36% of employees reported that their depression, bad nerves or anxiety were caused by work, while 55% said work made their symptoms worse.

The same report found that only 5% of employees found life outside work very stressful.

The report contains a wealth of information and is well worth a look. It is one of four commissioned by DWP examining GP, employer and employee attitudes and behaviours towards health and well-being at work. I'll be reporting more on this soon.

The conclusions are in line with the World Health Organisation finding that depression is the largest cause of disability in the world.

You can read more in these articles: The Cost of Stress and Depression.