Our attitude to mental health is hurting us all

Last month Time to Change released the results of a survey into the impact of stigma in mental health.

Stigma is the process of outcasting people from society because they do not fit with the idea of what is ‘normal.’   It has existed in all societies and all ages, taking different forms depending on the cultural norms in a time or place.

There are many examples. For example overweight or obese people are stigmatised in a culture that worships physical perfection. They are stereotyped as a group as lazy or greedy, a process which makes it easier to separate ‘them’ from ‘us.’ They lose respect and status and become easy victims of discrimination.

The important thing to notice is that the stereotyping occurs after a group is identified as not fitting in. It is not fact-based but a device to justify the stigma. Think of any persecuted group throughout history. In my own time in Bosnia, people were reduced to the status of animals as a device to harm or kill them.

A recent article in the Observer discussed the disturbing level of violence against disabled people in Britain. It described the violence and hate thrown at a man with MS.

It also pointed to a work-based survey on attitudes to disability carried out by BT in which 65 per cent of respondents said they avoided disabled people because they didn’t know how to behave around them.

A visual difference from what is perceived as ‘normal’ quite easily leads to marginalisation. However stigmatisation goes beyond that. For example, 38 per cent of those who responded to the BT survey thought disabled people were a burden on society, a negative stereotype justifying their victimisation.

Another feature of branding people with health problems is to blame them for their misfortune (see obesity, above) or secretly believe they are making up or exaggerating their condition. This is particularly so in the realm of mental health. Classifying people with depression as 'weak' is a permission to discriminate against them, even though it has no basis in reality.

An unfortunate side effect is that people who develop symptoms of say depression fear a diagnosis in part because of the stigmatising consequences. It is estimated by NICE that only about 50 per cent of people with depression see a GP. In a society that has normalised excessive drinking and drug-taking, self-medication is a less shameful response – around 5 million Britons drink every day to feel less anxious or depressed.

According to the Time to Change survey, 80 per cent of respondents had experienced stigma or discrimination in some sphere of their life because of a mental health problem, while 67 per cent would not tell their employer.

As depression and anxiety are the most common health issues of any type at work, this is a serious issue that can only be addressed by bridging the confidence gap that exists between employees and their organisations.

This begins at the top, where management culture is formed.

Recession: pushing workers to the edge

Workplace stress has been on the rise in the UK since 1992, according to a new report from the British Academy focussing on mental health and the recession.

Until the 2008/9 recession, work stressors - the triggers of stress such as high workload and loss of control - had risen between 0.5 and 1 per cent a year. This jumped to 4-6 per cent in the downturn. 

This corresponds with a series of independent reports from the DWP, CBI and CIPD which put stress at the top of workplace health issues.

The rise of the super-competitive, globalised market in the 1990s has been a major cause.  While it led to a rise in living standards as measured by GDP, it also increased job instability, work intensity, conflict and bullying and work/life imbalance, all of which have worsened in the recession.

Work intensification has been a feature of the way work has changed over the last twenty years, with nearly half of all Europeans now working at very high speed three quarters of the time. In the recession, 44 per cent of Britons said they were working under excessive pressure several days a week, with one third labouring under too great a workload. 

A record number of Britons have temporary or part-time jobs. As the new report claims, 'Workers in these types of contract are more vulnerable than permanent workers. They usually carry out the most hazardous jobs, work in poorer conditions, and often receive less occupational health and safety training. These new forms of employment contract are associated with less job security than full-time permanent contract jobs.'

In the recession, 35 per cent of employees on temporary contracts found they could not get a permanent job (as opposed to 25 per cent pre-recession), accelerating the move towards the long term 'casualisation' of the labour market.

Between 5-6 per cent of European workers have been subject to some form of bullying, violence or harassment. This has increased as the economy has moved towards the delivery of services, with 14 per cent reporting being bullied in this sector.

The restructuring, downsizing and other crises associated with the recession has accelerated this, with 20 per cent of employees reporting an increase in inter-personal conflict in the spring of 2010, and 15 per cent reporting an increase in bullying by managers.

Strangest of all in this time of increasing psychological distress, sickness absence rates have fallen since the recession. Based on all the available evidence, the obvious conclusion is that more workers are coming into work with symptoms of stress and other common mental health conditions such as anxiety and depression.

Presenteeism is a little understood but significant factor underscoring performance at work. A recent Work Foundation report indicated it could run at three times the rate of sickness absence.

In a recession it is reasonable to think that employees feel pressurised to come into work while unwell to support their colleagues or their own position in the face of redundancies. The Work Foundation report also found that many also come in to work because of the support they get from colleagues.

The mere fact that employees turn up to work, however, is not indicative of the health of an organisation. As well as under-performance, the worsening conditions at work risk exacerbating already vulnerable people, creating problems of long term absence and disability. According to the CBI mental ill health is the leading cause of long term sickness in the UK.

Employers should pay heed to this with another recession looming, as pushing the workforce to the edge has longer term consequences for them and society. Rather than accepting this as inevitable, actively managing stress can bring advantage in difficult times.