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Employee perspectives on mental health in the workplace

Contents:	Summary Introduction Methodology Findings Discussion Recommendations References Appendices

Summary

Background

This is a crucial point in the development of mental health and employment policy in Scotland with the workplace identified as one of the four priorities for health improvement (Scottish Executive, 2003). Policy and practice has evolved in recent years from a focus on stress at work and rehabilitation to include the promotion of mental health and well-being in the workplace and job retention. A study commissioned by the Health Education Board for Scotland on employers'; views of mental health in the workplace identified ambiguity in definitions and a lack of practical guidance on of mental health in the workplace that was accessible and relevant to employers. 

Aim

The research reported here was commissioned in response to the above issues to examine the employees' perspective and inform the development of the mental health agenda in Scottish workplaces.

Approach

The main objective of the research was to gather the experiences of employees (with and without experience of mental health problems at work) of mental health at work and to understand what they would like employers and workplaces to do to improve these experiences.

Overseen by an Advisory Group comprising representatives from the employment and business community in Scotland, the research was conducted over six months, beginning in September 2002.

A brief literature review was followed by focus group discussions and one to one interviews with employees from small, medium and large companies and supported employment initiatives from across Scotland. Investigations focussed on four key areas:

• Definitions and understandings
• Promoting mental health and well-being in the workplace:
• Addressing mental health problems in the workplace
• How to look forward to change, to improve mental health and well-being in the  workplace

Data collection was completed with a Stakeholder Workshop with participants from a cross section of employees from different employer organisations and the research Advisory Group.

Difficulties were encountered by the research team in identifying employees to take part in the focus group element of the research; these have important implications for future work on mental health in the workplace. Approaches through employer organisations, firstly to secure agreement and access to employees and secondly, to recruit a group of employees in that workplace to take part in a group discussion hit against barriers. Employers reluctance to get involved was variously ascribed to pressures of work and time required to set up focus group or recent involvement in other HEBS activities. In some instances support from HR and from Occupational Health was not matched by support from management (and vice versa). Employee reluctance was also a problem on grounds of lack of interest, concerns about confidentiality of research findings and about talking on this topic with a peer group. In one instance, staff were advised by the employer that participation would have to be in their own time.

Key findings and discussion points

Perceptions and understandings:   Employees' perceptions of the contribution of work to mental health and well-being reflected other research findings and demonstrated good insight into mental health problems and stress.

Work and mental health and well-being:   Mental health and well-being at work hinged on relationships at work, a manageable workload and a good work / life balance. The impact of mental health on work performance and attendance was thought to be directly related to the response from employers in terms of the timing and type of support on offer for employees in the workplace.

Promoting mental health and well-being in the workplace:   There was some scepticism amongst employees about the integrity of intention behind some workplace supports such as stress policies or counselling services. It was thought that such interventions were not helpful if the general workplace culture did not support mental well-being in the first place.

Getting help and support with mental health problems at work:   Many mental health problems at work go unnoticed until they reach crisis. A supportive workplace culture was deemed key to engender employee expectations of a positive response to disclosure of a mental health problem. It was recognised that management require support to know how and when to deal with employees in such situations. 

A whole organisation approach to improving mental health and well-being in the workplace:   Respondents emphasised the need for employer's awareness regarding the benefits they can gain from providing supports that will enhance workforce retention, reduce absence and gain them recognition as an employer of choice. The focus of mental health and well-being should filter through all levels of the organisation, including action and accountability for managers, human resources, occupational health and individual employees.

Inhibiting and facilitating factors:   Barriers to employers acting on the mental health and well-being agenda included lack of awareness, low commitment, little interest and perceived lack of financial incentive. Key enablers were thought to be legislation and government guidance, financial incentives, awareness of the business argument for supporting employees.

 

Recommendations

Seven key recommendations were produced from the research including:

• Making the case to employers for improving mental health and well-being at work using a business oriented model, supported through better co-ordination and communication of this message via bodies that work with employers.
• The role of managers in promoting mental health and well-being in the workplace should be recognised and supported through skill development as part of a whole organisational approach.
• Promoting job retention through stronger local and national employer networks that share knowledge and offer advice to employers.
• Reward schemes should extend their remit more widely to increase the status of  accreditation for attention to mental health and well-being in the workplace accreditation amongst employers.
• Supports and resources for employers through provision of examples of good practice to indicate the range of actions that employers are already undertaking to contribute to mental health and well-being in the workplace.
• Tackling stigma and negative attitudes to mental health in the workplace.
• Future research needs to address the lack of commitment of mainstream employers and employees to participate in the mental health and well-being debate.

 

Context

The research reported here was carried out at a critical point in the development of mental health and employment policy in Scotland:

• the Disability Discrimination Act 1995 includes people with mental disability and requires employers to make reasonable adjustments to the work environment to accommodate this
• past emphasis on mental health at work has traditionally focused on the effects of stress in the workplace and on the workforce (HEBS 2001, HSE, 2001)
• the regulations of the Employment Act 2003 contain provision for flexible working arrangements for parents of young or disabled children, in order to enable working parents to retain their job
• there are early indications of a reorientation in practice in relation to employment development and employment support for people with mental health problems, to extend beyond models of intervention premised on rehabilitation supporting return to work (Butterworth, 2001). More recently in both policy and practice, awareness is emerging of the role of job retention strategies, which aim to facilitate early intervention and support to maintain in employment people who develop mental health problems (Department of Work and Pensions, 2003)
• the workplace is one of the four priority areas for health improvement identified by the Scottish Executive (Scottish Executive, 2003). The National Programme to Improve Mental Health and Well-being in Scotland provides an important impetus to actions in a range of sectors and settings, including the workplace, to enhance mental health and well-being.

In 2002, the Health Education Board for Scotland (HEBS), commissioned research with employers on the availability of information on, and their views about mental well-being at work. This study also looked at employers' perceptions of barriers to action to promote mental well-being at work. The study indicated that, for employers, there is considerable ambiguity in the information available on mental health, mental illness and stress. It also suggested that employers require more practical guidance to indicate the business case to support action on mental heath improvement in the workplace and to highlight evidence of what works (Lee, 2002).

In view of these findings, HEBS and the Scottish Executive National Programme to Improve Mental Health and Well-being in Scotland commissioned a further research study. This second study set out to understand mental health at work from the perspective of employees and to consider in particular:

• employee understanding of mental health and well-being in the workplace, stress at work and mental illness
• employee experiences of actions designed to improve mental health in the workplace, including steps to promote mental well-being, to prevent or alleviate the development of mental health problems and to support and rehabilitate those with experience of mental health problems
• actions that employees would like to see taken forward by employers to improve mental health in the workplace
• perceptions of likely motivators/incentives and barriers to such action being taken by employers.

Mental health and employment policy is presented within the National Programme as comprising three distinctive, but intertwining strands, which have been explored in this research into employees' perspectives:

• firstly, the promotion of mental health and well-being in the workplace for all employees
• secondly, the steps that might be taken to support and retain in work those who develop mental health problems
• thirdly, the responsibilities of and actions required by employers to facilitate the return to mainstream work of those affected by mental health problems or mental illness.

Study aims

The aim of the research reported here was to identify key issues from the employee's perspective that would inform the development of the mental health agenda in Scottish workplaces. The main themes that the research was asked to address were to examine employees' perspectives on mental health at work and what they would like employers/workplaces to do to improve these experiences, taking account of the three dimensions featured above: promotion, prevention and return to work. The research was carried out with two principal groups: employees with and employees without identified experience of mental health problems.