Report 48: Mental health, employment and the social care workforce
Who helps people with mental health problems gain and regain employment?
The majority of employers agreed that there is a link between work and the health and wellbeing of their employees, and that they have a responsibility to encourage employees to be physically and mentally healthy (21).
This section looks at research about the roles of those who can or potentially could help people already in the workforce to deal with mental health problems and retain their jobs, and help people with mental health problems to gain or regain social care employment. This includes GPs and other staff in primary care, those working in occupational health (OH) and human resources (HR), and line managers.
There is a surprising lack of research in this area, particularly in relation to the role of human resources, though much that applies to line managers is also relevant to HR.
The research shows a need for more training for all relevant professionals which would enable earlier identification of problems experienced by existing staff, and more confidence in employing or re-employing people with mental health problems.
Primary care can play a vital role in the rehabilitation of people with mental health problems back into work, enabling them to remain in work even if they are receiving treatment. In fact eight out of ten of people say they would consult their GP first for treatment if they thought they had a mental health issue (93).
GPs can use their position as the first port of call to assist people back to work through flexible application of the fit note (60) (seeLaw, policy and guidance) and referrals to employment advisers, who are now likely to be integrated with local Improved Access to Psychological Therapies services (81).
Research looked at whether primary care physicians trained to deliver a minimal intervention for stress-related disorders were more effective than those delivering care as usual in enabling return to work among patients with sickness absence linked to mental health problems.
Occupational physicians trained primary care practitioners (PCPs) how to diagnose a stress-related mental health issue or to detect anxiety or depression; how to help the patient think about and plan for return to work; how to monitor patient engagement; and how to signpost on to more specialised services if the patient was not making expected progress.
The research looked at whether functional recovery was achieved within three meetings of doctor and patient. Even though the amount of sick leave taken was unaffected, those diagnosed as having stress-related mental health problems seemed to return to work slightly more quickly than those in the usual care group (94).
Occupational Health staffOpen
Occupational health practitioners have a significant role to play in supporting social care employees with mental health problems, but there is limited evidence on efficacy of interventions delivered by them.
This lack of research may be because of the variety of systems for providing OH interventions. While local authorities have OH as a council-wide corporate function, smaller and medium sized social care establishments access OH help from independent practitioners or the local authority; by contract with OH companies or by purchasing relevant skills as necessary from primary care practitioners. Some smaller organisations seek advice, guidance and support in OH matters from their insurers.
Identification of workplace factors that are perceived to have contributed to any depression is a key role of the OH professional (95). There has been an audit in the UK (95) of how OH practitioners are applying evidence-based guidance on depression (96), and the management of long-term sickness absence. The audit examined whether OH doctors and nurses were taking depression into account as an influence on periods of sickness absence. It also explored barriers to return to work, and the use of psychological and physical therapies provided by the employer. It recommended more effective systems for early referral to OH, and further development and improvement of early detection of depression. The results provide OH with a clear steer on supporting employees with mental health problems which may also be applicable to social care.
A trial in the Netherlands compared a CBT-based intervention delivered by OHPs with care as usual on a range of work outcomes such as absenteeism, full and partial return to work and recurrence rates.
OH practitioners used a CBT approach to encourage employees to think about causes for their mental distress, develop strategies for managing stressors and practice and embed their learning. At three months the intervention group had significantly higher return to work as well as shorter periods of sickness absence
Human Resources staffOpen
None of the identified research for this briefing was conducted with human resources professionals (HR), but they are central to the delivery or initiation of many of the interventions. In social care workplaces such as local authorities, HR functions are either located in service departments, such as adult social care, or increasingly as corporate functions with specific departmental links or teams.
In many of the smaller social care businesses, managers or owners often take responsibility for HR duties themselves. They can access help from umbrella organisations that provide infrastructure support to the sector, such as courses and training in relevant knowledge and skills on recruitment procedures, support for vulnerable people or the impact of the Equality Act 2010 (78).
Training for line managers is relevant for HR practitioners, many of whom will have management responsibilities. Also some of the low-cost interventions reviewed, such as those delivered by post or telephone, could be promoted by HR.
While employers are gradually recognising a duty of care towards their employees and the economic cost of absence due to mental health problems, there has been shown to be a pressing need for line managers to be better informed.
More than half of those employees who reported that they were line managers said that they had never received information, help or advice on how to manage stress amongst the employees for whom they were responsible (21).
A review of workplace interventions for employees with mental health problems identified underdeveloped capabilities among line managers in dealing with employees with mental ill health related sickness absence (98). Lack of appropriate training in relevant skills and mental health awareness was a particular gap. Improving mental health literacy and awareness at work is something that people with mental health problems have identified as critical (99) (16).
One of the most important improvements that could be made at work is to open up discussions about mental health problems and ensure that line managers receive appropriate training. For example, the ‘double tick’ symbol used by those organisations signed up to Mindful Employer (SeeAdditional online resources) enabled job applicants to have confidence in the company’s levels of mental health awareness (22). Training for managers has been shown to be effective (See boxes)
An active listening intervention by line managers for approximately 2000 employees in a Japanese manufacturing company seemed to demonstrate an effect on decreasing job stressors, stress reactions and workers’ sick leave due to mental health problems. Managers learned active listening skills to improve their communication with and support for their employees. They became making them more willing to approach an employee after noticing changes in behaviour, to initiate a conversation on relevant issues, signpost individuals for treatment; and provide ongoing support at work including making reasonable adjustments (100).
A UK training intervention for line managers on mental health problems has demonstrated a significant effect, sustained at eight month follow-up, on knowledge, attitudes, willingness to engage and self-reported confidence levels. The training emphasised recognition of very early signs of mental health problems at work; useful approaches to colleagues or those you manage about whom you are concerned; and information on the range of professional support and treatments that are available (101) (102).