Are we leaving mental health intervention too late?

Mark Blunden,

A room in town

It is a somewhat startling fact that 50% of mental health problems are established before the age of 14, but little is done by ‘the system’ to ensure the effects of these problems do not carry into adulthood.

A further sad fact is that the third leading cause of death in 15 to 19 years olds is suicide (WHO). The World Health Organisation goes on further to state that ‘The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.’

During our formative years (10 to 19 years) we are more vulnerable to mental health problems as we grow and change physically and mentally. Other social factors such as poverty, violence (especially in the home), family breakdown / divorce and other adverse experiences prevent adolescents from thriving and entering adulthood free from trauma and burden.

Most mental health conditions forming in these years go undetected and are therefore carried into adulthood and inevitably into the workplace. Four out of ten sicknotes now relate to mental health issues.

According to The Centre for Mental Health sickness absence due to mental health issues cost UK business £34.9bn last year.

Picking up the signs of mental health in adolescents is not easy for the already burdened education system despite a greater presence of wellbeing programmes entering into schools and other education establishments.

In the UK it is estimated that three children in every classroom is suffering with a mental health problem (Young Minds). We also live in a country where the number of young people presenting to A&E with urgent mental health needs has tripled in the last ten years.

It is perhaps then no surprise, though clearly hugely tragic that The Samaritans report a rise in suicide rates for those under 25 with female suicide rates having increased since by 93.8% from 2012 to 2019.

In men the rate has thankfully decreased and its lowest point since 1981. The rate though is still way too high, and according to a BBC report it is still the single biggest killer of men under 45.

This fact is one I often discuss with clients, colleagues, and business associates. Despite the awareness of the benefits of discussing and dealing with poor mental health it seems that we condition boys from a young age not to express emotion. It is still seen as a sign of weakness. This perhaps, is a reason that the construction industry has the highest rate of suicide than any other industry. Construction, despite encouraging more women into roles is still very male orientated. Charities such as The Lighthouse and Mates in Mind formed to tackles these issues.

Men are also less likely to seek help. A UK British Medical Journal report notes that consultation rates were 32% lower in men. This especially applies to issues around mental health. When people do then self-refer to their GP, long wait times and short consultation times (10 minutes standard with your NHS GP) do not help always.

When issues are then diagnosed, referral to talking therapies takes time but is improving since the introduction of the Improving Access to Psychological Therapies (IAPT) programmes was introduced. This aims to get people into support within 28 days of referral, though add to that a common lead time of up to three weeks to see a GP in some areas.

Whilst we might have to keep the faith that the NHS can reduce waiting times, the private sector is rapidly adapting to the demand for treatment. Of course, the cost of private therapy is way beyond the means of many people. Charities and low-cost counselling centres are available and provide important services but still charge a fee.

As guardians of future generations, parents and carers are best placed to break the conditioning described above and encourage children to talk about their feelings.

For zero cost, we can make a huge difference to the outcomes of our young people.

Have treatments for mental ill-health been put on hold through lockdown?

mental ill-health: Employees took significantly less time off work during the first lockdown between March and July, according to research carried out by NTT Data for NHS Digital. The number of fit notes dropped by 34% compared with the average for the year.

The proportion of those notes, however, shows a steep rise in mental health-related illnesses resulting in time taken off work. Mental health problems now account for four in 10 (41 per cent) of all sick notes signed by GPs during the pandemic.

Employer role

Vicki Chauhan, head of public services at NTT Data UK, pointed to the increased importance of employers in ensuring mental health is seen as a priority among line manager and their reports.

“These are extraordinary times and until we can return to a level of normality, employers must remain conscious of the challenges that remote working poses to mental health and continue to support their staff as this pandemic evolves.”

In its response, the CIPD has called for HR to make sure managers provide regular one-to-ones alongside virtual team gatherings, to be flexible and empathetic.

Other new research from Benenden Health has suggested that almost half UK employers have seen an employee leaving their company because they perceived their mental wellbeing was not being cared for. 55% of employees in the study said they would look for a new employer if they believed mental wellbeing wasn’t being supported (78% among the 18-24  age group).

Plugging the workplace wellbeing gap

EAPA UK chair Eugene Farrell said: “Understandably people have been cautious about making appointments with GPs. We’ve stayed away from surgeries and hospitals for anything we’ve believed to be non-urgent – to protect ourselves from risks of Covid-19 infection, but also so we don’t feel we’re taking up NHS time unnecessarily.

“Early signs of mental ill-health are all too easy to ignore, to try and brush aside. That’s the problem here. Access to support via the NHS has also been perceived to be difficult, even before the pandemic. The danger is that many of the people going to their GPs for sick notes have been doing so as a last resort, when problems with anxiety and depression have reached a more serious stage.

“At a time when so many more people in the UK workforce are facing additional strains – from the isolation of working from home, from increased work and financial insecurities, from the impact of the virus on the health of family and friends – it’s critical that employees know there are straightforward ways to access support. Good information as a fundamental, but also someone they can talk to for reassurance and to flag the best next steps for them as individuals.”

The winter health policy paper from Government (Staying mentally well this winter: click here) is important recognition of the challenges of the darker months ahead. At the same time, the paper potentially misses out on a crucial point: that work, workplaces and EAPs are an essential platform to the nation’s mental wellbeing.

Christmas, heralding the start of winter, will be a welcome chance for a break for employees from all the alien stresses of 2020 – a respite from workplace infection worries, the downsides of WFH and days filled with Zoom calls, the threats of burnout. But as it is every year, Christmas is also still a challenging period given the strains on finances, on relationships; feelings of isolation and loneliness; the sheer pressure of expecting every moment to be merry and bright.

The biggest challenge signalled by Government and the NHS is awareness of mental health problems and a willingness and opportunity to get help. ONS figures suggest the numbers of referrals to the NHS for mental health conditions has been falling during the pandemic. It appears people don’t want to go to GPs or hospitals: they don’t want to waste NHS resources, or expose themselves to greater risk of Covid-19 infection.

Instead there’s perhaps been a battening down of the hatches, similar to what happened during wartime. We stay safe, shut out our worries. The problem with this is that the ‘losses’ are felt most keenly when the war ends, in our case when the vaccine programme is well under way in springtime. The crisis might be over, but that’s when people see and feel the loss of family and friends; the loss of jobs and financial securities. There’s also going to be strong sense of loss of time, lost chances for keeping up social connections, for fulfilment of hopes and plans.

The proportion of the population having to deal with Covid-19 infection will always be relatively small compared with the numbers affected financially and/or psychologically. Just as has been recognised with the economy, the fall-out from the pandemic in terms of psychological wellbeing will be long-term.

Work plays a critical role in the mental health of every nation. Providing money yes, but it’s just as important in giving people a sense of purpose, status, structure and routine, as well as friendships, the feeling of being part of a community. That’s why the furlough scheme and the efforts of employers to keep as many people in work as possible have been invaluable, being flexible, offering WFH, making modifications to ensure workplaces are Covid-safe. EAPs have been – and will continue to be – an essential part of what work means and offers to so many employees.

EAPs are helping to ease the burden on NHS services, offering easier access for employees to mental health support, when and how it’s needed, and at an earlier stage. A recent EAPA study compared the use and waiting times for NHS services (via the Improving Access to Psychological Therapies programme (IAPT)) with EAPs. Although caution should be paid as the data is from different studies/different groups of clients, it showed an average waiting time from referral to treatment of 20 days through IAPT, compared with 8.8 days with an EAP. Clients who completed treatment with IAPT needed an average of 6.9 sessions; with EAPs this was four.

Public Health England’s Better Health campaign is all good in terms of advice and awareness. In practice though, for the working population, there is easier to access support via employer funded EAPs, providing more immediate availability of professional support online, by phone, and through video calls.

Andrew Kinder, Vice Chair of Employee Assistance Professionals Association (EAPA), on health policy paper www.eapa.org.uk

Bosses fail to live up to pandemic demands for ‘caring’ leaders

pandemic demands: Three-quarters of UK professionals believe their company’s leadership fell short of expectations during the crises of 2020, according to a survey of 3,500 professionals in October.

ILM, a City & Guilds group business, found that an absence of soft skills was the main problem: more than a third reported that leaders or managers failed to motivate their teams; 31% said leaders did not show empathy and emotional intelligence (31 per cent). Employees claimed this had led to a significant impact on their own motivation and performance.

Despite the evident need, 35% went on to say that bosses had not demonstrated problem-solving skills. 29% that there was a lack of basic organisational skills. People management was considered to be the most important skill for leaders (68%), followed by good communication skills (48%) and the ability to build relationships and interpersonal skills (48%).

People power

“Leaders are always an easy target for criticism – it’s not surprising that one way or another, staff will have felt disappointed by their manager’s response over this most difficult of years,” says EAPA UK chair Eugene Farrell [https://www.eapa.org.uk/].

“On the one hand, employees depend on bosses to make the right decisions for the good of long-term performance, to be decisive and tough-minded. On the other, they want them to see the bigger picture, to be considerate of employee experience and needs, preserving a sense of positive purpose, mission and community.

“This is why the role of HR is so important in providing the glue between those two different forces in the life of organisations, where one is often pulling against the other.

“What’s been demonstrated by the Covid-19 period is the critical importance of strong leadership combined with a culture of support. That includes maintaining day-to-day communications and encouraging time for interaction of all kinds between employees. But also a package of services, like the EAP, that demonstrate commitment to wellbeing and provides an outlet for people to talk about personal issues – the kinds of issues that managers aren’t ever in a position to help with.

“Once this basis of support, trust and confidence, has been created, people can be relied on to do the right thing more often, to provide support for each other in the knowledge that there’s always going to be someone there for them.”

Should anti-vaxxers be banned from workplaces?

Anti-vaxxers: Around 38% of the 13,000 professionals surveyed by Nature Medicine in November said they would ignore the advice from an employer to receive a Covid-19 vaccination.

Significantly, that would mean the UK wouldn’t be able to meet the WHO recommendation, the need for two-thirds of the population to be vaccinated in order for the pandemic threat to come to an end.

Growing activism

The statistic is just one signal of a mixed picture of attitudes to how the UK should move forward to end the crisis. Activism is growing internationally among groups who believe coronavirus restrictions have been out of proportion with the health risks, and have caused more harm than good in terms of lost jobs, isolation and damage to mental health.

London has seen a series of protest marches, including those led by the Save Our Rights UK group, calling for more protection for people’s rights, privacy, family life and medical freedoms. 

Under current regulations, employers cannot insist that employees take a vaccine; and there has been no indication, so far, of any sectors planning to introduce a requirement, even in healthcare.

Diversity still matters

“Everyone wants 2021 to see a return to something more like normal life,” says EAPA UK chair Eugene Farrell. “There may be different views about how that can best happen, but employers need to ensure all of that spirit of togetherness during times of adversity, of being a community that supports each other and shares its challenges, isn’t lost.

“Respecting diversity of opinions can be as important as respecting other kinds of diversity. There are many different reasons why someone won’t want to take a vaccine once they become available – due to a pre-existing conditions or fears about side effects and implications for mental health. Under current rules, any employer who asks an anti-vaxxer not to come into work would be subject to a discrimination claim.

“Again, it’s when there are heightened tensions like these that EAPs are so important. Helping more people deal with their anxieties means employees as a community are more tolerant, more willing to listen to and understand the needs of others, to be trusting of their employer. That way, everyone stays positive, even if we don’t share the same views.”

Employee wellbeing: still more talked about than effectively managed

The wellbeing of 43% of staff members is ‘less than good’, suggests new feedback from employees in August 2020.

The figures are part of the Embracing the Age of Ambiguity report produced by insurance group Aviva. 34% of staff said they had carried on working even when they didn’t feel well. At the same time, only 26% agreed with the idea that their organisation was genuinely concerned about their wellbeing.

Fine words

The report points to the importance of relationships in the pandemic age. Just over half believed  their employer had managed to create a sense of ‘company togetherness’ through communications.

But only 15% of staff agreed that their employer understood them as individuals and what properly motivates them.

Report co-author, Professor Cary Cooper of Alliance Manchester Business School, said: “A new partnership is required. One that recognises the immense challenges to employee wellbeing, as well as the need for more a personalised approach. We all have different personalities, different ways of dealing with pressure and different needs – knowledge is growing in this area.”

Personal attention

EAPA UK chair Eugene Farrell said: “The employer/employee relationships is being tested by the pandemic conditions – the remote working, the uncertainty, the need for reassurance and support.

“The Aviva report highlights how the internal comms and initiatives to demonstrate togetherness and understanding need to be backed up with a sense of individual support – much more than just offering a corporate line on the importance of wellbeing.

“EAPs are crucial to this picture. Access to professionals means a chance to discuss personal situations and challenges, to be listened to, a way to plan and take action. It means that line managers aren’t expected to become involved with tangles of personal issues, but can focus on making the new work roles and routines effective for both sides of the relationship.”

Do we need robots to keep up with EAP demand?

Maybe it’s not surprising that employees would rather talk to a robot than their line manager. 82% of people think robots can support their mental health better than humans, according to a global study by AI software firm Oracle.

The impacts from living and working under pandemic conditions are so common, from people working longer hours, the unwanted merging of work and home lives, the increased uncertainty and stress. That means hassle-free access to support is more important than ever. One in four of us, it’s reported, are burnt out, and we’re still some way off from returning to more normal routines.

Digital services are instinctive. If we want to shop, be entertained or find something out, we turn first of all to an instant digital source. It’s so much quicker and easier than having to make a trip out or even pick up a phone.

Judgment-free

The developments in chatbot and AI technology for providing tailored advice to employees have been impressive, but can automation ever replace a human being? According to the Oracle study the main reasons for turning to a robot – other than speed – are that AI is wholly unbiased and won’t pass judgment on the employee. 77% of employees surveyed in the UK wanted more access to technology to support their mental health, with 69% being receptive to the idea of a robot therapist.

Globally, 68% of people said they would prefer to talk to a robot over their manager about stress and anxiety at work. 75% said the use of AI had already helped their mental health at work: providing the information needed to do their job more effectively, automating tasks and decreasing workload to prevent burnout.

What does AI mean for EAPs?

Certainly AI can offer an instant engagement tool. EAPs have responded quickly to the changing needs of employers and their people during lockdown and distancing, building on the range and availability of online resources. Critically this has included providing access to human support through remote and video counselling, the all-important conversations with professionals able to understand all the complex nuances of someone expressing their emotions and struggles. For someone coping with mental illness at any stage, struggling to find reassurance and a solid basis of meaning and purpose, is it really healthy for them to always know they’re only talking to an impassive, uncaring void? Mental health has to be based on human care.

It’s also critical that HR don’t overlook the findings around talking to line managers, leaving sensitive and personal issues for the AI to clear up. It’s not the answer. Even if they can’t and shouldn’t take on the role of counsellor, managers continue to need be trusted and to have empathy and emotional intelligence. As the pandemic has demonstrated, work and workplaces aren’t just incredibly important economically in people’s lives but socially. Work is where people come together, have shared goals and struggles, share support and all the rewards of being together. In the same way, EAPs will always be about people helping people.

Eugene Farrell, EAPA UK chair, EAP Demand

Christmas parties – will it be wrong to celebrate?

Almost 90% of employees would prefer to have £50 gift voucher than a company Christmas party in 2020, according to a YouGov poll. 46% don’t want a party on whatever terms, compared with 24% who say they do.

In practice, other research by HireSpace has highlighted how 89% of employers are planning to have an online Christmas party this year. With virtual events now so commonplace, organisers are being urged to move beyond online Zoom quizzes and ‘virtual drinks’ events. More adventurous ideas being suggested include arranging a cook-along making festive foods, virtual cocktail making and wine tasting, virtual escape rooms and fun, collaborative games and sports, such as trying to set new world records together.

Hard cash

Media have also been reporting on a letter to Rishi Sunak from Labour MP Chris Evans about an alternative.

He has called for firms to be given the option of making tax-deductible Christmas cash payouts, to “make up for the odd working conditions of 2020…It’s win-win for everybody. The workers would get a few extra quid, it would be a morale booster for the company and it wouldn’t cost them an extra penny.”

Let it glow

EAPA UK chair Eugene Farrell said: “The novelty of online socialising has lost much of its gloss over the past eight months. But the Christmas party is another of those events, whether everyone loves them or not, that are an important part of the annual routine and rhythm of our working lives. It’s a shared experience, a time to step back from ordinary work and its pressures and see each other as people – a chance for bosses to reflect on what everyone has been through in this painful year, to say thank you to a whole community for coping and getting things done together.

“There are all kinds of alternatives to the office party that can work, employers need to make a special effort this year to understand what’s going to be most appreciated, where the festive feel good factor is going to come from – some fun spent seeing each other online; socially-distanced time to feel some moments of real togetherness; a thoughtful gift or hamper.

“But it will be important that Christmas – a time when people can be most reflective about their lives and relationships, their state of mind and wellbeing – isn’t downgraded as less important.”

Even in a pandemic, health benefits are being forgotten and under-sold

Only around half of employers believe staff know and understand the range of health benefits available to them, according to a study by the group risk body GRiD.

A third of employers said they didn’t think staff understood the benefits on offer; 10% thought they were only aware of some of the offering. 35% of staff claimed their organisation had not communicated the benefits range (or couldn’t remember if they had). 38% of employers communicated a change in benefits when it happened; 29% at the recruitment stage; 21% just once a year; and 8% not at all.

Unappreciated

GRiD also looked at the issue of whether employers understand which benefits are most valued by their people. 54% of small and medium-sized firms don’t bother to measure staff appreciation of employee benefits – and one-third of larger organisations (with more than 250 employees) are the same. The figure rises to 68% among micro-businesses (with fewer than 10 employees).

When feedback is gathered, 34% said this was carried out via a formal survey. 31% of HR teams just used informal feedback. A third used a ‘suggestions box’. 27% based their understanding of staff appreciation on the level of usage.

In its analysis of the findings, GRiD has warned HR against relying on usage rates – particularly in a context where awareness levels appear to be low. HR need to be pro-active in asking employees regularly about their experiences and attitudes towards specific benefits.

Measure to improve

EAPA UK chair Eugene Farrell [https://www.eapa.org.uk/] said: “EAPs have never been more important. It’s critical that all staff are aware of the full range of expertise and support that an EAP offers across the spectrum, from everyday worries around finances and relationships, to access to professional counselling. An EAP isn’t just for help dealing with crises after they’ve happened – just one of the misapprehensions that comes from a lack of communication.

“Measurement of effectiveness and ROI is fundamental. As EAPA’s recent study has shown, it’s the employers who are most engaged and interested in the performance of their EAP, who provide regular management reports using the EAPA calculator, who look at the potential for evolving the offering to best suit their workforce, who see the biggest ROI.”

Why aren’t employers listening to Covid-19 anxieties?

A new report from whistleblowing charity Protect has exposed poor responses from employers to staff with legitimate worries about pandemic safety measures and furlough fraud.

The Best Warning System: Whistleblowing during Covid-19 is based on an analysis of more than 600 calls to the Protect advice line. The majority of cases were found to be around companies exploiting the Government’s furlough scheme, asking furloughed employees to carry on with work duties; followed by the lack of availability of PPE and provision for social distancing.

‘Indifferent’ response

The analysis highlighted how 32% of the managers involved had lost their job as a result of whistleblowing, compared with 21% of those who were non-managers. Furlough fraud was a particular problem among small employers. 41% of employers were said to have been ‘indifferent’ about the issues raised.

One case study featured a worker at a food processing plant whose worries about employees breaching social distancing guidelines had been ignored by HR. When he began to wear a face mask at work he was suspended. Although new rules around wearing face masks were introduced, the whistleblower was still dismissed.

Staff are the best early warning system for making sure workforces are kept safe, said Protect chief executive Liz Gardiner: “There is no excuse for employers to ignore whistleblowers, but during a global pandemic, it is a danger for us all when concerns are not acted on and the consequences could be a matter of life and death.”

Keep talking

“All employees have to feel they can raise legitimate fears about safety or law-breaking,” said EAPA UK chair Eugene Farrell. “During the current climate of crisis it’s an imperative. A lack of trust can spread quickly and lead to a toxic culture of silence and suspicion, low motivation, relationship breakdowns.

“The best employers will actively be working to build a culture of security, where people feel able to speak up if they need to, knowing they will be listened to, there will be a professional response from their line managers and issues won’t just be swept under the carpet.

“Having an EAP in place is a key element for a building a secure and resilient culture. Besides being a demonstration of commitment to the psychological wellbeing of staff, it means that people are able to work out personal issues and any related work stress or financial worries, making then better placed to deal with strains from working through the Covid-19 period.”