Managing staff with mental ill-health

Mental ill health is very common, with 1 in 4 of us experiencing a period of mental ill health in the course of our lifetime[1].  It is therefore essential that managers become confident in supporting staff with mental health issues. 

Like our physical health, our mental health can fluctuate on a spectrum from good to poor.  Mental health problems can affect all of us – often as a result of experiences in our work and personal lives.  In many cases people recover completely from an episode of mental ill health, and if the episode acts as a trigger to taking better care of their mental wellbeing, they may be more resilient in future.

There are benefits from managers adopting an early intervention approach to mental health issues, since this makes it more likely that the individual will recover quickly and be able to remain in work.  The onset of mental ill-health may be more immediately noticeable to onlookers than to the person experiencing difficulties, so the manager and colleagues may have a role in spotting early symptoms of distress, and encouraging the individual to see their doctor.

Mental ill health includes a range of conditions, of which by far the most common is depression.  Other conditions include bipolar disorder (a mood disorder which can cause extreme ‘highs’ and ‘lows’, anxiety, panic attacks, obsessive compulsive disorder and psychosis. Many conditions can be effectively managed by a combination of medication, talking treatments such as counselling or psychotherapy and practical assistance. Despite popular misconceptions, people with mental health issues are very rarely a danger to anyone other than themselves.

1.    Role of the line manager

How people are treated and managed on a day-to-day basis is central to their mental well-being and engagement.  Thus line managers have a key role in supporting well-being, spotting early signs of mental health problems and initiating early intervention.  Poor line management may exacerbate or even cause mental health problems and stress.  Getting it right is often a matter of common sense.  A good manager will regularly ask staff how they are, take an interest in their wellbeing, communicate expectations, monitor and review workloads and be personally accessible.  People with mental health issues say that having a supportive line manager makes a great difference to their working life.

You also need to think about the effect on other team members when one member of the team has mental ill-health.  You may need to discuss with the individual concerned whether they are willing to share some information with the rest of the team.  You may need to raise awareness about mental ill-health, and what you can all do to help.  You may need to deal with other members of the team feeling under additional pressure.

As a manager who is managing a team member who has mental health issues, you may have mixed feelings.  You may feel that there is a tension between your desire to support a team member and your need to ensure that work gets completed to deadlines. You may feel frustrated, or out of your depth and in need of support yourself.  Managing someone with complex mental health issues may be challenging, and you may find it helpful to talk the situation through with Occupational Health staff, the Staff Disability Advisor or an HR officer.  Remember that you need to protect your own mental wellbeing.

 2.    Spotting early signs of stress or possible mental ill-health

Spotting signs of stress or mental ill health at an early stage means that managers can encourage an individual to seek help before difficulties escalate into a crisis or sickness absence.  Often a key is a change in typical behaviour. Symptoms will vary, and every individual’s experience is different, but potential indicators include:

  • physical symptoms e.g. fatigue, headaches, indigestion, changes in sleep patterns;
  • psychological symptoms e.g. including anxiety, tearfulness, low mood, indecisiveness, loss of humour, illogical thought processes;
  • behavioural symptoms e.g. including increased smoking and drinking, withdrawal, irritability, restlessness, uncharacteristic errors, and uncharacteristic problems with colleagues,
  • changed attendance patterns (lateness, working long hours, taking leave at short notice).

If you notice some of these signs, or have other reasons to think that an individual is not well, talk to them privately to explore what is going on. Remember that even if someone is displaying some of these signs it doesn’t automatically mean that they have a mental health problem. The person  may be have a different health condition or some other issue.  Someone who is experiencing early signs of mental ill-health may have difficulty in recognising that they have a real health problem and need to seek medical help.  You may want to encourage them to visit their G.P. and reassure them that they will not be seen as wasting the time of medical professionals. 

There may be occasions when you suspect from someone’s behaviours that they may have a mental health issue, but they insist that there is no problem.  In this situation you need to establish clear expectations for behaviour and performance.  It may take a while before the individual recognises that they are not be functioning well.

3.    If someone discloses a mental health issue

If someone tells you they have a mental health problem aim to hold an open and honest conversation with them.  Disclosing a mental health problem may feel a risky step to take, so make it easier by keeping an open mind and listening to the individual.  Avoid making assumptions about a person’s symptoms, or how they may affect their ability to do their job.  Many people manage their condition and perform their role to a high standard.

Reassure the individual that you will treat this as confidential information, and will not pass on private information to their colleagues.

Explore how the condition affects the individual, and how you can help them at work.  Being at work, rather than taking sickness absence, helps to maintain mental wellbeing. The individual benefits from the regular routine, from being able to perform useful work and from the social contacts.  There may be things that a manager can do to help the individual.

Talking treatments have been shown to be effective for mental ill-health, however there are long waiting periods for some types of treatment. An individual's mental health may deteriorate during the prolonged waiting period.

Remember that the university has a legal duty to make reasonable adjustments for disabled people, including those with mental health issues.

Work with the individual to develop a plan for supporting them in the workplace. Seek advice from the Occupational Health Service or the Staff Disability Advisor and from HR staff.

4.    Planning ahead

It may be helpful for the individual and manager to develop a plan while the individual is in good health about how any future deterioration in mental wellbeing will be handled. This is sometimes known as a Wellness Action Plan or Healthy Work Plan.

The plan may contain:

  • Details of agreed reasonable adjustments to help the individual stay healthy in the workplace.
  • A list of factors that can contribute to the individual becoming unwell, and how the individual will manage them if they cannot be avoided.
  • Early warning signs of an individual’s deteriorating mental health, and how they would like their employer to respond.
  • Definite signs that the individual is unwell, and how they would like their employer to respond.
  • Contact numbers for the employer to call if they are concerned about the individual’s health.
  • Agreement as to who may see the form.
  • Signatures from employer and individual that the plan expresses their agreement.
  • Review date.
  • Things that the employee undertakes to do outside work to support themselves in returning to good health e.g. balanced diet, adequate sleep etc.

5.    Sickness absence for mental health issues

Proactive management of absence is central to the effective management of mental health problems as well as other sickness or disability-related issues. If the manager keeps in contact with someone while they are away, this will make it easier for them to return to work. 

a.      While an employee is off sick:

  • Keep in regular contact with them, tell them they are missed and create a strong expectation that they will return to work.  Respect an individual’s preferences on the frequency and type of contact.
  • Arrange how work will be handled during the individual’s absence.  It should not just pile up until the person’s return!  This is especially important if the original difficulties were related to the stress of managing the workload.
  • Consider whether any reasonable adjustments are needed in the workplace.
  • Discuss a phased return to work.
  • Hold a return-to-work interview to discuss any support needs and agree regular reviews.   Discuss an early warning system for any future difficulties.
  • If workplace stress contributed to the individual’s ill-health, agree a plan for how to prevent a recurrence of their illness.  This may involve assistance with prioritising, reallocation of some work, further training or revision of work processes.
  • Consider a gradual resumption of tasks.  It may be better for the individual to start with a limited number of tasks.
  • Brief other team members about the individual’s wishes, so that they can be supportive but not intrusive. Respect the individual’s wishes on privacy.
  • Update the individual about any workplace developments in their absence.
  • Remember that even though the individual is back at work, they may still be living with mental ill-health.  Being at work may be part of their recovery process.
  • Monitor performance and give the individual honest feedback. 

b.     When an individual returns from sickness absence:

  • Hold a return-to-work interview to discuss any support needs and agree regular reviews.   Discuss an early warning system for any future difficulties.
  • If workplace stress contributed to the individual’s ill-health, agree a plan for how to prevent a recurrence of their illness.  This may involve assistance with prioritising, reallocation of some work, further training or revision of work processes.
  • Consider a gradual resumption of tasks.  It may be better for the individual to start with a limited number of tasks.
  • Brief other team members about the individual’s wishes, so that they can be supportive but not intrusive. Respect the individual’s wishes on privacy.
  • Update the individual about any workplace developments in their absence.
  • Remember that even though the individual is back at work, they may still be living with mental ill-health.  Being at work may be part of their recovery process.
  • Monitor performance and give the individual honest feedback. 

6.    Performance concerns

If there are concerns about poor performance, the manager should explore whether there is a health or disability issue, including mental health, before implementing any formal performance management steps.  Asking simple questions about how an employee is, and whether anything is affecting their performance can give them an opportunity to disclose a disability, mental health issue or something else going on in their lives.  It may also be useful to ask about relations with colleagues.

Managers should not force someone to disclose a mental health issue, or suggest they are ill, but can explore this in a way that is not intrusive or judgemental.  One way is to start from your own observations e.g. “I’ve noticed that you’ve been having a lot of headaches recently. How are you feeling?”

If the manager is aware of a mental health issue, s/he should explore possible reasonable adjustments for mental ill-health and performance should be monitored. In the small number of cases where an individual with severe mental health issues is unable to perform their role despite adjustments, HR advice should be sought.

Evidence of performance, including attendance records, should be collected, and should form the basis for an honest discussions between manager and employee.  This makes it more difficult for the individual to deny the existence of any difficulties.

It may be helpful for a second person to sit in as an observer on all one-to-one meetings. A person with complex mental health issues may have difficulty in making a realistic assessment of a situation, and may fantasise about what has been said.

7.    Career development

Line managers should support the career progression of all staff, and encourage them to access training and development opportunities.  People with mental health issues may have low self-esteem, so may need encouragement from their managers to take advantage of opportunities or explore different directions.  The manager may be able to help by encouraging a realistic assessment of the potential stresses of different roles, while avoiding being over-protective.

8.    Recruitment and selection

A recruiting manager should focus on whether a job applicant has the necessary skills and experience to carry out the work role.

  • Give realistic information about the stresses and demands of a work role, especially any intensive work periods with tight deadlines.
  • Be aware that an applicant may choose not to mention any mental health issues at interview.  They are not obliged to tell the interviewer.
  • Remember that failure to appoint the best applicant because they have disclosed a mental health issue would be unlawful direct discrimination on the grounds of disability.

9.   Tips for talking about mental health concerns

Where

  • In private, preserving confidentiality for the employee.  Avoid glass-walled offices.
  • In a venue where the employee feels equal e.g. seated at same level.
  • An employee who is on sickness absence may find it easier to meet away from the office on neutral ground.
  • Avoid interruptions by phone or other people.  Make sure people can’t walk in on you.

How

  • Speak calmly
  • Listen carefully
  • Set clear parameters for confidentiality: “I’m not going to share this information with anyone unless I believe that you or someone else is at risk of harm, when I have a duty of care to speak.”
  • Encourage the employee to talk
  • Be prepared for some silences – it may be difficult for an employee to talk.
  • Avoid being too prescriptive with advice or recommendations. The individual must agree to any actions proposed.
  • Try to use open questions such as:
    • “You seem a bit down/angry/under pressure, how are you feeling?”
    • “Would you like to talk about it?”
    • “How can I help of support you?”
    • “Have you spoken to your GP or anyone else?”
  • Try to keep your own emotions out of the situation. An approach of curiosity, and wanting to learn, may work best.  The individual may already be having difficulty in managing their powerful feelings. Sometimes you may be able to help them recognise how they are feeling, and add a broader view “I hear that you are annoyed with yourself for making that error, but you recognised it immediately and took appropriate action.”
  • Focus on solutions not problems.

What next?

It is important that several things emerge from any discussion:

  • The employee should feel reassured that something will be done to help them.
  • The manager and employee agree a plan of action and support, detailing the steps that will be taken to help the employee recover.
  • Agree whether further support will be sought e.g. from Occupational Health Service.
  • A time and place are agreed for a meeting to review whether any support agreed is working, and whether the employee is benefitting.

11.                    Further support

For further advice please contact the Staff Disability Advisor, Caroline Moughton caroline.moughton@admin.ox.ac.uk , the Occupational Health Service or your local HR staff.

[1] Goldberg and Huxley (1992) – further supported by the results of all three Adult Psychiatric Morbidity Surveys, most recently in 2009.

Find out more

An introduction to mentally-healthy workplaces

Employers' guide to mentally healthy workplaces

How to support staff who are experiencing a mental health problem

How to promote wellbeing and tackle the causes of work-related mental health problems

How to take stock of mental health in your workplace

Managing and supporting mental health at work: a guide for employers