Action on Stigma feedback report
Note: This report is also available for download in PDF, Microsoft Word and text document formats from the Shift Employment Network.
Action on Stigma Feedback Report
Employers’ views on promoting mental health and ending discrimination at workReport on the feedback exercise
June 2007
Foreword
Tackling mental health problems in the workplace is a priority for this Government.The extent to which employees and fellow managers experience stress, anxiety, depression and other mental health problems has gone widely unrecognised. It has recently been estimated that nearly three in every ten employees will have a mental health problem of some sort in any one year (‘Mental Health - The Last Workplace Taboo’, Shaw Trust 2006).
Despite good practice amongst some employers, the cost to the economy of mental illness is enormous. An estimated 80 million workdays are being lost every year from time off work due to stress, depression and anxiety, at a cost to businesses of £9 billion a year (‘Mental Health - The Last Workplace Taboo’, Shaw Trust 2006).
What’s more, many people are sometimes unnecessarily forced to give up their jobs because they have a mental health problem. Many more never get the chance to prove themselves because potential employers think they won’t be able to cope - this is a terrible waste of talent for British business. And others struggle to access goods and services because of stigma and discrimination.
All this happens despite the fact that the medical outlook for people with mental health problems has never been brighter. Contrary to popular belief, the vast majority of people who develop problems can and do make a good recovery. Often, it is not their health that stands in their way of getting back on their feet. It is the fear, ignorance and discrimination - often unconscious or unintentional - they face when telling employers about their diagnosis.
So I have been delighted by the positive reaction we have had to the ‘listening exercise’ we conducted to find out how we can best help businesses address these issues. Almost all the employers we talked to from both the public and private sector fully supported the Action on Stigma initiative. The business benefits from tackling these issues, like improved productivity and staff retention, seem to be increasingly widely appreciated.
This report sets out what you told us about what would help you put Action on Stigma into practice. Top of your wish list was advice about what you can do to prevent mental health problems at work and how you can help staff when they develop them.
Our next step is to produce an Action Plan, informed by this report. This will detail the full range of tools and advice that are currently available and in the pipeline for employers and individuals seeking employment.
I encourage you to take full advantage of these resources – and spread the word to friends and colleagues. I have no doubt employers, their staff and customers will all reap the benefits.
Professor Louis Appleby
National Director for Mental Health, Department of Health
About the Action on Stigma listening exercise
Action on Stigma is a Department of Health initiative that aims to build on the good work already undertaken by many organisations to improve mental health in the workplace. Launched in October 2006, Action on Stigma sets out six key principles for employers to adopt that will make their workplaces more mental health-friendly for both staff and customers. These include increasing employees’ understanding of mental health problems and also changing policies and practices that are stigmatising and discriminatory.
Following the publication of the Action on Stigma discussion document, a listening exercise was launched to seek the views of employers, people with mental health problems and other stakeholders. The exercise was conducted from October 2006 to January 2007 by Shift, the Department of Health-funded campaign to tackle the stigma and discrimination associated with mental illness. The exercise provided people and organisations with the chance to feedback their views both online and via a number of regional events across England. This activity was designed to find out what stakeholders thought about the issue and what additional support employers thought they needed to help them adopt the principles.
It also posed a number of questions including:
- Do you agree with all the Action on Stigma principles?
- Which principle would you find most helpful?
- What are the obstacles to adopting the principles?
- What practical help would enable you to make these principles a reality?
This report sets out the findings from the listening exercise and how these will help inform the future work of the Action on Stigma programme.
The Action on Stigma Principles
- Employers can demonstrate that employees are helped to look after their mental health by making them aware of the steps they can take to preserve and maintain their own and others mental well-being
- Employers promote a culture of respect and dignity for everyone, ensuring that the staff are trained to recognise and be sensitive to mental distress or disability in others, whether they are workplace colleagues or customers
- Employers encourage awareness of mental health issues, so that employees are aware of the signs of distress and understand the importance of seeking help early
- Employers can demonstrate that no one is refused employment on the grounds of mental health or disability
- Employers make reasonable adjustments to the work environment for people with mental health problems so that they can continue working
- Employers can demonstrate that they take positive steps to ensure that people with mental health problems are not disadvantaged, in relation to the availability of their goods and services
Who we spoke to
A document called Action on Stigma: Promoting Mental Health, Ending Discrimination at Work was produced when the programme was launched. The document set out the vision for Action on Stigma, highlighted some of the best practice that already exists and outlined the principles that government would like to see adopted.
The document also asked for people’s views and was disseminated with a questionnaire to both public and private employers, as well as other stakeholders, to get their feedback. This exercise generated 239 responses from a wide range of organisations.
Five regional listening events were also held in York, Coventry and Bristol, London and Nottingham. They were attended by around 450 people. These included representatives from, in the main, public sector organisations, including local government, service user organisations and individuals.
Key findings: what you told us
This section reports the results of the electronic and paper returns and provides a narrative of the debate during the workshops held at the regional events. Responses reflected personal knowledge and experience. The listening exercise also identified a number of employers, committed to improving their employees’ mental health, who had developed effective workplace practices. As might be expected, the workshops provided an opportunity for more wide-ranging discussion about the subject and this is also reported.
Do you agree with all the principles?
89% of respondents agreed with the Action on Stigma principles - 213 backed them, with only 17 out of 239 saying that they did not agree with all of them.
In debate:
Some respondents questioned whether principles 4, 5 and 6 simply restated what is already a legal duty under the Disability Discrimination Act (DDA), whilst others supported their inclusion to remind employers and reinforce the requirements of the DDA.
Some employers felt that Action on Stigma did not sufficiently recognise existing good practice
For consideration in the Action Plan:
1. The Action Plan should consider ways of linking this initiative to other national schemes aimed at reducing discrimination and improving workplace health, such as the HSE stress management standards and Investors in People.
2. A significant number of comments were made on the phrasing of principle 3, which originally read: “Employers encourage awareness of mental health issues, so that employees are aware of the danger signs and understand the importance of seeking help early.”
The use of the term ‘danger signs’ was felt by some to be unsuitable. As a result principle 3 has been re-phrased to read: “Employers encourage awareness of mental health issues, so that employees are aware of the signs of distress and understand the importance of seeking help early.”
Which principle would you find most helpful?
From the electronic and paper responses, of the 234 who responded to this question, Principle 2 (promoting a culture or respect and dignity) was cited by 71 respondents as being most helpful. Principles 1 (mental health promotion) and 3 (awareness of the early signs) were both the next most frequently cited, chosen by 43 people each. Principle 6 (availability of goods and services) was listed as being the most helpful by only 6 respondents.
Where this was discussed in workshops, Principle 2 again was cited as the most helpful.
In debate:
In the workshops most stakeholders thought that things would not improve unless we promoted a culture of acceptance when it comes to mental health problems, not only in the workplace but more widely in society. As one employer said: “Things will not change until employees feel happy to disclose their mental health problem.”
A key conclusion from one workshop was:
“There is a need to focus on the wider societal context of
this work... employers cannot address the whole issue by
themselves. Attitudinal shift in the wider community is
required.”
Whilst the impact of mental health problems was understood as a barrier to employment or promotion, the impact on a person’s ability to access goods and services did not appear to be appreciated. In the workshops there was some confusion as to the meaning of Principle 6 and a request for examples.
For consideration in the Action Plan:
3. The Action Plan will need to explore how to engage with the media, other government departments and national organisations to change the views and attitudes of society as a whole.
4. It would be helpful if examples of difficulties in accessing goods and services were made available.
What are the main obstacles to adopting the principles?
As can be seen from the graph below, general fear and ignorance in society, together with employers’ attitudes, ignorance and lack of resources account for more than 50% of the responses. It is interesting to note that lack of government support and lack of time were issues raised as obstacles by the fewest respondents.
In debate:
This question prompted wide discussion in three distinct areas.
Stress
The first area was stress, different perceptions of stress and how employers and employees regard stress-related problems. Some employees perceived that many managers saw stress as a sign of weakness. It was commented that “senior managers set the tone of the workplace, and if it that’s a long hours culture where you can never show weakness, then employees cannot be seen ‘not to fit in with it’.”
The mantra “stress – you don’t know the meaning of the word” was said to be inappropriately used in a way that denigrated the real suffering of employees off with mental health problems. The point was made that staff did not understand or accept that stress affects different people differently.
At the same time it was recognised that employees also have responsibilities and need to disclose any problems if it is affecting their work or workplace relationships. It can cause problems at work if a member of staff will not admit or recognise they have a mental health problem. However, workplace attitudes were highlighted as an obstacle to openness, with many workers said to think poorly of colleagues ‘off with stress’. This was said to discourage employees from being open about their mental health problems and from seeking help. It was commented that there was an “unwillingness on the part of some employees to be open with their employer for fear of retribution” and that “employees are afraid of using the support available in case it will identify them as having a mental health problem to their colleagues”.
Sickness absence arrangements in the workplace
Some people reported that sickness absence procedures conflicted with best practice for handling mental health problems. There was often a pressure on managers to reduce sickness levels, but this would in turn only add to the distress of staff off with mental health problems. Situations where an endless stream of oral or written warnings were being handed out would clearly not help to promote mentally-healthy workplaces. This scenario was sometimes allowed to develop because of weak occupational health advice.
Another situation described related to workers who have repeated periods off work with illness. This can lead to a feeling of ‘not again!’ amongst the rest of the staff team who have to pick up the extra workload.
Another scenario described related to a positive approach taken by the employer which falls down because the rest of the staff team have not been involved. In this example someone is given time off to recover from their mental health problems. Part of their rehabilitation might involve them taking part in social or leisure activities at or near to work. Fellow employees, upon witnessing their colleague ‘out and about’, quickly jump to the conclusion that ‘nothing’s wrong’ and that the individual is just ‘skiving’.
Stigma
The attitude of society in general was cited as a significant barrier to reducing stigma. The fear and perception of heightened risk, and the assumptions of poor attendance and reduced productivity, were all cited as attitudes that discouraged greater openness about mental health problems. Also, openness could jeopardise promotion and other opportunities. Other common workplace responses to people with mental health problems included over solicitousness and, at the other extreme, ostracism. It was also observed that as long as people with mental problems remained reluctant to disclose their problem, colleagues would be unable to provide support.
For consideration in the Action Plan:
5. How can the support currently available from different government departments be made more widely known and easier to access?
6. The debate highlighted the need for more research into why people discriminate. There also appears to be a need for more research to identify what interventions will: make the workplace more understanding; encourage people to talk about their problems and persuade colleagues and managers to listen without prejudice.
What practical help would enable you to make these principles a reality?
Demand was greatest for information, advice, help and awareness training sessions.
In debate:
Information, advice and support
The most pressing request was for access to consistent
information, advice and support. It was clear that
employers need an accessible source of advice and guidance
which fits their needs and that they can trust. Links to
Jobcentre Plus or the local Disability Employment Advisor
need to be strengthened, together with access to helplines
and regularly updated websites with information on
employment and mental health. More printed materials were
also requested including the Mind Out ‘Line Managers’
Resource’.
Respondents also requested ‘awareness packs for employers’,
themed seminars or workshops and information fact sheets.
These sentiments were felt most strongly by smaller organisations and businesses where specialist HR advice is not always available. Some employers said it was very difficult to work out where to get advice. One said: “Where should employers turn for help? It can be very confusing. Do you go to your Jobcentre Plus, the HSE, the Workplace Connect website, Shift, your Primary Care Trust, your local authority, the charities …”. Another said: “We need bullet points on a postcard, picking out key messages, supported by the CBI, Chamber of Commerce, etc.”
Leadership
The culture and ethos of an organisation is unlikely to undergo lasting change unless its most senior management is engaged. A key factor emerging from the workshops was the need for the leadership of an organisation to embrace this agenda, promoting a positive response to mental health problems and protecting staff from harassment and bullying. It was also suggested that these issues should be regularly included in reports at a board level in order to foster CEO and board interest in the championing of dignity and respect at work.
Again, it was remarked upon that the ‘corporate culture’ reflected the views of society in general, where the prevailing media stereotype of mental health problems is one of heightened risk. It was felt that recent examples of high-profile celebrities sharing their experiences of mental health problems has gone some way to address this, but that change will not happen overnight and there needs to be long-term sustained effort to change societal attitudes.
There was very strong feedback that many managers, particularly first line managers and team leaders, lack leadership skills, have insufficient knowledge of HR practice and policies and are poorly equipped to support staff. This is particularly true of small organisations that do not have in-house HR and access to occupational health services.
Stress
It was commented on that experiencing stress was perceived as a sign of weakness by some employers. Where there is a pressure to deliver against targets, or conform to a ‘long hours’ culture, there is a perception that results will be adversely affected should people with mental health problems be accommodated. Small businesses and small teams within larger companies would have particular difficulties in absorbing additional work in the absence through periods of illness. This is despite recognition that maternity leave and flexible working because of childcare needs must be accommodated. It was suggested that small teams should be able to negotiate reduced output or workload to accommodate a phased return to work. Small firms might benefit from additional financial support (through the benefits system, similar to maternity leave) to provide cover or backfill. Within the NHS some people felt that commissioners needed to understand the impact of a phased return to work or flexible working.
For consideration in the Action Plan:
7. There is a need for good quality, consistent guidance and information (up-todate, accurate, comprehensive, easy to understand and in a range of formats to suit different audiences). The Action Plan should consider ways to evaluate current guidance and information, identify gaps and seek ways of making the most useful resources more widely available. This should include information about mental health promotion, prevention and strategies for supporting people with mental health problems in the workplace. It should also simplify access to practical tools and advice that will provide support to employers and employees.
8. The Action Plan should consider, in collaboration with DTI and DWP, what support can be made available to both employees and managers in the recruitment process.
9. The Action Plan should provide links to exemplar organisations where strong leadership is being given on this agenda.
What are the key opportunities in adopting these principles?
It is worth noting that almost all respondents cited a reduction of stigma and improved understanding of mental health as a key opportunity.
In debate:
There was a consensus that the Action on Stigma initiative could improve productivity and the general health and wellbeing of staff. It was thought that it would probably benefit retention and recruitment outcomes, as well as reducing discrimination in relation to the receipt of goods and services.
It was also suggested that adopting the principles and demonstrating a caring culture would enhance the image of an organisation, further developing ‘corporate social responsibility’. It was also suggested that the principles would “encourage an ‘open’ environment where people can talk about what they think and how they feel”.
The need for effective HR policies and practice to make the principles a reality was consistently remarked upon. One respondent stated that “the public sector need to ensure this message is delivered through all departmental heads, district managers and local managers. Too often the message is lost between head office policy and the field.”
For consideration in the Action Plan:
10. The Action Plan should seek to increase understanding of the benefits to business, including recruitment, retention and increased productivity, in order to increase interest and awareness at the most senior levels.
Other issues
Meetings with stakeholder organisations and government departments
As part of the listening exercise Shift has also met with a number of government Departments and professional organisations to talk about Action on Stigma. Shift has met with: the Cabinet Office, the Department for International Development, the Department for Work and Pensions, the Department for Culture, Media and Sport, the Home Office, the Department of Education and Skills, the Department for Communities and Local Government, the Department of Transport and the Ministry of Defence.
Shift has also met with the Institute of Directors and the Federation of Small Businesses. There was across the board support for the principles and a number of key issues emerged. Primary amongst these was the need to ‘join up’ existing initiatives managed by Government Departments and their associated agencies. A number of programmes exist that relate to improving mental health, but these are not always working together, risking reduced impact and success with employers. The Action Plan should consider ways to ensure that the advice, statistics, research evidence and communication coming from all parts of Government is consistent.
What else do we know about employer attitudes to mental health?
The Disability Rights Commission (DRC) commissioned a survey by GfK NOP of small and medium-sized businesses’ attitudes to mental health in February 2007. The survey found that there was a perception among around one third of small and medium-sized businesses that having a mental health problem affects job performance and could pose a health and safety risk to the individual or colleagues. Given research evidence that most people with mental health problems can work effectively and safely this suggests that there may be a need for improved advice and support to small and medium sized businesses in order to reduce anxieties and help them with day-to-day employment issues.
When asked why current employees should reveal a mental health problem, most respondents mentioned ‘so additional support can be given’ or ‘so we can make the right workplace adjustments’. Fewer had the same response when considering recruiting potential employees.
The majority of employers said that free access to a helpline providing advice on how to help an employee who is stressed or unwell return to work and operate effectively would be helpful.
Only 25% of managers were aware of procedures in their organisation for dealing with employees’ mental health problems.
Conclusion
Almost all of those consulted during the listening exercise gave their support to this initiative. The response to the listening exercise and contributions to the regional events have helped identify obstacles to the adoption of the principles and what support employers would find most helpful.
The most immediate and significant areas the exercise has highlighted as needing to be addressed in the Action Plan are:
- Considering ways of linking this initiative to other national schemes aimed at reducing discrimination and improving workplace health, such as the HSE stress management standards and Investors in People.
- Revision of the phrasing of principle 3 to remove the term ‘danger signs’, which was felt by some to be inappropriate.
- Exploring how to engage with the media, Government departments and other national organisations to change the views and attitudes of society.
- Providing employers with examples of difficulties in accessing goods and services.
- How support currently available from different government departments can be made more widely known and easier to access.
- The need for research into the reasons why people discriminate. There also appears to be a need for more research to identify what interventions will make the environment more acceptable and encourage staff to talk about their problems and to listen to others without prejudice.
- The need for good quality consistent information
(up-to-date, accurate, comprehensive, which is easy to
understand and is presented in a range of formats to suit
different audiences). The Action Plan should evaluate
current guidance and information, identify gaps and seek
ways of making the most useful resources more widely
available.
The Action Plan should:
- Provide access to information about mental health promotion, prevention and strategies for supporting people with mental health problems in the workplace.
- Simplify access to practical tools and advice that will provide support to employers and employees.
- Consider what support can be made available, in collaboration with DTI and DWP, to both employees and managers in the recruitment process.
- Links to exemplar organisations where strong leadership is being given on this agenda should be provided.
- Increasing understanding of the benefits to business, for instance in recruitment, retention and increased productivity, is vital. The Action Plan should describe the importance of strong leadership from the most senior level in the organisation, and help make leaders aware of what constitutes best practice and what their legal obligations are.
About Shift
Shift is a five year initiative in England set up to tackle stigma and discrimination surrounding mental health issues. Our aim is to create a society where people who experience mental health problems enjoy the same rights as other people.
To work towards this, we work with young people, public services, private, voluntary and professional organisations and the media, drawing on expertise in public health and mental health promotion, communications, disability rights, service redesign, research and evaluation.
If you would like to find out more about us and our work, please visit our website: www.shift.org.uk
Getting in touch with Shift
There are a number of ways in which you can get in touch
with us:
- By phone: 0845 223 5447
- By email: shift@csip.org.uk
- By post: Shift 11-13 Cavendish Square London W1G 0AN
Copies of this report
This report is available in the following formats:
- Microsoft Word format
- Plain text (without graphs)
- HTML
All versions can be viewed or downloaded from the Shift
website:
www.shift.org.uk
Masthead photo by Thomas Stromberg. Used under a Creative Commons licence.
