I would rather tell an employer I have excruciating period pain or terrible diarrhoea than say I need to take a day off for my mental health. Despite the mental health awareness days, mindfulness at work courses and stigma-bashing posters, many of us still feel that our bosses are not open to accommodating mental illness – and we may be right.
Andrew Berrie, employer programme manager at the Time to Change campaign, says nine in 10 people who experience mental health problems report facing stigma and discrimination. More than half say they experience that stigma the most at work, meaning many do not feel they can talk openly with their line manager. Things are improving, says Berrie – but the stigma means that, like me, 95% of employees would prefer to call in sick with a made-up reason, rather than reveal the truth about their poor mental health.
Geoff McDonald is co-founder of minds@work, a network of professionals seeking to build psychologically healthy workplaces. He says: “I think there is still a huge disconnect between what senior leaders think the culture and openness is, and what it actually feels like on the frontline, whether or not you can have those conversations.” He tells of a senior executive who walked into a mindfulness class his company was running, surveyed the room and said: “So, these are the people who can’t cope in my business.” The organisation had ticked a box, but not changed the culture of intolerance that fosters judgment of those who struggle. We are making progress, McDonald says, but we are “still at the foothills of climbing Mount Everest”.
It is not just tokenism we are smelling, but fear, too, he says. “There has been a lot of campaigning, awareness-building, encouraging people to talk – but I think there is still this fear of not knowing what to do or say, even at the simplest of levels.” He says line managers often confess that they are fearful of saying the wrong thing, telling him that if someone came to them saying they were suffering from anxiety, they wouldn’t know how to handle it.
Clinical psychologist Dr Beverley Flint, from Camden and Islington NHS Mental Health foundation trust, runs C&I Wellbeing, offering mental health support training for managers and HR staff. She says many businesses and organisations are blind to the reality of what their employees are going through.
When she meets employers who tell her they “don’t have a problem with mental health” in their workplace, she says she raises an eyebrow. “I tell them: ‘But you do, you just don’t know about it. You will have people in the workplace who have a diagnosis – I’d love to see your staff retention data.’ People get annoyed with me when I say that.”
Chris (not his real name) works for a large corporation. Three years ago he was signed off with stress for five months when he could no longer complete simple tasks. He was impressed with how HR managed his situation – he felt heard and supported, and was given the space and time he needed, with a phased return to work. But since then, he has learned to be selective about whom he talks to about his state of mind.
“Sometimes I’ll hide my story, and sometimes I’ll say I burned out – it depends on the signals I’ve received from them, if they’ve opened the door for me with their attitude.” It is not about what the organisation says about its policy or culture, he explains. “The culture is generated by the people in the teams and their leaders. If the leader is not tolerant of mental health problems, you’ll have a culture where you don’t talk about them and they get driven underground. All it takes is one person in your proximity to be a threat, and you’re never going to share anything.”
When he has been open with senior colleagues, the worst responses came from people who changed the subject; the best from those who said: “Thank you for revealing something that is not easy to talk about.” He makes it sound simple.
In one sense, it is that simple. But it is also far more complex. We are constantly told that mental health is like physical health – that it is like a broken leg. While this has been important in emphasising that mental illness can affect anyone, that it is nothing to be ashamed of and not something we can control, that both mind and body must be taken equally seriously – it is, ultimately, a lie. A broken leg has an obvious, diagnosable cause; it is likely to have the same symptoms in everyone and to heal in a predictable way, and once it does, it may never break again. The mind does not work like this.
Although mental health and physical health work very differently, employers have a legal responsibility to treat these two kinds of illnesses exactly the same, says Richard Martin, a former employment lawyer who is now head of mental health at consultancy Byrne Dean and author of This Too Will Pass: Anxiety in a Professional World. “The Health and Safety at Work Act, other legislation and case law require employers to create a safe working environment,” he says. “On a building site, that would mean making sure we wear all the right equipment and have the right training to use different machines. But the reality for a lot of businesses is the most serious risks are for mental health.”
There is an obligation on employers to ensure the workplace is safe from excessive pressure and the problems that may come from that. There is also a positive obligation to accommodate people with disabilities and make reasonable adjustments to the workplace, although what that means in the context of mental health is unclear, says Martin. “If my disability means I’m in a wheelchair, you understand that means we need a ramp and wider corridors. But in the context of mental health, what does it mean? “That’s not always a straightforward question.”
Berrie says reasonable adjustments might include allowing staff to take time off work for appointments, or to work from home on occasion if that is helpful; and temporarily reallocating tasks they find stressful.
Having had a mental breakdown himself, Chris says he can spot the warning signs in others: “I’ve noticed people whose hair and skin has been getting greyer and greyer, who are saying the sorts of things I was saying when I was overworked. I’ve sat down with them and listened, not because I have to fix them, but because I wish someone could have done that for me.”
Creating that space to talk should not only be down to people with lived experience, says Flint. “It needs to be a normal part of one-to-one meetings: managers need to check in with people regularly. Not the arbitrary, ‘You all right?’, then thinking about what they’re having for dinner – but really listening to the answer. Then, if they notice that someone is looking tired all the time or their performance is going downhill, it’s so much easier to say: ‘I’m a bit worried about you.’”
In other words, managers need to care, to send the sign to their employees that it is safe to talk. Everybody benefits if they do. “The science and evidence tell us that if people with depression are able to tell their manager about it, they are less likely to take time off, and if they do take time off, they are likely to come back sooner than they might have done,” says Flint.
Knowing when to take time off for mental health problems can be tricky. For some, going to work offers a way out of a day that has begun with a feeling of doom and a tightness of the chest, but for others, even with the same diagnosed condition, it will be different. Flint says: “People living with a chronic mental health condition need to be recognised as experts in themselves.”
When each case is likely to need a different workplace response, it has to start with an open conversation.
Chris says being able to speak freely about his mental health has changed his life. “Where that has been possible, it has been a wonderful, freeing moment,” he says. “The personal connections I’ve made with people in those brief chats have been huge. It normalises it all, makes it manageable. It makes you feel that it isn’t this impossible thing to get over.”
