12 February 2009
Bridget Leathley

Buzz Aldrin suffered from clinical depression. It didn't stop him being the second man to walk on the moon. Handel, Beethoven and Tchaikovsky (probably) had bipolar disorder. Few would wish they'd been cured if that had meant we'd be deprived of their music.

A BBC Horizon programme on mental health in November last year featured 10 people, five with a history of mental illness, five considered "normal". For five days, three mental health experts watched them closely. With difficulty, and using some very specific tests, they spotted the anorexia and the obsessive compulsive disorder (OCD) sufferers. They failed to spot the others, misidentifying some of the "normal" people; see www.bbc.co.uk/headroom/newsandevents/programmes/horizon_hmay.shtml

The Horizon experiment demonstrates that mental illness does not set people apart from the rest of the population. The 2005 Disability Discrimination Act (DDA) requires employers to make reasonable adjustments for disabled people, including those suffering from a "mental impairment", to make it possible for them to work. HSW subscribers can access an explanation of how the 2005 DDA extended the 1995 Act at new disability discrimination law requires adjustments for mental conditions.

Work itself can lead to mental health problems, with stress now overtaking other health problems as the leading cause of absence from work. Stress was covered in a previous feature (see site-specifics-stress) so this web review will concentrate on reasonable adjustments for existing mental health problems. That said, if you're following the HSE management standards for work-related stress, you will have a good framework to support those with other mental health problems.

Illegal risk assessments

DDA 2005 should be read in conjunction with the original DDA of 1995 to understand its effects, one of which was to remove the requirement for mental impairments to be "clinically well-recognised". Both Acts can be found at www.opsi.gov.uk/acts

The Code of Practice on Employment and Occupation 2004, written by the HSE and the old Disability Rights Commission - DRC, since replaced by the Equality and Human Rights Commission (EHRC) - supports the DDA legislation. To download the code, go to the EHRC site, select "publications" and then narrow the topic to "disability" and the audience to "employers".

Other useful routes to follow on the EHRC site are "your rights" - "equality and discrimination" - "disability" - "disability in employment", and "campaigns" - "equally different".

The code of practice warns employers not to assume that a person with a mental health problem cannot do a demanding job, and provides an explanation of discrimination in recruitment, promotion, contracting and employment. It gives examples of reasonable and unreasonable adjustments, often citing physical disabilities, but with the principles clear nevertheless.

Sections 6.7 to 6.13 will be particularly useful in understanding how you can - and can't - use a risk assessment to evaluate the risks posed by having people with disabilities (including mental health problems) perform a particular job. Study this well; in certain circumstances, carrying out a risk assessment may lead you to break the law.

Most of the EHRC disability publications targeted at employers (accessed as above) are about disability generally, such as short leaflets on health and safety and reasonable adjustments, and will need interpretation to apply them to mental health. Health and Safety for Disabled People and Their Employers includes a case study dealing with post-natal depression. It explains that short-term impairments such as post-natal depression or grief are not covered by the DDA, but recommends that "supporting employees with health conditions, whether or not they are covered by the DDA, is good practice and will help ensure that employers get the best out of their workforce".

One document in the list is more specific. Leading by Example: Making the NHS an Exemplar Employer of People with Mental Health Problems provides the business case for improving recruitment and retention of those who have suffered from mental health problems.

Mindful employers

Search for "mental health" on the HSE website you are directed to work-related stress. As noted above, the stress management standards could be a useful starting point for managing pre-existing mental illness. So, for example, moving someone with OCD into a job where they have more control over how and when they work might allow them to manage their condition more easily while still making a valuable contribution to the organisation.

The HSE disability area (select "disability" from the dropdown "health and safety topics" menu on the homepage) includes the Easy Read Guide pdf, which provides a simplified explanation of terms such as risk assessment ("when employers look at how people could be hurt at work"). It explains that while you can do a risk assessment if the disability changes the way the job will be done, you can't do a risk assessment just because someone is disabled. The guide also offers mental health examples.

Some readers might find the style patronising, but if you have employees who need something straightforward this guide could be useful. The "guidance for people doing risk assessment" link may also be informative.

Mindful Employer - is an informal network of UK employers and support organisations that includes small, medium and large organisations in the private, public and voluntary sectors. Employers can show a commitment to being a mindful employer by signing the Charter for Employers Who Are Positive About Mental Health. There is also lots of information on mental illness, the law on discrimination as it applies to mental health, and ideas on training staff to recognise and manage mental
health issues.

Disability charity Shaw Trust encourages employers to "create a healthy workplace" at www.tacklementalhealth.org.uk. Advice includes how to set up an early warning system to recognise signs of mental health problems, and how to develop a mental health policy.

Employers with concerns about their staff could direct them to http://www.healthymindsatwork.org.uk/ for advice on recognising and tackling problems, and contact details of support organisations. Bear in mind, though, that websites and helplines alone will not fulfil your responsibilities for your employees' mental health. See http://onlinestressaudit.com and select the feature "employer's responsibilities after Dickins" for a summary of a recent judgment.

The Department of Health has a programme called Shift that aims to reduce the stigma and discrimination people with mental health problems suffer. Go to www.shift.org.uk/employers to find "a practical guide for managing and supporting people with experience of mental health problems in the workplace".

If you want advice on ensuring your fire evacuation plan meets the needs of those with mental health problems, look out the free download Fire Safety Risk Assessment: Means of Escape for Disabled People at www.communities.gov.uk. Select "all publications" then "search publications" and type "disabled" as the key word. Tick "all sites" but de-select every publication type except "good practice and guidance".

The grid in Appendix 1 of the guidance lists options for an evacuation plan, and recommends which are suitable for which conditions. So, for example, someone with high levels of anxiety may need someone pre-assigned to meet them at their workstation to support their exit.

Out of mind

The Department for Work and Pensions has advice on DDA law plus case studies at www.dwp.gov.uk/employers/dda The case studies help explain the principles of reasonable adjustment, but do not refer to mental illness.

In its report titled Stress and Mental Health in the Workplace, mental health charity Mind considers how work-related stress and a pre-existing tendency for depression can feed off each other (case studies one and four) and gives examples to illustrate how the costs to an organisation are lower if they tackle mental health problems early (case studies two and three).

The closing recommendations promote the idea that a strategy which supports those with mental health problems will be effective in helping all employees. From www.mind.org.uk, select "news, policy and campaigns", "Mind campaigns" and find the link under "past campaigns".

Mind also offers advice on employing people with mental health problems; see "information", "factsheets and booklets by subject" and "employment".

Mindout is a campaign run by charities, employers and voluntary groups "working to bring about positive shifts in attitudes and behaviour surrounding mental health". The "working minds" area of its website at http://mindout.clarity.uk.net/default.asp provides the business case for a positive approach to mental health at work, as well as some examples of good and bad practice.

Selecting "mental health" at www.bohrf.org.uk will take you to a useful summary of the British Occupational Health Research Foundation's research on mental health in the workplace. There's a lot to read, but try the snappy summary for employers and employees in Workplace Interventions for People with Common Mental Health Problems, which states that 15%-20% of workers may have "a mental health problem ... which is not necessarily associated with work". 

If you want to know more about specific types of mental illness, there are various charitable organisations that can help. Charities covering a range of conditions include:

• Mind at www.mind.org.uk: select "information", "booklets by series" and "understanding" for topics from addiction and anxiety to seasonal affective disorder and self-harm
• Rethink at http://www.rethink.org: select "about mental illness" then "mental illnesses and disorders" for links to factsheets on subjects including anxiety, ADHD, eating disorders and schizophrenia
• SANE at http://www.sane.org.uk/: select "about mental illness" and choose from depression, anxiety, schizophrenia, manic depression, phobia and obsession.

Charities focusing on single conditions include:

• AnxietyUK: covers claustrophobia and OCD
• OCD Action: provides advice that managers may find useful under "carers/family/friends" and "what can relatives and friends do to help?"
• Bipolar Aware: offers work advice under
  "education"
• Manic Depression Fellowship: produces a guide titled Employers Guide to Manic Depression and Employment, priced £3
• Depression Alliance: go to "what we offer" then "corporate" to download Understanding Depression for Managers & Employers, which makes a clear distinction between stress and clinical depression
• The National Autistic Society: select "information shortcuts for..." then "employers and corporate supporters" for advice on recruitment and retention.

Disclosure

In the disability area of the TUC website you should find a link to the download Representing and Supporting Members with Mental Health Problems at Work; select "disability" under the "equality" heading at www.tuc.org.uk

This guidance is targeted at trade union representatives, but is equally useful for employers.

The TUC advises that "measures aimed at supporting all staff will be equally effective for people with mental health problems". It calls for mental health problems to be approached in the same way as other health problems, and provides guidance on disclosure and on what constitutes reasonable adjustments in the workplace.

Case studies make the guidance easy to read and understand, and the appendices provide an overview of some common mental health problems.

The TUC warns that health and safety should not be used as a reason not to employ someone. As with the EHRC Code of Practice, the TUC guide warns that you could be discriminating by carrying out a risk assessment for someone with a mental health problem when a risk assessment would not have been carried out if someone else was doing the same job.

There is less of relevance in the health and safety area of the TUC website. As with the HSE website, mental health is clumped together with stress.  Choose "stress" under the "health and safety" heading on the homepage, and then find the news release of September 2005 called "workers 'need mental health help'", which points out the cost benefits of helping employees with mental health problems stay in work.

Five a day

Mental Health First Aid (MHFA) aims to support those with developing mental health problems, or in the midst of a mental health crisis, until they can reach professional help. The National Institute for Mental Health (NIMH) and Care Services Improvement Partnership (CSIP, part of the Department of Health) offer MHFA courses at www.mentalhealthfirstaid.csip.org.uk Courses in Scotland can be found at www.healthscotland.org.uk/smhfa, and in Wales at www.mhfa-wales.org.uk

While these three sites provide details of mental health first-aid trainers and courses available, they offer little practical advice.

The mental health first-aid programme in Scotland was featured on the BBC
Radio 4 programme Case Notes in July 2008. As HSW went to press, the transcript and the audio "listen again" were still available on the BBC website. Find "Case Notes" in the programme finder A-Z directory at www.bbc.co.uk/radio4 and select "go to website", then choose "first aid" in the previous programmes list. You will need to fast forward about 20 minutes into the programme to listen to the feature.

For practical MHFA advice, you could look to Australia, where the training was developed. From www.mhfa.com.au select "first aid strategies", or look at the MHFA Guidelines on depression, suicide, psychosis or self-harm. There is also an e-learning CD-ROM.

The key messages on mental health in the workplace are that we should not
assume that someone with a mental health problem cannot safely do a particular job, and that we should seek to provide a mentally safe working environment for all employees.

If you need cheering up after all this, take a look at a slightly different approach to the issues, and help with some research at the same time: visit www.mindapples.org and "take the test".

Celebrity mad

There seems to be a fascination with which celebrities, old and new, have suffered from which mental health conditions. Here are a few:

• www.rethink.org/about_mental_illness/peoples_experiences/jesss_journey/famous_people.html
• www.mindout.clarity.uk.net/headspace for people in the music industry
• www.mindout.clarity.uk.net/1in4
• www.patienthealthinternational.com/features/3118.aspx for a list of writers, composers, poets and artists.

Categories:
Stress/bullying, Article, Mental health