561673 other2014
RSH0010.1177/1757913914561673Current Topics & OpinionsCurrent Topics & Opinions
Current Topic & Opinion
‘Mind Your Own Business’ – how can we best support employers to improve the mental health of their employees? Every organisation in Britain is affected by mental distress and ill health in the workforce. At any one time, one worker in five will be experiencing mental distress, depression or problems relating to stress. Mental ill health is normal in every workplace in the land.1 Ruth Fletcher-Brown, Public Health Specialist (Mental Health and Domestic Abuse) at Rotherham Metropolitan Borough Council looks at how best we can support employers to improve mental wellbeing in their organisation. Despite the prevalence of mental distress Traditionally, where mental health within workplaces, health promotion interventions in the workplace have workplace interventions have tended to existed, they have tended to focus on focus on physical health,2,3 perhaps individuals, relating to problems and not answering why and how interventions because employers understand this. Research with employers in the Yorkshire work.7 The recent report by the Chief and Humber region revealed that despite Medical Officer8 commented that stress and mental health problems being workplace strategies which were about the most prevalent causes of sickness prevention had not proved cost effective, absence, only 33% of respondents and by focusing on risk, it may perversely provided mental health and stress lead to an increase in illness reporting. reduction interventions, compared to The knowledge of how and why 79% on exercise.4 From the perspective interventions are effective is important when considering the of employees, research diversity of workplaces in from the Priory Group5 highlighted that fewer fewer than three the United Kingdom. Initiatives promoting than three in ten people in ten people mental health within would tell their employer would tell their workplaces need to be about their mental health employer about mindful of the uniqueness condition. their mental of organisations, their It is well documented health condition working climates and that creating mentally priorities.9 Resources, healthy workplaces has benefits for employees and employers. both financial and time, are limited within Research from Business in the the public sector and with employers; Community found that the Financial therefore, learning should be shared to Times Stock Exchange (FTSE) 100 make best use of these limited companies, which had robust resources. arrangements for employee An increasing number of employers engagement and wellbeing, would like more support on mental outperformed the rest of FTSE 100 health, and Rotherham employers companies by 10%.6 expressed this same need.10
18 Perspectives in Public Health l January 2015 Vol 135 No 1
Rotherham’s response was to deliver a project to assist workplaces to be mentally healthy places for all, help managers to support at risk people and create a positive attitude towards employing people with mental health problems. Mind Your Own Business (MYOB) was managed and delivered by National Health Service (NHS) Rotherham on behalf of Rotherham Strategic Partnership from 2008 to 2013, funded primarily by the Big Lottery Fund with additional funding from NHS Rotherham. MYOB was part of Altogether Better in Yorkshire and the Humber, a five-year regional–local collaborative programme aimed at building the region’s capacity to empower communities to improve their health and wellbeing and to reduce health inequalities. MYOB had a particular focus on small and medium employers (SME) which have fewer resources than larger employers. During the period of the programme, MYOB worked directly with 1,679 individuals, 102 (72%) SMEs and 39 (28%) large employers, spanning the public, private and voluntary sectors. Employers were engaged by MYOB through third-party referrals from teams and agencies that linked with employers
Copyright © Royal Society for Public Health 2014 SAGE Publications Downloaded from rsh.sagepub.com at UNIV OF GEORGIA LIBRARIES on May 31,1757-9139 2015 ISSN DOI: 10.1177/1757913914561673
Current Topic & Opinion such as Rotherham Investment and Development Office (part of Rotherham Metropolitan Borough Council), Healthy Schools, Voluntary Action Rotherham and Being Better (which was a European funded project supporting businesses with health and financial management) and advertising.
Delivery Model The level of interventions depended on the needs of the employer. The project facilitator would, if requested, meet with the employer offering a needs assessment to assess their current working practices against evidence based practice. Various interventions were offered: •• Accredited Mental Health First Aid (MHFA) training; •• Managing Mental Health: Skills for Line Managers training; •• Directory of services; •• Train the trainer courses; •• Assistance to develop resources, for example, staff intranet/leaflets; •• Support with specific queries from employers; and •• Learning events in response to National Policy; Fit Note and Equality Act briefings. A popular resource with employers was a toolkit produced by MYOB and NHS Doncaster. This toolkit collated information for employers relating to mental health in including sample policies. For SMEs, the toolkit enabled them to adapt these policies for use in their own organisation. MYOB’s achievements included: •• 616 Rotherham employees attending accredited MHFA training; •• 292 Rotherham employees attending Managing Mental Health – Skills for Line Managers training; •• 4 employees becoming MHFA instructors; and •• 127 organisations collecting a Mental Wellbeing in the Workplace Toolkit.
Evaluation Methodology A number of tools were used to measure the success of the project:
•• Attendees on the MHFA or Managing Mental Health: Skills for Line Managers completed questionnaires before and several months after the training to measure changes in knowledge, confidence and attitudes. •• The impact on employers and the wider workforce was measured through feedback surveys and the collection of employer case studies. •• An evaluation of the Mental Wellbeing in the Workplace toolkit via an online survey. •• An independent evaluation of 11 MYOB case studies conducted three years into the project.
needs vary even within similar sectors. Workplace projects should consider the increased use of information technology which can result in more people lone working, part time staff, fixed term posts and employers having multiple workplace sites. These factors need to be considered to ensure that the offer and implementation of workplace mental health initiatives are realistic and achievable. This can only be achieved by working closely with the workplace to assess their specific needs because ‘one size does not fit all’.12 Employers benefit from hearing from other employers through formal and informal networking opportunities. There has been frequent feedback from What we learnt? employers that supporting each other on The following recommendations are the mental health agenda is based on the information gleaned from beneficial.12,13 The national emphasis has interviews with employers that engaged focused on large organisations with MYOB and evidence from supporting smaller employers; in supporting literature. Rotherham, large employers requested There are numerous reasons which networks with similar sized organisations might persuade employers to address to share resources and best practice. the mental health of their employees, for Sharing success stories and learning example, legislation and increasing provides opportunities to ‘sell’ the sickness absence levels. MYOB found benefits to other employers14 and can be that legislation and economic reasons as powerful as quantitative data in while important were not the only convincing employers about the incentive for employers to take action. importance of workplace health.4 The business case for staff wellbeing in Better links between mental health relation to customer service and the services and employers are necessary. desire to know how to help individuals Evidence shows that the sooner people and groups of staff with poorer mental access help when they are unwell, the health were other incentives. better the outcome and the less likely the Champions within the workplace need mental health condition will become to engage a cross section of staff groups more serious and long term, creating including Trade Union and Health and dependence on services for long-term Safety representatives. When initiatives care.13 The findings from MYOB become ‘psychologically owned’ by highlighted the value employers placed employers and employees, through their on knowing what health services were engagement, they are more likely to be available to support employees, thereby sustained and mainstreamed into the increasing their confidence to contact policy and practice.11 Engagement of health services for advice and support. senior managers is Collating fundamental to the success information for of workplace health and employers which is Tailored and wellbeing programmes and evidenced, credible practical advice needs to be ‘active and and valid in relation to offered to local visible’.12 employers should mental health policies Tailored and practical be based on their and guidance is advice offered to local beneficial and saves socioemployers should be based employers time. demographic on their socio-demographic Rotherham employers profile profile, recognising that described searches
January 2015 Vol 135 No 1 l Perspectives in Public Health 19 Downloaded from rsh.sagepub.com at UNIV OF GEORGIA LIBRARIES on May 31, 2015
Current Topic & Opinion they had done on the Internet to elicit mental health information prior to MYOB. The information on the MYOB toolkit was evidence based, citing the Health and Safety Executive, National Institute for Health and Care Excellence, Department of Health and Department of Work and Pensions. The British Occupational Health Research Foundation highlighted employers who were trying to manage common mental health problems in the workplace regardless of the evidence available to support effective practice.15 Black12 reports that the lack of information available to employers is the most common barrier to them investing in the health and wellbeing of employees. Employers in Rotherham commented positively on the support provided by the project facilitator, reflecting that this post
provided ‘credibility’ for the emphasis on workplace mental health. SMEs in particular benefit from direct support.16 The relationship between project facilitator and workplace champion often involves several different stages, starting as an ‘activator’, targeting and engaging employers to ‘sign up’ to the project and finishing as a ‘supporter’. The long-term aim should be for this ‘activator’ role to be handed over to the workplace champion.11 In June 2014, Public Health England launched a new workplace health initiative – ‘The Workplace Wellbeing Charter’.17 This is a national framework for local Health and Wellbeing Boards to use as part of their work to address the health and wellbeing of adults. The framework allows employers to audit and
benchmark against an established and independent set of standards; to develop health, safety and wellbeing strategies and plans; and to receive national recognition of their efforts. While workplace health and wellbeing initiatives should be ‘employer and employee driven’, external stakeholders need to adopt a ‘supportive function’ when working with employers.14 When employers have a positive experience of working with external stakeholders, they value this support as bringing external capacity and expertise which is not available in their organisation.4 The learning from MYOB will help inform the implementation of The Charter in Rotherham, enabling employers to embed workplace health within their organisation.
Darcy H, Daniel L, Tyers C, James L. What Works at Work: Review of Evidence Assessing the Effectiveness of Workplace Interventions to Prevent and Manage Common Health Problems. Leeds: Corporate Document Services, 2007. 8. Annual Report of the Chief Medical Officer. Public Mental Health Priorities: Investing in the Evidence. 2013. Available online at: https:// www.gov.uk/government/uploads/system/ uploads/attachment_data/file/351629/Annual_ report_2013_1.pdf (Last accessed 14th October 2014). 9. Robinson M, Raine G, South J. Mental Health and Employment: Evidence Review. Centre for Health Promotion Research. Leeds: Leeds Metropolitan University, 2010. 10. Trajectory. Mental Health: Still the Last Workplace Taboo? 2010. Available online at: http://www.shaw-trust.org.uk (Last accessed 14th October 2014). 1. Robinson M, South J, Kinsella K. Altogether 1 Better Thematic Evaluation: Mental Health and Employment Project. Leeds: Leeds Metropolitan University, 2010.
12. Black C. Review of the Health of Britain’s Working Age Population: Working for a Healthier Tomorrow. London: TSO, 2008. 13. Department of Health. The New Public Health Responsibility Deal. London: COI, 2011. 14. Makrides L, Heath S, Farquharson J, Veinot PL. Perceptions of workplace health: Building community partnerships. Clinical Governance: An International Journal 2006; 12(3): 178–87. 15. Seymour L, Grove B. Workplace Interventions for People with Common Mental Health Problems: Evidence Review and Recommendations. London: British Occupational Health Research Foundation, 2005. 16. Department for Work and Pensions and the Department of Health. Improving Health and Work: Changing Lives. London: The Stationary Office, 2008. 17. National Health Service (NHS). The Workplace Wellbeing Charter National Award for England. 2014. Available online at: http://www. wellbeingcharter.org.uk/index.php (Last accessed 22nd October 2014).
References 1.
2.
3.
4.
5.
6.
The Sainsbury Centre for Mental Health. Mental health at work: Developing the business case. Policy paper 8, 2007. London: The Sainsbury Centre for Mental Health. Hughes S. Mental health promotion in the workplace. Journal of Mental Health Promotion 2002; 1(3): 20–6. Kuhn K. Mental health promotion in the workplace: A European perspective. Journal of Public Mental Health 2006; 5(1): 29–34. Brightpurpose Consulting. Health, Work and Well-Being Research in Yorkshire and the Humber. Brightpurpose Consulting for the Department of Health, London 2010. The Priory Group. Mental health stigma silences employees. Available online at: http:// www.priorygroup.com/latest-from-the-priorygroup/item/news/2014/08/11/mental-healthstigma-silences-employees (Last accessed 7th November 2014). Towers Watson. BITC Workwell FTSE 100 public reporting benchmarking research findings. Available online at: http://www.bitc.org.uk/ourresources/report/workwell-benchmarking-report (Last accessed 14th October 2014).
7.
20 Perspectives in Public Health l January 2015 Vol 135 No 1 Downloaded from rsh.sagepub.com at UNIV OF GEORGIA LIBRARIES on May 31, 2015
RSH0010.1177/1757913914561673Current Topics & OpinionsCurrent Topics & Opinions
Current Topic & Opinion
‘Mind Your Own Business’ – how can we best support employers to improve the mental health of their employees? Every organisation in Britain is affected by mental distress and ill health in the workforce. At any one time, one worker in five will be experiencing mental distress, depression or problems relating to stress. Mental ill health is normal in every workplace in the land.1 Ruth Fletcher-Brown, Public Health Specialist (Mental Health and Domestic Abuse) at Rotherham Metropolitan Borough Council looks at how best we can support employers to improve mental wellbeing in their organisation. Despite the prevalence of mental distress Traditionally, where mental health within workplaces, health promotion interventions in the workplace have workplace interventions have tended to existed, they have tended to focus on focus on physical health,2,3 perhaps individuals, relating to problems and not answering why and how interventions because employers understand this. Research with employers in the Yorkshire work.7 The recent report by the Chief and Humber region revealed that despite Medical Officer8 commented that stress and mental health problems being workplace strategies which were about the most prevalent causes of sickness prevention had not proved cost effective, absence, only 33% of respondents and by focusing on risk, it may perversely provided mental health and stress lead to an increase in illness reporting. reduction interventions, compared to The knowledge of how and why 79% on exercise.4 From the perspective interventions are effective is important when considering the of employees, research diversity of workplaces in from the Priory Group5 highlighted that fewer fewer than three the United Kingdom. Initiatives promoting than three in ten people in ten people mental health within would tell their employer would tell their workplaces need to be about their mental health employer about mindful of the uniqueness condition. their mental of organisations, their It is well documented health condition working climates and that creating mentally priorities.9 Resources, healthy workplaces has benefits for employees and employers. both financial and time, are limited within Research from Business in the the public sector and with employers; Community found that the Financial therefore, learning should be shared to Times Stock Exchange (FTSE) 100 make best use of these limited companies, which had robust resources. arrangements for employee An increasing number of employers engagement and wellbeing, would like more support on mental outperformed the rest of FTSE 100 health, and Rotherham employers companies by 10%.6 expressed this same need.10
18 Perspectives in Public Health l January 2015 Vol 135 No 1
Rotherham’s response was to deliver a project to assist workplaces to be mentally healthy places for all, help managers to support at risk people and create a positive attitude towards employing people with mental health problems. Mind Your Own Business (MYOB) was managed and delivered by National Health Service (NHS) Rotherham on behalf of Rotherham Strategic Partnership from 2008 to 2013, funded primarily by the Big Lottery Fund with additional funding from NHS Rotherham. MYOB was part of Altogether Better in Yorkshire and the Humber, a five-year regional–local collaborative programme aimed at building the region’s capacity to empower communities to improve their health and wellbeing and to reduce health inequalities. MYOB had a particular focus on small and medium employers (SME) which have fewer resources than larger employers. During the period of the programme, MYOB worked directly with 1,679 individuals, 102 (72%) SMEs and 39 (28%) large employers, spanning the public, private and voluntary sectors. Employers were engaged by MYOB through third-party referrals from teams and agencies that linked with employers
Copyright © Royal Society for Public Health 2014 SAGE Publications Downloaded from rsh.sagepub.com at UNIV OF GEORGIA LIBRARIES on May 31,1757-9139 2015 ISSN DOI: 10.1177/1757913914561673
Current Topic & Opinion such as Rotherham Investment and Development Office (part of Rotherham Metropolitan Borough Council), Healthy Schools, Voluntary Action Rotherham and Being Better (which was a European funded project supporting businesses with health and financial management) and advertising.
Delivery Model The level of interventions depended on the needs of the employer. The project facilitator would, if requested, meet with the employer offering a needs assessment to assess their current working practices against evidence based practice. Various interventions were offered: •• Accredited Mental Health First Aid (MHFA) training; •• Managing Mental Health: Skills for Line Managers training; •• Directory of services; •• Train the trainer courses; •• Assistance to develop resources, for example, staff intranet/leaflets; •• Support with specific queries from employers; and •• Learning events in response to National Policy; Fit Note and Equality Act briefings. A popular resource with employers was a toolkit produced by MYOB and NHS Doncaster. This toolkit collated information for employers relating to mental health in including sample policies. For SMEs, the toolkit enabled them to adapt these policies for use in their own organisation. MYOB’s achievements included: •• 616 Rotherham employees attending accredited MHFA training; •• 292 Rotherham employees attending Managing Mental Health – Skills for Line Managers training; •• 4 employees becoming MHFA instructors; and •• 127 organisations collecting a Mental Wellbeing in the Workplace Toolkit.
Evaluation Methodology A number of tools were used to measure the success of the project:
•• Attendees on the MHFA or Managing Mental Health: Skills for Line Managers completed questionnaires before and several months after the training to measure changes in knowledge, confidence and attitudes. •• The impact on employers and the wider workforce was measured through feedback surveys and the collection of employer case studies. •• An evaluation of the Mental Wellbeing in the Workplace toolkit via an online survey. •• An independent evaluation of 11 MYOB case studies conducted three years into the project.
needs vary even within similar sectors. Workplace projects should consider the increased use of information technology which can result in more people lone working, part time staff, fixed term posts and employers having multiple workplace sites. These factors need to be considered to ensure that the offer and implementation of workplace mental health initiatives are realistic and achievable. This can only be achieved by working closely with the workplace to assess their specific needs because ‘one size does not fit all’.12 Employers benefit from hearing from other employers through formal and informal networking opportunities. There has been frequent feedback from What we learnt? employers that supporting each other on The following recommendations are the mental health agenda is based on the information gleaned from beneficial.12,13 The national emphasis has interviews with employers that engaged focused on large organisations with MYOB and evidence from supporting smaller employers; in supporting literature. Rotherham, large employers requested There are numerous reasons which networks with similar sized organisations might persuade employers to address to share resources and best practice. the mental health of their employees, for Sharing success stories and learning example, legislation and increasing provides opportunities to ‘sell’ the sickness absence levels. MYOB found benefits to other employers14 and can be that legislation and economic reasons as powerful as quantitative data in while important were not the only convincing employers about the incentive for employers to take action. importance of workplace health.4 The business case for staff wellbeing in Better links between mental health relation to customer service and the services and employers are necessary. desire to know how to help individuals Evidence shows that the sooner people and groups of staff with poorer mental access help when they are unwell, the health were other incentives. better the outcome and the less likely the Champions within the workplace need mental health condition will become to engage a cross section of staff groups more serious and long term, creating including Trade Union and Health and dependence on services for long-term Safety representatives. When initiatives care.13 The findings from MYOB become ‘psychologically owned’ by highlighted the value employers placed employers and employees, through their on knowing what health services were engagement, they are more likely to be available to support employees, thereby sustained and mainstreamed into the increasing their confidence to contact policy and practice.11 Engagement of health services for advice and support. senior managers is Collating fundamental to the success information for of workplace health and employers which is Tailored and wellbeing programmes and evidenced, credible practical advice needs to be ‘active and and valid in relation to offered to local visible’.12 employers should mental health policies Tailored and practical be based on their and guidance is advice offered to local beneficial and saves socioemployers should be based employers time. demographic on their socio-demographic Rotherham employers profile profile, recognising that described searches
January 2015 Vol 135 No 1 l Perspectives in Public Health 19 Downloaded from rsh.sagepub.com at UNIV OF GEORGIA LIBRARIES on May 31, 2015
Current Topic & Opinion they had done on the Internet to elicit mental health information prior to MYOB. The information on the MYOB toolkit was evidence based, citing the Health and Safety Executive, National Institute for Health and Care Excellence, Department of Health and Department of Work and Pensions. The British Occupational Health Research Foundation highlighted employers who were trying to manage common mental health problems in the workplace regardless of the evidence available to support effective practice.15 Black12 reports that the lack of information available to employers is the most common barrier to them investing in the health and wellbeing of employees. Employers in Rotherham commented positively on the support provided by the project facilitator, reflecting that this post
provided ‘credibility’ for the emphasis on workplace mental health. SMEs in particular benefit from direct support.16 The relationship between project facilitator and workplace champion often involves several different stages, starting as an ‘activator’, targeting and engaging employers to ‘sign up’ to the project and finishing as a ‘supporter’. The long-term aim should be for this ‘activator’ role to be handed over to the workplace champion.11 In June 2014, Public Health England launched a new workplace health initiative – ‘The Workplace Wellbeing Charter’.17 This is a national framework for local Health and Wellbeing Boards to use as part of their work to address the health and wellbeing of adults. The framework allows employers to audit and
benchmark against an established and independent set of standards; to develop health, safety and wellbeing strategies and plans; and to receive national recognition of their efforts. While workplace health and wellbeing initiatives should be ‘employer and employee driven’, external stakeholders need to adopt a ‘supportive function’ when working with employers.14 When employers have a positive experience of working with external stakeholders, they value this support as bringing external capacity and expertise which is not available in their organisation.4 The learning from MYOB will help inform the implementation of The Charter in Rotherham, enabling employers to embed workplace health within their organisation.
Darcy H, Daniel L, Tyers C, James L. What Works at Work: Review of Evidence Assessing the Effectiveness of Workplace Interventions to Prevent and Manage Common Health Problems. Leeds: Corporate Document Services, 2007. 8. Annual Report of the Chief Medical Officer. Public Mental Health Priorities: Investing in the Evidence. 2013. Available online at: https:// www.gov.uk/government/uploads/system/ uploads/attachment_data/file/351629/Annual_ report_2013_1.pdf (Last accessed 14th October 2014). 9. Robinson M, Raine G, South J. Mental Health and Employment: Evidence Review. Centre for Health Promotion Research. Leeds: Leeds Metropolitan University, 2010. 10. Trajectory. Mental Health: Still the Last Workplace Taboo? 2010. Available online at: http://www.shaw-trust.org.uk (Last accessed 14th October 2014). 1. Robinson M, South J, Kinsella K. Altogether 1 Better Thematic Evaluation: Mental Health and Employment Project. Leeds: Leeds Metropolitan University, 2010.
12. Black C. Review of the Health of Britain’s Working Age Population: Working for a Healthier Tomorrow. London: TSO, 2008. 13. Department of Health. The New Public Health Responsibility Deal. London: COI, 2011. 14. Makrides L, Heath S, Farquharson J, Veinot PL. Perceptions of workplace health: Building community partnerships. Clinical Governance: An International Journal 2006; 12(3): 178–87. 15. Seymour L, Grove B. Workplace Interventions for People with Common Mental Health Problems: Evidence Review and Recommendations. London: British Occupational Health Research Foundation, 2005. 16. Department for Work and Pensions and the Department of Health. Improving Health and Work: Changing Lives. London: The Stationary Office, 2008. 17. National Health Service (NHS). The Workplace Wellbeing Charter National Award for England. 2014. Available online at: http://www. wellbeingcharter.org.uk/index.php (Last accessed 22nd October 2014).
References 1.
2.
3.
4.
5.
6.
The Sainsbury Centre for Mental Health. Mental health at work: Developing the business case. Policy paper 8, 2007. London: The Sainsbury Centre for Mental Health. Hughes S. Mental health promotion in the workplace. Journal of Mental Health Promotion 2002; 1(3): 20–6. Kuhn K. Mental health promotion in the workplace: A European perspective. Journal of Public Mental Health 2006; 5(1): 29–34. Brightpurpose Consulting. Health, Work and Well-Being Research in Yorkshire and the Humber. Brightpurpose Consulting for the Department of Health, London 2010. The Priory Group. Mental health stigma silences employees. Available online at: http:// www.priorygroup.com/latest-from-the-priorygroup/item/news/2014/08/11/mental-healthstigma-silences-employees (Last accessed 7th November 2014). Towers Watson. BITC Workwell FTSE 100 public reporting benchmarking research findings. Available online at: http://www.bitc.org.uk/ourresources/report/workwell-benchmarking-report (Last accessed 14th October 2014).
7.
20 Perspectives in Public Health l January 2015 Vol 135 No 1 Downloaded from rsh.sagepub.com at UNIV OF GEORGIA LIBRARIES on May 31, 2015
