- Stress is the most common manifestation of mental illness in workplaces.
- All organisations have mental health-related duties to their employees under the Equality Act 2010 and must also comply with the Health and Safety at Work Act 1974 (HSWA) and the Management of Health and Safety at Work Regulations 1999.
- Investing in managing the risks can deliver significant financial and other benefits.
Traditionally, mental health issues have been overlooked in the workplace. The stigma attached to having a psychiatric disorder is such that employees have been reluctant to seek treatment. Further, many have sought to hide the fact that they are suffering from a mental illness. This position is beginning to change as media and political campaigns have shone a spotlight on the issue.
Fact and figures
The most common manifestation of mental illness in workplaces is stress. The Health and Safety Executive (HSE) defines stress as ‘the adverse reaction people have to excessive pressures or other types of demand placed on them’ at work. Work-related stress is a major cause in poor employee health, which can also lead to poor productivity, poor organisation performance, human errors and increased sickness absence.
Research indicates that employee stress levels are increasing in line with the growing demands of modern-day employment, and that mental health issues are being encountered more frequently. NHS Digital analysed 12 million fit notes prepared by GPs between 2014 and 2017 and found a 14% increase in the number of workers signed off sick or put on restricted duties because of stress or anxiety.
In 2016, the Chartered Institute of Personnel and Development (CIPD) published a survey which found two of the most common causes of long-term absence were stress and mental ill-health. In respect of these findings, the report also noted that:
- The most common cause of stress remained workload, followed by non-work relationships/family and then management style.
- Two-fifths of organisations claimed that there had been an increase in the last 12 months of reported mental health problems, such as anxiety and depression, compared with the previous year.
- Only a third of the organisations reviewed had a policy that covered mental health. An additional 12% of the organisations were in the process of drafting such policies.
- A substantial number of the organisations reviewed were taking steps to promote good mental health, through flexible working options, improved work–life balance, counselling and other employee assistance programmes.
- One in 10 of the organisations reviewed had a standalone wellbeing strategy. Only 8% of the organisations reviewed were not doing anything at all to improve employee health and wellbeing.
The HSE estimates that stress, depression and anxiety account for more than 11.5 million working days that are lost each year at a cost of over £5 billion to the economy.
Mental health charities believe that these statistics do not necessarily reflect the fact that there has been an increase in mental health problems. They believe that they are more likely a reflection of a greater willingness to disclose such problems. Either way, dental practices are under pressure to manage and support mental health better at work.
All dental practices have mental health-related duties to their employees under the Equality Act 2010 (the Act), i.e. stress and other mental illnesses can be classed as disabilities for the purpose of the Act.
Where a member of staff is disabled, there is an obligation under the Act to make reasonable adjustments. Typically, adjustments for mental health issues may include changing a worker’s duties, work location, hours of work, breaks, how they are supervised and their interaction with colleagues. Phased return to work after absence are also typically regarded as reasonable. It is always vital for employers to make decisions on what adjustments are reasonable, in consultation with the employee concerned, often with the benefit of occupational health advice.
Dental practices must also comply with the Health and Safety at Work Act 1974 (HSWA), which imposes a general duty to ensure the health, safety and welfare at work of all employees. The Management of Health and Safety at Work Regulations 1999 (the Regulations) impose the following duties on employers:
- Risk assessment – A dental practice needs to undertake a ‘suitable and sufficient’ assessment of the health and safety risks that employees are exposed to at work. It needs to review the assessment whenever there is reason to suspect that it is no longer valid or there has been a significant change in the matters to which it relates.
- Applying the principles of prevention – Where a dental practice implements any measures as the result of a risk assessment, it needs to apply the ‘principles of prevention’. Those relevant to stress are:
- avoiding risks
- combating risks at source
- developing a coherent overall prevention policy which covers technology, organisation of work, working conditions, social relationships and the influence of factors relating to the working environment
giving appropriate instructions to employees.
- Providing information to employees – a dental practice needs to provide ‘comprehensible and relevant information’ to employees about the risks to their health and safety identified by the assessment and the measures that will be implemented as a result.
The Regulations also require employees to tell their employer about either of the following that affects their health and safety or that arises out of or in connection with their work:
- any work situation which the employee reasonably considers represents a serious and immediate danger to health and safety
- any matter which the employee reasonably considers represents a shortcoming in the dental practice's protection arrangements for health and safety.
The HSE has devised Management Standards to assist and encourage employers to comply with their legal obligations, and to prioritise and measure their performance in managing work-related stress.
Six areas are covered by the Management Standards: demands, control, support, relationships, role and change. The HSE guidance states: ‘these are the six key areas of work design that, if not properly managed, are associated with poor health and wellbeing, lower productivity and increased sickness absence. In other words, Standards cover the primary sources of stress at work’. The Management Standards are intended to help employers demonstrate good practice through a step-by-step risk assessment of what the dental practice will need to do to tackle work-related stress.
ACAS has prepared a downloadable advisory booklet which expands on the HSE's approach and focuses on providing practical examples of how employers can tackle stress in the workplace.
There are undoubtedly challenges for dental practices in managing mental health at work. Investing in managing the risks can, however, deliver significant benefits in terms of: reduced staff turnover; higher performance; increased morale; financial savings; and, enhanced employer reputation.
Examples of proactive steps taken by dental practices to manage stress in the workplace include:
- managers setting a positive culture, playing an active role in workplace mental health campaigns and training others as mental health champions
- equipping line managers to respond confidently and fairly to the mental health needs of their reports through training (e.g. giving them confidence around managing reasonable adjustments, knowing what is reasonable and what is not)
- offering employee assistance programmes, including access to confidential counselling and support
- ensuring that the dental practice’s approach to mental illness in the workplace is clear and that an effective policy framework is in place and kept up to date
- undertaking work-related mental health and stress audits to highlight problems area, identify causes and steps forward, such as where local management issues or organisational change have created stress hotspots
In January 2017 Theresa May appointed Lord Stevenson and Paul Farmer CBE to lead a review with the aim of providing practical help to employers on employee wellbeing and mental health. It is also expected to make recommendations on whether the Equality Act should be changed to better protect mental health.
While details of a possible change to the Act are currently unclear, the Conservative manifesto promised to strengthen disability discrimination protection for people with shorter-term mental health issues, described as ‘episodic and fluctuating’, with depression given as an example. The moves to extend disability discrimination protection provides further impetus for employers to review and improve their mental health strategy, policies and practices.
- Tackling work-related stress using the Management Standards approach, HSE, March 2017: http://bit.ly/Using-Management-Standards
- What are the Management Standards?’ HSE: http://bit.ly/ManagementStandards
- NHS Digital findings: http://bit.ly/NHS-Digital-findings
- Absence Management: Annual survey report 2016, CIPD: http://bit.ly/CIPD-Report
- Advisory booklet – Stress at work, ACAS: http://bit.ly/ACAS-booklet
Use the following items in the Toolkit to put the ideas in the article into practice:
- Checklist - Stress test for managers
- Checklist - Stress test for staff
- Checklist - How productive is your workplace
About the author
Ben Woods is a Partner for Eversheds Sutherland solicitors.