The cost of mental health problems to the economy in England have recently been estimated at a massive £105 billion. Treatment costs are also expected to double in the next 20 years.
Its true, mental health is everyone’s business. But it’s becoming more and more recognised that employers play a vital role in helping to prevent issues from arising and supporting those struggling.
The fact is that being employed is generally good for people’s mental health and wellbeing. At the same time, nearly one out of seven experience an issue of mental health in the workplace, while some 80% experience workplace stress.
Good support by employers can not only improve the lives of those struggling, but reduce turnover, replacement costs, low morale and poor performance. Therefore, it’s important that employers and health and safety professionals alike have a clear understanding of mental health and the risks.
Mental Health in the Workplace
To gain a better understanding of the types of issues we are talking about, let’s explore the symptoms and treatments for some common mental health issues. Below are some of the major mental health conditions that affect around 25% of the population at some time in their lives.
Everybody experiences days when they feel ‘down, fed up and miserable.’ This is normal as most people will usually not feel like this after a day or two. However, if the feelings continue for more than two weeks and affects the person’s ability to work and maintain relationships, then it may well be clinical depression.
Depression is a feeling of profound sadness, inner emptiness, hopelessness and helplessness, accompanied by morbid preoccupations, it effects 3% of women and 2% of men at any one time. It is the second most common mental illness throughout the world.
Symptoms of Depression
Symptoms of depression may include:
- Loss of confidence
- Blaming themselves over issues that was not their fault
- Becoming tearful
- Not eating
- Poor sleep
- Not being able to concentrate
- Wishing they were dead
A person with depression will look sad, they may not interact or engage with colleagues, they may neglect their appearance.
Risk issues for Depression
Suicide whilst relatively rare can happen. In the UK, suicide is the second leading cause of death in the 15 to 34 year age group. Factors to consider are that in 60% of suicides a mood disorder (depression or mania) is a diagnosis. Males are more likely to commit suicide than women.
Other risk factors are:
- Male, older, living alone
- Specific history of previous suicide attempts
- Agitation, insomnia
- Impaired memory
- Feelings of hopelessness
Since 2019 Covid-19 and enforced isolation is still only being recognised as a significant risk factor.
Suicide Treatments & Interventions
- Talking therapies such as Cognitive Behavioural Therapy (CBT) helping the person to change the way they think.
- Physical exercise
- Sleep management
- Anti-depressants (not at first)
- Electro Convulsive Therapy (Usually as a last resort)
Anxiety (Anxiety Disorders)
We all experience anxiety at some time during our lives. This can be due to having to sit an examination, attend for an interview, flying on an airplane. However, after the event, we return to a more relaxed state.
Sometimes, however, a member of staff may suffer with anxiety that is pervasive and so severe the person may experience a panic attack causing the person to believe they are going to die.
Anxiety can be described as an impending sense of doom. There may be a sudden onset of intense apprehension, fear, chest pains, headaches feeling that the person is going to lose consciousness.
Symptoms of Anxiety
Symptoms of anxiety may include:
- Unrealistic or excessive fear and worry
- Difficulty making decisions
- Shortness of breath
- Dry mouth
- Neck/back pains
- Intrusive thoughts
Generalised Anxiety Disorder (GAD)
It is estimated that 1 in 6 of us will suffer Generalised Anxiety Disorder. When this is the case, the person’s behaviour may be significantly affected. This includes symptoms such as:
- Being very distressed in situations
- Avoiding situations
- Preoccupied with other issues
- Not wanting to engage with people
- Expressing dread at the prospect of doing a simple task
Panic disorder can be described recurrent attacks of panic (anxiety) that are unpredictably and unexpectedly. There is usually a sudden onset of intense apprehension, anxiety, fear with feelings of impending doom or even death.
The person may experience dizziness, nausea, sweating, shaking and rapid heartbeat, often causing the person to believe they are having a heart attack.
As a result of this, the person may develop what experts call ‘anticipatory fear’ of loss of control, so the person becomes afraid of being left alone in public places. Anticipatory fear may itself cause an attack.
Phobia derives from the Greek word ‘phobos’ meaning ‘fear’. People with phobias experience persistent, excessive fear response to objects or situations that for most of us are not slightly scary or only mildly distressing. One definition is that a phobia is an irrational fear. Examples of phobias may be, going out of the house, speaking in public, travelling on a bus or meeting people at social events.
When people have a phobia, they will avoid situations because they are frightened that it will cause them to have a panic attack. When this becomes the case, the phobia is having an intrusive and detrimental effect upon their lives and the fear persists over an extended period of time.
Obsessive Compulsive Disorder (OCD)
Obsessions are recurring and persistent, thoughts, images or impulses that are experienced as intrusive, distressing and absurd to the person. The person will try to ignore them. However, eventually a person may respond to the experiences by trying to ‘neutralise’ them by using some ritualistic thought or action.
These repeated behaviours or mental acts are undertaken to relieve anxiety provoked by the obsessions and are called compulsions. Compulsions can also be defined as voluntary motor actions which are reluctantly performed.
Simple examples are: Checking that you have locked the door at night and instead of being reassured by going through the process, constantly returning to ‘check’. Or constantly washing hands. When a person is experiencing OCD tries to resist or ignore the obsession, there is a mounting sense of tension which can only be relieved by giving in.
|Prevalence of types of OCD|
|Insistence on Symmetry||31%|
|Fear of Contamination||45%|
Post Traumatic Stress Disorder (PTSD) & Acute Stress Disorder
Post-traumatic stress disorder and acute stress disorder can develop after a distressing or catastrophic event.
Until 1980, the condition had been known by other term such as ‘combat neurosis’, ‘shell shock syndrome’ and ‘traumatic neurosis’ in this country – stemming from experiences in both the first and second world wars.
The Lockerbie disaster (1988) and The Hillsborough disaster (1989) are recognised as catastrophies which resulted in death, threatened death, serious injury or abuse. This can also include rape or even traffic accidents.
When this has occurred, the person may display symptoms such as:
- Re-experiencing the trauma (recurring nightmares, memories and flashbacks) which cause the person to become anxious and distressed
- Avoiding behaviours, crowds or driving on motorways
- Hyperarousal symptoms – exaggerated startle reflex, constantly being on alert
- Emotional blunting
- Anger control problems
Treatment & Management of Anxiety Disorders
One of the fundamental principles in psychiatric diagnosis is to first eliminate any physical illness or cause. Methods of treatment include:
- Cognitive Behavioural Therapy (CBT)
- Relaxation training
- Medication (SSRIs) Selective Serotonin Re-Uptake Inhibitors (These are a group of anti-depressant medications that have a tranquillising effect thus reducing aggression and anxiety)
More Serious Mental Health Problems
Psychosis (singular ) (Psychoses plural)
In psychiatry, when classifying types of mental ill health, there was a tradition of breaking them into two main groups are known as the Neuroses and the Psychoses.
Anxiety, phobias, OCD come under the heading of neuroses, because they are linked to anxiety and the person experiencing such conditions retains contact with reality. They know they are unwell.
However, when the person is psychotic, they are experiencing a much more serious and distressing condition. The person is likely to experience serious changes in their thinking, their perception, their mood and their behaviour. Such conditions result in the person struggling to look after themselves or concentrate on their work.
There is often a loss of contact with reality – in other words, the person may not believe they are unwell and instead believe they are being followed or that they are very special and rich.
There are a number of conditions that fall under this category of mental ill health and these include, schizophrenia, bi-polar disorder, schizoaffective disorder.
Schizophrenia is a major psychiatric disorder, or cluster of disorders, characterised by psychotic symptoms that alter a person’s perception, thoughts, affect, and behaviour. Each person with the disorder will have unique combination of symptoms and experiences.
Often the person may experience hallucinations (false perceptions) such as hearing voices. These are often distressing to the person. Such symptoms have a huge impact on the person’s behaviour, thinking and their emotions. I worked with a colleague who one day out of the blue, said, ‘Where is it?’
Years ago, it was called manic depressive psychosis. The quintessential symptom being the presence of mania, which can be thought of as the opposite of depression.
Those experiencing mania have an enhanced sense of happiness (almost euphoria), are overactive, feel a pressure to speak, and even have delusions of grandeur.
They may start several projects and never complete them such is their speed of mind and wanting to do everything. When challenged or interrupted may produce anger and even aggression.
If mania is the ‘north pole ‘of their condition, then within days the person’s mood may plummet to the ‘south pole’ which is the depressive side of the condition. The change in mood, behaviour and even appearance is often remarkable if not spectacular.
Treatments for Severe Mental Health Conditions
Increasingly the use of talking therapies are finding value in these conditions that have previously been viewed by experts as inappropriate. Supportive psychotherapy and problem solving work by helping a person to identify and resolving current life difficulties.
Medication is often the most effective – anti-psychotic drugs aim to stabilise mood or instil normal thought processes.
Mental Health First Aid (MHFA)
The maximum ‘catching a condition early enough allows for more effective treatment’ applies in mental health as much as any physical ailment. Mental Health First Aid (MHFA) is a system designed to do just that. Mental Health First Aiders are individuals in the workplace who are trained at spotting when someone may be struggling with a mental health issue. And they know how to offer help.
One of the great benefits of training employees in MHFA, is the fact that first aiders are pioneers in smashing the ‘do not discuss’ stigma of mental health in the workplace. They help create a culture of normality when talking about emotional or psychological problems and by being around they can help colleagues identify potential problems before they become bigger or more significant issues.
Another benefit of having MHFA in the workplace, is that it provides guidance and signposting for other help and allows employees to recognise that their issues are not unique or insurmountable.
In the next blog, I will explore a programme designed to help employees to stay mentally well when they are mentally well by using a number of resilience building exercises and help them to take control of their emotional wellbeing.